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By Duncan Cooper, Consultant in Public Health, Associate Director of the Reducing Inequalities Alliance (Bradford District and Craven).

If faced with a difficult problem I’m an advocate of always having a nosey at how someone else has approached it. With this in mind, I went down to Birmingham to attend the National Health Equity Conference. It was a one-day event about building a ‘social movement’ to improve health equity (headed by Sir Michael Marmot). An  aim that seemed similar to what we’re trying to do with the Reducing Inequalities Alliance in Bradford District and Craven.

Health equity: the state in which everyone has a fair and just opportunity to attain their highest level of health.

During the day there were some stark facts and big challenges thrown down, some inspiring examples of work around the country, and lots of good advice from our national and regional leaders. I’ve noted a few of the highlights below.

Be positive

Michael Marmot started by looking at the increasingly large proportion of wealth concentrated in capital cities across Europe. For example, if you take London out of the UK economy, what’s left behind is an economy as poor as Mississippi (the USA’s poorest state). He said we can’t shy away from these facts but moved onto a positive message to set an action focus, saying that:

  • evidence comes in many forms, and
  • we don’t want to hear it doesn’t work; we want to hear how we make it work

Another way to say this is that talking about failures just contains problems, talking about successes contains wisdom.

The importance of trust

With a show of hands by sector it was clear that the VCSE sector were the most represented in the room (more than NHS, Local Authorities or business). This led to a discussion about the importance of trust. Trust within our own work networks, trust between people that make decisions, trust between communities and community based services (work being taken forward locally by the Diversity Exchange).

The primary care workshop majored in on trust. That trust is a huge commodity in primary care (and care in general), and we need to build trust into our systems of care (and not always refer to other specialists or services). We heard how trust was being built with patients by having holistic conversations rather than blindly following single condition pathways or pieces of guidance.

What’s happening elsewhere?

There was a great example from an East London network of hospital trusts who are doing a variety of things in improving health equity, including:

  • Ring-fencing the proportion of local jobs in the Trust.
  • Supporting employment, for people with multiple disabilities.
  • Working with the private sector to fund pathways from low educational attainment towards qualifications and training
  • Working between the NHS and the VCSE to increase the social value components of contracts (valuing non-healthcare outcomes) and new areas where the VCS can break through into delivery.

Building a movement for health equity

Perhaps the most important part of the day was hearing a range of perspectives from national leaders about how we build a movement for health equity. Some key points included:

  • It doesn’t all need to be about money and funding
  • Be opportunistic
  • Be positive
  • Movements need to be about action and disruption (passion and allyship alone isn’t enough)

We heard from Michael Marmot (Institute for Health Equity) – who’s 3 challenges for health equity were:

  1. Intergenerational equity – do we think our children will have a better life than us?
  2. Improving the social determinants of health – to do this we have to somehow tame excesses of capitalism
  3. Seeing the common good – recognising a common purpose on which to build a social movement

Bola Owolabi (NHS England Core20PLUS5) spoke of the contribution of the NHS to reducing health inequalities. This contribution is not as large as the social determinants of health but is still a big chunk – in fact 20%. She spoke of the duty of the NHS (as commissioners and providers of health services) to involve communities directly in our work. There are also ways the NHS can reduce inequalities as a local anchor institution and employer and via its NHS estate.

Kevin Fenton (Office for Health Improvement and Disparities (OHID) spoke of lessons learnt in developing social movements, including:

  1. Developing our story and narrative. Using the importance of now and sharing our experiences and stories.
  2. Being organised to make a difference. Although a movement can appear organic in nature, it needs structure and organisation behind the scenes. For example, do we have the right strategic boards, people, and communities around the table? Do we have our data and evidence organised? Are we ready to move and respond quickly?
  3. Finally – leadership. We need lots of leaders, and there are already many. Ask yourself, what do I need to do to be this leader?

Peter Gladwell (Legal and General) spoke about the role of private business in reducing inequalities, and what might motivate business to be involved in health equity?

Firstly, there are many chief executives and heads of business’s who care passionately about social justice. They see it as a corporate and not just personal issue. Business does gives money to charities, but they can do much more to develop their Corporate Social Role. He saw the ways business can get involved in health equity as:

  1. The way business treats its employers
  2. The services and products that businesses create.
  3. The influence business has with local and central government.

Questions from the audience

Questions from the floor and discussion centred around the vulnerability of social movements, e.g. pandemics, funding, changing political ambitions, austerity, legal changes. But by bringing many conversations together (focussed on equity and inequalities), we keep the conversation going and are stronger as a collective.

A question I asked the panel was how do we measure the impact of a social movement for health equity? We clearly need more than a data driven dashboard here. Some useful suggestions from the panel were:

  • Setting some clear core goals to start with.
  • Measuring collective advocacy (who’s contributing? which partners? which communities? how’s the movement grown?)
  • Measuring your deliberate as well as organic activity (taking notice of the spontaneous and unexpected gains).
  • Ultimately have long term outcomes that can be measured by data (we’ve tried to identify a few locally (page 13))

The conference closed with Michael Marmot’s take home message which was simple:

To put health ‘equity’ at the heart of all our policy.

Find out more about the national health equity network here.

View more inequalities blogs below or on our Reducing Inequalities Alliance webpage. To write a blog about inequalities work you’re involved in, please email ria@bradford.nhs.uk

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