Health outcomes in the UK are quite different for different groups of people. Perhaps unsurprisingly, health inequalities track social and economic inequalities, something highlighted during the COVID 19 pandemic. Alison R. McKinlay and Jack M. Birch write that the research, policy, and service sectors must collaborate to reduce the impact inequalities have on health outcomes.

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Health inequalities are “systematic, avoidable and unfair differences in health outcomes” and the social determinants of health are largely responsible for the entrenched health inequalities we observe around us. Increasingly, intersectional characteristics are being acknowledged as important influences of health outcomes, including combined discrimination caused by racism, sexism, xenophobia, homophobia, and transphobia.

The pandemic’s unequal impacts persist, with deprived areas experiencing higher rates of long COVID, compounded by stigma that hinders healthcare access and worsens mental health.

The COVID-19 pandemic highlighted health inequalities, exacerbating poor health and wellbeing. For example, structural racism means global majority ethnic groups in the UK are more likely to live in poor quality housing and have insecure employment, increasing their mortality risk from COVID-19. The pandemic’s unequal impacts persist, with deprived areas experiencing higher rates of long COVID, compounded by stigma that hinders healthcare access and worsens mental health. Given that these inequalities are in many ways, not new or unique to the situation arising from the COVID-19 pandemic, it is important to consider how policy can narrow health inequalities given their prevalence over time.

Tackling health inequality through research

Addressing inequality is a focus for many health organisations and research funders, particularly in countries like the UK. One such example is the National Institute for Health and Care Research (NIHR), which in November 2024 implemented a requirement that all applicants for NIHR funding explicitly demonstrate how their work will contribute towards reducing inequalities in health and social care.

However, for actions against inequality to be effective, a multi-faceted change to the wider eco-system is required. This includes conducting policy-focused research on interventions both within the health and social care system and outside of it. Interventions within the healthcare system, such as those optimising uptake of cervical screening in people with a severe mental illness, are important to mitigate the impacts of the social determinants of health that have already occurred and affect people in these groups. Complementary interventions are also needed that directly work to prevent the unequal impact of the social determinants of health, such as those seeking to address local economic development as a mechanism to improve work and living conditions.

How populism may exacerbate health inequalities

Public health can be negatively affected by populist-aligned beliefs during global crises, creating divisions and eroding social unity. Populism includes far-right and far-left attitudes, separating “us” in the desirable in-group and “them” in the unfavourable outgroup, creating dichotomies between “ordinary” people and “out-of-touch” others. Evidence from previous crises, such as the 2008-2009 financial recession, has been linked to increases in populist beliefs. And rising populism influences resistance to public health interventions, further widening health and social inequality.

Many working in health and social care have witnessed the real-life impact of inequality in their clinical practice and frontline work. Recent events such as the COVID-19 pandemic and political climate in the United States highlight how prevalent anti-science or anti-medicine voices are in mainstream spaces and how easily pseudoscience and false information can spread. Institutions traditionally considered sources of trustworthy health information are less relied upon due to beliefs in conspiracy theories, denial of scientific evidence and rise of populist-aligned beliefs. We recognise how important it is to carefully consider how to mitigate this uncertainty in health and social care. For instance, ensuring that voices expressing doubt in medical and scientific advice are not ignored and acting to address concerns directly as a means of building trust and creating certainty.  

Many working in health and social care have witnessed the real-life impact of inequality in their clinical practice and frontline work.

Unlike the 2008 recession, the role of online health information with the accompanying spread of misinformation online is more prevalent. As a consequence, progress towards equity and social justice risks being lost. With 52 per cent of the UK population relying on social media for online news, social media platforms must take ownership of their role in accurate information sharing to promote digital health literacy. Studies have shown that digital health promotion messaging on social media during the Mpox virus outbreak played a significant role in effectively sharing correct information, reducing stigma and promoting health advocacy, reinforcing the importance of truthful information on social media. While accurate, transparent health information to dispel myths and conspiracy theories is vital, this is only part of the broader picture.

Policies targeting the root causes of inequality, and strategies promoting social cohesion are steps in the right direction but not a total panacea.

What next?

Amid growing inequality and instability, rebuilding and retaining unity is paramount. Health and social care sectors must actively plan to mitigate the public health consequences from rising disparities. Collaborative efforts between research, policy, and service sectors are essential, alongside their work with marginalised communities. Policies targeting the root causes of inequality, and strategies promoting social cohesion are steps in the right direction but not a total panacea. We hope the health and social care field, alongside public health policy and funding sectors, will continue to pool efforts to improve public health by acting to reduce inequality.

The authors are funded by the National Institute for Health and Care Research and Care (NIHR) Policy Research Unit Behavioural and Social Sciences (project reference NIHR206241). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the National Health Service (NHS), the NIHR, Medical Research Council (MRC), Central Commissioning Facility (CCF), the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC), the Policy Research Unit programme, or the Department of Health and Social Care (DHSC).

All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science.

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