When we think of pressures on health systems, we often focus on budgets, workforce shortages, or the rising burden of chronic disease. But beneath these immediate challenges lies a deeper and more corrosive force: inequality.

Health inequalities are not accidental. They are shaped by policy and worsened by neglect. The real question is not whether inequality undermines health systems, but how much inequality they can tolerate before they begin to fracture.

Inequalities in Health Outcomes: The Stark Reality

The latest evidence from the UK Health Security Agency’s Health Inequalities in Health Protection Report is unambiguous. People living in the most deprived 20% of areas in England are nearly twice as likely to be admitted to hospital with infectious diseases as those in the least deprived.

For respiratory infections, the disparities are even starker:

  • 7x higher admission rates for tuberculosis
  • 6x higher for measles
  • 3x higher for influenza
Inequalities in emergency hospital admissions between the most deprived and least deprived quintiles, England, 1 September 2023 to 31 August 2024
Source: UK Health Security Agency

A Global Problem, Not Just a Local One

While the UK data is compelling, inequality in health outcomes is a global issue.

Life expectancy has doubled over the past two centuries, yet its distribution remains profoundly unequal. In Japan, Italy, and much of Western Europe, average life expectancy exceeds 80 years. Meanwhile, in parts of sub-Saharan Africa, it remains below 60.

Infant and child mortality, once universal, has dramatically declined. However, the chance of a child dying before their fifth birthday is still ten times higher in the poorest countries compared to the richest. These inequities are not natural; they reflect choices about how societies allocate resources and invest in public health.

Evolution of health protection coverage as a percentage of total population
Source: Our World in Data

The Social Determinants of Health

The World Health Organization (WHO) has long highlighted that more unequal societies are also less healthy societies. Inequalities follow a clear social gradient; even those in the middle fare worse than those at the top.

These differences result from choices in housing, education, employment, taxation, and health system design. Tackling these upstream factors narrows inequalities, while ignoring them entrenches disadvantage.

Determinants of population health
Source: National Center for Biotechnology Information

The Hidden Costs of Inequality

The consequences of health inequalities are felt in both human and financial terms. For example, the NHS spends between £970 million and £1.5 billion annually on avoidable hospital admissions linked to deprivation.

Globally, countries with higher levels of income inequality tend to experience:

  • Lower life expectancies
  • Higher infant mortality
  • Higher rates of mental illness and obesity

The more unequal a society, the more fragile its health outcomes, and the more strained its health system becomes.

Inequality in Times of Crisis

The COVID-19 pandemic laid bare these vulnerabilities. Far from being “the great equaliser,” the virus exposed and magnified existing divides. Marginalised groups, migrants, people in prison, and those experiencing homelessness suffered disproportionate burdens and were often invisible in surveillance systems.

The same dynamic plays out with climate change. Heatwaves, floods, and storms hit hardest those already disadvantaged: people in poor-quality housing, precarious employment, or without insurance. Refugees and displaced populations face heightened risks of both infectious and chronic disease.

Inequality weakens health systems’ resilience to crises, transmitting disadvantage across generations. Children born into poverty are more likely to experience poor health, reduced educational attainment, and lower life chances.

Can Health Systems Afford Inequality?

The evidence is clear: every preventable admission, every outbreak that disproportionately affects vulnerable groups, and every policy that ignores the broader determinants of health represents a cost that health systems cannot afford.

So, how much inequality can a health system tolerate before it breaks? The reality is that we are already testing those limits. Unless policy shifts decisively towards prevention, equity, and structural reform, today’s inequalities will become tomorrow’s unmanageable crises.

From Neglect to Action

Health inequalities are not inevitable. They are created by policy and sustained by neglect and can only be dismantled by deliberate, evidence-based action.

The choice is not whether to act, but how long we can afford to delay.

Authored by Tom Varghese, Global Product Marketing & Growth Manager at Orion Health.

Resources:

Allison, Rosalie, David J. Roberts, Adam Briggs, Shona Arora, and Sarah Anderson. “The Role of Health Protection Teams in Reducing Health Inequities: Findings from a Qualitative Study.” BMC Public Health 23, no. 231 (2023). https://doi.org/10.1186/s12889-023-15143-7.

National Academies of Sciences, Engineering, and Medicine. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press, 2017. https://doi.org/10.17226/24624.

Our World in Data. “Global Health.” Updated February 2024. https://ourworldindata.org/health-meta.

UK Health Security Agency. Health Inequalities in Health Protection Report 2025. London: GOV.UK, 2025. https://www.gov.uk/government/publications/health-inequalities-in-health-protection-report/health-inequalities-in-health-protection-report-2025.

WHO Regional Office for Europe. Health and Reduced Inequalities: Policy Brief. Copenhagen: World Health Organization, 2019. https://apps.who.int/iris/handle/10665/331976.

Champs Public Health Collaborative. “UKHSA Release Inequalities in Health Protection Report.” June 2, 2025. https://champspublichealth.com/ukhsa-release-inequalities-in-health-protection-report