Complete guide to NHS health inequalities in the UK — Core20PLUS5 framework, deprivation gap, ethnic health disparities, equity strategy, Marmot principles, and health inequalities software.
The life expectancy gap in the UK is 9.4 years for men between most and least deprived areas. NHS England's Core20PLUS5 framework targets the most deprived 20% and inclusion groups. This guide covers the complete health inequalities strategy.
Core20PLUS5 Framework
| Component | Description | Focus |
|---|---|---|
| Core20 | Most deprived 20% of population (IMD) | Target interventions here first |
| PLUS — Ethnic minorities | Black, Asian, mixed, other ethnic groups | Maternal mortality, diabetes, mental health |
| PLUS — Inclusion groups | Homeless, GRT, LGBTQ+, refugees, disabilities | Tailored access and support |
| Clinical 1 — Maternity | Smoking in pregnancy, breastfeeding, maternal mortality | Reduce disparities |
| Clinical 2 — SMI | Annual health checks for severe mental illness | Reduce premature mortality |
| Clinical 3 — Respiratory | COPD, asthma admissions, flu vaccine | Reduce excess admissions |
| Clinical 4 — Early cancer | Cancer screening uptake, early diagnosis | Reduce late-stage diagnosis |
| Clinical 5 — Hypertension | BP control, CVD risk management | Reduce stroke and heart attack |
Health Inequality Actions for Hospitals
- Data collection: Record ethnicity, deprivation (IMD), language, disability for all patients
- Stratified reporting: Report quality metrics by demographic groups
- Disparity identification: Identify where outcomes differ by group
- Targeted outreach: Proactive outreach to underserved groups (screening, immunisation)
- Language access: Professional interpreters, translated materials, bilingual staff
- Cultural competency: Mandatory cultural competency training for all staff
- Community partnerships: Partner with community and faith organisations
- Transport support: Hospital transport for patients from deprived areas
- Digital inclusion: Support patients without digital access (non-digital pathways)
Ethnic Health Disparities in the UK
| Condition | Disparity | Action |
|---|---|---|
| Maternal mortality | Black women 4x higher than white | Targeted maternity care, risk assessment |
| Diabetes | South Asian 2-6x higher prevalence | Targeted screening, prevention |
| Cardiovascular | South Asian 50% higher mortality | Early intervention, BP control |
| Mental health | Black people 4x more likely to be detained | Crisis care reform, community alternatives |
| Cancer screening | BAME groups 20% lower uptake | Culturally tailored invitations, outreach |
Frequently Asked Questions
- What is Core20PLUS5?
- Core20PLUS5 is NHS England's approach to reducing health inequalities. Core20 = most deprived 20% of population. PLUS = other inclusion groups (ethnic minorities, homeless, Gypsy/Roma/Traveller, LGBTQ+, people with disabilities). 5 = five clinical focus areas: maternity, severe mental illness, respiratory, early cancer diagnosis, hypertension.
- What is the health inequality gap in the UK?
- Life expectancy gap: 9.4 years for men, 7.6 for women between most and least deprived areas. Healthy life expectancy gap: 19 years. People in deprived areas spend 29 fewer years in good health. Ethnic minorities have worse outcomes in maternal mortality, mental health, and chronic disease.
- How should NHS hospitals address health inequalities?
- Hospitals should: 1) Collect demographic data (ethnicity, deprivation, language), 2) Stratify quality metrics by demographics, 3) Identify disparities in access and outcomes, 4) Implement targeted interventions, 5) Provide language access, 6) Cultural competency training, 7) Partner with community organisations.