The Royal College of Ophthalmologists (RCOphth) has today joined with other representatives of the Inequalities in Health Alliance (IHA) in a letter to the Prime Minister urging him to take bold action to ‘level up health’ in the next phase of pandemic recovery.
The Alliance is calling for an explicit cross-government health inequalities strategy, with clear measurable goals, that considers the role of every department and every available policy lever in tackling health disparities.
In ophthalmology we know that Black, Asian and minority ethnic communities and others experiencing socio-economic disadvantage experience worse eye health, which will seriously damage their quality of life if it leads to vision loss. A cross-government strategy to tackle health inequalities should help to address these disparities.
Read the letter to Prime Minister
The impact of non-clinical factors on the health
The IHA membership represents patients, communities, doctors, nurses, public health and social care professionals, dentists, pharmacists, and local authorities. This broad membership has seen countless examples of the impact of non-clinical factors on the health of people across the country.
The physical and mental health of people of all ages is affected by health inequalities – unfair and avoidable differences in health and access to healthcare across the population, and between different groups within society. Even before COVID-19, the gap in healthy life expectancy between the richest and poorest areas was around 19 years.
Unfortunately, you are much more likely to experience poor eye health if you come from a Black, Asian and minority ethnic background. Almost half of those with sight loss are economically disadvantaged, in households earning less than £300 a week, while people of south Asian and black African and Caribbean backgrounds are at much greater risk of developing glaucoma and diabetic retinopathy1. What is true for eye health applies across the board, with poverty and ethnicity strongly linked with many diseases and illnesses. Clearly, we all need to take steps to address the specific factors affecting disparities of access and outcomes in our own sector. However we also need government to look at the bigger picture and focus on how it can reduce health inequalities. That is why RCOphth strongly supports this call for a cross-government strategy to reduce health inequalities.
Read more here: Powerful stories make the case for a cross-government strategy to reduce health inequalities | RCP London
An evidence base for inequalities in eye health
The Eye Journal has published a number of papers on inequalities in health:
1.Prevalence of refractive error, visual impairment and access to eyecare for the homeless in Wales, United Kingdom (Nov 2020)
‘These findings indicate a significant disparity in ocular health, visual acuity and refractive error amongst the homeless in comparison with the general population.’
2. The state of ocular health among London’s homeless population (Dec 2016)
‘This study shows that there is a high prevalence of uncorrected refractive error among patients attending the Crisis for Christmas eye clinic. These data also show high prevalence of ocular pathology. There is a clear need for the provision of eye tests and spectacles to tackle the issues and prevent visual impairment. More research and eye care services are needed to investigate how this is linked to their living status and enable this vulnerable population to transition out of homelessness.’
3. Socio-economic differences in accessing NHS spectacles amongst children with differing refractive errors living in Scotland (April 2021)
‘Children in areas of greater deprivation and in more rural areas are not disadvantaged in accessing NHS spectacles. This did not vary by refractive error group. This suggests that health policy in Scotland is accessible to those from all deprivation levels and refractive errors.’
4. Is there an association of socioeconomic deprivation with acute primary angle closure? (June 2021)
‘Socioeconomic deprivation is an important risk factors for patients presenting with APAC. Socioeconomic deprivation should be incorporated into the design of glaucoma services and considered when triaging patients for prophylactic and therapeutic LPI and cataract surgery.’
5. Global burden of paediatric vision impairment: a trend analysis from 1990 to 2017 (June 2021)
‘The global health burden of paediatric vision impairment decreased from 1990. Refractive, near vision impairment and other causes were associated with socioeconomic development.’
6. Assessing financial insecurity among common eye conditions: a 2016–2017 national health survey study (August 2021)
‘There are several demographics with eye disease that self-report financial insecurity. There should be greater concern for financial insecurity among diabetic retinopathy and glaucoma patients. Ophthalmologists should consider engaging in proactive discussions with at-risk patients to reduce potential non-adherence secondary to financial insecurity.’
7. Socio-economic status and outcomes for patients with age-related macular degeneration (March 2019)
‘This study found poorer baseline visual acuity (VA) among people with wet age-related macular degeneration (AMD) from more deprived areas. This work suggests a need for earlier identification of AMD among more deprived populations.’
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