How can healthcare education effectively prepare healthcare professionals to recognize, address and mitigate health inequalities within diverse patient populations?
Studying in East London, homelessness is a pervasive reality. While I attempt to assist by offering food or spare change, their evident health struggles lead me to ponder on the challenges they endure. Despite the NHS providing free healthcare at the point of access1, their condition illustrates the pressing need for additional support systems. This serves as a reminder that greater efforts are required for the healthcare system to achieve its goal of universal benefit, as intended.
The issue of health inequalities is a major and escalating challenge– with studies revealing that those in areas most deprived of healthcare are expected to live 18 years less than those in the least deprived areas2. Prevalence of co-morbidities and early onset of illnesses has also been shown to be notably higher in more disadvantaged groups3. Coincidentally, it has been shown that health inequality in 2011-2012 alone cost the NHS 4.8 billion pounds4, accounting for a fifth of its budget - further straining the NHS’ financial situation, affecting the quality of care that patients receive.
Understanding of the concept of inequality is therefore crucial to delivering healthcare that strives for equity. Research indicates that only 16% of adult medical practices and 18% of clinical pediatricians report routinely screening for social determinants of health (SDH).5,6 The key challenge in education is not only integrating academia, community engagement and exposure for teaching health inequality but also ensuring healthcare professionals can effectively apply it in practice. Whilst reassuring to see that 90% of medical schools provide community teaching from the first year of undergraduate medicine, including learning about individual patient’s lived experiences, there is no standardization of teaching, as they vary between medical schools7. Moreover, SDH is often taught as a stand-alone module, without continuity or linkage to the sciences that are taught and seems to have lost its importance all together in clinical years of the curriculum – this not only limits the effectiveness of pre-clinical teaching, but failure to reinforce these concepts also makes it difficult for integration into practice. There is so much we can learn from community education, but a significant challenge is the predominance of clinicians originating from privileged socioeconomic backgrounds, which may impede their ability to fully empathize and comprehend the perspectives of individuals from less advantaged circumstances.8
Education can address this by promoting social mobility in medical schools, reducing barriers, and increasing enrollment of students from disadvantaged backgrounds, fostering future professionals better equipped to empathize with social determinants of health (SDH). Mitigating biases and structural stereotypes is also important, as shown in the BAME initiative, which has increased representation of ethnic minority groups in NHS across the board 9. The RCGP also plans to provide training in underserved or rural areas, as it can help encourage healthcare professionals to remain in those communities after qualifying, benefiting both professional growth and local healthcare needs10.
Ultimately, health inequality is a multi-faceted problem, but I believe that continued emphasis on education can lead to a future where inequalities in health are reduced.
References
1. The NHS Constitution for England [Internet]. GOV.UK. 2023. Available from:
https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england 2. Health inequalities in a nutshell [Internet]. kingsfund.org.uk. 2024. Available from:
https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/health-inequalities
nutshell#:~:text=The%20gap%20between%20people%20living,in%20the%20least%20deprived%20areas 3. Multiple long-term conditions (multimorbidity) and inequality- addressing the challenge: insights from research [Internet]. 2023 Sep. Available from: https://evidence.nihr.ac.uk/collection/multiple-long-term-conditions multimorbidity-and-inequality-addressing-the-challenge-insights-from-research/
4. Asaria M, Doran T, Cookson R. The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation. Journal of Epidemiology & Community Health [Internet]. 2016 May 17;70(10):990–6. Available from: https://jech.bmj.com/content/70/10/990
5. Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals. JAMA Netw Open. 2019;2(9):e1911514. doi:10.1001/jamanetworkopen.2019.115146
6. Garg A, Butz AM, Dworkin PH, Lewis RA, Serwint JR. Screening for basic social needs at a medical home for Low-Income children. Clinical Pediatrics [Internet]. 2008 Jun 20;48(1):32–6. Available from: https://doi.org/10.1177/0009922808320602
7. Lee SWW, Clement N, Tang N, Atiomo W. The current provision of community-based teaching in UK medical schools: an online survey and systematic review. BMJ Open [Internet]. 2014 Dec 1;4(12):e005696. Available from: https://bmjopen.bmj.com/content/4/12/e005696
8. White C. Just 4% of UK doctors come from working class backgrounds. BMJ [Internet]. 2016 Nov 23;i6330. Available from: https://www.bmj.com/content/355/bmj.i6330
9. England N. NHS England » New figures show NHS workforce most diverse it has ever been [Internet]. 2023. Available from: https://www.england.nhs.uk/2023/02/new-figures-show-nhs-workforce-most-diverse-it-has ever-been/
10. Hawthorne K. Breaking the inverse care law in UK general practice [Internet]. Breaking the Inverse Care Law in the UK. Available from: https://www.rcgp.org.uk/getmedia/be6b2aba-330f-4993-9d3f-63f09795c9b9/breaking inverse-care-law-UK-general-practice.pdf
