Health is affected by many aspects of our daily lives - where we live, how much we earn, our education, and our social connections. These everyday factors that affect health are what experts call 'social determinants of health'. 

At the Patients Association we work with others to understand how these factors affect patients’ access to healthcare, their experiences of care, and the outcomes of the treatment and care they receive. 

Left behind

Work we did last year with the British Red Cross offers insights on how where you live is critical to your experience of healthcare. 

We spoke to people in ‘left behind’ neighbourhoods. These areas are characterised by worse socio-economic outcomes and lower levels of social infrastructure, than other neighbourhoods. 

Our work found that in these neighbourhoods, patients struggled to access the information needed to make informed healthcare decisions. They had poor communication experiences – often no attempt was made to  to adapt communication for people with mental health problems, learning difficulties, or physical disabilities.

The consequence of this was a growing distrust in the healthcare system among patients, which led many to rely on charities as their first point of contact for health-related issues.

More recent work we've done has shown how patients’ experiences can vary depending on where you live. In the East Midlands, nearly two in five (37%) respondents to the survey we ran just before the election reported struggling to access GP appointments for new, changing, or existing conditions in the previous six months. In contrast, only one in four (25%) respondents in Greater London reported similar difficulties. 

Money

Also from that survey, we found people who earned more than the UK national annual income of £35,000 were more likely to agree they had been able to access the care they needed and that their care had been well-coordinated. This wasn’t the case for respondents with annual incomes below £35,000. These findings suggest that regardless of where you live, a good income is an indicator of ability to access care. 

We also found differences between the use of private healthcare services when patients were unable to access care in the NHS. 

A quarter (25%) of respondents with a household income over £75,000 reported using private healthcare in the last six months due to inability to access NHS care. In contrast, only one in ten (10%) with a household income of £15,000 or less reported the same. This disparity highlights how financial barriers can limit healthcare options for lower-income patients.

Outcomes

Work we’ve done is backed up by far larger academic studies. Earlier this year, the Institute of Health Equity reported widening inequalities in health, including differences in life expectancy, across England. The report links widening discrepancies to social determinants of health. The authors note that spending by local authorities on housing, education and social care had dropped. This affected already vulnerable people by reducing services many relied on. 

Allowing health disparities to persist is damaging not only to the individuals affected but society more widely. Delayed treatment and inadequate preventive care for overlooked communities often result in more severe health issues, leading to higher long-term healthcare costs. Moreover, poor health outcomes can perpetuate cycles of poverty and social inequality, imposing broader societal costs.

Investing in preventive medicine and ensuring timely access to care for all communities is not just the right thing to do - it is also financially sensible. Focusing on health inequities will ultimately improve overall population health while potentially reducing long-term healthcare expenditures.

Planning

In our election manifesto, we called on the new Government to make addressing health inequalities and ensuring marginalised communities can access services a key focus of its health strategy. 

This should be part of a health-in-all-policies approach to health and plans to reduce growing health inequalities. Specific interventions on the social determinants of health must be at the heart of planning. Patients and marginalised communities must be involved in that planning.  

This kind of approach to healthcare policy and service design is not just a matter of fairness; it's an investment in the nation's future health and prosperity. As we move forward, policymakers and healthcare providers must prioritise addressing these social determinants to create a more equitable and effective healthcare system for all UK residents.

Learn more about our current work with patients on how to reduce health disparities and improve access to quality care for underserved populations by joining the webinar, Barriers to care faced by those with cancer and blood disorders on 3rd September. Book you free place.

Find out more about our other projects.

• Whose needs are going unmet and what should be done about it? Our project with the British Red Cross. 
• Beyond the breaking point. Patients' experiences of healthcare and their priorities for the new Government.
• Patients can't wait. The Patients Association's general election manifesto 2024.