Addressing health inequalities

Individuals at highest risk of inappropriate polypharmacy are those with the greatest frailty, and on the most medicines and taking high risk medicines. Analysis from Scottish data shows that those in the most deprived communities take the greatest number of medicines, and analysis of high-risk combinations show that these are highest in the most deprived areas. We also know that life expectancy is lower, and disease burden higher in areas of deprivation.

While the main drivers of health inequalities lie outwith health services, our services and the way we deliver them play an important role. In this small section we raise awareness of health and healthcare inequalities and connect to emerging evidence on effective ways of mitigating inequalities in healthcare. This section is supported by Inequalities in chronic pain experiences and care where fuller explanations and literature citations are given, including the intersectional nature of health inequalities i.e. that health inequalities can be more fully understood by exploring factors beyond only socioeconomic deprivation.

Scotland has high levels of health inequalities,⁹² with poorer areas recently experiencing worsening health. Health inequalities are ‘unjust and avoidable differences in people’s health across the population and between specific population groups’,⁹³ meaning that when it comes to differences, we should consider what differences are avoidable and what are not. Polypharmacy is a good example; Chart 1 below shows increasing medicines with age, elements of this are not avoidable, however, the chart also shows large differences between areas of relative affluence and deprivation – factors here are avoidable (and also complex).

Data confirms that there is greater prescribing in higher SIMD categories, indicating polypharmacy and multimorbidity (see the chart below)

Medication burden comparison for age and deprivation

Click on the image to view a larger version

Actions on health inequalities

In the context of undertaking medication reviews, approaches to care can be adopted to account for some of the factors that maintain inequalities. If any service improvement approaches are being undertaken, accounting for equitable care should be considered, and Inequalities in chronic pain experiences and care contains further details of supporting literature and resources to help.

Approaches to consider in delivering care include:

Raising healthcare professional (HCP) education and awareness of health inequalities, driving factors, impacts on individuals and the limitations of tackling inequalities solely through healthcare
Consideration of additional support that might be needed to reduce barriers at service interfaces e.g. support mechanisms to help attendance at specialist appointments, care coordinators, interpreters or specialist support for those with sensory impairment
Continuity, building relationships and trust in delivery of care is helpful in particular for marginalised groups. Service design aspects to consider: continuity in timetabling, personal lists and longer consultations
Improving healthcare professionals’ understanding of power imbalance – understanding that different groups may hold different levels of power that influences consultations, and can inhibit people asking questions that matter, leading to over-medicalisation

Health literacy involves a functional understanding of any health condition. It supports the ability and opportunity to implement management and to navigate health systems. To promote health literacy within healthcare, use verbal communication strategies, accessible information, specialist support for those with sensory impairment, easy-to-navigate services and flexible care

Trauma-informed approaches to health service provision are typically service-wide with connections to trauma treatment options. In consultations it is important to give space to develop trust and for people to tell their stories; fostering individual choice and control, and being sensitive and aware of cultural, historical and gender-related issues
Welfare and financial inclusion – HCPs can routinely enquire about money worries and signpost patients to welfare resources e.g. Citizen’s Advice Bureau