What can UK Healthcare Services do to improve health equity?

What is health equity?
Health equity is the principle that everyone should have a fair opportunity to attain their full health potential, meaning that no one should be ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance’. Health inequalities are not inevitable, and could be significantly reduced by community-based services adopting an adjusted approach to tackling preventable diseases and conditions based on the latest research.

Health inequalities are not only unfair, but also costly to society, resulting in lower productivity, higher health and social care spending, and reduced tax income. For example, guidance from the Office for Health Improvement and Disparities indicates that health inequalities cost the UK economy as much as £33 billion per year in lost productivity and between £20 billion and £32 billion per year in increased health and social care expenditure.

Where are we now?
The UK is working towards achieving health equity and reducing health inequalities by implementing various policies and initiatives, which include:

• ensuring the impact of health inequalities across different sectors and levels of government is considered during policymaking
• monitoring the progress of reducing health inequalities in England using the Public Health Outcomes Framework
• embedding health equity into practice by providing strategic policy advice to the highest levels of government; collaborating with research centres in industry, academia and the NHS; and generating new knowledge and evidence to provide a broad range of scientific services.

How can healthcare services support health equity?
At Reed Wellbeing, our mission is to help people lead healthier lives through easy-to-access, effective interventions. We are dedicated to addressing a range of well-being barriers within the UK population by maintaining robust clinical governance in our approach to delivering equity of access and anticipated outcomes in our healthcare delivery. For example, to help people within the UK lead healthier lives, Reed Wellbeing delivers a personalised, outcome-driven approach across our services. By focusing on each individual and their circumstances, we make sure everyone can achieve the intended results of the program, regardless of any disadvantage or socially determined circumstance.

To make this happen, our team of clinical experts continually monitor the effectiveness of our services by investigating and recognising any locality-based determinants of health inequity to help us provide recommendations on service improvements tailored towards supporting people using our services. Once recommendations have been made, we work collaboratively with internal and external stakeholders to support the timely implementation and evaluation of improvements based upon the recommendations. Where possible, we seek input from people using our services to ensure our services reflect lived experiences. With links to multiple local authorities across the UK, this approach enables us to support health equity by developing new and innovative strategies that make services equitable for everyone.

We believe that this creates a relational and equity-centred approach with local partners that all healthcare services across the UK could benefit from to increase access and improve overall health outcomes. For example, utilising more focus groups made up of health professionals and service users, and improving strategies within the company structure that offer staff initiatives, such as our recent smoking cessation support, financial education sessions, and menopause support hub, enable us to become more health equitable for a varied approach.

Which health outcomes could services focus on to improve equity?
A number of negative health experiences and outcomes among people in the UK are partly affected by dietary habits. Food practices of minority ethnic groups vary by ethnicity, generation, geographic origin, age and religion. Other factors that sit alongside ethnicity (e.g., social, gender and economic factors) also affect healthy eating, food choice, the timing of meals and portion sizes. As a person's culture can impact the food choices they make, this can also affect eating patterns, the relationships and experiences they have with food. It is, therefore, important for all healthcare professionals to understand these cultural differences to improve health equity by delivering high-quality, culturally relevant nutritional advice and guidance bespoke to the individual. For example, to support the participation of different cultures, Reed Wellbeing provides coach support in three main areas to improve:

1. Cultural knowledge of food and diet needs
We addressed this by creating a ‘Nutrition for different cultures' practitioner resource aimed at delivering tailored support to people from varying cultures. By increasing coaches' knowledge of traditional foods within different cultures and their understanding of where those foods fall within the Eatwell Guide, their ability to recommend culturally relevant food alternatives and cooking methods improved.

2. Cultural competence
The ability to understand and interact effectively with people of cultures different to your own is an important component in addressing health equity. One way we do this is by recognising and responding to individual needs, and adapting sessions accordingly using the relevant evidence base of research (e.g., the 5 steps to cultural competence).

3. Person-centred coaching
By providing high-quality, tailored nutritional advice and guidance to people from all cultures and backgrounds, we aim to improve health equity through cultural awareness and competence. To achieve this, all coaches are trained to base their delivery on person-centred coaching and be aware of the five core elements to this approach that ensure interactions and interventions are effective for everyone. These are active listening, expressing empathy, goal-setting, open questions and individual preferences.

What methods of healthcare delivery can services use to support health equity? 
While seeking help is considered an important step towards accessing appropriate treatment, research estimates that at least 1.4 million older adults, eight million people with a mental health difficulty, and up to 18 million people living with a long-term health condition do not have access to all the care and support they need. Following recent growth in digital health care solutions post COVID-19, offering a remote service has helped many practitioners to reduce or remove barriers to accessing care and ensure that people receive the right quality of care. Remote patient monitoring is becoming well evidenced as a new approach to addressing social determinants of health, advancing health equity by improving access to care.

Our integrated health services are offered either as fully remote or as a hybrid of face-to-face and remote delivery. This includes a fully remote well-being service as part of the Department for Work and Pensions Restart Scheme, where our participants receive tailored care, which helps to remove some of the primary barriers to accessing support, such as transport, psychological and mobility issues. Similarly, we tailor support to stop smoking based on individual need, delivering face-to-face appointments with carbon monoxide monitoring, where possible, and offering the rest of the program as hybrid or fully remote to work around any potential challenges, such as work or childcare commitments, health conditions and geographical barriers.

How could services use a balanced approach to digital healthcare to improve health equity?
Digital healthcare is an approach to healthcare delivery that encourages innovation and promotes care at scale. It became more prominent during the COVID-19 pandemic as a way to connect with patients virtually, during a time when face-to-face interactions were limited, and has since evolved globally, with an increasing number of healthcare systems adopting digital approaches to complement their existing services. This could include the use of the NHS app for vaccination passports or remote GP appointments, or telehealth services that enable use of medical devices that track things like blood pressure, blood sugar (glucose levels), oxygen levels or urinary tract infections, to name a few.

Digital healthcare doesn't just stop with healthcare systems, it is also something often used by individuals on a day-to-day basis through step counters, wearable devices like smart watches or symptom tracking apps/diaries. This gives patients the autonomy to understand and learn more about their health, fostering empowerment in the patient population. Using digital healthcare can promote health equity, as it supports healthcare provision that is more focused, reducing costs and subsequently increasing the scale in which it can be provided. It enables patients in remote areas to access healthcare in the same way as those closer to medical facilities.

There are still some challenges, however. Some healthcare providers do not yet have the physical or data storage infrastructures in place that would allow for the safe and secure roll out of digital healthcare. Additionally, not all providers have physical or financial capacity to invest in this area. More evidence is still required in this growing area on short- and long-term effectiveness of digital solutions. There remains stigma around the digital aspect within some organisations that requires time and strategic intervention to overcome, which means there is currently variation across the services provided geographically, for instance, such as differences in the medical devices available to patients between regions. There are also challenges in the way in which digital healthcare is accessed, due to reduced access to digital devices, like smartphones, in some households, or reduced digital literacy.

Key takeaways

• The importance of person-centred support that accounts for cultural, local and other factors.
• There is an array of opportunities available through digital healthcare, and these should be properly utilised and researched.
• Achieving health equity will require intentional intervention all the way from front-line workers to government.

Authors
L. Falconer, D. Jakeman, J. Jones, L. MaGinn, J. McGivern, B. Snow, M. Quick
Reed Wellbeing

Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.