Health inequalities: how nurses and midwives can make a difference

Health inequalities are avoidable differences in health between groups of people. These differences arise because the factors that influence our health, including food, housing, employment, education and transport, are not equally distributed throughout society. This means that some people are dying earlier than they should because, as individuals, they cannot change the way these things are distributed. By understanding more about the things that influence the distribution of health-creating factors, nurses and midwives can help people to live longer, healthier lives.

Social context, including where people are born, grow, live, work and age directly affect their health outcomes. The unequal exposure to environmental, behavioural and social risk factors can lead to physical health conditions, such as high blood pressure, which in turn can lead to the development of non-communicable and communicable diseases such as certain cancers and respiratory and cardiovascular conditions. Once present in a person's life, these factors combine and make it increasingly difficult to achieve good health. This is particularly true when a person experiences several related factors at the same time, making it difficult to change one without changing the others. For example, when a person lives in an area with limited access to affordable healthy food sources and has insufficient funds to travel to a place where availability is more prolific. As well as eating a poor diet, if this person also smokes cigarettes, takes very little physical exercise, and lives in housing that is sub-standard, the reality is that they are more likely get certain diseases (Public Health England (PHE), 2019a). Although some in society would suggest the impetus for health must come from the individual, research shows that, when simultaneously experiencing these inter-related factors of disadvantage, an individual requires practical assistance from external sources to achieve good health. Figure 1 sets out four domains of health inequality, which will be useful for readers when considering the actions that can be taken to address these within their practice.