Addressing health inequalities

Health inequalities are unfair and avoidable differences in health between different groups of people. These differences happen because of the conditions we grow up in, live in, and work in. These conditions affect how we feel, think, and behave, and can impact both our physical and mental health.

Health inequalities are caused by many factors, such as income, housing, education, work, environment, and transport. For example, people with lower incomes or who live in poorer areas might not have access to good healthcare, healthy food, or safe housing. These factors can lead to worse health outcomes.

The good news is that health inequalities are preventable. By improving the conditions people live in, we can help everyone have a fair chance at good health.

We want everyone in Surrey Heartlands to have the same chance to live a healthy life, no matter where they live or who they are.

Taking action to reduce health inequalities helps to:

• improve people's lives
• lower the cost to the NHS and social care by preventing illnesses
• support the economy by creating a healthier population.

Health inequalities can be seen in differences in life expectancy. In Surrey Heartlands, people generally live longer than in most of England, but there are differences across the area.

For example, on average in Spelthorne, men live to 80.7 years, while in Elmbridge, they live to 82.5 years. For women, life expectancy is lowest in Spelthorne at 84.2 years, and highest in Epsom & Ewell and Mole Valley at 85.8 years.

In Surrey, the biggest differences in life expectancy are caused by heart and blood vessel diseases, cancer, and COVID-19.

To fix health inequalities, we need to work together for the long term. This means everyone from different services, communities, and levels of government and local government being involved.

Although Surrey is one of the most affluent counties in England, resulting benefits, when relating to health, are not evenly distributed with some of our residents less advantaged than others.

Core20PLUS5 is a national approach to help reduce healthcare inequalities. This defines a target population – the ‘Core20PLUS’.

CORE 20

The most deprived 20% of the national population as identified by the Index of Multiple Deprivation.

In Surrey the five most deprived 'Key Neighbourhoods’ (wards) in the County, form Surrey’s CORE20 (four out of five of these are within the 20% most deprived nationally).

PLUS

ICS-chosen population groups experiencing poorer-then-average health access, experience and/ or outcomes, who may not be captured within the CORE20 alone and would benefit from a tailored healthcare approach, for example inclusion health groups.

Surrey’s PLUS priority populations are communities of identity and geography which are often overlooked and currently most at risk of experiencing poor health outcomes, alongside a further 16 Key Neighbourhoods with the highest levels of deprivation. The groups are:

• Carers and young carers
• Looked after children and adults with care experience
• Children with additional needs and disabilities
• Adults with learning disabilities and/or autism
• People with long term health conditions, disabilities or sensory impairments
• Older people 80+ and those in care homes
• Black and Minority Ethnic groups*
• Gypsy Roma Traveller community*
• Young people out of work
• People experiencing domestic abuse
• People with serious mental illness
• People with drug and alcohol problems*
• People experiencing homelessness*

*The groups that align directly with the NHS Inclusion Health Framework target populations.

All details on the Key Neighbourhoods and Surrey Priority (PLUS) Groups can be found on Healthy Surrey.

FIVE (5)

Nationally, the five key clinical areas of health inequalities are:

1. Maternity – ensuring continuity of care from women from Black, Asian and minority ethnic communities and from the most deprived groups.
2. Severe mental illness – ensuring annual physical health checks for people with SMI to at least nationally set targets.
3. Chronic respiratory disease – a clear focus on Chronic Obstructive Pulmonary Disease (COPD), driving up uptake of Covid, Flu and Pneumonia vaccines to reduce infective flare-ups and emergency hospital admissions due to those flare-ups.
4. Early cancer diagnosis – 75% of cases diagnosed at stage 1 or 2 by 2028.
5. Hypertension case finding (early detection of high blood pressure) – improving lipid management by proactively identifying people at risk and optimising their management.

We know these areas contribute significantly to driving health inequalities.

In Surrey, this work is aligned with the delivery of the Surrey Health and Wellbeing Strategy.

Adopting the approach for children and young people

The Core20PLUS5 approach has been adapted for children and young people, where we want to ensure we are specifically considering young carers, looked after children/care leavers and those in contact with the justice system, with the following five clinical areas of focus:

1. Asthma – Addressing the over-reliance on medication (e.g. inhalers) and decreasing the number of asthma attacks.
2. Diabetes – Increasing access to real-time continuous glucose monitors and insulin pumps for those from more deprived and ethnic minority backgrounds; and increasing the proportion of those with Type 2 diabetes receiving care as recommended by NICE (National Institute for Health and Care Excellence).
3. Epilepsy – Increasing access to epilepsy specialist nurses and ensuring access in the first year of care for those with a learning disability or autism.
4. Oral health – Reducing the number of children admitted to hospital aged 10 and below for tooth extractions due to decay.
5. Mental health – Improving access to children and young people’s mental health services for 0–17 year olds, including those from certain ethnic groups and more deprived backgrounds.

Reducing health inequalities is a priority in Surrey Heartlands. The aim is to provide care that suits individual needs and is given at the right time and place using the Core20PLUS5 approach. This ensures that plans meet the needs of everyone, including children and young people.

Giving children the best start in life is important for improving health and reducing inequalities.

To understand local health needs, Joint Strategic Needs Assessments (JSNA) are used. These provide information about the health needs of Surrey's population and help when making decisions about services. The JSNA also supports the Surrey Health and Wellbeing Strategy which sets out health priorities for everyone in Surrey.

There are several projects in Surrey Heartlands to help reduce health inequalities, which support four main goals for the NHS in England:

1. Improve health and healthcare for everyone.
2. Reduce inequalities in health, experience, and access to services.
3. Make healthcare more efficient and cost-effective.
4. Help the NHS support the community and economy.

Each of the four areas in Surrey Heartlands has its own projects to reduce health inequalities.

Surrey Downs

The Pulling Together programme helps people living longer with conditions like asthma, diabetes, heart disease, and dementia.

East Surrey

The Growing Health Together programme invites people in East Surrey to work together to create a place where everyone’s health can improve.

Guildford and Waverley

Local partners are talking to residents to understand what matters to them and what affects their health and wellbeing.

North West Surrey

Organisations in North West Surrey are working together to improve both physical and mental health, and to build strong communities that support each other’s health.