Imagine dying from a disease which is completely manageable. This is what happened to David Clapson, a former soldier with Type 1 diabetes. His insulin was essential to manage his condition, but when his benefits were cut, he couldn’t afford electricity to keep it refrigerated. A preventable death caused by poverty. David’s story highlights how deadly health inequalities can be.

Healthcare Access: More Than Just Seeing a Doctor

Healthcare might be free in the UK, but access to healthcare doesn’t necessarily mean equal health outcomes. In fact, the healthy life expectancy in the most deprived areas of the UK is 18 years lower than in the wealthiest areas. Despite healthcare being a Human Right, many people are in environments or have lifestyles that make it difficult to stay healthy in the first place. These factors that affect heath are called ‘Social Determinants of Heath’.*

Social determinants include:

• Income and job security: People with low incomes or insecure jobs often have less access to healthy food, safe housing, or even time off to see a doctor.
• Education: Health literacy—the ability to understand health information—can vary greatly, making it harder for some groups to make informed decisions.
• Living environment: Those living in polluted or unsafe areas face higher risks of respiratory problems or injury.
• Social support: A lack of community or family support can leave people isolated and more vulnerable to health issues.
• Healthy standard of living: A poor standard of living may involve food insecurity which can result in malnutrition.

This is a topic which may come under ‘ethics’ questions in interview. Here is a link with advice on how to tackle these questions.*

Inequity vs. Inequality: What’s the Difference?

Equality means giving everyone the same care, while equity means giving people the care they need based on their unique circumstance. Healthcare inequity is about the unfair differences in access, treatment and outcomes based on social conditions.

For example, maternal mortality is three times higher for Black mothers than for white mothers in the UK. This difference isn’t just about access to doctors, it’s about underlying issues such as systemic racism and social barriers that impact health outcomes.

NHS Approach: Addressing Inequality

The NHS recognises that health inequality is a huge issue. After the COVID-19 pandemic exposed the devastating effects of health disparities, the NHS launched initiatives to reduce health inequities. Some of their key priorities include:

• Reducing digital exclusion: Providing face-to-face care for patients who struggle with remote consultations.
• Collecting better data on ethnicity: To understand and address disparities in health outcomes for different ethnic groups.
• Focusing on prevention: Programs like targeted vaccinations and health checks for vulnerable groups aim to prevent illness, rather than just treating it.

What Can Doctors Do to Improve Health Inequity?

As a future doctor, you are in a position to make a real difference to your patient’s quality of life and health outcomes, even though you're only one part of the solution. Here’s what you can do:

• Understand their social history: Take time to learn about your patients' lives outside of their health. This will help you to assess and treat the patient holistically
• Advocate for your patients: Help patients access services outside of healthcare, like housing or mental health support, which greatly impact their well-being.
• Consider social prescribing, to meet the needs of the patient
• Promote health literacy: Explain medical information clearly and avoid jargon. Use visuals or easy-to-read leaflets to ensure they understand their options.
• Reflect on prejudices: Be aware of any personal or systemic biases that could impact the care you provide. Regularly reflect on how you can deliver more equitable care.
• Participate in community care: Work with community health programs that bring healthcare directly to the people who need it most, such as mobile clinics.

Summary: A Bigger Problem Than You Might Think

Healthcare inequity is a complex issue, deeply rooted in the social and economic conditions that patients live in. Doctors play a key role but are just one piece of a much larger puzzle. To fully address health inequity, it will take cooperation across many sectors, and a focus on social determinants. Healthcare inequities is a topic that comes up frequently in medical school interviews and can be challenging to answer. If you need help with interview preparation or in any stage of your medical school application, Future Doc 1-1 coaching can help.

Written by Luiza