The Pervasive Challenge of Health Inequalities: Transforming Healthcare Education for Systemic Change
More than 4.5 billion people worldwide lack access to essential healthcare, resulting in millions of preventable deaths annually.1 Such deaths stem from inequalities, including unequal resource allocation, geographical barriers, and systemic inequities, highlighting the need for accessible interventions. These inequalities reveal how socioecological factors like education, income, and service access perpetuate disparities.2 In fact, in many cases, an individual’s postcode shockingly predicts life expectancy more accurately than their genetic code, reflecting the stark divide in health outcomes3. Addressing these remediable health disparities requires systemic reforms that reinforce equitable access and improve the quality of care for all patients4.
Health inequalities affect patients in diverse ways, from reduced life expectancy to higher rates of chronic illness in disadvantaged populations. For example, data from the Organisation for Economic Co-operation and Development show that individuals across 17 countries with lower educational attainment live significantly shorter lives compared to their more educated counterparts: 8.2 years less for men and 5.2 years less for women5. Additionally in Wales alone, child mortality rates were 70% higher in the most deprived areas than in the least deprived, illustrating the devastating impact of social determinants on health6. These examples show that health inequalities are not confined to one region or demographic but are a global challenge affecting various patient populations.
Despite the clear need for action, healthcare education faces several obstacles when attempting to reduce these inequalities. Traditional training models often emphasise clinical and biological factors, leaving students underprepared to address the socioecological determinants that shape health outcomes7. Curricula frequently lack consistency in how they integrate these topics, making it challenging for students to gain a comprehensive understanding of the factors influencing disparities8. Moreover, healthcare education remains fragmented, with public health, social sciences, and clinical disciplines often operating independently9. This siloed approach limits collaboration and fails to provide a holistic perspective on health inequalities, leaving future professionals ill-equipped to address the systemic nature of these issues.
However, transformative approaches in healthcare education can enable future professionals to better recognise and mitigate these inequalities. Longitudinal integrated clerkships, for example, immerse students in underserved communities, helping them understand the interplay of social, economic, and medical factors10. These programmes rely on the “ecological model of competence”, which focuses on the interaction between individual capabilities and environmental pressures such as access to resources and community challenges11. This framework encourages students to consider not only medical factors but also broader systemic barriers. Integrating critical consciousness frameworks into the curriculum can further empower students to challenge inequalities and take actionable steps towards health equity12. Structured health equity curricula and interprofessional education promote collaboration across disciplines, equipping students with the skills to address policy-level inequalities and implement effective, patient-centred solutions13. These strategies not only improve cultural competency but also enhance patient trust and satisfaction, ultimately leading to better health outcomes and more equitable healthcare services14. By reframing healthcare education to emphasise equity, future professionals can develop the expertise needed to bridge systemic gaps, foster innovative solutions, and create a more just and effective healthcare landscape.
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Baciu, A., Negussie, Y., Geller, A. and Weinstein, J.N. (2019). The Root Causes of Health Inequity. [online] National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK425845/.
Lopez, N. and Gadsden, V.L. (2016). Health Inequities, Social Determinants, and Intersectionality. NAM Perspectives, [online] 6(12). doi:https://doi.org/10.31478/201612a.
Murtin, F., Mackenbach, J., Jasilionis, D. and Mira d’Ercole, M. (2025). Inequalities in longevity by education in OECD countries. [online] OECD. Available at: https://www.oecd.org/en/publications/inequalities-in-longevity-by-education-in-oecd-countries_6b64d9cf-en.html [Accessed 10 Jan. 2025].
Roberts, M., Morgan, L. and Petchey, L. (2023). Children and the cost of living crisis in Wales. [online] Available at: https://phwwhocc.co.uk/wp-content/uploads/2023/09/PHW-Children-and-cost-of-living-report-ENG.pdf.
Vögele, C. (2015). Behavioral Medicine. [online] ScienceDirect. Available at: https://www.sciencedirect.com/science/article/abs/pii/B9780080970868140607.
Nour, N., Stuckler, D., Ajayi, O. and Abdalla, M.E. (2023). Effectiveness of alternative approaches to integrating SDOH into medical education: a scoping review. BMC Medical Education, 23(1). doi:https://doi.org/10.1186/s12909-022-03899-2.
Reedy-Rogier, K., Hanson, J., Emke, A. and Coolman, A. (2024). Combatting Fragmentation: Lessons Learned from an Integrative Approach to Teaching Health Equity. Journal of General Internal Medicine. doi:https://doi.org/10.1007/s11606-024-08967-5.
Carrigan, B., MacAskill, W., Janani Pinidiyapathirage, Walters, S., Fuller, L. and Brumpton, K. (2024). Fostering links, building trust, and facilitating change: connectivity helps sustain longitudinal integrated clerkships in small rural and remote communities. BMC Medical Education, 24(1). doi:https://doi.org/10.1186/s12909-024-06373-3.
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NHS England (2020). NHS England» Our approach to reducing healthcare inequalities. [online] www.england.nhs.uk. Available at: https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/our-approach-to-reducing-healthcare-inequalities/.
Beach, M.C., Price, E.G., Gary, T.L., Robinson, K.A., Gozu, A., Palacio, A., Smarth, C., Jenckes, M.W., Feuerstein, C., Bass, E.B., Powe, N.R. and Cooper, L.A. (2005). Cultural Competence: a Systematic Review of Health Care Provider Educational Interventions. Medical Care, 43(4), pp.356–373. doi:https://doi.org/10.1097/01.mlr.0000156861.58905.96.
