Health inequalities are avoidable, unfair, and there are systematic differences in health between different groups of people. Health inequalities exist due to differences and interactions between a variety of factors across a population, including income, housing, and environment, as well as access to and experience of health and other social services. These factors and interactions are themselves often rooted in historical and ongoing experiences of discrimination and exclusion for some groups, which perpetuate inequality.
In the UK, 50% of people in the most deprived areas report poor health by age 55–59, over two decades earlier than those in the least deprived areas. South Asians in the UK have a 40% higher death rate from coronary heart disease than the general population, and people living in non-decent homes – those with a hazard or immediate threat to health – are more likely to report less than good health than those living in decent homes in the private rented sector or their own homes. These examples are amongst the growing evidence of health inequalities and the circumstances that shape them.
The Covid-19 pandemic has made clear an urgent need to address longstanding, interlinked social, economic, and health inequalities – and particularly in diverse (and highly unequal) urban areas. It is vital that we now learn lessons from the last few years and to bring together communities, voluntary organisations, the NHS, and local government in partnership to build trust and improve health and wellbeing across geographical areas, including through the recently established Integrated Care Systems (ICS).
Across London boroughs, there is growing recognition of the connections between health, wealth, and place, and the role that public health, the voluntary and community sector, and other local council services can play in addressing inequalities locally.
The London Borough of Ealing was one of the areas of the capital hardest hit by the pandemic. In response, new local partnerships across health and social care, the voluntary sector, and community organisations emerged in Ealing, as in other places, illustrating the rich community assets and creativity of Ealing residents. Notably Ealing has set up a Community Champions programme recruiting volunteers to act as a link between the council and community to support and promote health and wellbeing. Concerted efforts to sustainably link community assets with health and social services are needed, building on existing assets and connections.
In Ealing, an established interdisciplinary and multisectoral partnership involving Ealing Council, NHS North West London, Southall Community Alliance, Voices of Colour, The Young Foundation, and the Institute of Development Studies (IDS), will use participatory and ‘creative health’ processes to build shared understandings and a framework to understand the key ‘problems’ related to health inequity, engage with the local ICS and identify leverage points in the system, and take steps towards a new community asset and research partnership that centres the lived experience of individuals.
Over nine months, our collaboration will explore:
- how community organisations and stakeholders understand and experience health inequity and what their priorities for action are.
- what local assets, organisations, and partnerships have been established prior to, and during the pandemic.
- ideas and lessons for how the NHS and local government can build trust and work in partnership with voluntary and community organisations to improve health for local populations.
- how could a community asset and research partnership to improve health equity in Ealing be developed and sustained.
Our approach will include the mapping of community assets and actors; community consultation and insight sessions to understand barriers to accessing and to discuss ways to improve health services; training, supporting and exploring the experiences of community peer champions; and a reverse mentoring programme to expose local government and NHS professionals to community experiences and perspectives.
For further information about the project, please contact Megan Schmidt-Sane at the Institute of Development Studies (IDS).