The role of nurses in addressing health inequities in the UK

In healthcare, the term health ‘inequality’ is often used to describe differences that exist between communities in terms of health access, status and outcomes. However, focusing on equality (treating people the same) is problematic, for example, sending two people a letter about a forthcoming appointment (equality), yet one of them cannot read. As such, we need to move towards a focus on equity, where we consider and address individual needs (such as literacy in the case above) to ensure that no-one is left behind (United Nations, 2015). In order to achieve equity, we need to consider the wider social determinants of health including income/wealth, food, education, water/sanitation, employment, health care, and the built/natural environment (Marmot and Bell, 2018).

There is a link between social exclusion (degree to which people able to participate in society) and inequity, affecting different groups and communities in the UK (Figure 1). Social exclusion is multi-dimensional encompassing social, cultural, economic and political aspects (Khan et al, 2015). It has a profound impact upon health, as people who are socially excluded have higher morbidity and mortality, yet also experience the greatest barriers in accessing healthcare. It is also important to recognise intersectionality; the degree to which the different social exclusion attributes interact and compound increasing vulnerability and further perpetuating exclusion (Parker et al, 2024). As the largest healthcare professional group, we argue that nurses need to be aware of social exclusion and its impact upon health.

Two factors that many socially excluded groups experience are discrimination and poverty. Firstly, discrimination, considering the different groups (Figure 1) you can identify associated discrimination; racism, sexism, ageism, disablism and homo/transphobia. This discrimination can manifest in factors influencing the wider determinants of health such as discrimination in education and employment, income and access to accommodation and health care. There are calls internationally to recognise ‘povertyism’, that is discrimination that occurs on the basis of socio-economic disadvantage (United Nations 2022). 

Secondly poverty, poverty is the single largest determinate of health in that poorer people have shorter lives and greater health and wellbeing challenges (WHO  2021). The most recent figures from the Office for National Statistics (ONS, 2022) identify that, between 2018 and 2020, living in the most deprived areas of England resulted in a shorter life expectancy (9.7 years for men, 7.9 years for women) compared to their counterparts in the least deprived areas. Between 2017–2022, around 22% of the UK population and 29% of UK children were living in poverty (Joseph Rowntree Foundation, 2025). Again, poverty impacts upon the wider social determinant of health in terms of increased risk of malnutrition and chronic disease (McHugh et al., 2024), living in poor quality housing (McCartney et al., 2019), and poorer access to healthcare, leading to delayed diagnosis and treatment, exacerbation of chronic health conditions and an increase in mental health-related conditions (Brown 2023). Children living in poverty have an increased likelihood of experiencing adverse childhood experiences, poorer physical and mental health (Lacey et al., 2020), reduced educational attainment, difficulties in building loving connections and social bonds (Pickett et al., 2022) all of which increase their chances of living in poverty as adults, leading to a generational cycle of poverty.

Due to the drives towards digital healthcare, Kickbusch et al (2021) argued that digital transformation has to be included as a new wider determinate of health, and it is perhaps unsurprising that those who are socially excluded or live in poverty also experience digital exclusion (Heaslip and Holley 2023). Core components of digital exclusion include: a lack of access to hardware devices (SMART phones, computers, etc.), a lack of connectivety (access to the internet, around 1.7 million households in the UK have no broadband or internet at home [ONS, 2019]), a lack of ability/digital literacy to utilise resources (around 2.4 million people in the UK are unable to complete the basic task of getting online [ONS, 2019]), and a lack of motivation or ability (due to disability or confidence).

As identified, health inequity is inexorably linked to the wider social determinants of health. Marmot and Bell (2018) argue that addressing it requires a life course approach (in early life [under 5], young people [15–24 of age], adults and older people). As such, we believe addressing social determinants is a key opportunity for all nurses. As nurses, we are the largest healthcare professional group, we are connected and work within communities but are also consistently identified as one of the most trusted professions in the Ipsos Veracity Index (2025). We must use this position to work with and advocate for people and communities in our services. 

Our NMC Code (2018) highlights our responsibility to ensure assessment of people’s physical, social and psychological needs, to promote wellbeing, and to prevent ill health. In order to achieve this, we must consider individuals’ personal and social instances (NMC 2025), and this includes a discussion around their financial situation. While formal financial assessment may fall outside nurses’ scope it is appropriate to explore circumstances and refer to colleagues as needed. 
As nurses we can also contribute to national and international policy drives aimed at reducing health inequity. For example, in England there is the Core20PLUS5 initiatives for adults and children and young people (see Table 1 [NHS England, 2023]). Nurses have a key role in delivering this. However, we question how many nurses are aware of it and argue we must keep abreast of national policy drivers if we are to fulfil our roles in prompting health and reducing illness.

As nurses we oversee patient/people’s experiences and we can role model the fundamentals of inclusive, culturally sensitive care (Medina-Martínez et al, 2021), creating an inclusive environment where everyone feels heard and valued. We need to use our advocacy role, encouraging healthcare providers to understand and address institutional barriers to engagement with people who are socially excluded, enabling co-design of services (Chikwira, 2023). This is really important in the current drive to increase digital healthcare, advocating for those patients/people who cannot access digital healthcare to ensure their healthcare needs are also met.

It is evident that health inequity is a major issue within the UK and nurses have a fundamental role in addressing this. Firstly, they can, through a holistic assessment and appropriate referrals, begin to address some of the wider determinants of health. They can champion socially excluded groups’ access to healthcare through awareness of national and international policy drivers and lastly, they can advocate for more inclusive healthcare services to ensure no-one is left behind.

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