Synopsis
Recognise avoidable differences in health and healthcare, analyse their causes without stereotyping, and design proportionate primary-care action that improves access, experience and outcomes.
- Health inequalities are systematic, avoidable and unfair differences in health, exposure, access, experience or outcome between groups or across a social gradient.
- Equality provides the same resource; equity matches support to different barriers and need; proportionate universalism combines universal provision with greater intensity where disadvantage is greater.
- Measure several stages separately: eligible population, offer, contact, uptake, process quality, treatment, experience and outcome; overall averages can hide loss at one stage.
Reasoning priorities
Locate where groups are lost between eligibility and outcome.
Measure denominator, offer, contact, uptake, treatment and outcome separately; a similar final count may conceal different need.
Worked reasoning
Practice data show 72% annual-review completion overall but 41% among patients recorded as needing an interpreter; invitation counts are similar.
- Validate denominator, interpreter coding, contact success, appointment offer, attendance and completed components; stratify without publishing identifiable small cells.
- Engage patients and reception, interpreting and clinical staff to test explanations; they identify English-only automated calls, short appointments and inability to request an interpreter online.
- The final action is a small co-designed test: preferred-language call booking, pre-booked interpreter and a longer combined review slot, while retaining ordinary routes for everyone.
- Verify impact over successive weeks using completed review, patient experience and interpreter availability, plus balancing measures for waiting time and staff workload; adapt before wider rollout.