Health inequalities are unfair and avoidable differences in health across the population, and between different groups within the society, arising because of the conditions in which we are born, grow, live, work and age. These conditions influence opportunities for good health, and how individuals think, feel and act, and this shapes mental health, physical health and wellbeing.

Health inequalities have been documented between population groups across at least four dimensions (NHS England » Definitions for Health Inequalities), as illustrated below. These dimensions often overlap with people falling into various combinations of the categories. Examples of the characteristics of people/communities in each of these groups are:

• Socio-economic status and deprivation: e.g. unemployed, low income, people living in deprived areas (e.g. poor housing, poor education and/or unemployment).
• Protected characteristics: e.g. age, sex, race, sexual orientation, disability
• Vulnerable groups of society, or ‘inclusion health’ groups: e.g. vulnerable. migrants; Gypsy, Roma and Traveller communities; rough sleepers and homeless people; and sex workers
• Geography: e.g. urban, rural.

The NHS Long Term Plan (LTP) sets a clear precedent for embedding equalities thinking in planning and delivering commitments in local health systems. All systems are expected to set out specific measurable goals and mechanisms by which they will contribute to narrowing health inequalities by 2023/24. NHS England and NHS Improvement will support local health systems to better address inequalities in access, experience and outcomes by supporting, incentivising and assuring targeted, localised actions to address them. This includes the development and dissemination of data, information and tools to inform local service planning and provision.

Action on health inequalities requires improving the lives of those with the worst health outcomes, fastest (NHS England » Definitions for Health Inequalities). To this end, the Mayor of London set out his aims, objectives and actions for addressing health inequalities in London within the London Health Inequalities Strategy.