Despite great progress in cancer diagnosis, treatment and survival over recent decades, there are significant inequalities and barriers in Wales that reduce the chances of everyone experiencing outstanding cancer services and care.
Health inequalities, embedded within health and care systems, but also a consequence of non-healthcare factors such as geography, transport, educational attainment and economic deprivation, contributes to concerning variation. The covid-19 pandemic has exacerbated existing inequalities, but it also shines a light on new concerns as we commence on a prolonged post-Covid recovery.
At their most extreme, inequalities determine people’s chances of cancer survival – an unacceptable outcome in a modern, relatively prosperous country. Overcoming cancer inequalities is a core aim of Cancer Research Wales, underpinning the research we fund and support.
This aim informed our recent decision to support and sign – alongside 33 other organisations – an open letter to the First Minister, and leaders of the main opposition parties in Wales calling for the creation of a broad, cross-department strategy to reduce health inequalities. The text of the letter follows.
We want this letter to inform the up-and-coming Senedd elections and influence the post-election landscape. A strategy would acknowledge the scale of the problem we face; prioritise clear collective government action and set us on a path towards better health and well-being outcomes for the people of Wales.
22 February 2021
Dear First Minister,
We are writing to you today from the Welsh health and social care policy forum, an alliance of organisations hosted by the Welsh NHS Confederation.
The COVID-19 pandemic has exposed and intensified existing health inequalities – that is, the unfair and avoidable differences in health and wellbeing outcomes across the population, and between different groups within society.
Tackling the social causes of health inequalities has never been more urgent; this is not an issue to be addressed once the pandemic is behind us. As the Senedd Finance Committee’s recent report on the Welsh Government’s Draft Budget for 2021–22 says:
‘the true scale of the implications for the health and wellbeing of people in Wales may not become clear for years. The crisis has exacerbated underlying issues, including … ongoing health inequalities across Wales’
That is why we are asking you to commit to a cross-government strategy to reduce health inequalities.
In October 2020, the Welsh health and social care policy forum called for a ‘cross-governmental, whole-sector response to physical and mental health inequalities to create the economic, social, natural and home environment that supports positive wellbeing throughout the life-course for all people in Wales and reduce inequalities for the next generation’.
This approach has broad support across the health and social care sector. It should include ensuring everyone in Wales has a good quality, safe, warm home that can adapt as their needs change. Priority should be given to service user engagement and acting upon the views and experiences of communities and people who have unequal outcomes or experience challenges in accessing services.
A wider strategy is required because health inequality is the result of many and varied factors. It should not sit solely within one minister’s portfolio; tackling it should be a priority running through all government activity and be a priority for all organisations.
It is a decade since the Welsh government produced Fairer Health Outcomes For All. We’re aware that Public Health Wales is leading on prevention work through Building a Healthier Wales, but we believe that social care and the NHS alone simply don’t have the levers to make some of the other radical changes we know are vital, including action to tackle poor housing, access to education, and poverty reduction, which sit across a variety of government portfolios.
As you may know, your Labour colleagues in England have supported this ask. Jonathan Ashworth MP, shadow secretary of state for health and social care, has called publicly for a cross-government health inequalities strategy in Westminster. We urge you to make the same decision in Wales as we approach the next Senedd election.
Collaborative and integrated working amongst all professionals and organisations across Wales, including those working in health, local government, education, and the environment, is key. Collectively, we must create the economic, social, and natural environment that supports good health and wellbeing and reduces health inequalities.
Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health – accounting for between 30–55% of health outcomes – and senior clinicians within NHS Wales have recently acknowledged that ‘poverty and health inequality’ are the reasons for high COVID-19 death rates in the south Wales valleys.
The World Health Organization has shown that differences in health are influenced by the following factors:
• 35% is linked to income security and social protection
• 29% is linked to living conditions
• 19% is linked to social and human capital
• 10% is linked to health services
• 7% is linked to employment and working conditions.
The Senedd Equality, Local Government and Communities Committee’s report into inequality and the pandemic found that:
‘Men, older people, people from Black, Asian and minority ethnic groups, people with existing health conditions, disabled people and people living in deprived areas have higher coronavirus mortality rates. The [pandemic] recovery must be targeted at those who have lost the most, and this opportunity must be used to rectify existing inequalities.’
In a recent poll commissioned by the Royal College of Physicians (RCP) for the launch of the UK Inequalities in Health Alliance, it was found that:
‘82% of respondents in Wales wanted to see a government strategy to reduce inequalities in health and 61% thought governments across the UK should be doing more to address health inequalities. 63% are concerned that the health gap between wealthy and deprived areas is growing. 82% think that all parts of government should have to consider the impact of their policies on people who are less well off, with more than half strongly agreeing. 25% of respondents selected long term health conditions as the health inequality they were most concerned about, with 17% opting for poor mental health.’ [Yonder/Populus opinion poll, October 2020]
These results show widespread public concern over health inequalities and overwhelming support for action across Wales. We therefore urge you and your government to commit to collective action to develop a cross-government health inequalities strategy with a clear action plan and milestones, working in collaboration with partners across every sector.
We look forward to your response.
With thanks and best wishes,
CEO, Cancer Research Wales
Co-signed alongside 33 other Wales-located health and care organisations.