How can healthcare education effectively prepare healthcare professionals to recognise, address and mitigate health inequalities within diverse patient populations?
Health inequalities are pervasive unfair differences in health across the population (1). Importantly, they are avoidable, and with adequate intervention, including comprehensive education of healthcare workers, we can identify and reduce them. The social determinants of health (SDOH) are key to understanding health inequalities. These are the non-medical factors like socioeconomic status (SES), race and ethnicity, education and many more which can influence health outcomes by up to 30-55% (2).
For example:
Lower SES, income and education level all increase the risk of cardiovascular disease (3).
Black women in the UK are significantly more likely to die during childbirth (4).
UK children in the most disadvantaged 10% are twice as likely to be overweight or obese than those in the most advantaged 10% (5).
Many of these factors intersect and it is important to consider how inequalities can compound. For example, studies show that black people have worse health outcomes than white people in the same income bracket, likely due to the added effect of systemic discrimination (6). Given the significant impacts of health inequalities, healthcare education must prepare students to address and mitigate them effectively.
However, there are many barriers to improving healthcare education in this respect. One such barrier is a lack of representation and exposure to the diverse groups that students go on to serve. A recent study recognised the lack of faculty diversity at senior positions in UK medical schools, and the limited opportunities for students to interact with diverse patient populations during their placements, particularly if these populations struggled to access services (7). Furthermore, many curricula fail to integrate the SDOH or have adequate representation in educational materials. For example, dermatology teaching often focuses on white skin, leaving clinicians less equipped to diagnose conditions in darker skin tones (8). Unfortunately, implementing structural changes like diversifying faculty and revising curricula requires time and financial investment, slowing progress. Additionally, healthcare education alone cannot address systemic inequalities, such as poverty or food insecurity, which fall outside the healthcare sector’s direct influence.
Healthcare education can still provide meaningful benefits. For instance, helping students to reflect on the factors which have shaped their own perceptions, via tools like the Harvard Implicit Association test, could improve self-awareness and reduce the risk of unconscious bias in clinical practice (9). Additionally, embedding the SDOH in teaching, alongside a holistic approach to health, could increase students’ confidence in identifying health inequalities in action and understanding the wider context of patient care. Finally, increasing diversity in case studies and educational images could enhance cultural competence and help students better serve diverse patient populations. One study also highlighted how universities are in a unique position to collaborate with local underserved communities, simultaneously pioneering initiatives to improve health outcomes and producing healthcare workers who are well-versed in the challenges these populations face, with relevant frontline experience (10).
By embedding these strategies into medical education, we can prepare healthcare professionals to recognise, address, and mitigate health inequalities, creating a more equitable healthcare system for all.
References:
1. NHS. What are healthcare inequalities? [Available from: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/what-are-healthcare-inequalities/.
2. WHO. Social determinants of health 2025 [Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1.
3. Teshale AB, Htun HL, Owen A, Gasevic D, Phyo AZZ, Fancourt D, et al. The Role of Social Determinants of Health in Cardiovascular Diseases: An Umbrella Review. Journal of the American Heart Association. 2023;12(13):e029765.
4. Knight M, Bunch K, Kenyon S, Tuffnell D, Kurinczuk JJ. A national population-based cohort study to investigate inequalities in maternal mortality in the United Kingdom, 2009-17. Paediatric and Perinatal Epidemiology. 2020;34(4):392-8.
5. Spencer N. The social determinants of child health. Paediatrics and Child Health. 2018;28(3):138-43.
6. Bell CN, Thorpe RJ, Jr. Association between Income and Obesity in Black Men: The Role of Work-Life Interference. Ethn Dis. 2020;30(4):629-36.
7. Forrest D, George S, Stewart V, Dutta N, McConville K, Pope L, et al. Cultural diversity and inclusion in UK medical schools. The Clinical Teacher. 2022;19(3):213-20.
8. Mangion SE, Phan TA, Zagarella S, Cook D, Ganda K, Maibach HI. Medical school dermatology education: a scoping review. Clinical and Experimental Dermatology. 2023;48(6):648-59.
9. Implicit P. Project Implicit- Overview [Available from: https://implicit.harvard.edu/implicit/education.html.
10. Awosogba T, Betancourt JR, Conyers FG, Estapé ES, Francois F, Gard SJ, et al. Prioritizing health disparities in medical education to improve care. Annals of the New York Academy of Sciences. 2013;1287(1):17-30.
