This page contains information and resources to help health and care professionals to understand health inequalities, and ways in which you can address them through your work.
Health inequalities are ‘unfair and avoidable differences in health across populations and between different groups within society’ (The King’s Fund 2020).
The unequal distribution of the social factors which affect our health – such as education, housing and employment – drives inequalities in physical and mental health, reduces people’s ability to prevent sickness, or to get treatment when ill health occurs.
These inequalities are complex and rooted in society, but they can also be prevented. The dimensions of health inequalities are overlapping, as shown in the illustration pictured above right.
As a result of the pandemic, we are all more aware of what is meant by health inequalities and the ways in which they impact on people’s lives.
Therefore, it is vital to act now and drive forward work programmes that reduce inequalities, prevent poor health and improve people’s opportunities for better health.
It is vital too that the structural inequalities in our society – unemployment, overcrowded housing, and a lack of green space, as a few examples – are tackled because it is changes at the root cause that will reduce health inequalities in the long term.
Health inequalities are the result of a complex range of interrelated causes – and the causes of those causes.
In some cases, actions will be primarily in the hands of one partner within the local health and care system.
In other cases, reducing inequality will require close collaboration between several organisations across the system.
Integrated Care System (ICS) partners are committed to taking action at all levels and these are set out in Northamptonshire’s Population Health Management Strategy.
At each level, the partners within the Integrated Care System (ICS) – not just the NHS and the local authorities, but the voluntary and community sectors too – will need to come together to plan in ever finer detail the actions they are going to take, individually and collectively, to reduce health inequality.
The actions will involve working together to ensure effective action on:
- Determinants of health: education, employment, housing and poverty-reduction programmes
- Health and wellbeing services: smoking, alcohol, nutrition, physical activity and recreational drug use, promoting parity between mental and physical health
- Ill-health prevention programmes: vaccinations, screening programmes
- Health care services (mental and physical health): diagnostic, treatment and rehabilitation programmes
- Social care programmes: care in the community including hospital at home, domiciliary support and residential care support
- End of life support: services that support a dignified and pain-free death.
Core20PLUS5 is a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and at Integrated Care System level. The approach defines a target population cohort – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement, as shown in the illustration below. Click here for further information about Core20PLUS5.

Information and resources
To enable partners across our health and care system to consider health inequalities in everything that they do, a suite of information and resources are available.
Please click on the expandable headings below for full details.
There are a range of data sources to help you understand the local population and to ensure that your services are appropriate to meet local needs.
- Northamptonshire Joint Strategic Needs Assessment
Northamptonshire’s Joint Strategic Needs Assessment, or JSNA, is a process that looks at the current and future health, care and wellbeing needs of Northamptonshire residents to inform and guide the planning and commissioning of health, wellbeing and social care services. - Local Health | Public Health England
Quality assured small area health-related data visualised in maps, charts, area profiles, and reports. - Health Inequalities Dashboard | Public Health England
This tool has been developed to present evidence of health inequalities in England. Measures of inequality are provided for key indicators being used by Public Health England to monitor progress on reducing inequalities within England. - SHAPE | Strategic Health Asset Planning and Evaluation
Strategic Health Asset Planning and Evaluation (SHAPE) is a web enabled, evidence based application that informs and supports the strategic planning of services and assets across a whole health economy. Its analytical and presentation features can help service commissioners to determine the service configuration that provides the best affordable access to care. - Health Inequalities Improvement Dashboard
The Health Inequalities Improvement Dashboard builds on our learning from the COVID-19 pandemic around the importance of good quality data to provide insights to drive improvements in tackling health inequalities. The dashboard can be accessed through the Future NHS Equality and Health Inequalities Network workspace, where you can click on the ‘Health Inequalities Improvement Dashboard’ tab to see instructions for how to access the dashboard. The dashboard is available to regions, systems, primary care networks, NHS providers and local authorities to see their own local data. - Inequality Tools | Office for Health Improvement & Disparities
This page contains data on health inequalities at England and local level, including the Health Inequalities Dashboard and Segment Tool interactive web tools. - Equality and Health Inequality Packs | NHS RightCare
These packs have been developed to support health and care systems design and deliver services that work to reduce health inequalities in access to services and health outcomes for their diverse local populations. - Public health profiles | Office for Health Improvement & Disparities
A large public health data collection where data is organised into themed profiles. Start by choosing a profile from the list. - Global burden of disease tools | Institute for Health Metrics and Evaluation
Explore regional data for the East Midlands.
