AYPH’s Rachael McKeown explores what the ‘Core20PLUS5’ approach to reducing health inequalities is and why we need a different strategy that prioritises young people.
Covid-19 has exposed and exacerbated many health inequalities that exist in our society, as it seems that your health is increasingly determined by where you live and the money you have. NHS England has recognised that they have a role to play in making sure that everyone is able to access timely and high quality care and that people do not face barriers or disadvantage within the system. NHS hospitals also make up a large part of the economy and environment that they are based in. The recent creation of NHS integrated care systems (ICSs) aims to take a local approach to addressing the needs of the population groups that they serve.
It is within this context that NHS England and Improvement have taken a specific focus on tackling health inequalities. Earlier in 2021, Dr Bola Owolabi was appointed as Director of Health Inequalities, with a specific remit for providing solutions and actions that can be taken within the NHS to equalise health outcomes. The peak of this work is the roll out of a targeted approach to reducing health inequalities, called ‘Core20PLUS5’, which ICSs will embed locally.
The name of the approach goes some way to explain the elements that make up the strategy. ‘Core 20’ is the most deprived 20% of the national population and the ‘plus’ represents the ‘inclusion health’ groups (such as migrants or those experiencing homelessness), as these populations are more likely to experience health inequalities. The ‘5’ relates to the top five clinical areas NHS England have identified as a priority for taking action: maternity care, severe mental illness, chronic respiratory disease, cancer diagnosis and hypertension.
This approach is not relevant or applicable to young people aged 10-25. The clinical areas are adult focused and demonstrate how young people’s needs are not prioritised in policy and practice.
At AYPH, our health inequalities programme aims to shine a light on the specific health needs of young people and their experiences of health inequalities. We know that data reveal health inequalities early in life, which become embedded in adolescence due to the unique ways in which young people are transitioning through different aspects of their life. Michael Marmot’s first priority area for reducing health inequalities is “giving every child the best start in life”, closely followed by his call for “enabling all children, young people and adults to maximise their capabilities and have control over their lives”. The NHS ‘Core20PLUS5’ approach fails to recognise that early intervention will prevent health inequalities forming early and having life-long impacts.
Last week, we responded to NHS England’s survey about their approach, highlighting the importance of health inequalities experienced by young people. We recommend a new approach is developed that meets the needs of young people, by addressing clinical areas where data demonstrates diverging health outcomes. We are open to working with the NHS to develop tools and resources that reduce health inequalities in the 10-25 age group.