Public health: inequalities and prevention

Clare Lally; Natasha Mutebi; Stephen Naulls; Sumayyah Mian; Yohanna Sallberg

Overview

The UK’s Faculty of Public Health defines public health as the “science and art” of preventing illness, helping people to live longer and promoting good health through society-level interventions.[1] This in turn can reduce pressure on healthcare services.

Health inequalities are “unfair and avoidable differences in health across the population, and between different groups within society”.[2] The Office for Health Improvement and Disparities (OHID) identifies four broad contributing factors:[7]

Socioeconomic status and deprivation: including low income, unemployment and living in a deprived area.
Geography: local area, levels of social connectedness and whether the area is urban, rural or coastal.
Vulnerable groups: for example migrants, and people experiencing homelessness.
Protected characteristics: including age, sex, race, sexual orientation, gender reassignment, religion or belief, and disability.

For example, approximately 24% of the UK population live with disabilities. Data shows that people with disabilities are almost twice as likely to die from preventable causes, 42% compared to 22% respectively.[3] People with learning disabilities also face significant unmet need.[4]

In 2021, Public Health England estimated that health inequalities cost taxpayers £68 billion from extra healthcare costs, lost productivity, lost tax revenue and benefit payments.[5]

Risk factors for developing long-term health conditions include health-related behaviours such as smoking, physical inactivity and poor diet.[6] These risk factors are more prevalent in disadvantaged communities.[7] Healthy choices are often limited for disadvantaged communities, or households living in poverty due to wider determinants of health.[8] These include living conditions in which people are “born, grow, live, work and age”.[22][23] Examples include early years (0-5 years), education, employment, and housing.[22][23][24]

Although mental and physical health is highly interconnected, this article focuses primarily on long-term physical health conditions. Many contributors highlighted specific policy challenges and uncertainties around mental health challenges, which are described in the following horizon scan articles:

Challenges and opportunities

Geographical disparities

In England, there is an 18-year gap in healthy life expectancy (the average number of years that somebody can expect to live in good health without being affected by conditions or diseases) between the most and least affluent areas of the country.[9][10]

People living in the most deprived areas, particularly in the North of England, coastal towns, and parts of the Midlands, experience worse health outcomes and higher rates of chronic illness than those in more affluent areas. For example, women in the most deprived communities now live nearly eight years less in good health than those in the least deprived.[11]

The government’s 2025 10-Year Health Plan for England aims to redirect billions in NHS resources to underserved regions, including working-class and coastal communities, to improve equitable access to care.[12],[13] In June 2025, the government announced The Fair Funding Review 2.0, a consultation on the approach to local authority funding reform through the Local Government Finance Settlement from 2026-27.[14]

Our briefing on geographical differences in healthy life expectancy (PB 67) outlines evidence around these challenges and policy considerations in more depth.

Health inequalities across ethnicity

Some ethnic groups face significant disparities in health outcomes. For example, Black communities have higher rates of mental health crises and detainment under the Mental Health Act (PN 671)[15] and up to four times higher maternal mortality rates compared to White counterparts.[16] Romany and Traveller communities face structural discrimination, stigmatisation and social exclusion across wider determinants of health, leading to a 25-year lower life expectancy, and poorer health and socioeconomic outcomes than the general population and other ethnic minority groups.[17][18]

Poverty

In the UK, 21% of people live in poverty.[19] Evidence shows that people living in poverty find it harder to live in good health, access health services, and experience worse health outcomes than the rest of the population.[20][21] Reasons include unequal access to healthy diets from food insecurity (HS 70)[22][23][24] poor-quality housing, and stress from accumulation of hardships.[33][25] The UK remains one of the worst-performing high-income countries for child poverty reduction and child health inequalities among European countries (HS 135).[26][27][28]

Interventions

Public health interventions include behavioural support (such as smoking cessation or physical activity programmes),[29][30] mental health interventions (particularly early support in schools or primary care),[31] and action on wider determinants of health, such as improving housing, reducing air pollution, and promoting access to healthy diets.[32][33][34][37]

