Not Hard to Reach – Just Hardly Reached: A Case for Public Health Reform

13th November 2025

My lived experience…

I was born and raised in England, a child of Indian migrants who arrived in the early 1960s with little more than determination and hope. My mum, a housewife and my dad, a mill worker in Lancashire, built their lives from scratch. With limited English and a handful of equally hard-working friends, they lodged, saved, and eventually co-purchased a home. Later, as their children were born and their roots deepened, they bought their own house, a modest terrace in a tightly woven Asian community.

In my childhood, children weren’t just raised by parents, they belonged to the community. Aunties and uncles next door, elders down the street, friends across the road: they all shaped our upbringing. Meals were simple, fresh, home-cooked, and shared. We played freely in the streets, ball games, laughter, scraped knees – the kind of joy that doesn’t cost anything but creates the best memories lasting a lifetime.

We now live with comforts my parents could never have imagined in their early days. Yet, amid this transformation, I can’t ignore the health consequences facing the elders from my original community. Diabetes, arthritis, heart disease, and high blood pressure have become distressingly common. The same people who once raised me with warmth and resilience now navigate clinics and medications. Why does their generation face such burdens? And more importantly, why do these disparities still exist?

The answer lies in unfair and avoidable gaps. Migrant communities like ours faced language barriers, limited healthcare access, and a lack of culturally sensitive health advice Their jobs were physically taxing, their housing often overcrowded, and their health needs overlooked for decades.

Even today, health inequality in England is a stark reality. Many factors including socioeconomic status, race, and geography continue to shape who lives well and who suffers. Structural inequalities continue to be deep-rooted into our systems. Sadly, many groups remain stuck at the fringes of society, where health is compromised before it’s even considered.

Meanwhile, today’s lifestyle brings new challenges. My children, blessed with more than I had, now want to spend much of their leisure time tethered to devices rather than the streets. Their diets are richer, but not always better. The very luxuries we’ve gained are now contributing to more complex public health issues driven by modern lifestyle influences.

The case for reform…

As someone who has worked in public health, I’ve seen firsthand how deeply health outcomes are shaped by where people live, their socioeconomic status, and their cultural background. Life expectancy can vary dramatically between neighbouring postcodes. Access to care, quality of services, and even the likelihood of receiving timely treatment are all influenced by these factors. These aren’t just statistics, unfortunately they’re lived realities. A report by the King’s Fund Health Inequalities in a nutshell (2024) (Ref 1), stated, ‘’people living in the most deprived areas have a life expectancy a decade shorter than those living in the least deprived areas (life expectancy is 76 years in Blackpool and 86 years in Kensington).’’

My own family has felt the devastating impact of these inequalities. My father, living in an intergenerational household, passed away very unexpectedly during the COVID-19 pandemic. His risk was compounded by the very factors that define health inequality: ethnicity, housing conditions, and underlying health vulnerabilities. The pandemic exposed and intensified the disparities that had long existed. According to the Office for National Statistics (2020) (Ref 2), South Asian communities experienced significantly higher COVID-19 mortality rates. Public Health England’s (2020) (Ref 3) review echoed this, highlighting how structural racism, overcrowded housing, and occupational exposure contributed to the disproportionate toll on Black, Asian, and Minority Ethnic (BAME) groups.

But the solutions don’t just lie in policy documents, they live in people and place. In my public health work, I’ve become passionate about building social capital and community resilience. Rather than starting with what communities lack, we should begin with what they have: deep-rooted networks, informal support systems, cultural wisdom, and local leaders. A strength-based approachmeans elevating these assets, rather than imposing external fixes.

As health and care professionals we need to shift our mindset. Communities are not “hard to reach” they are hardly reached. The onus is on systems to earn trust, to embed equity into everyday practice, and to design services that reflect the people they serve. But reform is not a one-way street, individuals and communities also have a vital role to play in shaping their own health outcomes. When systems remove barriers and build trust, they create the conditions for people to engage, lead, and take ownership. Public health reform must empower communities, not just serve them, by recognising their assets, amplifying their voices, and supporting their capacity to act.

The NHS’s 10-Year Health Plan (Ref 4) acknowledges this stark truth. It commits to tackling health inequalities through fundamental reforms, including:

Diverting billions of pounds to deprived areas to address the ‘inverse care law’—where those in greatest need often receive the poorest care.
Publishing detailed data on waiting times by ethnicity, deprivation, and age to expose and address unfair treatment.
Rolling out Neighbourhood Health Centres in areas with the lowest healthy life expectancy, bringing care closer to communities.
Investing in community – based support, early intervention, and culturally sensitive outreach.

These are promising steps, but they must be matched by bold, sustained action. So, what strategies should we be using?

Strategies to Tackle Health Inequality…

Community-Led Health Initiatives: Empower and mobilise local groups to lead health education, screening, and support tailored to cultural needs.
Culturally Competent Care: grow inclusive leaders by training them to understand and respect diverse backgrounds, languages, and beliefs so this can be filtered through the wider workforce.
Data Transparency: Continue publishing granular data to identify gaps and hold systems accountable.
Integrated Services: Co-locate health, social care, and financial support in accessible hubs, especially in disadvantaged areas.
Early Years Investment: Prioritise child health through access to better nutrition, housing, and education to break cycles of disadvantage.
Digital Inclusion: Ensure tech-based health solutions don’t leave behind those without access or digital literacy.
Shift from activity-based to equity-based: funding models to ensure resources follow need not just demand.

Our role in reform…

I believe health inequality isn’t just a policy challenge, it’s a moral one. The postcode you’re born in shouldn’t determine the quality of care you receive or the number of years you live. The NHS was built on the promise of care for all. I feel as a wider system we can really make a difference through a concerted effort to restore that promise, not just in hospitals, but in homes, communities, and every corner of our country. I’m fortunate to work within the NHS Transformation Unit, where I collaborate with colleagues who are deeply committed to driving change. Every day, I see firsthand the passion, creativity, and determination that fuels our collective effort to reduce health inequalities. Whether it’s redesigning services, amplifying community voices, or challenging systemic barriers, we’re united by a shared belief: that everyone deserves the same chance at a healthy life, regardless of where they live or who they are.

At the TU, we are committed to addressing health inequalities in all areas of our work, here you can read more about How we Support Reducing Health Inequalities – Transformation Unit. Guided by our enabling ethos and focus on population health, we work with our clients to improve patient health outcomes through inclusive, data-informed approaches. Our approach to health inequalities is embedded meaningfully across all our offers and methodologies, with a robust way of evaluating the impact of our work. Please visit our website to find out more Contact us – Transformation Unit