Published On: 29 April 2014Tags:

This paper argues that within the English health system the ‘Equality and Diversity’ (E&D) and ‘Health Inequalities’ (HI) agendas remain poorly integrated at both national and local level.  In particular, the HI agenda has largely failed to pay explicit attention to axes of inequality other than the socioeconomic gradient. We suggest that the disconnection between E&D and HI work hampers progress towards better understanding of the processes that perpetuate poor health outcomes. It also limits coordinated intervention to address need across the health system, including action on the wider determinants of health.  In this paper we are particularly concerned with the slow progress towards tackling ethnic inequalities in health and healthcare, but similar concerns have been voiced in relation to other key axes of difference and disadvantage, not least disability and age (CPA, 2009; Emerson and Baines, 2009).

Key messages:

  • There are many potential synergies between the Equality & Diversity and Health Inequalities agendas. Both are fundamentally concerned with reducing inequity in access to health-promoting resources.
  • However, the origins of these two areas of work differ and, within English health policy and practice, they have tended to develop independently rather than in a coordinated fashion at both a national and a local level.
  • The resulting divergence in agendas and practices is reflected in the framing of much Health Inequalities work, in which socioeconomic inequality is the core focus and other dimensions of disadvantage, including ethnicity, are neglected.
  • The separation of these two important areas of work is not inevitable given that examples of more integrated approaches are found in some UK initiatives and internationally.
  • Integration of these agendas requires not only administrative but also political and methodological alignment, but much could be gained from more joined up strategy and action.
  • Understanding and meeting the needs of those with the worst health outcomes – for whom there is often an interplay of multiple processes of exclusion – demands that we take a more integrated and holistic approach.


  • Equality and diversity: origins, developments and critiques
  • Health inequalities agenda: origins, developments and critiques
  • Towards more integrated approaches
  • Future directions
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Author(s): Salway, Sarah; Carter, Lynne; Powell, Katie; Turner, Daniel; Mir, Ghazala; Ellison, George TH
Briefing series: Better Health Briefing Paper 32
Publisher: Race Equality Foundation
Publication date: April 2014