‘Levelling up’ must include reducing health inequalities
The Prime Minister has begun to set out in earnest his plans for levelling up the UK. Not only does he want to bridge long-standing divides in economic performance between the regions, but also the great disparities there are regionally in healthy life expectancy.
This is a potentially huge challenge but one that must be embraced, for the pandemic has exposed just how entrenched these inequalities are.
The Government, in partnership with industry and patient groups, is seeking solutions. ‘Levelling up’, its flagship policy initiative, focuses on economic imbalances between regions, but if we truly want to ‘level up’ Britain we must also focus on reducing poor health outcomes in those same areas.
This matters because health inequalities have a real impact. The APPG for Longevity has shown that there would have been 40,000 fewer deaths in the UK if the national Covid mortality rate had been as low as the least deprived places. They even estimated that 30% of the productivity gap between the North and the rest of England is due to ill health, at a cost of £13 billion a year.
There are also large regional differences in other areas, such as cancer mortality outcomes and life expectancy. In general, life expectancy is highest in those areas of the UK with the highest productivity – London, the South East, and the East of England – and lowest in those areas with the lowest productivity – Wales, the North East, and the North West. This is also the case on an individual level.
As the Health Foundation made clear last year, “income is associated with health: people in the bottom 40% of the income distribution are almost twice as likely to report poor health than those in the top 20%. Poverty in particular is associated with worse health outcomes.” Improving health outcomes generally has the potential to benefit the poorest in particular.
A new report from Microsoft argues that digital technologies could make a significant contribution to reducing health inequalities. Despite exciting and dynamic advances, health technology is often framed as something that can reinforce health inequalities rather than help tackle them. But Covid-19 has accelerated the use of digital technology and demonstrated the benefits it can bring.
In the Health Foundation’s survey of NHS staff conducted between October and November 2020, 82% of respondents said their organisation had increased its use of technology to some extent during the pandemic and 51% had been personally involved in that increased use of technology. In fact, we now have compelling examples of how outcomes can be improved when these technologies are integrated into a holistic health data ecosystem.
NHS Greater Glasgow and Clyde, for example, hoped to avoid hospital admissions by catching warning signs early for patients with serious lung conditions. By using wearable devices linked up to hospital systems, they were able to remotely monitor breathing machines of patients, in their homes and in real time. It reduced hospital admissions and created a model that is being rolled out for other conditions. Data, in other words, has managed to close the gaps for some of their most vulnerable patients.
By ensuring data is collected on the most at-risk groups, or those with the most complex needs, the health and social care system should be better able to respond in times of individual need, in turn reducing variation in ill-health and mortality outcomes across the UK. This applies as much to social care as to health care.
The next step for health and social care is to embrace this use of patient data to make treatment more targeted and more personalised. Many patients with long-term health conditions have complex needs that mean they come into contact with multiple local services.
Imagine being an A&E doctor and being able to immediately bring up all relevant information, along with up-to-date data from wearable technologies such as blood oxygen monitors. That’s a vision of a truly joined-up health and care service: fluidly linking information from a range of sources to make the system as responsive as possible to patient need.
However, poor health outcomes do not have a single cause and just as important as integrating services within the NHS is forging partnerships with organisations working outside the health and social care system, such as employment support or housing associations. As such, technology has genuinely transformative power to help if targeted in the right way – by being the infrastructure around which disparate services and organisations can support each other’s long-term objectives.
In short, by collating better data on patients, in turn enabling early detection and prevention, it is hoped that the stubborn link between longer-term conditions and increased hospital admissions can be tackled. The fact that this issue disproportionately affects people living in more economically disadvantaged areas makes it a priority social policy goal.
The Government now has an opportunity to do this, by embracing innovations in tech and data sharing technologies. As restrictions begin to lift and health services can – over time – return to pre-Covid working, the Government must take the opportunity to tackle longstanding inequalities in health outcomes. It is time to think clearly and creatively about how digital technologies can be part of this story.
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