Guest blogger Kerry Holden (bio below) has written this blog in preparation for next Wednesday’s Journal Club (register here) writes…

Health inequalities are sadly deeply embedded in society and unfortunately growing, leading to unequal access to services and poor care experiences. These disparities contribute to earlier deaths, reduced healthy life expectancy, intergenerational trauma, and substantial economic costs. However, many of these health inequalities are preventable.

Reports by Douglas Black in 1980 and Donald Acheson in 1998 emphasised the need for ongoing efforts to tackle health inequalities and address the broader factors that influence health, such as socioeconomic conditions, education, and environment. The subsequent Marmot reviews, in 2010 and 2020, set out an analysis of the causes of health inequalities in England and described what needed to be done to address them. Now, we are in 2025 and in reflection, can we say we have done enough to make a difference with regards to health inequalities in infectious diseases and infection prevention and management? In next week’s Journal Club, we will be reviewing this article together and I really look forward to exploring this further with you.

Why I chose this article?

Health inequalities refer to preventable and unjust differences in health outcomes between different groups of people. These disparities often arise due to factors like socio-economic status (income, employment), geography (region), specific characteristics (such as ethnicity or sexual orientation or disability), and social exclusion (e.g., homelessness or being an asylum seeker). People facing multiple disadvantages experience compounded effects of inequality.

Certain populations, such as black and ethnic minority groups, people experiencing homelessness, those in poverty, and the LGBTQ+ community, often face worse health outcomes. Barriers to healthcare, such as discrimination, lack of understanding from healthcare professionals, and logistical issues like travel costs and language barriers further prevent these groups from accessing care. Additionally, negative experiences with healthcare systems, including racism, contribute to a mistrust that exacerbates inequalities. Recent statistics show that black infants experience twice the mortality rate compared to white infants, and people in deprived areas have higher mortality rates from cardiovascular diseases. These truly shocking inequities sparked my professional curiosity, wanting to further understand what this means for infectious diseases and IPC; leading me to this article.

This study aimed to provide insights into the impact of socioeconomic factors, protected characteristics, and inclusion health groups on infectious disease prevalence, focusing on diseases such as TB, HIV, STIs, hepatitis C, vaccination, and antimicrobial resistance. The study outcomes would then inform the development of public health policies that address these inequalities.

The study uses a systematic overview of reviews approach. It discusses findings from 108 studies on health inequalities relevant to the UK, across various groups published between 2005 and 2020.

Key findings

• Infectious diseases contribute significantly to health inequalities, with diseases like Tuberculosis, HIV, and Hepatitis C posing substantial global and economic burdens.
• In the UK, infectious diseases account for 7% of deaths and 4% of life years lost, costing around £30 billion annually. Many infectious diseases are preventable through vaccination and other measures, but some groups remain under-vaccinated due to various barriers.
• There is a higher risk of infectious diseases, antimicrobial resistance (AMR), and under-vaccination faced by individuals in “inclusion health” (socially excluded and vulnerable populations) groups such as migrants, refugees, homeless people, and sex workers.
• Migrants, particularly vulnerable ones like refugees and asylum seekers, have a higher risk of infectious diseases such as HIV, TB, and Hepatitis, as well as AMR.
• Homeless people and certain ethnic groups, such as Gypsy Roma/Travellers, are also at increased risk for infectious diseases, for example, having a higher TB incidence.
• Ethnic minorities and men who have sex with men (MSM) have a higher prevalence of infectious diseases and AMR. The review emphasises the need for tailored interventions for these groups, highlighting the importance of addressing inequalities in vaccine access as well.
• People in lower-income, lower-education, and deprived areas being at greater risk for infectious diseases and lower vaccination uptake. The review suggests that individuals from these socioeconomically disadvantaged groups should be targeted for public health interventions.

Overall, the review stresses the need for targeted public health policies to reduce inequalities and improve health outcomes, particularly for groups at high risk of infectious diseases and AMR. It also notes significant evidence gaps in some areas, calling for more focused research in these domains.

Limitations of the study:

Some of the reviews included in the study were not systematic reviews, meaning the Assessment of Multiple Systematic Reviews V.2 (AMSTAR2) tool, which is specifically designed to assess the methodological quality of systematic reviews, may not have been fully applicable. As a result, the quality of the non-systematic reviews may not have been as thoroughly or critically assessed. Additionally, because the study was an overview of reviews, it did not include evidence from primary studies, which could have led to missing relevant data and insights.

What this means for IPC?

The pandemic turned a spotlight on the impact of health inequalities for many of us in IPC. Alongside the continued moral and economic case for acting, the pandemic brought new factors into play that can be harnessed to drive improvements. The National Action Plan (NAP) on ‘Confronting antimicrobial resistance, 2024-2029’ now includes a focus on reducing health inequalities, signalling a commitment to tackle this issue systematically.

Tackling these health inequalities requires a coordinated approach across various sectors, including government and healthcare systems. We must focus on prevention and as infection preventionists, we can play a significant part in effecting change in this area. A simple change could include altering our data collection to better target high-risk groups, such as gathering information on patient ethnicity or postcodes. This approach emphasises the importance of targeted interventions rather than broad, one-size-fits-all strategies.

We need to address racism and discrimination, and involve local communities and patients in decision-making. We also need ongoing efforts to build trust with marginalised communities, who are critical to improving health outcomes for all. Ongoing education and support for healthcare and social care workers is also necessary to help them understand and address health inequalities in their everyday practices. Sharing best practices and learning from each other through publication and presentations are essential steps to create meaningful, collective change.

Overall, the message is clear: to reduce the burden of infectious diseases, health inequalities must be recognised and tackled through collective, informed, and continuous efforts.

Bio

Having worked in infectious diseases and Infection Prevention and Control for the last 15 years, Kerry is Deputy Director of IP&C Gloucestershire Hospitals NHS foundation Trust. An active member of the Infection Prevention Society, Kerry is their Vice President and remains a member of the Education and Professional Development Committee. She is chair of the Chief Nursing Officers national IPC shared professional decision making council and South West IPC Network. Kerry is passionate about prevention, quality improvement and supporting expanding and evolving the role of IPC Practitioners to meet the diverse and evolving needs of our communities. Kerry is an independent Nurse prescriber and uses her role to support nursing involvement in antimicrobial stewardship.