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Inequalities in Health Alliance

The RCP convenes the Inequalities in Health Alliance, a coalition of organisations who have come together to campaign for a cross-government strategy to reduce health inequalities.

The IHA was launched in October 2020, when it wrote to the prime minister to ask government to do three things: 

  • develop a cross-government strategy to reduce health inequalities 
  • commence the socio-economic duty, section 1 of the Equality Act 2010 
  • adopt a ‘child health in all policies’ approach. 

Membership is open to registered charities, NHS and social care organisations, public bodies, community groups and campaigning organisations that have an interest in reducing health inequality. Members of the IHA contribute to its ongoing campaign by promoting the ask for a cross-government strategy to reduce health inequalities to government, their memberships and networks. 

Apply to be a member of the Inequalities in Health Alliance

What has the IHA done so far? 

In February 2020, following the publication of Health Equity in England: the Marmot review 10 years on, the RCP wrote to the prime minister along with other Medical Royal Colleges and the Royal Colleges of Midwifery and Nursing. We urged him to adopt the recommendations of the report and go a little further. 

The RCP then convened the IHA and wrote to the prime minister in October 2020 and February 2021. We reiterated our aims and requested a meeting to discuss the government’s approach to reducing health inequalities. We received a reply from the then Public Health Minister, Jo Churchill MP, reaffirming the government’s commitment to reducing health inequalities as part of the ‘levelling up’ agenda.  

While we were pleased to receive a response, we were disappointed that the prime minister asked the Department of Health and Social Care to respond to it as a ‘health-related matter’. As the minister herself said, “health is the product not just of health services, but of our behaviours and of the environment in which we live”, which is why we are calling for a cross-government strategy. 

In September 2021, 92 senior leaders of IHA members wrote publicly to the prime minister to reiterate the call for a cross-government strategy to reduce health inequalities. This letter was sent alongside a new position paper by the RCP which included real life stories of how people’s health is damaged by social factors such as poor housing conditions and being unable to afford public transport. 

In January 2022, the IHA issued a briefing to MPs on its calls for a cross-government strategy to reduce health inequalities ahead of a Westminster Hall debate about the Office for Health Improvement and Disparities and health inequalities.  

Office for Health Improvement and Disparities  

In March 2021 the government announced that it would create the Office for Health Promotion (OHP) and a cross-government ministerial board on prevention. Commenting on the launch, Dr Andrew Goddard, president of the RCP, said we were pleased to see the government recognise that coordinated action across government is needed to tackle the wider determinants of health. He said the creation of a cross-government ministerial board, alongside the Office of Health Promotion, could be a turning point for addressing health inequalities if it was given a remit to take policy action in other departments on issues like poor housing and air pollution which we know affect health outcomes. 

In September 2021, the OHP was renamed the Office for Health Improvement and Disparities (OHID). OHID launched on October 1 2021. In response, Dr Goddard said: “While the OHID will do much to improve health inequalities, we also need a cross-government strategy, led by and accountable to the prime minister. The OHID has a unique opportunity to begin levelling up the health of the population, but we need more than coordination of government work…we need strong political leadership to ensure that the good work of one department isn’t being undone by the unintended consequences of policy in another.” 

The announcement of the OHID referred to ‘a new cross-government agenda which will look to track the wider determinants of health and reduce disparities’, which could be the development of the strategy we need. If so, we look forward to the prime minister making that clear and laying out how all government policy will be assessed against the need to reduce inequalities and improve population health. 

Why we need a cross-government strategy 

A cross-government strategy is needed because health inequality is the result of many and varied factors. While it may seem that health inequality is a matter for the Department of Health and Social Care or the  NHS, health and social care services can only try and cure the ailments created by the environments people live in. If we are to prevent ill health in the first place, we need to take action on issues such as poor housing, food quality, communities and place, employment, racism and discrimination, transport and air pollution. All parts of government and public services need to adopt reducing health inequality as a priority. 

The socio-economic duty is key to ensure that the needs of vulnerable people, who can all too often be forgotten, are considered in every decision. It is vital that the impact of policies made at the highest level of government on the poorest in society are weighed up before final decisions are made. This gives us the best chance at avoiding unintended consequences falling disproportionately on the most disadvantaged.   

Finally, the importance of early years for adult outcomes is also well known. The COVID-19 pandemic has reminded us of the importance of high levels of general good health. For example, we have seen all too clearly that by allowing more and more children to become obese in the past we increased their risk of dying from COVID-19 in the present. We need to be prepared for future pandemics, and make sure all public policy is focused on making sure every child has the best chance of good health throughout their life. 

We will keep our members and partners updated as this work progresses. If you have any questions or would like more information, please contact us via policy@rcplondon.ac.uk