Governments of recent years have all had encouraging words to say about reducing health inequalities, but actions to match this haven’t always been forthcoming.

In the third and final part of our blog series on health inequalities, written in collaboration with health inequalities expert, Dr Naheed Rana, we look at what the current government says about this most key of issues. And is it something that will now be deprioritised as a result of the upheaval at NHS England and the major focus on reform?

If so, what impact will this have on prevention, wellbeing and life expectancy in the short, medium and long-term?  

What has the government said about health inequalities?

In its manifesto ahead of the general election last year, the Labour Party committed to reducing health inequalities, emphasising that it "cannot be right that life expectancy varies so widely across and within communities”. The party pledged to tackle the social determinants of health and set an ambitious goal of halving the gap in healthy life expectancy between the wealthiest and most deprived regions of England.

Since coming to power, there has been significant discussion about reform, with a particular focus on prevention and shifting care away from hospitals to community settings to ensure the NHS is 'fit for the future.' But, so far, little direct talk on how health inequalities will be addressed.

That said, the government has started to implement some bold policies, such as continuing the previous Conservative-led government’s plans to introduce the Tobacco and Vapes Bill (currently stuck at the 2nd reading stage in the House of Lords). This legislation will ensure that anyone born after 2008 will never legally be able to buy tobacco. It will also give the government powers to extend the indoor smoking ban to certain outdoor settings, including outside schools, hospitals and in children’s playgrounds, to help create the first smoke-free generation.

In December 2024, meanwhile, restrictions on TV advertising of junk food before the watershed were announced to help curb childhood obesity, with the changes set to take effect in October 2025.

What’s next?

One of the first steps taken by the government when it came into power was to commission the ‘Darzi report’, carried out by former health minister Lord Darzi, which reported its findings in September 2024. It was a comprehensive and significant evaluation of the NHS, examining its current state and proposing reforms to ensure the system is fit for the future.

The review identified several key challenges and opportunities for improvement, with a particular emphasis on health inequalities. One of the critical issues highlighted was the need to address severe variations in care, especially for vulnerable groups such as those with learning disabilities.

Darzi stressed that people with learning disabilities experience much poorer health outcomes and shorter life expectancies compared to the general population. The report called for targeted efforts to reduce these inequalities, ensuring that vulnerable populations receive the care and attention they need to improve their quality of life and health outcomes. This includes reforming healthcare services to be more inclusive, addressing social determinants of health, and promoting better integration of care for these individuals.

The Darzi report informed the government’s consultation on a new 10 Year Health Plan, with Change NHS launched in October 2024 to hear the public’s views, experiences and ideas on how best to shape healthcare in England.

As part of this plan, several working groups have been established, with a focus on addressing health disparities and improving equity in healthcare. These groups will play a crucial role in shaping propositions for NHS Trusts and wider Integrated Care Boards (ICBs), ensuring that health equity is embedded in the delivery of care across the country.

Additionally, these working groups will play a pivotal role in translating the goals of the 10 Year Health Plan into concrete actions that address health inequalities and promote health equity across the healthcare system. By focusing on these areas, the plan will aim to create a healthcare system that not only provides high-quality care but also ensures that care is accessible, equitable and inclusive for all.

What more needs to be done?

The Darzi report and the 10 Year Health Plan are steps in the right direction, but there are concerns among some that, as a result of the current turmoil surrounding NHS England and the government’s laser-like focus on reform, health inequalities won’t receive the prominence they deserve.

It is critical, when taking action to address health inequalities, that community engagement, involvement and development is included at a national, regional and local level, to get input from the people who are most affected.

Since the pandemic, there has been a strong recognition of the importance of community involvement and co-design in shaping healthcare policies and services. Local public health systems have made significant progress in embedding community leadership into health inequalities and equity-focused strategies.  

By actively involving communities in decision-making processes, local authorities and healthcare organisations can better understand the unique needs of different populations and develop more effective, tailored approaches. This collaborative approach helps ensure that the voices of those most affected by health disparities are heard and that solutions are grounded in the lived experiences of individuals and communities.

At the heart of this approach is the belief that community-driven initiatives are essential for tackling the root causes of health inequalities, from social determinants to access to care. These efforts not only empower communities but also create more sustainable and equitable healthcare systems that are better equipped to meet the diverse needs of the population.

There has been considerable discussion about reform and improvement, with conversations at both national and local levels focusing on tackling health inequalities and promoting equity. However, there still appears to be a lack of a comprehensive, integrated plan that addresses the full range of factors contributing to health disparities.

To truly tackle health inequalities systematically and effectively, it is essential to consider broader policy areas such as housing, job security, social care, and the wider determinants of health. These factors are deeply intertwined with health outcomes and must be addressed together in order to create lasting change.

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