Health inequity in Lambeth

 2. We need to detect and treat long-term conditions far earlier

On average, people in our place living with long-term conditions are diagnosed with their first health condition at age 35, quickly followed by a second condition at age 42. Risk factors, such as smoking or high cholesterol, are often evident earlier. 62% of people living with two or more conditions experience at least one risk factor before they develop a second condition.

3. We need to take a preventative approach, which tackles the wider determinants of health

Our programme focuses on even earlier signs in people’s lives that their health will be at risk, related to their finances, employment and homes.

To spot the warning signs that identify those most at risk of developing long-term conditions, the healthcare system needs to take a more preventative approach, intervening earlier and considering the social determinants of health, rather than addressing health issues in isolation. First and foremost, this change is needed to improve people’s lives, closing unjust gaps in health outcomes. But there are also benefits to the public purse, as supporting people living with multiple long-term conditions is costly.

4. Chronic pain and mental health conditions shape the daily lives of many people in our young, urban and diverse place

11% of people in our place experience chronic pain, rising to 52% among people living with two or more long-term health conditions. Yet pain is poorly understood and managed in our healthcare system. 11% of all people and 38% of those living with two or more long-term conditions experience depression.

These commonly under-diagnosed and under-treated conditions are closely related to the way we live now, influenced by socio-economic factors including insecure housing, precarious work, unsafe neighbourhoods, isolation and financial difficulties.

5. People from Black and other ethnic minority communities face the biggest health inequities

Black people are more likely to experience deprivation than people of other ethnicities in Lambeth. The proportion of people living with two or more long-term conditions is substantially higher among Black communities (29%) than in Asian (19%) and White (17%) communities.

Looking closely at specific ethnicities, we see a particularly high share of people living with multiple long-term conditions in the Black Caribbean community (37%). We see a particularly low share of people living with two or more long-term conditions who identify as White other (12%).

Although people from Black and some ethnic minority communities are more likely to experience multiple long-term conditions, White people are being diagnosed earlier.

On average, White people are being diagnosed with their first condition at age 32 and then their second at 41. Black and Asian people are, on average, diagnosed four years later, with their first condition at age 36 and their second at 45 for Black people and 46 for Asian people. We hypothesise Black people are, on average, experiencing their first long-term condition just as early as White people but that there are systemic reasons behind their diagnosis being delayed.

For example, common mental health conditions are much less likely to be picked up in Black people living with multiple long-term conditions. Of those living with two or more conditions, 26% of Black people lived with diagnosed depression and 38% with anxiety, compared with 45% of White people living with depression and 56% with anxiety. A range of factors are contributing to these needs not being identified and treated. These include lack of trust in mainstream services amongst Black communities, patterns of racism and stigma in the healthcare system and a disbelief among Black people that the healthcare system can meet their needs.

These factors were identified in our recent COVID-19 Lived Experience research, which was delivered by community researchers working within their communities.

6. Urban health challenges vary between neighbouring communities and require deep understanding and tailored solutions.

Experiences of ill health vary between communities. Nuanced analysis of health in different communities is imperative to avoid the ‘tyranny of averages’. By looking at people’s ethnicity, language and country of birth combined, we detect great differences between communities in identification of two or more long-term conditions: from 17% in the Portuguese speaking community, to 21% for White British people, 23% in the Somali community (the largest refugee community in Lambeth), 26% amongst Black Africans and 37% in the Black Caribbean community. Addressing the differences between communities will inevitably require deep understanding and tailored solutions.

Taking what we have learnt from this research, and from our work with partners in local communities, the following sections of this report illustrate how we can tackle health inequity in four areas – finance, work, housing and neighbourhoods – to change the direction of the current urban health crisis playing out in people’s lives.