In the second of this three-part blog series on health inequalities, written in partnership with Dr. Naheed Rana, we explore why health inequalities are nothing new and examine initiatives aimed at making a meaningful difference in the UK.

If you missed part one, you can catch up here.

A long-standing issue

It seems important to state from the outset that health inequalities are far from a new phenomenon. Over the decades, numerous reports and policies have attempted to address these disparities, dating back to The Black Report in 1980. More recently, in February 2020, the Institute of Health Equity published “Health Equity in England: The Marmot Review 10 Years On”, a report commissioned by the Health Foundation to assess progress and mark 10 years on from the landmark study “Fair Society, Healthy Lives (The Marmot Review)”. Once again led by Professor Sir Michael Marmot, the new report evaluated progress or decline in five key policy areas since 2010:

• Giving every child the best start in life
• Enabling all people to maximise their capabilities and have control over their lives
• Ensuring a healthy standard of living for all
• Creating fair employment and good work for all
• Developing healthy and sustainable communities

The findings were certainly sobering. The report found that, in the decade since 2010:

• People are spending more years in poor health
• Life expectancy improvements have stalled and, for women in the 10% most deprived areas, even declined
• The gap in health outcomes between wealthy and deprived areas has widened
• Place matters - those living in deprived areas of the North East, for example, face significantly worse health outcomes than those in similarly deprived areas of London, with nearly five years' difference in life expectancy.

A 2024 report by the Health Foundation projects that, if current trends persist, health inequalities will worsen over the next 20 years. People living in the 10% most deprived areas will likely be diagnosed with serious illnesses a decade earlier than those in the most affluent areas. These figures underline the urgent need for targeted interventions to address the social determinants of health, improve access to care in disadvantaged areas, and reduce disparities in treatment and prevention.

What is being done to change things?

While the situation is critical, efforts are being made to address these issues. The Covid-19 pandemic prompted NHS England to issue guidance outlining eight urgent actions to combat health disparities. These have since been refined into five key priority areas, forming the foundation of the National Healthcare Inequalities Improvement Programme:

• Enhancing access to healthcare
• Tackling social determinants of health
• Ensuring equitable treatment
• Targeting interventions in the most disadvantaged communities
• Embedding health equity into NHS planning and service delivery

Additionally, NHS England introduced equality objectives for 2024/25 and 2025/26, emphasising its responsibilities as a system leader, commissioner, and employer. The first-ever ‘Patient and carer race equality framework (PCREF)’, was also launched, mandating NHS mental health trusts to embed anti-racism initiatives across England by March 2025. Furthermore, the PCREF will form part of Care Quality Commission (CQC) inspections. However, given the recent government announcement to abolish NHS England and reform the NHS more generally, the longevity and prioritisation of these initiatives remain uncertain.

Beyond this, in November 2024, the UK government announced a £9 million investment into a new research centre dedicated to reducing health inequalities in the UK. The ESRC Centre for Lifecourse Health Equity (Equalise), based at University College London, brings together a multi-disciplinary team to investigate the root causes of disparities and develop innovative solutions to improve healthcare access and outcomes for disadvantaged populations.

Similar projects have been launched across England, including by the University of Surrey, Buckinghamshire New University, the University of South Wales, and the University of Essex - often in collaboration with local councils. Additionally, the NHS Confederation has developed a practical guide to help integrate health inequality measures into Integrated Care Systems (ICSs), aiming to embed long-term structural change across health and social care services.

England could also draw lessons from its neighbours, where healthcare is devolved. In Northern Ireland, the Live Better Initiative was introduced in 2024 to reduce regional health disparities. In Scotland, meanwhile, the new Scottish Health Equity Research Unit (SHERU) was established to improve health, reduce inequalities and drive policy-based research on health equity.

What does the abolition of NHS England mean for health inequalities?

The potential impact on health inequalities from the recently announced abolition of NHS England could be significant.

For example, it could lead to the loss of a dedicated health inequalities focus. NHS England has spearheaded various health equity initiatives, including the National Healthcare Inequalities Improvement Programme and PCREF. Without a dedicated body, there is a risk these targeted efforts may lose momentum.

There could also be financial and structural disruptions, with any major reorganisation of the NHS carrying risks of funding gaps, administrative turmoil, and workforce instability - all of which could disproportionately affect the most vulnerable communities.

On the other, more positive hand, a restructured system could allow for better coordination between health and social care, particularly if it strengthens Integrated Care Systems and embeds health equity into decision-making processes more effectively.

And more devolved responsibility to regional bodies could mean decision-making will move to a local level and therefore closer to patients and communities, making health leaders more attuned to the needs of the local population. In theory, this could be the ideal opportunity to prioritise health inequalities. If resources follow adequately, and are ring-fenced to specifically tackle health inequalities, then this could bring a renewed focus to tackle health inequalities and promote equity at “place”.

Much more to do

While numerous strategies and research efforts are underway to tackle health inequalities, the issue remains deeply entrenched. Without sustained investment and clear policy direction, these disparities will continue to widen. The upcoming abolition of NHS England introduces further uncertainty - whether it leads to positive reform or exacerbates existing challenges will depend on how structural changes are implemented.

What is clear is that the fight against health inequalities must remain a priority. Long-term commitment from policymakers, healthcare professionals, and communities alike is essential if we are to build a fairer, healthier future for all.

In the third and final part of this series, we will be looking at what the government is planning to do in the future to tackle health inequalities once and for all.

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