A NICE way to reduce health inequalities

You will probably have heard of health inequalities. You may even experience them yourself because of where you live, or perhaps because of your protected characteristics. Reducing health inequalities is one of our core principles. But what exactly do we mean by the phrase?

Health inequalities are differences in health across the population and between groups that are systematic, unfair and avoidable. They're caused by the conditions in which we are born, live, work and grow. These conditions influence our opportunities for good mental and physical health. 

Cause and effect

The factors that can cause health inequalities include:

• socioeconomic status and deprivation  
• sharing protected characteristics  
• belonging to vulnerable or excluded groups of society
• geography.

These factors often overlap and people can fall into combinations of these categories. This can worsen the severity of inequalities experienced.  

We can see and measure these inequalities through differences in things such as: 

• how common certain conditions are and the number of deaths linked to them
• behavioural risks to health, such as smoking
• wider determinants of health, such as housing and employment
• access to care 
• quality and experience of healthcare services. 

Our role in reducing health inequalities

Our guidance supports strategies that improve population health as a whole, while offering particular benefit to the most disadvantaged.

By incorporating our recommendations into their work, health and care professionals can make sure the care they provide is effective, uses resources efficiently, and reduces inequalities and unwarranted variation.

We have an extensive library of guidance which is aligned to key health inequalities frameworks. We also have guidance available on approaches to addressing health inequalities, such as community engagement and shared decision making.

Our recently launched NICE and health inequalities webpage gathers together all of this guidance in one place. It then maps it to the most commonly used health inequalities frameworks, specifically:

• The adapted Labonte model - a simple but effective map of the causes of, and opportunities to tackle, health inequalities. This model can guide effective strategies to reduce them.
• Core20PLUS5 - NHS England’s approach to support integrated care systems to reduce healthcare inequalities.

The new resource page raises the profile of our offer and the fit of our guidance with system needs. We want it to show how our products can support the system's current priorities.

The establishment of integrated care boards will impact how NICE recommendations are funded, adopted and implemented. There is now a greater need for integrated guidelines that extend across health, social care and public health. A recent example of this is our guideline 'Integrated health and social care for people experiencing homelessness'. It aims to improve engagement with care and make sure it is coordinated across different services.

Stepping up to our unique role

We consider health inequalities in all aspects of our work. We need to prioritise our efforts on those areas of guidance and appraisal that target specific groups or conditions where there is widest variation in practice or outcomes. And, where it can have the greatest impact.

Our strategy also emphasises the importance of working with our partners, to increase the use of our guidance, monitor its adoption, and measure the impact on health outcomes and inequalities.

We're working to improve our approach to considering equalities and health inequalities in guidance development.

This has led to the equality impact assessment (EIA) being revised to become an equality and health inequalities assessment, or EHIA for short.

The EHIA serves 2 key functions:

• To broaden consideration beyond those sharing a protected characteristic to include other dimensions of health inequalities such as deprivation, geographical factors, and vulnerable groups.
• To be proactive in finding opportunities within guidance development to reduce health inequalities.

We may not always be able to directly influence some of the wider determinants of health. However, we can help reduce health inequalities by preventing or mitigating the causes of them through the guidance and recommendations we make for the health and care system.

Making a real difference

Our work to help reduce health inequalities is already making a difference.

In 2021, we recommended the first treatment in 2 decades for sickle cell disease​ (SCD), a disorder that disproportionately affects people from Black African and Caribbean backgrounds.

We recommended a drug called Crizanlizumab (Adakveo, Novartis) as a treatment for preventing recurrent sickle cell crises in people aged 16 or over. Clinical evidence suggests that people on this new, intravenous treatment have significantly fewer sickle cell crises in a year (compared to those receiving standard treatment options).​

The cost-effectiveness estimate for Crizanlizumab was above what we normally consider for NHS resources. But, the significant unmet need for effective treatments for people with SCD was highlighted. This was along with the awareness that SCD is more common in African or African-Caribbean family origin, who tend to have poorer health outcomes.

As a result of our recommendation, it is now recommended for people with SCD using a managed access agreement.

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