What are health inequalities?
The King’s Fund defines health inequalities “as avoidable, unfair and systematic differences in health between different groups of people.
“There are many kinds of health inequality…. but they are ultimately about differences in the status of people’s health [or] differences in the care that people receive and the opportunities that they have to lead healthy lives.”
Health inequalities can involve differences in:
- health status, for example, life expectancy
- access to care, for example, availability of given service
- quality and experience of care, for example, levels of patient satisfaction
- behavioural risks to health, for example, smoking rates
- wider determinants of health, for example, quality of housing
In England, health inequalities are often analysed and addressed using four factors:
- socio-economic – such as income
- geographic – for example, the region someone is from or whether they live in a city or the countryside
- characteristics including those protected in law – such as sex, ethnicity or disability
- socially excluded groups – for example, people experiencing homelessness
Understanding the needs of people experiencing health inequalities is a key priority for our Integrated Care System. It’s important that we identify and work with groups experiencing health inequalities as part of our projects.
Take time to build relationships
Information:
We recommend that you work with trusted community organisations made up of the people you are hoping to reach. They can put you in contact with the right communities. This will help you to plan and deliver your engagement activity in a meaningful way.
Building relationships and trust takes time.
Some communities may have never engaged with health and care organisations before or may have had negative experiences when they have.
For example, some communities have experienced consistent systemic racism and may be reluctant to use healthcare services. They may not be prepared to engage with organisations they do not trust, based on their past experiences.
Remember to factor this into your timelines and how you approach your conversations.
Intersectionality
Social categories (such as race, class, and gender) create overlapping and interdependent systems of discrimination or disadvantage. For example, black African heritage women experience different disadvantages and discrimination than gay migrant women.
Work with communities to understand how they view themselves in the context of the issue that you wish to involve them in.
Try to speak to people in spaces that belong to the community, places that are familiar, safe, and welcoming to your target group. For example:
- Community festivals
- Places of worship
- Schools, youth centres and libraries
- Public squares and markets
- Cafés
- Barber shops
Culture and cultural differences
Speak to community leaders to understand different cultures, including things like dress, physical contact, cultural behaviour, community languages and food.
Work with communities to co-create training to increase understanding of issues, community priorities and challenges.
Avoid making assumptions about culture and experiences based on your own views and biases (both implicit and explicit). Be inclusive, with respect and consideration of people’s differences.
Cultural events
Plan around and take account of significant cultural events, such as religious observance, and relevant social events, such as school holidays. You may need to avoid arranging events on certain days of the year, or at certain times.
Check the Diversity Resources interfaith calendar
If working face to face, think about providing culturally specific refreshments such as halal, kosher and/or vegetarian.
Language
The language we use to talk about our plans should also reflect the ways the people we are speaking to express themselves.
Use culturally appropriate language – words, phrases, analogies, and concepts that speak directly to the experiences and reality of the community are useful tools of engagement as they indicate who you are trying to communicate with.
Accessibility
Consider translating information into different languages or use interpreters, if your audience needs it.
Be yourself, be relatable
This is vital when it comes to inspiring trust. If you want people to give you something of themselves, it pays to give something of yourself too.
If you are asking people to share their lived experience then perhaps think about sharing some of your own.
Consider how you dress and present yourself – if you want to create a relaxed environment, make sure you dress in a relaxed way and use relaxed, informal language.
Be creative
People often do not always have the time or resources to go to meetings. Think about different places and ways you could attract people to talk to you.
For example, you could consider sitting in a community café with a sign that reads, “Come and talk to me about…” This may reach a wider range of people or people who are usually busy, but may have 15 minutes to spare for a chat.
Promotion
Advertise through networks, publications and channels your communities are connected to.