Some sections of society have poorer health than others. Most strikingly, people from the most affluent areas of the country will have almost 20 more years of healthy life than those in the most disadvantaged areas. This is a central concern for public health professionals and indeed, tackling these ‘health inequalities’ was enshrined as a core element of Public Health England’s role when it was established in 2013.
With responsibility for public health moving from the NHS into local authorities, we now have a great opportunity to work closely with public leaders and communities to act on the wider determinants that impact on peoples’ chances of good health like housing, employment and education. While focussing on changing behaviours such as smoking is very important, this cannot be done in isolation from the wider circumstances in which people live their lives.
PHE launched its National Conversation on Health Inequalities earlier this year. The ‘conversation’ is not about describing the problem but about using these new public health networks to engage the public at large about what health inequalities mean to them, and what can be done better.
We want to develop a common language and understanding that will help our local partners to work with communities on the causes of inequalities and in planning potential solutions for change. Sharing the lessons learned through the National Conversation is a key part of developing a wider understanding of the perceptions of health inequalities and what will effectively reduce them.
We know that health inequalities and their causes are complex and can be difficult to convey. When discussing why people from poorer backgrounds are more likely to suffer from poor health it is easy to focus on behaviour like smoking and diet. However, as highlighted in the Marmot Review in 2010, there are more complex reasons for poor health, due to interconnected social, educational, economic and structural issues.
Public health professionals and local authority partners may be familiar with these more complex causes, but for us to be successful in reducing inequalities, we need to provide clearer ideas with which communities can engage.
As part of the first phase of the National Conversation we commissioned research with local communities to understand how the general public identify and describe health inequalities and to highlight potential opportunities for innovation in communication and action.
This research, which involved interviews with stakeholders (including Directors of Public Health and local authority councillors) and workshops with members of the public across England, helped identify the challenges involved in engaging the public in this dialogue, as well as some key principles to consider.
The research suggested that members of the public struggle to engage with the concept of health inequalities as described by public health professionals and that discussion around the issues that affect inequalities can be highly sensitive.
People understand inequalities in terms of income, education, employment and housing but do not necessarily see how these can impact on their health. Connections were made between inequalities and resulting lifestyle choices; drinking or smoking, and their effect on mental health, but in the main, people related health inequalities to access to their GP or other health services. These are certainly important aspects, but by no means the whole story.
We are hosting a National Conversation Health Inequalities event today to discuss this and we have published the research findings and a toolkit for local authority colleagues to support their own conversations with their communities on health inequalities.
These documents can be taken, used and shared by any public health professional or local authority colleague looking to discuss health inequalities with their local community. They provide a review of the challenges involved and a series of clear principles people can use to encourage positive engagement on health inequalities, with those who are most affected.
We would encourage anyone with an interest in public health to take a look at these documents and hope they will help services in their work with communities, and help with the second phase of the National Conversation.
We are using today’s event to help shape our next steps and will be working closely with local authorities to see what they learn from any engagement, as well as producing more resources to help our colleagues on the ground develop a common language and understanding. If you have any thoughts I’d welcome them in the comments below.