A male health professional looking through some medical files

Health inequalities: a reflection

Published: 16 February 2023
In this blog,Dr Hannah Tharmalingam reflects on the disappointing progress that has been made in the area of health inequalities over the past decade.
Dr Hannah Tharmalingam, Consultant Clinical Oncologist and Macmillan National Clinical advisor.

Dr Hannah Tharmalingam Consultant Clinical Oncologist specialising in gynaecological and urinary cancer. And Macmillan National Clinical advisor with a special interest in health inequalities.

"There can be no more important task for those concerned with the health of the population than to reduce health inequalities" - Prof Sir Michael G Marmot

What are health inequalities?

Health inequalities describe the systematic differences between groups in society that are unjust and preventable resulting in some people being more likely to suffer worse health than others.

Although highlighted and exacerbated by the COVID-19 pandemic, health inequalities existed long before then and were intertwined across all aspects of health and in particular, cancer care. Their impact can be seen across the cancer pathway from prevention and early diagnosis, through treatment, survivorship and end of life care. 

What the research says

An image of an exercise monitor

Research from the Office of National Statistics shows those living in deprived areas are more likely to smoke than those in more affluent areas, thought to be attributable to a variety of factors including housing and income pressures.

Similarly, maintaining a healthy diet is particularly challenging for those on the lowest household incomes who would need to spend a significant and often unsustainable proportion of their disposable income on food in order to follow standard healthy eating advice for their families.

In addition to risk factors, those from deprived groups are less likely to attend cancer screening programmes which are absolutely crucial to catching cancers at their earliest stage when they may potentially be curable. Furthermore, primary care, the mainstay of current access into the cancer diagnostic pathway is comparatively under-funded and under-staffed in more deprived areas exacerbating barriers to early diagnosis and a better chance of survival.

And so the wealth gradient translates quite clearly into a health gradient with cancer outcomes getting considerably worse at the lower end of the scale.

As we struggle through an increasingly tumultuous cost of living crisis in the UK with a widening of income inequality, it is absolutely critical that the government acts on its commitment to ‘levelling up’ with health at the core of policy. It is ultimately action to eliminate wealth inequalities that will eventually help eliminate health inequalities.

Whilst perhaps the most evidence-based and best understood, socio-economic factors are however only one component of a number of complex, inter-sectional drivers of inequality in cancer care, particularly within the critical spectrum of prevention and early diagnosis.

It has long been established that those from ethnic minority backgrounds face more barriers to presenting to their doctor with potential red-flag symptoms and are less likely to participate in cancer screening programmes. More recent evidence has corroborated the difficulties in screening access for those from the LGBTQ+ community.

Both groups report worse experience once on the cancer pathway with difficulties with respect to provision of information, communication and decisions regarding care. 

What do we have to say about it?

At Macmillan Cancer Support we recognise that these inequalities are unacceptable.

We are working on a number of projects across the organisation to try and address them including:

  • partnerships to support under represented communities in navigating cancer care
  • educational resources to help our professionals provide the tailored support and personalised care which everyone should receive.

Reducing health inequalities is very high on our agenda and we will continue to do all we can to ensure that everyone, no matter what their background, can live well with cancer

Access training and webinars

If you are interested in enhancing your knowledge in reducing inequalities in cancer care the Learning Hub has several key digital learning resources available which include:

  • Reducing inequalities in cancer care for LGBTQ+ communities - includes webinars exploring barriers to screening, and looking at how good is our care for LGBTQ+ young people
  • Developing cultural competence elearning programme - aims to equip professionals and the wider workforce with skills and knowledge to understand more about culture and how it shapes peoples' beliefs and attitudes towards cancer, to help support people across all cultures living with or affected by cancer.

Furthermore, this year will see additional launches in this space including:

  • Reducing inequalities in cancer care for LGBTQ+ communities e-learning
  • Health illiteracy and it's impact learning materials.

To access this content and visit the Learning Hub.