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What can the NHS do to prevent and reduce health inequalities?

A new set of papers from GPs at the Deep End imagines how the NHS should address the inverse care law, reduce the consequences of inequalities in health for individual patients, and narrow social differences in life expectancy.1

The principal causes of inequalities in health lie outside the health service, which is why policies to prevent health inequalities must address the wider social determinants of health, starting in childhood. However, it is insufficient to focus on the prevention of future inequalities in health. It is also necessary to reduce existing inequalities in health, and to prevent them getting wider. In practice, these approaches are complementary (Box 1).

#### Box 1. Prevention and treatment in one family

David is 14 months old. His 18-year-old mum Sarah has had anxiety problems since her older brother hanged himself 4 years ago. She started college but left when she became pregnant shortly afterwards. Sarah does not get on well with her mother, whom she accuses of drinking and ‘always shouting’ since her brother died. Her mum says she is ‘mental’ and a ‘teenage brat’. Sarah relies heavily on her own gran Margaret. Aged 50 years, she has moderately severe COPD (emphysema) and continues to smoke. Margaret has had several chest infections recently and is struggling to cope with Sarah’s often strange behaviour and with a lively toddler for whom she is the main care giver.

For David the next 2 years, as he learns to walk, talk, and interact, will have a huge effect on the rest of his life. Early years interventions such as parenting classes may be important, but on their own will fail to change his life opportunities. He will need supportive neighbours, a good nursery, and adequate family income, but also optimal COPD nurse reviews, responsive alcohol and mental health services, good communication with social workers, persistent …