Addressing health inequalities
Addressing Health Inequalities is a major strategic focus across the NIHR Manchester Biomedical Research Centre. This work is carried out in partnership with NIHR Manchester Clinical Research Facility (CRF), our host Trust, Manchester University NHS Foundation Trust (MFT), The University of Manchester, and our wider NHS and academic partners.
Our work to address health inequalities is driven by the Health Inequalities Steering Group (HISG). Led by Vocal – the team that brings people and health researchers together – and with members drawn from across the Greater Manchester (GM) research landscape, the group works to collectively address health inequalities in the research that Manchester BRC and Manchester CRF design, undertake and communicate.
The group exerts strategic influence and conducts activities across GM research infrastructure, in order to promote inclusive research.
Our aim and approach
We ultimately aim to reduce health inequalities by embedding inclusive research across GM – bench to bedside research that takes deliberate action to meet the health research needs of different people, to address barriers to inclusion and to promote environments where everyone feels included, respected and valued. This includes making participation in research accessible, the active involvement of people from all walks of life in research, and partnership working.
We prioritise research that is:
- most relevant to poor health outcomes and/or linked to GM priorities
- examines barriers to participation and explore approaches to broaden access
- develops more inclusive practices for both research participation and involvement.
Our highlights from 2020-2021
Telling our story
We have continued to tell our story of impact – how clinical research and public involvement can make a difference to health inequalities, through co-authored blogs on inequalities in the research response to COVID-19, and as co-presented webinars on COVID-19, inequalities and public involvement. We have additionally co-created events – including as developers and speakers at the Reaching New Members in a Virtual World event – and informed policy with our public contributor, including input to government inquiry on COVID-19 and inequalities.
Case studies about specific projects are included further down this webpage.
Addressing researcher barriers
We have addressed barriers and opportunities to deliver inclusive research by responding to the needs of our health researchers.
We have developed detailed health inequalities briefing notes for Manchester BRC researchers across our cancer, musculoskeletal, and respiratory themes. With Vocal, the Black Asian and Minority Ethnic Research Advisory Group (BRAG), The University of Manchester’s i3HS Hub, and as part of the Manchester BRC training programme, we have co-developed an Inclusive Research eLearning module, which is free to access and aimed at both researchers and public contributors.
Analysis of demographic data
We have analysed demographic data related to research participation across Greater Manchester and are undertaking a second equality review of participation in Manchester CRF research, with potential for implementation in Manchester BRC research. This data will be compared to selected national and local comparison data, and we are embedding methods to review the demographics of our participation across Manchester CRF research – and act on the findings. The heatmap below provides a snapshot of our participation across the North West.
More than 500 public contributors are actively involved in the work of Manchester BRC and Manchester CRF, with Patient and Public Involvement and Engagement (PPIE) in research supported by Vocal at all levels. All public are provided with feedback on the impact of their input and are remunerated in line with NIHR guidelines.
Our localised approach interventions have included working in the Wigan area; engaging with community, primary care and patient groups, to better understand structural barriers to participation in experimental medicine research This builds upon the learning from place-based engagement programmes with respiratory research in Wythenshawe (Breathtaking Lungs), Advanced Radiotherapy research in Oldham and online (Radiotherapy & Me) and through engagement focused on mental wellbeing in Oldham (Ideas Fund).
Next steps for 2021-22
Our activities have highlighted how joined-up working across integrated care systems, local primary care services, research infrastructure and community organisations, is essential to supporting ‘research-active’ communities according to their needs. We continue the work of the HISG across our BRC, CRF, MFT and UoM partners to address inequalities through promoting inclusive research.
Addressing health inequalities through our research: how we do it
One of the seven GM priorities is that fewer people will die early from cancer. Cancer prevention and early detection is also a BRC research theme.
The number of people who develop and die from cancer in Greater Manchester is significantly higher than the English average – we want to change this through research.
1. The Manchester Lung Health Checks (LHC) pilot
The LHC pilot brought lung cancer screening to some of the most deprived areas of Manchester. The disease is strongly associated with deprivation, and is the leading cause of premature death in the city.
