Health inequalities are present in the old and young
Dr Clarissa Giebel is a dementia care researcher at the University of Liverpool and the NIHR CLAHRC NWC. Her main research interest is enabling people living with dementia to stay in their own home for as long as possible, by maintaining their independence. Clarissa has worked on a multitude of NIHR- and Alzheimer's Society-funded, as well as some international, projects, and is currently looking into the socio-economic factors of accessing dementia care.
Health inequalities are often neglected in service designs and research. To refer to the World Health Organisation, ‘health inequalities are avoidable inequalities in health between groups of people within countries and between countries’. Socio-economic factors, such as poor education, unemployment, poor housing, level of income, ethnicity, and gender, influence a person’s health and their access to and use of healthcare services.
In a recent analysis of a large Household Health Survey in the North West Coast of England (one of the most deprived regions in England), we found that people not in employment and living in poor housing were more likely to attend an emergency department. The survey asked residents aged 18 and over from over 20 disadvantaged neighbourhoods. It wasn’t only socio-economic predictors that influenced healthcare utilisation. People struggling with activities of daily living such as washing and dressing (something that is particularly common in dementia) were more likely to attend emergency departments and general practices than people who were independent.
This begs the question whether older adults from poorer backgrounds might need different levels of healthcare, or if they struggle accessing the types of services they need in the first place. It doesn’t have to be restricted to emergency departments and doctors. It could include outpatient services, or even whether they get prescribed the correct medication. In the UK, people living with dementia from higher socioeconomic groups are 25% more likely to be prescribed medication to treat dementia than those from disadvantaged backgrounds. Ethnicity is also a factor that can influence health inequalities, as people from South Asian minority groups are less likely to recognise dementia so are less likely to go and see a doctor about their symptoms. This clearly shows how health inequalities are not only present in accessing an actual service location (such as a doctors surgery), but also other healthcare services people might need.
Whilst more and more is being done to understand where health inequalities are experienced, fewer initiatives are put into practice to tackle health inequalities. One tool that can be used to check that interventions help reduce health inequalities is the Health Inequalities Assessment Tool. It’s an easily accessible online form which has been designed with members of the public, and is increasingly being used in the development of research and implementation. On a logistical level, one important factor or ingredient is to have a supportive healthcare organisation on board. For example, if older adults struggle getting to their appointment for socio-economic reasons, such as not having enough money for a taxi or public transport, then maybe an outpatient service should come and visit the patients in their own home. This way, patients would get equal access to the care they need, regardless of their background.
Often, organisations don’t consider that people are struggling to access appointments due to their different backgrounds. One step is raising awareness that some patients need to see their clinician, or are in need of medication, but struggle to attend in the first place. These people and patients need to be enabled in the best way possible to get the care they need. The World Health Organisation has a great deal of information on how health inequalities may be tackled further on a global scale. We may think that poor health access is only present in third world countries, but actually, it can often be found just on our door step.