Health inequalities are known to exist across protected characteristics and other vulnerable groups. However, there is still a lot we don’t know or can’t examine due to the limitations of the data available. We aim to establish a much better set of routine data to support health systems to advance equality.
Examples of the evidence on health inequalities
Sexual orientation and gender Identity - Individuals who identify as a sexual minority experience health inequality. Those who identify as bisexual have reported the poorest health and those who identify as gay and lesbian have reported poorer health in regard to mental functioning, distress and illness status when compared to their heterosexual counterparts1. Research has also found there were disparities in the mental distress of bisexual and trans people compared to their gay and lesbian counterparts, resulting in the need for greater availability of specialist mental health services and counselling support for these groups2,3.
Ethnicity - Ethnic minorities receive a lower quality of healthcare than non-minorities, even when controlling for access-related factors. The sources of these disparities are complex and are rooted in historic and contemporary inequities and involve many individuals at several levels, including health and social care systems (and their administrative processes), health and social care professionals and patients4.
Disability - Research has shown a relationship with disabled people and poor mental health across their life-course5,6,7.
Accommodation type - Being homeless or sleeping rough have shown links with health inequality, with individuals being associated with shorter life expectancy, higher morbidity, and greater usage of acute hospital services8,9.
The gaps in evidence
There is often a lack of diversity and representation within research which is leading to a smaller evidence base for mental health and a lesser understanding of its relationship to demographics data10. Research around gender identity and sexual orientation often combine health profiles of these individuals without considering the health inequalities of each individual group. Although combining these data can be useful for analysis, it may hide important issues specific to distinct groups and be difficult to identify key disparities11.
The reasons for under-representation of ethnic minority groups in research are complex, and could be related to hesitancy from participants, lack of inclusion by researcher and/or health and social care staff, language barriers and other socioeconomic factors such as systemic inequalities12. Disability academics have stressed that previously, research on disability issues has failed to focus on the issues of greatest relevant to disabled people and therefore fail to address the issues they face13,14. There are difficulties in finding research about the rough sleeping population as they typically have experience high levels of traumatic life experience and negative experiences with health services that do not adapt to their needs, along with systems being inflexible in adapting their approaches to participating in research15.
We should be careful not to associate the lack of evidence and data with the clear risks certain population groups are exposed to. For example, a smaller number of reported mental health problems in certain demographic groups does not equate to these individuals having good mental health.
In addition, there are some important dimensions of health inequalities, such as deprivation, employment, income and educational attainment that are not protected characteristics under the Equality Act 2010. Therefore, the collection of equalities data and questions related to some of the main dimensions of health inequalities will support meeting the duties for these vulnerable groups.
Building evidence through our national routine data
By working with the system to implement this guidance, we aim to have robust and complete demographics data available for mental health, learning disability and autism services to better understand the inequalities experienced by patients. This guidance will also allow providers, advisers, lived experience practitioners, researchers, and other relevant stakeholders to input into and provide best practice to further increase the evidence base on health inequalities, improving as further iterations are published.