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Inequalities and climate 

Health inequalities are exacerbated by the climate crisis. People in poorer countries and communities bear the greatest burden of harms. And the drivers of the climate crisis and health inequalities are often the same.

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Climate health equity

The climate and ecological crises affects us all, but the impacts are not felt equally. Wider determinants of health such as housing, air pollution, the type of food available, transport options, local services, access to green space and education all have major impacts on our health, but they are unequally distributed. Many of the causes of climate change disproportionately affect marginalised communities, contributing to higher rates of health problems like heart and lung diseases.

Examples of health inequalities

  • Higher levels of air pollution from burning fossil fuels,
  • Energy inefficient homes that contribute to fuel poverty, wasted energy and bad health,
  • Poorly planned cities and towns that make active travel (walking and cycling) unsafe or inaccessible
  • Less access to green spaces, which can enable healthy outdoor exercise and are great for mental health.
  • Overheating in built-up areas (often due to the urban heat island effect)
  • Disadvantaged groups also have fewer resources to help them cope and adapt to our changing climate

The climate crisis can’t be addressed effectively without also tackling underlying socio-economic and racial inequalities. Read more about tackling the climate crisis and inequality together in this report chaired by Michael Marmot and Medact’s report on the public health case for a Green New Deal. Greener Practice members Emma Radcliffe and Farah Bede have written about what they have termed the inverse climate law in this BJGP article.

Core20PLUS5 is a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system level.

Launched in 2021, the approach defines a target population cohort – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement.

CORE20Plus

CORE20Plus

Core20PLUS5 is a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system level.

Launched in 2021, the approach defines a target population cohort – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement.

‘Core20‘

The most deprived 20% of the national population as identified by the national Index of Multiple Deprivation (IMD). The IMD has seven domains with indicators accounting for a wide range of social determinants of health.

‘PLUS‘

Regional population groups experiencing poorer than average health, but not captured in the ‘Core20’ alone.

Inclusion health groups include: ethnic minority communities, coastal communities, people with multi-morbidities, protected characteristic groups, people experiencing homelessness, drug and alcohol dependence, vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system, victims of modern slavery and other socially excluded groups.

‘5’

The final part sets out five clinical areas of focus.

  1. Maternity
  2. Severe mental illness
  3. Chronic respiratory disease
  4. Early cancer diagnosis
  5. Hypertension case-finding

Climate change impacts will most harshly affect the disadvantaged patient groups identified by ‘Core20PLUS’, as well as impacting on all five clinical areas. This highlights what is called the ‘intersectionality’ of these issues, and therefore tackling these problems is most effectively and sustainably done in conjunction.

In combination with the NHS net zero aims, this initiative will form a new bedrock for the provision of care, creating standards which are both equitable and sustainable.

With thanks to Farah Bede for content for this section.