National policy measures to support or mitigate healthy behaviours, such as through tax and regulation in the Soft Drinks Industry Levy,[35] can be more effective for some communities than information and educational campaigns alone.[36][37] Other proposals include the Sugar and Salt Reformulation Tax[38] and Tobacco and Vapes Bill.[39] There is long-standing contention over the balance between personal responsibility and state intervention in shaping healthier behaviours.[40]

Stakeholders across the health sector have called for a whole-government and prevention led policy approach to reduce the disparity gaps in health outcomes.[41] Researchers have also highlighted the importance effective primary care, screening programmes, and vaccination.[42]

Enabling parents to work, such as by supporting childcare costs, and improving child social security benefits can reduce the disadvantage gap in children by reducing homelessness, food insecurity, poor health and improving educational attainment (HS 135, PN 704).[43][44][45]

Researchers also highlighted the importance of prevention and early detection healthcare services, including effective primary care, screening programmes, and vaccination. Some contributors highlighted the third sector and community initiatives as effective partners for healthcare services to provide support and build trust with marginalised groups.[46][47]

Demand on healthcare services

Researchers outline that addressing wider determinants of health and promoting healthier behaviour change can alleviate pressure on health and social care services by reducing the incidence of diseases and multimorbidity (when somebody has more than one long-term health condition).[48]

In April 2024, there were 6.3 million people waiting to start NHS planned health care.[49] Over 300,000 patients had been waiting for over a year.[16] In the 2023/24, local authorities’ gross current expenditure on adult social care reached £27.1 billion, marking a £3.4 billion (14.2%) increase from the previous year.[50] Despite this increase, 40% of care providers reported operating at a deficit in 2023, indicating that current funding levels do not meet the sector’s needs.[51]

Key uncertainties/unknowns

Ageing population and multimorbidity

The UK’s ageing population presents a challenge for health and social care services as ageing is linked with increasingly complex healthcare needs.[52] While preventive interventions targeting conditions such as cardiovascular disease and dementia have been developed, their effectiveness in older populations is less well established.[53] See more on healthy ageing and care for older populations (HS71).

Some research has focussed on integrating prevention into routine care for people with multimorbidity, who often require individualised interventions.[54] Researchers have expressed concerns that policy often focuses on individual diseases rather than addressing the compounding impact of multimorbidity.[55] In 2024/25, UK Research & Innovation and the National Institute for Health and Care Research announced multimorbidity as a priority theme for research funding.[56][57]

Using data to understand needs

Lack of coding of protected characteristics and inclusion groups prevents accurate monitoring and insights on unmet need.[58][59] Stakeholders propose data sharing between the NHS, local government, relevant public and private sector organisations for a coordinated approach to designing and evaluating appropriate responses to population need and close gaps in population health research, policy and decision making.[60][61] However, people may have concerns about data privacy and security.[62]

Commercial threats to public health

Researchers highlighted that there is uncertainty in how to address the rise in some commercial determinants of ill-health, such as gambling, alcohol and vaping.[63] Several reports have highlighted the potential role of commercial actors in undermining public health policies.[62][64][65]

Workforce capacity

The ability of the NHS and local authorities to deliver preventive interventions at scale is constrained by workforce shortages, financial pressures, and competing demands.[66] See more in sustaining the health and adult social care workforce (HS 134).

Key questions for parliament

What legislative or policy changes are required to address health inequalities and ensure equitable access to preventive healthcare?
How can prevention be funded and prioritised within the NHS, and what incentives are needed to shift towards a more preventive model?
What incentives, if any, should be in place for businesses and employers to support workforce health and wellbeing?
What role should the government play in regulating commercial determinants of health, such as the food industry, alcohol, and digital environments?
How should public health messaging and behaviour change interventions be adapted for different populations?
What steps are needed to integrate prevention into routine care for children, older adults and those with multimorbidity?
How should Parliament balance state intervention with personal responsibility in shaping public health behaviours?

References

[1] Faculty of Public Health (nd). What is Public Health? Faculty of Public Health. Accessed 21 May 2025.

