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Addressing health inequalities

Through the work of the NIHR Manchester Biomedical Research Centre (BRC), NIHR Manchester Clinical Research Facility (CRF) and Manchester University NHS Foundation Trust (MFT) – which hosts both the BRC and CRF – we aim to reduce health inequalities by increasing diversity and research participation across Greater Manchester (GM) and reducing social inequality.

The Greater Manchester Health and Social Care Partnership had developed seven priorities based on the poorest health outcomes across GM:

The seven priorities

  1. More GM children will reach a good level of development cognitively, socially and emotionally.
  2. Fewer GM babies will have a low birth weight, resulting in better outcomes for the baby and less cost to the health system.
  3. More GM families will be economically active and family incomes will increase.
  4. Fewer people will die early from cardio-vascular disease.
  5. Fewer people will die early from cancer.
  6. Fewer people will die early from respiratory disease.
  7. More people will be supported to stay well and live at home for as long as possible.

Our approach to improving health inequalities is to try to make our research more accessible and inclusive. We will 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.

Case studies

Addressing health inequalities through our research: how we do it

Cancer 

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


Respiratory disease

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.


Blog series

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.

Tips for researchers

Our guidance to help researchers reduce health inequalities.