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Cross-government strategy needed to reduce health inequalities

Published: 15 Sep 2021 in Society news

Today, as part of the Inequalities in Health Alliance (IHA), the Society has signed a joint letter to the Prime Minister calling for a cross-government strategy to reduce health inequalities. The Alliance – a nearly 200-strong coalition - has been advocating for such a strategy since its launch in February 2020, following the publication of Health Equity in England: the Marmot review 10 years on – a seminal report which highlighted many stark disparities in health across England. The Alliance has been encouraged by commitments such as the Office for Health Promotion, the Levelling Up agenda, and the cross-government ministerial board on prevention. An explicit cross-government strategy to reduce health inequalities would help to bring these commitments together and catalyse the significant action needed to create change.

The COVID-19 pandemic has exacerbated existing inequality and has brought issues such as the lack of diversity in clinical trials into even starker reality. A recent study in The Lancet highlighted that even when taking age into account (the largest disparity factor found), Black males were 4.2 times more likely to die from COVID-19 than white males.[1] A systematic review from June 2020 reported that of 1,518 COVID-19 studies registered, only six were collecting data on ethnicity.[2] We believe everyone should have the opportunity to benefit from the outcomes of research and ensure its benefits can be shared equally. All aspects of research must be inclusive by design and must be representative of the patients with the disease.

Andrew Goddard, president of the Royal College of Physicians (RCP), which convenes the Alliance, said:

COVID-19 acted as a flag to unite behind. Now that we are emerging from the worst phases of the pandemic, we need a new flag. Reducing health inequalities is that flag because they have never been as big in modern times and the need to reduce them never more apparent.

In a new position paper, the RCP have used case studies to show that the causes of health inequalities often sit outside of the remit of the Department for Health and Social Care – bringing the need to involve other departments in a cross-government strategy into stark relief. These case studies include:
 
  • An extremely malnourished and dehydrated patient, eventually admitted to hospital with sepsis, regularly missing meals so that she was able to feed her teenage son and afraid to call her GP for fear that he would be ‘taken into care’.
  • A clinic providing bus passes because otherwise patients’ health deteriorated because they could not afford to attend for regular monitoring or treatment.
  • A patient whose asthma worsened when his landlord refused to fix mould in his private rented accommodation and instead evicted him.
  • A patient with obesity and diabetes who ate all his meals in fried chicken shops because he and his family lived in a grossly overcrowded apartment with no kitchen.
The Society joined the Alliance because we believe it is not possible to address health inequalities by working in silos: the experience of a wide range of healthcare professionals, scientists and policy makers is needed, both acting together and within their own focused areas of expertise. In our new Vision for Equality, Diversity, and Inclusion, the Society has committed to ensuring that pharmacology is – and will continue to be - for everyone. The vision states that all people should benefit from pharmacology research.

Some examples of our work in Equality, Diversity and Inclusion include:
 
  • Working with NHS England, NHS Improvement, Health Education England and other partners in the Clinical Pharmacology Skills Alliance to develop future-focused, multi-professional care pathways that can help more patients get access to research and appropriate, personalised care.
  • Working with cross-sector partners to inform the progression of the Health and Social Care Bill, calling for a strengthened mandate for NHS research.
  • Reviewing our undergraduate pharmacology core curriculum for inclusivity and supporting its implementation, so that the next generation of pharmacologists is equipped to carry out inclusive research and healthcare.
  • Using our in-house magazine, Pharmacology Matters, to launch a new content series– Identity+. The series will explore health inequalities across different communities and the role of the pharmacology community in addressing them.
  • Commissioning talks on inclusive pharmacology research and healthcare, showcasing these talks at our annual meeting, and using them to inform educational resources.
  • Collaborating with our journals to support inclusive research. For example, the British Journal of Pharmacology has set expectations that sex should be considered an experimental variable in all studies submitted for publication[3]; and recently published a special themed issue[4] drawing relevant studies together.
Professor Sir Munir Pirmohamed, the Society’s President, said:
 

As a consultant in the NHS and an academic researcher, I am dedicated to giving patients the best chance of a healthy life. The work of healthcare professionals, researchers, and the public funds that are invested in both, are undermined by the serious negative health impacts caused by factors such as poverty and the stress of unemployment or insecure employment.
 
Prevention is better than cure. Health inequalities are avoidable and must move up the Government’s agenda.

Visit the Inequalities in Health Alliance page to learn more about the Alliance.
Visit our website to learn more about our work in Equality, Diversity, and Inclusion.
To get involved or discuss our work further, please email: policy@bps.ac.uk


References

  1. Treweek, S., Forouhi, N., Narayan, K. and Khunti, K., 2020. COVID-19 and ethnicity: who will research results apply to?. The Lancet, 395(10242), pp.1955-1957.
  2. Treweek, S., Forouhi, N., Narayan, K. and Khunti, K., 2020. COVID-19 and ethnicity: who will research results apply to?. The Lancet, 395(10242), pp.1955-1957.
  3. Franconi F. et al (2007) Gender differences in drug response. Pharmacology Research 55 (2):81-95.
  4. Docherty, J.R., Stanford, S.C., Panattieri, R.A., Alexander, S.P., Cirino, G., George, C.H., Hoyer, D., Izzo, A.A., Ji, Y., Lilley, E., Sobey, C.G., Stanley, P., Stefanska, B., Stephens, G., Teixeira, M. and Ahluwalia, A. (2019), Sex: A change in our guidelines to authors to ensure that this is no longer an ignored experimental variable. Br J Pharmacol, 176: 4081-4086.