‘Levelling up’ in social determinants of health

Writing on the importance of levelling health inequalities across the UK, Lilly’s Laura Steele outlines the widening social determinants of health and potential solutions.

We live in a world where a person’s hometown, income, education and childhood circumstances have a direct impact on their risk of developing life-threatening health conditions. I saw this first-hand when I began my career in the pharmaceutical industry over 20 years ago in Brooklyn, New York, and sadly, I still see it today. Where you live impacts the health service you receive, how long you wait and which treatments you are eligible for. People living in the most deprived areas of the UK have higher rates of obesity. Ethnicity is also a factor in the risk of developing certain conditions, for example, people of South Asian descent are more at risk of developing type 2 diabetes at a lower BMI and younger age than people from white European backgrounds.

Social factors and their impact on health outcomes simply cannot be ignored. Understanding and tackling health inequalities is a high priority for Lilly, as we think about bringing innovative treatments to everyone who needs them. Our industry needs to play its part in helping to create a system that reduces inequalities in access and outcomes; only by working together can we tackle some of the greatest health challenges of our generation.

Collaboration and use of data

Constructing a strong partnership between industry, the NHS and the Government is key to creating an environment that supports access to innovative medicines for the benefit of patients. One way to do this is through better use of data.

The NHS is one of the largest sources of data in the UK, which presents a huge opportunity for collaboration in tackling inequalities. A core strategic aim for Integrated Care Systems is to use a population health management approach to look at historic and current data to understand the factors driving poor outcomes in different population groups. This analysis is then used to design new proactive models of care to improve future health and well-being.

However, data can only be used to help reduce inequalities if it’s consistent and accurate. When considering health outcomes for ethnic minority groups, NHS datasets currently do not define ethnic groups in a consistent way or consistently publish data by ethnicity . More specific and granular data reporting outcomes by ethnicity and other social factors would better equip policymakers to tackle inequalities.

Improving representation in clinical trials

Better data will also be generated by increasing the diversity of participants in clinical trials. An American study showed that while black patients have a 28% higher cancer-specific mortality rate than white patients, they only accounted for 4% of participants in lung cancer clinical trials . Under-representation in clinical trials can reinforce these disparities in health outcomes.

Lilly has established clear, measurable goals to increase diversity in our clinical trials, allowing us to better understand how our medicines work for all patient populations. We make a point of going out and contacting people who will benefit most from a potential new medicine, thus, ensuring that underserved communities and at-risk groups are appropriately represented in our trials.

We’ve recognised that participating in clinical trials can be difficult for certain groups of people. We’re addressing these barriers by bringing trials closer to where people live, using technology to reduce in-person visits and increasing flexibility in appointments. We also provide practical help, like making sure that participants don’t have to wait to be reimbursed for their travel costs. Now, 50% of our US study procedures can be done either at home or in a local healthcare setting.

The importance of communication

Lived experience and the relevance of the information about health are also critical. Our recently published Charter for Change looked at inequalities experienced by ethnic minority groups living with diabetes. The report explored the need for culturally competent healthcare. Health advice needs to be relevant to resonate. For example, information about healthy eating needs to focus on culturally appropriate diets. Another example can be seen in dementia care. If English is a second language, then it may simply be lost as brain function reduces, leaving that person more vulnerable to isolation, which can compound the cognitive deterioration.

Supporting people with health literacy is a crucial component that requires immediate attention. Your education and level of health literacy impact your ability to self-advocate and to navigate the system to seek treatment. Standard appointment letters sent to people living with long-term conditions may be long and may use complex, inaccessible language. This can lead to people failing to realise the importance of appointments, not being clear on the steps to take to manage their health and to individual conditions worsening.

The Government was due to publish a Health Disparities White Paper this year, however, this has been postponed, delaying the possibility of implementing new policy approaches to the challenge. The Government needs to step up their action to tackle health inequalities. The biggest threats to health and life—like cancer, diabetes and dementia—are all tied up with people’s social circumstances. We need to see real collaboration between industry, the NHS and the Government to drive change in reducing the UK’s health inequalities—and we need it now, so that we can overcome this disparity for future generations.