Smokers aged between 55 and 74, who were registered at participating GP practices, were invited to undergo a free lung health check, which were run from convenient community locations. This resulted in 4.4 per cent of participants being diagnosed with lung cancer – 80 per cent at early stage.
The outcomes highlighted the critical need for this intervention, and by targeting those at greatest risk in deprived areas, we detected a three-fold incidence of lung cancers as compared to the international average.”
Dr Phil Crosbie, study lead on behalf of the BRC.
I was scanned on the Tuesday there and then I was sent a hospital appointment and attended within a week of my lung health check. I honestly feel as though this lung health check has saved my life.
Michael Brady, patient.
2. Developing a breast cancer risk assessment programme for young women
Breast cancer incidence begins to rise as women enter their 30s and the disease is currently the most common cause of death in women aged 35 to 50. This new programme of work, funded by the Manchester Cancer Research Centre, will explore the acceptability and feasibility of giving personalised breast cancer risk estimates to women aged 30 to 39 years. The proposal is to use standard risk factors, a low dose mammogram (a breast X-ray containing 10 per cent of the radiation dose of a normal mammogram used in the NHS Breast Screening Programme) for breast density assessment and a saliva sample to assess genetic risk. Together, this would enable the identification of high-risk women who could then be offered enhanced screening and prevention services.
The identification of young women at increased risk of breast cancer, in the absence of a family history, is a vital step towards reducing the unacceptable death rates from this disease.
Dr Sacha Howell, who is leading the study on behalf of NIHR Manchester BRC
There is evidence to suggest that women from ethnic minorities are less likely to engage with early detection initiatives such as breast screening and present with later stage cancers. Therefore, researchers approached VOCAL for support arranging a public involvement group to inform study protocol development. After presenting the research to the BAMER Research Advisory Group (BRAG), one member (Ehinor Otaigbe, CEO of Wonderfully Made Woman) brought together a group of Black African Caribbean women at her community centre. Insights from this group included suggested recruitment strategies to engage BAMER communities.
BRAG act as a bridge linking researchers with BAMER communities. The group’s involvement will prove invaluable in engaging a variety of ethnic backgrounds in our research to reduce health inequalities. This in turn will ensure the development of a breast cancer risk assessment that is more widely acceptable and accessible.
Sarah Bellhouse, PhD researcher on the project
Another GM priority is that fewer people will die early from respiratory (lung) disease.
Lung diseases are the third most common cause of death in the UK. We want to change this, which is why programmes within our respiratory research theme are carrying out studies in this area.
The British Lung Foundation Early Chronic Obstructive Pulmonary Disease (COPD) Consortium Cohort study
COPD is one of the major drivers of social inequality in health. While lung health is improving among more well-educated sections of the population and those choosing not to smoke, a similar trend has not been seen in socially deprived areas. In Manchester, deaths caused by from COPD and lung cancer are among the highest in the UK.
We are recruiting 125 young smokers – who often neglect the fact they are at risk – as part of a UK multi-centre study. We will follow participants for three years, examining them in detail, with the hope to help find out more about this disease.
This is a challenging study, but it makes so much sense to focus on early disease instead of waiting for the disease to reach a stage where we can do little, and have failed to learn enough about the biological factors leading to this dreadful disease.
Professor Jørgen Vestbo, study lead on behalf of the BRC.
Our addressing health inequalities in research features a range of voices from across NIHR Manchester BRC, CRF and MFT. The opening blog by Dr Bella Starling, Co-Director of Public Programmes, sets out the shared vision that everyone in our increasingly diverse society should benefit from translational research. Other blogs within the series give more specific examples of work taking place across the organisation. It is a living series, meaning blogs will continue to be added over time.
- How can translational research benefit those who might need it the most? – By Dr Bella Starling
- Health inequalities in Greater Manchester – why they exist and what we are doing to address it – by Tracy Grey
- How we are using data to address health inequalities in research – by Gareth Adaway
- Public involvement and engagement in the COVID-19 crisis – by Dr Emily Howlett
Tips for researchers
Our guidance to help researchers reduce health inequalities.