Full report available here.
The global pandemic is exacerbating existing health and care inequalities. Allied Health Professionals (AHPs) are a foundational building block of health and care services and are keen to play their role in addressing inequalities. However, there is a lack of existing research exploring AHPs’ impact on health inequalities.
We undertook a rapid review to explore the impact of AHPs’ practice on health inequalities.
In Stage 1, we undertook a main rapid review of AHP interventions addressing health inequalities. Stage 2 involved an ancillary rapid review to identify learning from non-AHP settings.
We did not find any evidence demonstrating the direct and independent impact of AHPs on the gap in health outcomes between groups or across the socio-economic gradient. However, based on thirty-six articles, we found a large body of research describing how AHPs can affect inequalities in health outcomes indirectly.
In order to present this evidence in a coherent way, we organised the patterns found in the data into patient and organisational, and system level themes which are applicable across the different AHP groups.
The themes at the patient and organisational level concerned:
- more equitable access to allied health services for lower socio-economic groups, ethnic minority groups, people with mental health problems or in rural areas and specific disadvantage groups
- high-quality care and patient experience in terms of avoiding bias in decision making, having culturally appropriate services and meeting clinical standards
- addressing the social determinants of health through supporting employment and housing
- supporting mental wellbeing through specific AHP services and incorporating mental wellbeing considerations in routine AHP services
Themes at the system level were:
- ensure equitable distribution of workforce in underserved areas and allocation of funding proportionate to need
- better representation of minority groups, such as gender minorities, in clinical guidelines.
A final cross-cutting theme was engaging and empowering communities to support the co-design and delivery of culturally relevant services.
Based on these findings we propose the following policy recommendations:
- A programme of equity-focused quality improvement project which will be based on a national assessment of inequalities in access to AHP services, focusing on socio-economic and ethnic minority groups.
- AHP inequalities actions should be developed, implemented and evaluated at system, organisational and patient level, including the equitable distribution of funding and workforce.
- Services should be designed and delivered in culturally appropriate ways. This does not simply mean adapting services for different ethnic groups, but rather fundamentally rethinking the intrinsic, predominantly biomedical, western approach to health which may not be equally relatable to all communities.
- An economic assessment is needed to understand the distributional costs and benefits of AHP actions and identify where resources should be used to maximise the impact on inequalities both for the health care system, partner organisations, communities and individuals.
Based on these findings we propose the following research recommendations:
- This review has been able to map the existing evidence, however, a series of further reviews focusing on specific inequalities and AHPs’ roles should be undertaken to build an integrated evidence base.
- A focused review of the impact of certain AHPs’ roles on the distribution of specific social determinants of health, like employment, housing, social participation and education, is needed. Furthermore, AHP researchers should endeavour to integrate social outcomes as well as traditional biomedical outcomes.
- More research is needed to understand how to meaningfully co-design allied health services with communities. Existing efforts to co-design services should be evaluated to identify the guiding and transferable principles.