[2] Office for Health Improvement & Disparities (2022). Health disparities and health inequalities: applying All Our Health. UK Government.

[3] White, A., et al. (2022). LeDeR 2022 Annual Report Learning from Lives and Deaths: people with a learning disability and autistic people. Kings College London.

[4] Mencap (nd). Health inequalities and learning disability. Mencap.

[5] Public Health England (2021). Inclusive and sustainable economies: leaving no one behind (executive summary). UK Government.

[6] Everest, G., et al. (2022). Addressing the leading risk factors for ill health. The Health Foundation.

[7] Department of Health and Social Care (2020). Chief Medical Officer’s Annual Report 2020 – Health trends and variation in England, p74. UK Government.

[8] NHS England (nd). What are healthcare inequalities? NHS England.

[9] Office for National Statistics (2024). Healthy life expectancy in England and Wales: between 2011 to 2013 and 2021 to 2023. Office for National Statistics.

[10] The Health Foundation (2023). Nine major challenges facing health and care in England. The Health Foundation.

[11] Department of Health and Social Care (2025. Press Release, Landmark plan to rebuild NHS in working-class communities. UK Government.

[12] Baker, C. (2019). Health inequalities: Income deprivation and north/south divides. House of Commons Library.

[13] The Health Foundation (2025). Inequalities in neighbourhood-level life expectancy. The Health Foundation.

[14] Ministry of Housing, Communities and Local Government (2025). Press release Fairer funding for councils across the country in major reform. UK Government.

[15] Devonport, T.J, et al (2023). A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action. Journal of Racial and Ethnic Health Disparities, 10(4):1669-1681.

[16] Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (2024). Maternal mortality 2020-2022. MBBRACE-UK.

[17] Friends, Families and Travellers (2022). Briefing: Health inequalities experienced by Gypsy, Roma and Traveller communities. Friends, Families and Travellers.

[18] NHS Race and Health Observatory (2023). Inequalities in mental health care for Gypsy Roma and Traveller communities. NHS Race and Health Observatory.

[19] Francis-Devine, B. (2025). Poverty in the UK: Statistics. House of Commons Library.

[20] Mallorie, S. (2024). Illustrating The Relationship Between Poverty And NHS Services. The King’s Fund.

[21] Bidmead, E., et al. (2023). A rapid review of children and young people’s views of poverty and welfare in the context of Universal Credit. Children & Society.

[22] Blake, M. (2018). 1.2 million living in UK food deserts, study shows. University of Sheffield.

[23] Bidmead, E. et al. (2023). A rapid review of children and young people’s views of poverty and welfare in the context of Universal Credit. Children & Society.

[24] Rolker, J. & Bunn, S. (2022). Diet-related Health Inequalities. POSTnote 686, Parliamentary Office of Science and Technology.

[25] Joseph Rowntree Foundation, UK Poverty 2022: The essential guide to understanding poverty in the UK. Joseph Rowntree Foundation.

[26] Unicef (2023). Child Poverty in the Midst of Wealth. Unicef.

[27] Children’s Rights Alliance for England (2022). UK implementation of the UN Convention on the Rights of the Child. Civil society alternative report 2022 to the UN Committee – England Summary. Children’s Rights Alliance for England.

[28] Department for Works & Pensions (2025). Official Statistics Children in low income families: local area statistics, financial year ending 2024. UK Government.

[29] National Institute for Health and Care Research (2019). Adding behavioural support to drug treatment helps more people quit smoking. NIHR.

[30] Gilchrist, H., et al. (2024). Use of behavior change techniques in physical activity programs and services for older adults: findings from a rapid review. Annals of Behavioral Medicine, 58(3), 16-226.

[31] Faculty of Public Health (nd). Interventions to promote mental wellbeing and prevent mental illness. Faculty of Public Health.

[32] Richards, G.C., et al. (2023). Assessing housing exposures and interventions that impact healthy cities: a systematic overview of reviews. Perspectives in Public Health.

[33] Public Health England (2020). Review of interventions to improve outdoor air quality and public health: Principal interventions for local authorities. UK Government.

