Breaking the dependency cycle: Tackling health inequalities of vulnerable families

Across Western Europe the marked increase in life expectancy in recent decades is not always correlated to life spent in good health; indeed, the greater the income disparities within a country the greater the health and social inequalities. Conventional explanations for health inequalities, such as lack of access to medical care and unhealthy lifestyles, provide only part of the explanation. The more intransigent causes are the social determinants of health, including access to and opportunities in education, employment, housing, public transport and welfare services.
All countries, whatever the maturity of their health and social care services, experience varying levels of in-country health inequalities, with excess mortality and reductions in healthy life years correlated to regional deprivation.
Across all Western European countries, ‘vulnerable’ or ‘troubled families’, defined as those that are in contact with several departments of the local authority, including the child or youth welfare system, are a growing concern. These families rarely succeed in breaking the negative spiral, which leads to persistent poverty, deprivation and transgenerational dependency on public support. Living in vulnerable families accentuates the risks of poor life outcomes for those most dependent on family structures, especially children and adolescents. The current failure to address the social determinants of health for these vulnerable families is creating avoidable cost and social pressures on society.
The report illustrates how taking a life cycle approach to vulnerable families can improve targeting, prioritisation and impact of services at all stages of life. It provides current research evidence as well as good practice examples focussed on:

• maternity and infancy – providing a strong foundation for the rest of life
• childhood and adolescence – establishing healthy behaviours and building resilience
•  adulthood and working life – creating the conditions for a productive life
• elderhood and increasing frailty – achieving equality in length and quality of life
• an integrated, whole system approach – improving outcomes at all life stages.

Giving each child the best possible start in life is likely to deliver the best societal and overall health benefits. However, breaking the cycle of dependency for future generations also requires improvements in the living and working conditions of adult and elderly family members.
Deloitte believes that addressing inequalities for the most vulnerable members of society will lay the foundation for reducing health inequalities more generally and that sustainable change is achievable if all policy makers, public service providers, agencies and other stakeholders are prepared to:

• work across institutional and professional boundaries and with the wider public sector to take collective decisions on how and where to invest in joint actions to achieve better outcomes
• take a coordinated, case management approach with a community-based gatekeeping point for accessing services
• deploy analytics and digital technology effectively in both the planning and provision of services
• provide appropriate levels of health and social care funding, based on economic evaluation of cost-benefits and consider introducing new models of integrated funding and aligned incentives across all parts of the system.

Across all countries in Europe there is significant scope to work together more effectively to tackle the social determinants of health and reduce health inequalities. This is a moral and economic imperative, if countries are to provide an equitable, secure, and healthy future for everyone.
All countries, whatever the maturity of their health and social care services, experience varying levels of in-country health inequalities, with excess mortality and reductions in healthy life years correlated to regional deprivation.