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Tackling lung disease can help reduce health inequality
The Chair of the British Thoracic Society’s Board calls for concerted action to reduce the health inequalities of lung disease.
In England people living in the poorest areas will die many years earlier than those in the richest areas.
The gap in life expectancy at birth between the least and most deprived areas was 9.4 years for males and 7.4 years for females in 2015 to 2017.
In a rich country like ours many people find the current levels of health inequality unacceptable and there is certainly a steep challenge ahead for Government, NHS and wider society to address this burning injustice.
As a lung specialist I know first-hand that social deprivation and lung disease are bound together. The incidence and death rates for people with lung diseases in England are higher in poorer groups and areas of social deprivation, where there are often higher levels of cigarette smoking and exposure to air pollution, as well as poorer housing conditions and exposure to occupational pollutants.
So, what can the NHS do about it? The most important policy development in recent times is of course the NHS Long Term Plan and I hope this will accelerate positive change – although urgent solutions will also need to be sought across Government on issues such as poor housing and nutrition, poverty and air pollution.
The Plan spotlights the disproportionate contribution that lung disease makes to the health inequality gap. For example, in males, lung disease – including lung cancer, influenza, pneumonia and chronic lower respiratory disease – contributes more years of life lost (2.2 years) and exerts a greater impact on the life expectancy gap between the least and most deprived populations – than any other major disease area.
The good news is that we are now seeing a growing accumulation of strong policies, resources and services to enable the NHS and its partners to target work at specific populations and areas of need – preventing lung disease and managing it earlier and more effectively, which could make a real difference to the inequality gap. I will highlight just a few.
The Plan’s innovative ‘lung health check’ programme to diagnose lung cancer and chronic lung disease much earlier is initially being rolled out in 10 areas with the highest death rates from lung cancer. The programme will offer lung health checks to people aged between 55 and 74 who smoke or are ex-smokers to assess their risk of lung cancer, and then a chest CT scan if needed. The scheme aims to reach 600,000 people over four years, detect 3,400 lung cancers and improve survival in the worst hit areas of England.
The other great benefit of the ‘check’ is that other lung conditions such as chronic obstructive pulmonary disease (COPD) are also being identified and treated. In addition, everyone is being offered advice on how to keep their lungs as healthy as possible – including support to stop smoking.
We are all probably aware that smoking is a well-known marker of inequality. It is more common in people on lower incomes and is the predominant cause of lung cancer and chronic lung disease.
I thus applaud the NHS Long Term Plan initiative to provide treatment for tobacco addiction to all smokers in inpatient, maternity and higher risk outpatient specialties by 2023-4. I’m heartened that a new non-mandatory tariff is now available to help hospitals to get started and deliver effective stop smoking support. I hope this is a success – and that a national accountability mechanism is created in the future to make sure all our hospitals deliver this pivotal service effectively.
The majority of smokers want to quit, and a hospital stay provides a golden window of opportunity for the NHS to support them to start a life free of tobacco dependence. I encourage all my colleagues across the NHS to support delivery of the programme – it makes health and economic sense.
It is pivotal, however, that this policy forms part of a much wider, well-funded future tobacco control strategy so we can achieve the Government’s aim of a smoke-free generation by 2030.
As local NHS plans to improve the health of local populations near completion, I strongly urge commissioners to review them and use every lever and resource to help prevent lung disease, diagnose it early and provide the best standards of care for all patients. NHS RightCare, Getting it Right First Time (GIRFT) and the British Thoracic Society are all delivering important work to identify variations in respiratory care and outcomes across the country and provide data, guidance and expertise to promote uniform best practice.
By targeting our efforts to prevent lung disease and tackle it earlier we can really start to reduce the health inequality gap.
There’s a long and challenging road ahead but the NHS Long Term Plan represents a once in a generation opportunity for positive change and help improve the nation’s lung health across the board.
Thank you Jon, a very interesting read. Could you also comment on the inequalities in Cystic Fibrosis care?
There is Genetic Discrimination, with one gene type receiving CFTR modulator drugs (at >£285k per QALY), but other gene type being refused funding of CFTR modulators (at £218k per QALY).
There are inequalities in regions, Scotland has approved funding of Orkambi and Symkevi, England, Wales & NI has not.
And now we have individual patients purchasing generic drugs from abroad at the cost of £24k per year, causing inequalities in the life expectancy of CF patients due to personal wealth.
This resonated totally for me as an (integrated) respiratory physician working in inner London.
Recommend as reading for anyone who cares about addressing inequalities and/or whose aim is to improve outcomes and experience for people living with respiratory illnesses.