Health Inequality: The cardiovascular disease crisis in areas of high deprivation

Health Inequality: The cardiovascular disease crisis in areas of high deprivation

Authored by: Dr Matthew Lee; BMSc, MBBS, MSc

Last reviewed: Sept 2024.

What's in this PocDoc Article:

• What is health inequality?
• The link between deprivation, health inequality and health life expectancy
• How does deprivation cause an increased early mortality rate?
• Cardiovascular disease is a major source of health inequality in the UK
• Can cardiovascular disease (CVD) be prevented in these areas of inequality?
• The Core20PLUS5 approach and PocDoc

What is health inequality?

Health inequalities are the unfair and avoidable differences in health across the population, and between different groups within society. This inequality is worse in disadvantaged areas. To assess the prevalence of health inequalities in these areas, the English Indices of Deprivation (IoD) is used by the NHS, which highlights 7 areas which determine the level of inequality in an area.

The 7 factors included in the index of multiple deprivation are:

• Income 
• Employment
• Education
• Health
• Crime
• Barriers to housing & services
• Living environment

The link between deprivation, health inequality and health life expectancy

According to the Kings Fund, healthy life expectancy is up to 18 years lower in most deprived areas. This is due to the fact that individuals in disadvantaged areas have:

• Limited access to healthcare

• Experienced poor-quality healthcare services 

• Practised unhealthy lifestyle behaviours

As a result, individuals in these areas are at high risk of developing preventable diseases such as cardiovascular disease.

How does deprivation cause an increased early mortality rate?

Areas with high deprivation often also have high early mortality rates for preventable diseases. Studies have shown that early detection and treatment could have prevented many of these deaths.

According to the Office of National Statistics, in 2019, 64.2% of deaths were attributed to conditions that were preventable, while 35.8% were treatable.

In addition:

Cardiovascular disease is a major source of health inequality in the UK

Public Health England reports that premature death from CVD is 4x times higher for those living in disadvantaged areas. These individuals are also 30% more likely to have high blood pressure, which further increases the risk of developing cardiovascular disease.

The increased inequality in healthcare access for disadvantaged areas greatly increases the amount of CVD cases in these areas.

1) Individuals living in underprivileged areas may have limited access to proper health testing services that could save their lives.

2) A study done by the British Heart Foundation found that the inequality gap is highest during the prevention phase as disadvantaged areas have the highest levels of smoking, obesity and physical inactivity, which increases their risk of CVD.

PocDoc’s work in these areas has also highlighted other factors that can affect health care in disadvantaged areas:

• Cultural distrust of healthcare providers (HCP), often in marginalised groups who may have faced discrimination and mistreatment previously in the healthcare system.

• Lack of female HCP support: Some women may feel more comfortable discussing sensitive issues with female HCPs.

• Shifts in work or family commitments: Commitments such as child care or irregular work hours can make it challenging for individuals to attend screening events.

• Language barriers: Patients who do not speak the same language as their healthcare providers may find it difficult to communicate effectively with their HCPs. 

• Specific dietary intake and lack of awareness of cardiovascular disease: A lack of understanding of CVD and the dietary risk factors associated with the disease can increase the risk of CVD development.

Higher health inequality in these areas can result in premature mortality for those living in high-deprivation areas.

Can cardiovascular disease (CVD) be prevented in these areas of inequality?

According to the World Health Organisation, 80% of all CVD cases can be prevented. As a result, the government, through the NHS’s Long Term Plan, has made efforts to prioritise reducing CVD cases through higher awareness and prevention.

PocDoc has contributed to this effort by promoting the importance of primary prevention and early detection of CVD. The ease and convenience of PocDoc’s Healthy Heart Check make it even more impactful to individuals living in these areas.

According to PocDoc’s CEO and co-founder, Steve Roest, the key to reducing high levels of CVD in disadvantaged areas lies in improving local cholesterol detection and management systems.

“Local systems need to shift away from practice driven lab-based testing as the sole route, utilising new testing methods that are trustworthy, accurate and usable in different parts of the community.” – Steve Roest.

To help improve the outcomes of individuals in disadvantaged areas, the NHS has developed the Core20PLUS5 plan.

The Core20PLUS5 approach and PocDoc

The Core20PLUS5 is a national NHS England approach that aims to reduce healthcare inequalities by highlighting a target population and identifying 5 clinical areas that need improvement.

The program targets the:

• The most deprived 20% of the national population (Core 20)

• Groups that experience poorer than average healthcare access and might not be captured in the CORE20 (PLUS)

5 clinical areas that need accelerated improvement :

1. Hypertension case-finding and optimal management and lipid optimal management
2. Respiratory disease
3. Maternity
4. Severe Mental Illness 
5. Early Cancer Diagnosis

Through the PocDoc Healthy Heart Check, PocDoc has already made significant contributions to enabling interventions to optimise blood pressure and minimise the risk of myocardial infarction and stroke.

PocDoc has also been fully committed to reducing healthcare inequalities using these principles of the Core20PLUS5.