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Independents' Day

Why is PBC so key in tacking health inequalities?

Dr Amanda Killoran and Professor Mike Kelly of the NICE Centre for Public Health Excellence explain why PBC has such a key role in addressing health inequalities

Dr Amanda Killoran and Professor Mike Kelly of the NICE Centre for Public Health Excellence explain why PBC has such a key role in addressing health inequalities

Despite overall improvements in health, the gap between those worst off and more affluent groups continues to widen.

Some parts of the country have the same life expectancy as the national average for the 1950s. National targets require the gap to be reduced by improving the health of the poorest fastest.

Cardiovascular disease, cancer and respiratory disease contribute to a significant proportion of the difference in health between social groups. Infant mortality, low birth weight, smoking, inactivity, poor diet, obesity, teenage pregnancy and poor mental health are all socially patterned.

Policies that improve the social circumstances and opportunities of the more disadvantaged and vulnerable groups are critical to closing the gap. But healthcare also has an important contribution to make in ensuring equity of access to services and outcomes.

Evidence shows that programmes of primary and secondary prevention of CHD, diabetes and other conditions are cost-effective, but the inverse care law still operates with those most at risk not adequately served. Pursuit of health equity needs to be a key principle for PBC.

Practically, PBC consortiums have the opportunity to participate with the PCT and local authority in the wider local agenda of the community strategy and local area agreements to address issues of neighbourhood deprivation.

As Professor Chris Drinkwater states in his interview: ‘PBC provides the mechanisms for engaging effectively with local communities to determine collaborative actions for improvement.'

Assessing the precise nature and pattern of health inequalities between practices within PBC consortiums is critical to the commissioning process and targeting provision of services.

This demands development of information systems and use of methods such as small area mapping, health equity audits and surveys of views of vulnerable groups and communities.

All PBC plans need to be appraised in terms of their impact on health inequalities. All services need to take account of cultural, ethnic and social differences to avoid increasing health inequalities through greater uptake and coverage of services by more affluent groups.

Negotiation of contracts with trusts can reinforce evidence-based standards that strengthen preventive care pathways and require equity auditing measures.

Dr Matt Kearney describes how savings can be used to fund disease management programmes through a locally enhanced service. This demonstrates application of NICE guidance to be issued this month on reducing death rates in disadvantaged populations, and sets out effective interventions for detection and management of cardiovascular and smoking related diseases, including use of community-based case-finding.

New types of providers can be commissioned to develop targeted services such as the community outreach scheme, which is designed to reach disadvantaged and vulnerable high-risk groups who do not usually have access to GP services.

Evidence shows that the success of primary care-based commissioning models is dependent on effective management and organisational development as well as clinical engagement.

PBC is a complex and strategic process and embedding the principle of equity within this is the key challenge for tackling health inequalities.

Dr Amanda Killoran is public health analyst and Professor Mike Kelly is director of the NICE Centre for Public Health Excellence

How PBC can tackle health inequalities

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