By Karen Taylor, Director, and Dr Aiden Hannah, Deloitte Centre for Health Solutions

Last week we published our report: Tackling the gap: Harnessing community assets to improve equity in public health outcomes, the final report in our ‘Future of Public Health’ series. This report seeks to change the narrative from a focus on health inequity and deprivation statistics to one that promotes and harnesses the wide range of community assets to help reduce health inequalities and improve the lives of those with the worst health.¹ The report recognises that while the true upstream drivers of health inequalities require deliberate policy changes at the national level, a balance is needed between government support and local knowledge of where best to target support and interventions. This week’s blog highlights key findings from our research and the crucial role that public health can play in orchestrating the numerous stakeholders and utilise their local knowledge of place to tackle geographical inequality and unfairness.

Utilising the strengths of local communities to reduce health inequalities

The COVID-19 pandemic turned a spotlight on health inequalities across communities, exposing the injustice of health outcomes driven by where people live, the jobs they do and their ethnicity. The pandemic also illustrated starkly that improving the economic, social, and public health of communities means harnessing and utilising their strengths. It showed how strong wide-ranging, local relationships and new partnerships across organisational boundaries and communities were critical in providing positive responses to the pandemic. Moreover, that harnessing these local partnerships through further investment will help communities recover more effectively.

An asset-based approach to improving the resilience of communities

The Department of Health and Social Care (DHSC) and the new Office for Health Improvement and Disparities (OHID) have recognised the need for a place-based approach to reducing health inequalities and that action on health inequalities should aim to improve the lives of those with the worst health fastest. Importantly. Understanding the scale, extent and location of community health assets and deploying them effectively is a crucial task for public health teams (see Figure 1).

Figure 1. Optimising community assets to improve and empower individuals in creating resilient communities in public health

Source: Deloitte analysis

ICSs provide an opportunity for a shift in the way health and care is delivered

The Health and Care Act 2022, which received Royal Assent in April 2022, established 42 geographically based, Integrated Care Systems (ICSs) as statutory organisations and put them at the centre of a legislative framework that promotes collaboration and partnership-working aimed at integrating services for patients. It emphasises that ICSs will need to work with (and devolve both decision-making and power to) more local places and neighbourhoods where the connection to community is stronger.

Moreover, ICSs can provide new opportunities for the specialist public health workforce to work as part of a whole system approach, focused on improving population health and wellbeing outcomes ideally as a member of the Integrated Care Partnership. Given that so many causes of health inequalities sit outside the direct influence of health and care services, the senior stakeholders we interviewed for our research welcomed the creation of ICSs, seeing it as an opportunity to create an enabling infrastructure in which local communities can thrive. However, they also highlighted the need for public health to ‘have a seat at the ICS table’ and mentioned the importance for both public health and ICSs of having access to population health data to target interventions effectively. Public health teams need to seize the opportunity by adopting a brokering role between public and private partners across the health system; shaping the future role of population health management and prioritising ill-health prevention programmes and activities.

Our interviewees also saw the establishment of primary care networks (PCNs) of general practices as an important building block for integration of health care; especially their pivotal role in population health management (PHM), see Figure 2. During the pandemic, close collaboration between PCNs and public health teams proved invaluable, especially in the vital role in rolling-out the COVID-19 vaccination campaign. A survey of PCN clinical directors identified this shared purpose as instrumental in creating a sense of team, enabling staff to get to know each other and to build trust. Going forward it will be crucial to re-invigorate this shared purpose to tackle health inequalities.

Figure 2. PHM is a core capability that needs to be supported at place

Source: Adapted by Deloitte LLP

Strengthening the role of public health to reduce inequalities and deliver more equitable outcomes

The COVID-19 pandemic has demonstrated the value public health brings to improving health outcomes of local communities and what is needed for a resilient public health system. Equipping public health teams with the authority and resources needed to tackle the existing stark inequalities and resulting inequalities is essential. The emphasis needs to be on improving primary and secondary prevention through harnessing community assets to transform lifestyle behaviours. This will require funding and investment to strengthen public health teams, in order to realise the substantial cost-benefits of reducing avoidable health inequalities and creating a resilient, fairer public health system.

Priority actions for a fairer, more equitable and sustainable future for public health

The pandemic in exposing deep and long-standing health inequalities and a lack of progress in addressing the SDoH has highlighted the shortcomings in public health funding and the importance of harnessing community-based assets. It has also raised the public’s understanding of the critical importance of public health and its crucial role in strengthening the health and well-being of local economies. The pandemic has also galvanised the adoption of innovative solutions and opportunities to work differently, however, adoption is fragmented and needs to be scaled up. To improve the equity of future health outcomes, policy makers, public service providers, agencies and other stakeholders need to:

• work collaboratively across sectoral boundaries and involve the wider public health system in taking joint decisions to achieve improved health outcomes
• have open and transparent sharing of health data to enable both the planning and provision of services; however, service fragmentation and poor data interoperability are impeding an integrated approach to disease prevention, cure, and care
• provide appropriate levels of health and social care funding, based on economic evaluation of cost and benefits, and develop clear accountabilities for new models of integrated funding, with measurable performance indicators and aligned incentives across all parts of the system.

The government has committed to level up the country by boosting prosperity and widening opportunities in underserved communities aimed at closing the health inequality gap. Indeed, there is a general consensus that ‘building back fairer’ from the pandemic, requires action at all levels of government, health and social care providers, employers, communities and society more generally, including being held to account for ‘tackling health inequalities in all policies’.

During our research, we were struck by the optimism of health care professionals, public health teams and the wider stakeholder groups to deliver a fairer, more equitable and sustainable future for all. This optimism should be seized in order to realise their hopes that in five years’ time the public health system will be ‘equitable, funded, efficient, integrated and resilient’. We owe it to our population, and especially those in the most deprived decile, to invest in our public health system, including harnessing community assets, to once-and-for-all make this a reality.

Karen Taylor - Director, UK Centre for Health Solutions

Karen is the Research Director of the Centre for Health Solutions. She supports the Healthcare and Life Sciences practice by driving independent and objective business research and analysis into key industry challenges and associated solutions; generating evidence based insights and points of view on issues from pharmaceuticals and technology innovation to healthcare management and reform.

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Aiden Hannah, Research Analyst

Aiden has a background in physics and biomedical engineering, and a strong technical knowledge of diagnostics and digital healthcare. Most recently working as an academic researcher, he undertook a range of multidisciplinary projects involving close collaborations between MedTech companies and clinicians; supporting the development of novel biosensors and low-cost diagnostics, including clinical trial design and conduct. Aiden has focused on the health technology investment pipeline and the medical device regulatory processes as part of his doctorate industry placements.

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¹ https://www2.deloitte.com/uk/en/pages/life-sciences-and-healthcare/articles/the-future-of-public-health.html