Health inequalities

Improving the health of people with the worst health outcomes has been a priority for The King’s Fund since it was established in 1897, with its initial focus on raising money for London’s voluntary hospitals supporting people who were unable to afford care at home.

The advent of the NHS in 1948, and the introduction of universal health care, marked a change of direction for The King’s Fund. From this date the Fund would begin to focus its expertise and resources on developing good practice in the NHS, for example through training courses, or through grants designed to support new initiatives to improve the health of Londoners. As part of these new initiatives, the Fund began work to improve social care provision. In 1948, the Fund produced a report looking at the work of hospital ‘almoners’, trained hospital social workers who helped to co-ordinate aftercare for people leaving hospital. The King’s Fund recognised the importance of this role and offered bursaries to people wishing to train in this field. The Fund also became involved in projects to improve ‘the care of the aged sick’ and to improve care for men, women and children discharged from hospital by raising the quality and profile of convalescent homes.

During the 1960s The Fund first published several reports on providing services for older people, focusing on hospital care as well as access to wider services through day centres or voluntary schemes. Home care was also considered, a few reports focused on access to balanced meals through services such as meals-on wheels for those who were housebound.

By the 1970s and 1980s, the work of the Fund highlighted health inequalities experienced by disabled people or long-term conditions. In 1972, Room for improvement advocated for better environments for people with learning difficulties in both residential accommodation and hospitals. A few years later, in 1975 the Fund launched a five-year programme intended to help people with disabilities into adult education or employment. It also provided training for staff working with people with disabilities and advocated for better co-ordination of services. In 1995, The King’s Fund’s London Commission launched the older people’s programme. This work reflected on the needs and experiences of people living with long -term conditions, people living alone, in residential homes or sheltered housing.

An image showing the front cover of a report entitled, 'Care of the Aged Sick'. One the front cover is an illustration of a large home with gardens and a ramp leading up to the front door. The illustration is labelled, 'WESTMOOR, Roehampton'.

The care of the aged sick (1948)

The front cover of a report entitled, 'Meals for the elderly: a report on meals on wheels and luncheon clubs in two North London boroughs'. The front cover shows a series of four images, each with two elderly women in. In the first two images the women are by a dining table, looking out the window. In the bottom two images they have plates in front of them and are preparing to sit down to a meal.

Meals for the elderly : a report on meals on wheels and luncheon clubs in two North London boroughs (1971)

An image showing the front cover of a report entitled, 'Room for Improvement'. On the front cover is an illustration of someone in their bedroom. The bedroom is brightly coloured and has lots of posters and awards on the walls. There is a person stood in the window tending to some pot plants on a desk in front of the window. There is a dressing gown on the bed and slippers on the floor.

Room for improvement (1972)

An image of the front cover of a report entitled, 'The Forgotten People. Carers in three minority ethnic communities in Southwark'.

The forgotten people (1991)

A report entitled 'Beyond Samosas and Reggae. A guide to developing services for Black disabled people'. The front cover is bright red and in the centre is the outline of a piece of a puzzle in white. On the puzzle piece is a sign pointing in five directions. On the sign is written, 'Outreach work', 'Black personal assistants', 'Meals service', 'Interpreters', 'Peer Counselling'.

Beyond samosas and Reggae (1995)

The front cover of a report entitled, 'She dances to different drums. Research into disabled women's sexuality'.

She dances to different drums (1995)

Other projects at this time highlighted gaps in health services provision for people from Black and ethnic minority backgrounds. These projects provided resources and guidance for staff and carers on providing culturally appropriate care. The forgotten people (1990), looked at the experience of carers from Black and Asian communities.

In 1995, the Fund published a comprehensive literature review on the health status of Black and ethnic minority groups in the UK. This report highlighted a complex landscape where health inequalities existed both between different ethnic groups and across different health conditions. People from Black and ethnic minority groups were less likely to access the health care they need and when they did they were more likely to report poorer experiences.

In 1995 a further project, Beyond samosas and reggae worked with black disabled people to explore barriers to accessing care. Its title refers to ensuring the provision of culturally appropriate services.

She dances to different drums reported on research into the sexuality of disabled women. Carried out by researchers with lived experience of disability, this research sought to explore the intersectionality between sex, gender, race and disability. Resonant of these past projects our work in 2022 looks towards a new partnership between disabled people and health and care services. This research carried out by The King’s Fund and Disability Rights UK looks at how disabled people are currently involved in the health care system design.

In 2004 the government published the Wanless report Securing good health for the whole population the influence of this report lead to more discussion on prevention of ill health through prevention and influencing health behaviours. The King’s Fund participated in the debate through reports such as Nanny or steward? The role of government in public health (2005). The following Kicking Bad Habits programme published a series of case studies exploring the effectiveness of different interventions from the provision of better health information to offering financial incentives to encourage healthier choices.  

Following the publication of the Marmot Review in 2010 the King’s Fund has increasingly published on the complexity of health inequalities recognizing factors that affect us both as individuals and as communities resulting in the launch of the Vision for population health in 2018.

The Covid-19 pandemic has served to both highlight and exacerbate the devastating impact health inequalities can have on more vulnerable communities. As The King’s Fund turns 125, we recognise that much still has to be done to improve health and care for people with the worst health outcomes in England, and our latest programme of work draws from past experience as we seek to work with people with lived experience, communities and services to improve health and care for all.