Tackling health inequalities: examples from different services

Find out how other services have implemented changes to reduce the impact of health inequalities, and reflect on how you could transform your own service.

Examples of how services have tackled health inequalities

Musculoskeletal (MSK) service 


Your local population data shows you have a large Black, Asian and Minority Ethnic (BAME) community. You know from health inequalities data that BAME communities are more likely to have lower levels of physical activity. 

  • You review your service data and can see there is a poor uptake of exercise groups from this community, especially among Asian women. 
  • You work with a local Asian community organisation to run a focus group at a local coffee morning to explore barriers. 
  • As a result, the service runs a pilot of women-only exercise groups and works alongside voluntary organisations and community groups to encourage uptake.

Respiratory inpatients

From reviewing local data, you find there is a high prevalence of smoking. A survey of allied health professionals (AHPs) working on the wards identifies that most do not feel confident discussing smoking with patients or offering smoking cessation advice, and they do not make an onward referral.  

  • The AHPs are trained in how to give very brief advice on smoking and how to refer patients for nicotine replacement therapy during their hospital stay and to smoking cessation services in the community. 
  • Data for those seen on the ward is reviewed and, following the intervention, advice and referrals rates rise significantly.

Self-referral to MSK outpatient service

health inequalities

Through an equality and diversity audit, the team identifies that learning disabilities patients are not referring into the service.

  • The current self-referral process does not support people with learning disabilities accessing the service.
  • Discussions with the learning disabilities team identifies that this is due to the language used and the cognitive difficulties patients may have making it difficult for them to understand and engage with the self-referral process.
  • The service implements self-referral via an advocate and shares this information with the learning disabilities community, meaning others can refer on a service user’s behalf.
  • This change also benefits people in the community whose first language is not English, and potentially those with mental health conditions.

Pulmonary rehab

A pulmonary rehab service analyses data that shows a high percentage of referrals don’t attend or fail to complete the programme. The team compares completion data with similar services. 

  • The team explores the reasons for poor uptake by setting up a focus group and surveying the referred patients.
  • Results show the messaging makes patients believe they need to be at a certain level of fitness to start the rehab. Many are not at that level and do not know where to start. They are anxious about rehab and therefore do not attend.
  • The team sets up drop-in sessions and provides a video for patients on the importance of rehab and how to build their fitness to participate. 
A computer keyboard with a button labelled 'access'

Thinking about your own service

A good place to start when thinking about health inequalities is to reflect on your own service. How diverse is the team? Can they see the service through the lens of people from other cultures, beliefs, values and behaviours? Have they got access to training on cultural awareness, and is this sufficient? 

  • Does everyone in the community know about the service and how to access it?
  • Are there reliable interpreter services? Is British Sign Language (BSL) support available?
  • Can resources be supplied in other languages or formats? For example, neurodiverse patients might use Makaton (a communication tool using speech, signs and symbols), and learning disabilities teams often use pictures showing the exercises instead of written information.
  • What is the literacy level of the local population and do your communications reflect this?
  • Is there support to improve digital literacy to help members of the local population access services?
  • Are appointment letters clear about where the person will need to go and when, the amount of time it will take, parking availability and transport links?
  • Could services be provided closer to the community?
  • Can parents/carers bring their children or dependents?
  • Is there flexibility around appointment times?
  • Can patients without a registered GP – such as homeless people, refugees or Travellers – access the service? 
  • Can your patients give feedback? Many services now capture patient satisfaction digitally, but are there other ways for people to give feedback if this is not an option for them?
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