Paul Fisher
Head of Policy, Programmes, & Compliance, BIVDA
Last year, I stood on the top floor of the Royal College of Physician’s Spine Building in Liverpool. Looking to my left, I could see culture and history; universities, cathedrals, and museums.
To my right, the view was less rosy; deprivation and poverty evidenced by a former workhouse bordering a Victorian cemetery.
This is the reality of health inequality in the UK; that being born a mile away in Sefton means a woman can expect to live six years longer in good health than her friend in Liverpool.
Someone living in the most deprived areas of the UK is three times as likely to be dead by the age of sixty as those living in the least deprived.
Defined by the Kings Fund as avoidable, unfair and systematic differences in health between different groups of people, this deep-rooted health inequality deeply affects the health and wealth of the UK. More pertinently, this should not be the reality of the country that developed the NHS.
Reducing health inequality will take systemic action over decades; from housing to education. But there are options available to the health system to start to make immediate inroads.
Health inequality and diagnostic disparities are closely linked. Certain populations experience systematic disadvantages in accessing and receiving timely, accurate diagnoses, leading to poorer health outcomes.
Socioeconomic status, ethnicity, and geography play significant roles. Conversely, effective diagnosis enables early, appropriate, and effective treatment. So, by ensuring equitable access to diagnostic tests, better outcomes will be achieved.
Areas of opportunity include genomic screening. The NHS plans to offer screening to all newborn children, using a blood sample taken from the umbilical cord.
This will allow health professionals to assess the risk of certain diseases, to provide lifestyle advice, and to treat conditions – such as high cholesterol – before they affect quality and duration of life. This offers the genuine opportunity to build a proactive, not reactive, health service for all – based on prevention rather than cure.
With communities of lower socioeconomic status often living in poorer quality housing, they are more susceptible to respiratory infections. This was starkly shown during the COVID-19 pandemic, when poorer and minority ethic communities were disproportionately affected. There is also a risk of being unable to travel to health appointments.
But the solution here was also demonstrated during the pandemic – bring diagnostics to the community. Community Diagnostic Centres are able to offer a range of diagnostics services within the community. If the government are serious about reducing health inequality, we call on them to expand these services into a true, one-stop testing shop.
A self-employed patient is unduly impacted by multiple appointments, and less likely to attend. The same applies to carers, or single parents.
No one should need to visit multiple sites or take multiple absences from work to access reliable and effective diagnostics – and with small, relatively cheap, point of care diagnostics available there should be no need to.
However, with the current CDC’s heavily focused on imaging and only one in five based in the community rather than on a traditional health care site, there is work to do.
ARI hubs also offer a solution; keeping patients with respiratory conditions out of hospital, the rationale being supported by a diagnostic test.
Chronic conditions like diabetes and cardiovascular disease disproportionately affect underserved and socioeconomically disadvantaged populations—often due to delayed diagnosis, limited access to routine monitoring, and inconsistent care.
Prioritising equitable access to diagnostic tools and long-term monitoring could transform this landscape. By implementing widespread, affordable screening and regular monitoring—particularly in high-risk communities—policymakers can enable earlier intervention, reduce complications, and lower long-term healthcare costs while also reducing the state of health inequality in the country.
HbA1c testing and home-based blood pressure monitoring can help prevent hospitalisations and improve quality of life, especially when paired with community outreach and digital health solutions.
More broadly, with a post-COVID shift away from face to face consultations and the UK having the some of the shortest consultations in the world, poorer outcomes for ethnic minority patients have been linked to difficulties communicating with health professionals.
Diagnostics are colour blind – and where they are not (such as with pulse oximeters being less effective with darker-toned skins) technology has overcome this – allowing readings to be taken from areas with lower melanin levels.
To address the root causes of health inequality will take generations. But the diagnostic industry offers immediate mitigations. Integrating targeted diagnostics into national health strategies is a evidence-based part of the UK’s toolkit ensure that health inequality is tackled fairly, resulting in better outcomes for all.
Featured image via Prostock-studio / Shutterstock.
