Abstract
Background: Health inequalities in Hounslow reflect national disparities in England, where people in the most deprived areas live nearly a decade less than those in the least deprived areas. The NHS CORE20PLUS5 strategy, launched in 2022, provides a framework to systematically reduce these inequalities by focusing on the most deprived 20% of the population (CORE20) and underserved groups (PLUS), targeting five key clinical priorities. By utilising extensive resident engagement and population health data analysis, Hounslow Borough Based Partnership has adopted this strategy to improve health outcomes and address inequalities within its diverse community.
Approach: Hounslow implemented a systematic approach to understanding and addressing the needs of its CORE20 residents. This involved a population health management strategy combining data analysis with extensive resident engagement. Twelve areas in Hounslow were identified as CORE20, encompassing approximately 26,000 residents.
Nine local voluntary and community sector (VCSE) organisations were commissioned to engage 340 residents from these areas, gathering insights on the determinants of health and wellbeing, barriers to accessing services, and potential solutions. Findings from this engagement were triangulated with integrated care system data (WSIC), including health outcomes, as well as data on wider determinants of health.
Results: The findings revealed significant barriers faced by CORE20 residents, including poor access to healthcare services, lower levels of employment, and inadequate housing. Residents highlighted the impact of environmental factors, noting the advertisement of unhealthy food influenced their health and wellbeing. Field observations conducted in high streets within CORE20 areas showed a significantly higher density of unhealthy food advertisements (10 per 0.2 miles) compared to non-CORE20 areas (8 per 2.7 miles). Residents overall know what it takes to be healthy but highlighted the important issues which impact health such as trust in healthcare providers, the need for culturally appropriate services, and support for improving their local environment. Residents in CORE20 areas had higher levels of food insecurity and longer travel times to key services like GPs and pharmacies. Data confirmed these challenges, showing higher rates of A&E attendances, smoking, obesity, mental health conditions, and chronic illnesses among CORE20 residents compared to the wider Hounslow population.
In response, targeted interventions were implemented, such as outreach NHS Health Checks for adults aged 25-40, redesigned weight management and smoking cessation services focused on CORE20 areas, and increased GP incentives to enhance service uptake resulting in uptake of health checks amongst CORE20 residents growing from 6% to 30% in one year. These actions have begun addressing the identified barriers, with early indications of improved access and engagement.
Implications: This project underscores the importance of combining data-driven insights with community-led engagement to address health inequalities. By focusing on CORE20 residents, Hounslow has demonstrated how targeted, locally tailored interventions can begin to bridge the gap in health outcomes. Future steps include scaling up successful models, enhancing integrated care approaches through integrated neighbourhood teams, and continuing to involve residents in shaping solutions.
This initiative provides a replicable framework for tackling inequalities and ensuring that the most deprived communities are prioritised in health and care strategies.