Nearly 90% of doctors warn that health inequalities are harming patients

The Royal College of Physicians (RCP) has called on the UK government to set out how its health mission will tackle avoidable illness, as new data reveals widespread concern among doctors about the growing impact of health inequalities.

Nearly 90% of respondents to the RCP’s recent member snapshot survey reported they were concerned about the impact of health inequalities on their patients, while 46% said that at least a half of their workload was due to illnesses linked to social and economic factors - such as poor housing, education, and employment.

With a nearly 20-year gap in healthy life expectancy between the most and least deprived areas of England, the new figures highlight the urgent need for government action to improve the health of the nation, prevent avoidable illness and reduce pressure on the wider NHS.

Conducted in February 2025, the snapshot survey found that:

 • 89% (out of 882 respondents) said they were concerned about the impact of health inequalities on their patients

 • 72% (out of 879 respondents) reported seeing more patients in the past three months with illnesses caused or worsened by wider social determinants of health – things like poor quality housing, education, employment (including how much money someone has), air pollution and access to transport

• 46% (out of 857 respondents) said that at least half of their workload is due to illnesses linked to social factors

The RCP, which convenes the Inequalities in Health Alliance, has been calling for a cross-government strategy to reduce health inequalities since 2020, arguing that tackling the factors that make people sick in the first place – like housing, food quality and employment, often called the ‘social determinants of health’ – is vital to reducing avoidable demand on the NHS.

In opposition, the Labour party ‘health mission’ promised a mission delivery board to coordinate action on these social determinants of health across government departments.

The RCP says that clarity is now urgently needed: how will the health mission board deliver the government’s manifesto commitments to tackle the social determinants of health and halve the gap in healthy life expectancy between the most and least deprived regions in England?

Dr John Dean, RCP clinical vice president, said:

 ‘The UK government came into office promising bold action on the things that make us ill in the first place. Now it must set out the detail of its health mission and how the mission delivery board will tackle the root causes of ill-health such as poor housing, employment, tobacco, obesity and air quality.

‘With over 2.5 million more people in England projected to be living with a major illness by 2040, there is no time to waste. We need assurances that improving health and tackling health inequalities remain a priority.

‘Everything from the places we live to the food we eat affects our health. Government must use its health mission delivery board to deliver a cross-government strategy to reduce health inequalities and address the social determinants of health.’

Dr Ash Bassi, RCP regional adviser for Mersey, and a consultant gastroenterologist based in Prescot, near Liverpool, said:

‘As NHS doctors, we see every day how wider social determinants of health shape the wellbeing of our patients. In my own clinical practice in the north-west of England, it is clear that factors such as poor-quality housing, low income, air pollution, and lack of access to transport are lived realities for many of those we care for.

‘We see patients whose health conditions are worsened by damp and cold housing, where respiratory illnesses become chronic conditions. We see the impact of food insecurity, where poor nutrition contributes to long-term health complications. Poor uptake of screening programmes further exacerbates health inequalities. Patients struggling with unstable employment or financial hardship often delay seeking medical help, leading to more severe illness by the time they reach us.’ 

Dr Mustafa Kadam, RCP regional adviser for south London, and a consultant in acute internal medicine, general internal medicine and stroke medicine said:

 ‘While we pride ourselves on the NHS providing free care at the point of access, there remains a significant disparity in our patients actually accessing this care, particularly if they are living in the most deprived areas of the country.

‘Patients living in the most deprived areas are less likely to attend outpatient appointments. This could be down to employment pressures, lack of understanding of their illness, access to transport and the financial cost of actually getting to the hospital. Some years ago, we discovered that on average, it cost a patient £10.95 to travel by bus, taxi or train to the hospital. For some of them, it was as much as £80 for a return journey to get to their outpatient appointment.

‘Non-attendance to an outpatient clinic results in missed opportunities for the diagnosis, investigation and initiation of management of a health condition, which could substantially worsen a patient’s illness resulting in further health inequality.’ 

The RCP is calling for:

• a clear roadmap from the UK government on the work of the health mission delivery board and how it will drive cross-departmental action to tackle the social determinants of health, improve health and reduce health inequalities

• an update on the UK government’s proposed five-point plan for prevention

• a cross-government strategy to reduce health inequalities that tackles what makes us ill in the first place, including poor housing, education, employment (including how much money someone has), how things like alcohol and food are marketed, air quality and transport

• greater engagement with healthcare professionals, including RCP fellows and members, on UK government’s plans to reduce health inequalities and avoidable illness to ensure their expertise informs work on prevention.

Dr Sophia Than, RCP regional adviser for the west Midlands, and consultant hepatologist based in Coventry, said:

‘Most of our patients with alcohol-related liver disease are on a low income. This has an impact on their ability to attend clinics and ultrasound scan appointments and means we are unable to treat them in a timely way, which risks them becoming more ill, more quickly, because we haven’t been able to intervene quickly enough.’

Dr Ben Chadwick, RCP regional adviser for Wessex, and an acute medicine consultant based in Southampton, said:

‘At the front door of the hospital, we often see unwell patients struggling with drug and alcohol addiction, without a safe or appropriate place to call home. They are often left stranded in a hospital bed after their acute illness has been treated while we try to find community support for them. This leads to corridor care, because then there aren’t enough beds available for new acutely unwell patients who are in the emergency department and need our help. Addressing health inequalities would have a bigger impact on the wider health and care system.’

The RCP says reducing health inequalities is not just a health priority but an economic one. Before the pandemic, health inequalities were estimated to cost the UK £31bn to £33bn in lost productivity. Ill health in the population is increasingly visible in the labour market. The Keep Britain Working Review report, published in March, found there are 8.7 million people in the UK with a work-limiting health condition, up by 2.5 million (41%) over the last decade. The RCP says that tackling health inequalities and the root causes of ill health is needed to improve general levels of health and support people to live healthier, productive lives - providing cost-savings in the long term, as avoidable illness and health-related inactivity are reduced.

Reflecting on this social and economic impact, Dr Ash Bassi added:

 ‘The repercussions of health inequalities extend far beyond the individuals affected. They impact our ability as doctors to provide timely and effective care, as we find ourselves treating conditions that could have been prevented with better social support. The strain on services is real, and an increasing proportion of our clinical time is dedicated to addressing avoidable illnesses linked to these systemic inequalities.

‘Change is possible. Addressing these health inequalities requires a concerted effort from policymakers, healthcare providers, and communities. Investment in better housing, improved public transport, access to nutritious food, and economic support would make a tangible difference to our patients’ health outcomes. The need for action is urgent – because good health should not be determined by a postcode.’

Dr Jacob de Wolff, RCP regional adviser for northwest London, and a consultant acute physician based near Wembley said:

‘When I am about to review a patient newly admitted to hospital, one of the first things I do I find out where they live. The postcode reliably predicts what kind of health problems they might be experiencing: in the most deprived areas these are often related to poverty, lifestyle issues, poor nutrition, and loneliness. Many improvements could be made by addressing these social determinants of health.’