Northamptonshire local health reports
- North Northamptonshire
- West Northamptonshire
- West / North Northamptonshire side by side
- North Northamptonshire by ward, compared to North Northamptonshire average
- West Northamptonshire by ward, compared to West Northamptonshire average
Primary care data
- PCN profiles dashboard – NHS ViewPoint
NHS ViewPoint is formerly known as the national performance and population health management dashboard, and a user account is required to access this data. If you do not have an account, click here to register. - Office for Health Improvement & Disparities – National General Practice Profiles
These profiles are designed to support GPs, primary care networks (PCNs), clinical commissioning groups (CCGs) and local authorities to ensure that they are providing and commissioning effective and appropriate healthcare services for their local population.
Primary Care Network profiles
These Primary Care Network (PCN) profiles have been produced by Public Health Northamptonshire, with support from the NHS Northamptonshire Clinical Commissioning Group Primary Care team, in order to support PCNs to deliver strategies that promote illness prevention and address health inequalities.
- Arc Hub – PCN Profile (PDF)
- Blue – PCN Profile (PDF)
- Brackley and Towcester – PCN Profile (PDF)
- Daventry – PCN Profile (PDF)
- East Northants – PCN Profile (PDF)
- Grand Union – PCN Profile (PDF)
- Kettering and South West Rural – PCN Profile (PDF)
- MMWF – PCN Profile (PDF)
- M-WEB – PCN Profile (PDF)
- Northamptonshire Rural – PCN Profile (PDF)
- Parkwood – PCN Profile (PDF)
- Red Kite – PCN Profile (PDF)
- Rockingham Forest – PCN Profile (PDF)
- Royal Parks – PCN Profile (PDF)
- Triangle – PCN Profile (PDF)
- Wellingborough and District – PCN Profile (PDF)
Health Equity Assessment Tool (HEAT)
The Health Equity Assessment Tool (HEAT) is a practical framework that enables multiple audiences to systematically embed action on health inequalities and equalities in their work programme or service. The resources consist of:
- HEAT executive summary
- HEAT tool – full version
- HEAT tool – simplified version
- Case studies demonstrating practical application of the tool and the main benefits of applying it in different work areas.
Click here to access the Health Equity Assessment Tool from Gov.UK.
Health inequalities: placed-based approaches to reduce inequalities
These guidelines to support local action on health inequalities aim to:
- Reinforce a common understanding of the complex causes and costs of health inequalities
- Provide a practical framework and tools for places to reduce health inequalities
Community-centred public health: taking a whole system approach
These resources enable local systems to implement and embed community-centred approaches to health and wellbeing at scale. They are intended for use by local authority, NHS and voluntary and community sector (VCS) decision makers, to help them to:
- improve the effectiveness and sustainability of action to build healthy communities
- embed community-centred ways of working within whole systems action to improve population health
Understanding and tackling inequalities in healthcare provision
Guidance from the Midlands Health Inequalities Unit including how to assess the likelihood of inequalities in healthcare provision, the ways in which healthcare provision can help tackle inequalities and useful tools to support action.
Leadership Framework for Health Inequalities Improvement | NHS Confederation
The Leadership Framework for Health Inequalities Improvement programme is an NHS England and Improvement (NHSEI) programme to ensure that the NHS better prevents and responds to the health inequalities which many communities experience.
It include seminars on:
- National priorities Dr Bola Owolabi, National Director of Health Inequalities, NHSEI, shares the work of the Health Inequalities Improvement Programme and the national priorities for systems and providers, with a focus on the role of leaders.
- Leadership support The NHS Confederation’s EDI Group sets out the importance of the non-executive’s role in leading this agenda and how providers can take practical action to tackle health inequalities, introducing the tools and resources that have been developed to support this programme.
- Data for improvement NHSEI’s Health Inequalities Improvement Team show how data can be used to drive improvement, supported by the Health Inequalities Improvement Dashboard and Core20PLUS5.
To support board members to assess any strategies, delivery plans or other initiatives for their impact on health inequality, the NHS Confederation has also developed some key resources:
- Download the Health Inequalities Board Assurance Tool (pdf)
- Use the Board Reporting Template (.doc) to help you report back to your board
Health equity and inequalities assessments (pdf)
These slides will help you to understand the different types of health equity and inequalities assessments that are available and when to use them.
