The UK health system must address inequalities if we are to truly reduce the burden of respiratory illnesses

At the British Thoracic Society (BTS) 2023 Winter Meeting, frustration is evident at the thought of respiratory patients facing unnecessary hardship due to over-exposure to unhealthy environments or an inability to access high-quality care. 

Inequalities in respiratory medicine are often thought of in relation to physical access to care or diagnostics, but also result from many other determinants of health such as differences in protected characteristics, language, health literacy, deprivation, geography, and learning and cultural differences, amongst others.

Earlier this year, BTS published a Position Statement on Health Inequalities, which outlines the Society’s goals and intentions in reducing health inequalities. BTS is committed to continue its work on the practical ways these challenges can be addressed and is proud to contribute to initiatives such as improving access to health inequality metrics, service design guidance such as the Tobacco Dependency Project, and supporting opportunities for the development of useful, evidence-based resources.

This year the BTS Winter Meeting is hosting several sessions focused solely on health inequalities, including how to identify groups that are most vulnerable to poorer outcomes, and how to address any inequality through health policy, data, and service co-design. Sarah Woolnough, CEO of Asthma + Lung UK, is a speaker at one of these sessions and discusses the impact of health inequality on patients and communities.

On this, Sarah comments,

“No one should suffer worse health because of where they live or how much money they have, yet we know people in the most deprived communities across the UK are twice as likely to develop a lung condition and seven times more likely to die from their condition. The cost-of-living crisis continues to deepen those inequalities. With lung conditions the third biggest killer in the UK, it’s time for urgent action.

“With the NHS changing and Integrated Care Boards (ICBs) taking on more responsibility to provide for their local populations and knowing where the most disadvantaged communities are, it's important that ICBs reach out to those most likely to develop lung conditions. They need to provide early and accurate diagnosis for vulnerable groups, as well as effective pathways to treatment once diagnosed.

“However, prevention is still key, at both a local and national level and we need to see a continued focus on driving down smoking rates, reducing air pollution, improving access to cleaner travel, increasing vaccine uptake, and tackle the underlying causes of health inequality.

“But ultimately we must do all this working together with under-represented communities to build trust and understand their needs to be truly able to tackle health inequalities.”

Inequality permeates all respiratory care. It is well known that the most disadvantaged groups in society are more likely to have higher smoking rates, be exposed to higher levels of air pollution, poor housing conditions and occupational hazards, all of which increase the likelihood of respiratory illness and reduce life expectancy. Understanding and working to address health inequalities in respiratory is therefore vital if the goal is to achieve a healthier population. Given that health inequalities are often preventable, respiratory healthcare services must be better designed with addressing them in mind.

Chair of BTS, Paul Walker, added,

"The 1980 Black Report highlighted UK health inequality and its link with economic and social inequality. Nearly half a century later, much of this inequality persists and some has worsened. Recent UK data showed that the mortality difference between the least and most deprived communities is highest for three lung conditions - COPD, lung cancer and asthma. Respiratory patients deserve meaningful attempts to 'level up' and close this gap and BTS will continue to campaign for this to be a core health priority."