[34] Wentworth, J. & Chapman, J. (2024). Inequalities in diets. Parliamentary Office of Science and Technology.

[35] POST, Water fluoridation and dental health, POSTbrief, 21 August 2021

[36] Mallorie, S. (2022). Equity And Endurance: How Can We Tackle Health Inequalities This Time? The King’s Fund.

[37] Marteau, T. M., et al. (2021). Changing behaviour: an essential component of tackling health inequalities. The British Medical Journal, 372:n332.

[38] National Food Strategy: Independent Review (2021). The Plan, Chapter 16, Recommendation 1. National Food Strategy.

[39] Balogun, B. & Conway, L. (2024). Tobacco and Vapes Bill 2023-24. House of Commons Library.

[40] Holt-White, E. (2019). Public opinion on the determinants of and responsibility for health. The Health Foundation.

[41] Bibby, J., et al. (2024). Health at the heart of government. The Health Foundation.

[42] Lewis, T., et al. (2022). Equity And Endurance: How Can We Tackle Health Inequalities This Time? The King’s Fund.

[43] Brown, T. (2024). Child poverty: Statistics, causes and the UK’s policy response. House of Lords Library.

[44] Children’s Rights Alliance for England (2022). UK implementation of the UN Convention on the Rights of the Child. Civil society alternative report 2022 to the UN Committee – England Summary. Children’s Rights Alliance for England.

[45] Brown, T. (2024). Child poverty: Statistics, causes and the UK’s policy response. House of Lords Library.

[46] Devonport, T.J., et al. (2023). A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action. Journal of Racial and Ethnic Health Disparities, 10(4):1669-1681.

[47] Newbigging, K., et al. (2020). The contribution of the voluntary sector to mental health crisis care: a mixed-methods study. Health and Social Care Delivery Research, 8(29).

[48] Local Government Association (2024). Preventive and proactive care: research report. Local Government Association.

[49] NHS England (2024). NHS referral to treatment (RTT) waiting times data: April 2024. NHS England.

[50] NHS England (2024). Adult Social Care Activity and Finance Report, England, 2023-24. NHS England.

[51] Care England (2024). Sector Pulse Check: A snapshot of finances and the workforce in the adult social care sector in 2023. Care England.

[52] Stevenson, E. & Mutebi, N. (2024). Healthy ageing and care for older populations. Parliamentary Office of Science and Technology.

[53] Smith, S.M., et al. (2021). Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review. Systematic Reviews, 10, 271.

[54] Salisbury, C., et al. (2018). Management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach. The Lancet, (392).

[55] Head, A., et al. (2020). Multimorbidity: the case for prevention. Journal of Epidemiology and Community Health, 75, 242-244.

[56] National Institute of Health and Care Research (2020). NIHR IAT Priority Research Themes. National Institute of Health and Care Research.

[57] UK Research and Innovation (nd). Area of investment and support: Multimorbidity or multiple long-term conditions (MLTC). UKRI.

[58] Lewis, T., et al. (2022). Equity And Endurance: How Can We Tackle Health Inequalities This Time? The King’s Fund.

[59] Fogden, R., et al. (2022). Poverty And The Health And Care System: The Role Of Data And Partnership In Bringing Change. The King’s Fund.

[60] George, A., et al. (2023) Implementing the English health inequalities agenda: addressing challenges to person-level, cross-sectoral data linkage, access and routine use for local authority public health, International Journal of Population of Data Science

[61] Office for National Statistics (2025) Data-sharing: The beating heart of a successful public sector

[62] NHS England. (2024). Public attitudes to data in the NHS and social care. NHS England.

[63] Eckhardt, J. (2024). Commercial Determinants of Noncommunicable Diseases in the WHO European Region. World Health Organization.

[64] Pitt, H., et al. (2024). Developing structures to support researchers studying health-harming industries. Health Promotion International, 39(6).

[65] Dun-Campbell, K., et al. (2024). Commercial determinants of mental ill health: An umbrella review. PLOS Global Public Health.

[66] Early Intervention Foundation (2018). Realising the potential of early intervention. Early Intervention Foundation.

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