Local guidance – how to complete a Health Equity Audit
This slide deck from Northamptonshire Health and Care Partnership sets out useful guidance on how to complete a Health Equity Audit.
VCSE Inclusion Health Audit Tool
This online tool will helps organisations to audit their engagement with Inclusion Health groups. These are the groups identified as experiencing the worst health inequalities in the UK.
The tool consists of five sections and takes around 15 minutes to complete. Once you have completed the audit tool, you will be provided with a unique and tailored guide which will help your organisation to embed action on tackling health inequalities into its everyday activities.
Start the conversation – an NHCP guide to community engagement
Northamptonshire Health and Care Partnership has created a guide to help colleagues across our Integrated Care System to understand and lead engagement activities effectively and productively, with the support of the NHCP communications and engagement team. It has been created by a wide variety of community members, in collaboration with the team.
Six principles for engaging people and communities | National Voices
The six principles were developed by the People and Communities Board, in conjunction with the new models of care ‘vanguards’ sites, to give practical support to services as they deliver the ‘new relationship with people and communities;’ set out in NHS England’s Five Year Forward View. These ‘six principles’ set out the basis of good person-centred, community-focussed health and care.
Think Local Act Personal – support for co-production
Co-production can improve people’s wellbeing and has a positive impact on the workforce. The National Co-production Advisory Group supports TLAP, councils and providers to co-produce their work.
Healthwatch – your spotlight on health and social care
Northamptonshire Healthwatch listen to the issues that really matter to local communities and hear about your experiences of using health and social care services. The website contains information and resources on engagement as well as reports and insights from their engagement activity.
For information and support, including training, on health inequalities, please contact Chloe Gay by emailing chloe.gay@northnorthants.gov.uk
NHCP Leadership Matters Conversations – Health Inequalities

Health Education England elearning for healthcare (elfh) modules
Health Education England provides a whole range of training on topics relevant to health inequalities. These include the modules listed below. Please note you will need a Health Education England elfh log-in to access these training modules.
- Engaging with People and Communities
- Cultural competence
- Health Equality Framework
- Health inequalities
- Health Equity Assessment Tool
- Community-centred approaches to health improvement
Other e-learning
- Homeless health (Healthy London Partnership) – tailored for GP practice managers and receptionists
- Health equity: evidence, resources and guidance from Public Health England and partners to help support national, regional and local areas to reduce health inequalities.
- Guidance for NHS Commissioners on equality and health inequalities legal duties (NHS England, Dec 2018)
- Reducing health inequalities: system, scale and sustainability: models and interventions to reduce health inequalities (Public Health England, 2017)
- The NHS Equality and Health Inequalities Hub: support for promoting equality and tackling health inequalities for all patients, communities and the NHS workforce
- Reasonable adjustments for people with a learning disability: guidance supporting the Equality Act 2010 (PHE, Oct 2018)
- NHS entitlements for migrant health: advice and guidance for healthcare practitioners (PHE, Jan 2019)
- Policy & Publications from Friends, Families and Travellers: resources for Gypsies, Roma and Travellers (Office for Health Improvement and Disparities)
- Reducing health inequalities through new models of care: A resource for new care models (Institute of Health Equity)
- Supporting named leads for health inequalities on NHS boards: published by the independent NHS Race & Health Observatory with The King’s Fund and setting out recommendations to help ensure senior NHS officials responsible for improving health inequalities are able to make a difference (2021)
- NHS Reset: A New Direction for Health and Care (NHS Confederation)
- Local Government Association Health Inequalities Hub: explores different themes in detail, shining a spotlight on case studies from councils across the country and exploring how COVID-19 exacerbated existing health inequalities
- Inclusion Health: applying All Our Health: information to help front-line health and care staff use their trusted relationships with individuals, families and communities to take action on inclusion health (Public Health England)
The Future NHS Equality and Health Inequalities Network is a highly recommended resource hub for information and updates about health inequalities.
Follow the link below to join the workspace and you can sign up to receive updates when new information is added to the space.
If you have any information which you think would be useful to include on this page, please contact Chloe Gay by emailing chloe.gay@northnorthants.gov.uk