Norfolk and Waveney Integrated Care System

Norfolk and Waveney Integrated Care System

Reducing Health Inequalities

Tackling health inequalities is essential to the health and wellbeing of our whole population and the effectiveness and sustainability of health and care services.

It is a moral imperative concerning social justice. The issue should be of great importance to a caring and compassionate health and care system.

It is a legal requirement. The Health and Social Care Act (2012) placed responsibilities on health and care systems to: ‘…demonstrably take account of inequalities in access to and outcomes of healthcare’.

It makes economic sense. The financial and societal burden of ill health and disability, as well as premature mortality, is disproportionately focussed on the most deprived populations. These sections of society are least equipped and resourced to make best and most appropriate use of services. If the ‘unmet need’ for preventive services and those for early detection and management is not addressed in those at greatest risk, a large part of the growing demand on services and cost will persist.  

Protect Now is tackling inequalities and improving access to health and care services through population health management and risk stratification.

Population health management (PHM) is an approach used to improve the current and future health and well-being of people within and across a defined geographical area whilst simultaneously reducing health inequalities. It includes action to:

  • Reduce the occurrence of ill health
  • Deliver appropriate health and care services
  • Address the wider determinants of health and their impacts.

PHM uses data from available sources to guide the planning and delivery of care to achieve maximum impact on whole population health. It includes segmentation and stratification techniques to identify those most at risk of ill health and target interventions more effectively to support prevention or the ongoing management of symptoms and ill health.

PHM methodology allows health and care systems to gain a comprehensive understanding of population health need by joining up data relating to:

  • Health behaviours and status
  • Clinical care access
  • Use and quality of available services
  • Social determinants of health (such as housing, employment and education).

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