“Bridging the Health Gap”
“Let’s say you catch the Jubilee tube line travelling East from Westminster, for each stop that passes from Parliament, life expectancy drops by one year”. This shocking revelation is taken from epidemiologist and public health expert, Michael Marmot’s latest book, The Health Gap.
Not only do those with lower life expectancy have a shorter future, they are also more likely to experience poorer health during their life span. The grave reality is that people living in Southwark can expect to live four years less and in poorer health, than those in Westminster. Even street by street in parts in Westminster, the health gap prevails – for a child, simply being born in one place or another, changes their life trajectory dramatically1.
This is a particular issue for London; ever-rising costs in housing prices and rapidly evolving urban development programmes mean increased and more diverse demand on the healthcare services that support these localities. There is an urgent need to be flexible and to rapidly adapt to respond to the varying patient needs, or we risk growing disparities in care and greater inequalities.
The NHS was created out of the belief that good healthcare should be available to all, regardless of wealth2. At PPL we are passionate about reducing health inequalities and co-designing models of care that allow everybody to access the best care possible. The statistics presented in ‘The Health Gap’ made me reflect on our work, and consider this question: How can we better design and deliver more adaptive services to reduce health inequalities and improve health outcomes for the whole population?
A large part of the answer can be found in targeting efforts at children and young people (CYP), as the first five years of a person’s life are the most formative in terms of social determinants of future health.
If we take the healthcare ‘post code lottery’ of childhood asthma services as an example: figures show that hospital admission rates for children with asthma in Liverpool are 19 times higher than parts of London3. Within London itself, asthma prevalence varies alarmingly, with data showing that the highest rate of emergency admissions found in Lewisham and Lambeth, is over five times higher than in Bromley4.
Asthma is the most common long-term condition in children5. Severity of asthma varies from mild, moderate to severe, and can cause physical and psychological distress affecting quality of life. Differing access to asthma care and support has a significant impact on all aspects of a child’s life, for instance – many children with poorly managed asthma are missing a greater number of days of school – which impacts on their educational and socioeconomic outcomes as a future adult.
How can we reduce these health inequalities that exist on our doorstep?
An essential approach to solving disparities in asthma management is to improve care provision both in hospitals and closer to home, in the community, making sure children and young people have access to high quality treatment and support no matter where they live.
Across children’s asthma services in London, there are large variations in consistent delivery of recommended care processes, uptake of educational programmes, and achievement of treatment standards. It could be argued that part of the issue is the way that services are currently commissioned, with many Trusts delivering reactive acute care when they receive asthma patients, but missing an opportunity for proactive outreach within schools and the community, to provide preventative and educational opportunities tailored to different populations across London, in line with the evidence-based recommendations from the recent review by the Healthy London Partnership6.
Working with clients across the country to support the development of children’s services, at PPL we have learned that to reduce inequalities and provide high quality care for CYP, we must:
- Understand the CYP population, recognise their needs and characteristics
- Tailor care to local population needs, without compromising on quality
- Share best practice across the local network to ensure quality care practices are being replicated
- Form partnerships with commissioners, providers and patients to introduce new, innovative models of care and management
- Make use the resources available, the people, processes and systems which may come together to make a service work
- Use IT systems more effectively to promote joint working and support the delivery of quality care
- Integrate services between health and social care – improving housing, educational opportunities etc., will have a significant impact on health outcomes
There is a strong business case for commissioners and care providers to ensure equal access to quality asthma services to reduce inequalities and give children the best start in life.
1 Office for National Statistics. Life Expectancy at Birth and at Age 65 by Local Areas in England and Wales Statistical Bulletins. Accessed here: http://www.ons.gov.uk/ons/rel/subnational-health4/life-expectancy-at-birth-and-at-age-65-by-local-areas-in-england-and-wales/index.html
4 NHS Atlas of Variation in Healthcare for People with Respiratory Diseases (2012) Accessed here: http://www.eastsussexjsna.org.uk/JsnaSiteAspx/media/jsna-media/documents/nationalprofiles/profileassests/Atlas%20of%20Variation/RespiratoryHealthAtlasSept2012.pdf
6 London Children and Young People Strategic Clinical Network (June 2015). London Asthma Standards for Children and Young People. Accessed here: http://www.londonscn.nhs.uk/wp-content/uploads/2015/07/cyp-asthma-stds-062015.pdf