Health inequalities are differences in health outcomes between different groups of people, caused by a range of factors including socio-economic status, ethnicity, gender, and geography. 

According to the Kings Fund health inequalities are unfair and avoidable, and are a significant challenge for health systems around the world. In the UK for example, people living in the most deprived areas are more likely to die prematurely and experience a range of health problems than those living in more affluent areas. This needs to change.

Applying co-design techniques to the design of health services and products means involving marginalised groups as well as mainstream users throughout research and design phases. Marginalised groups may include people from ethnic minority backgrounds, disabled people, and people from low-income households.

This means we gain a better understanding of their specific health needs and experiences. Ensuring these needs are accounted for will achieve better health outcomes and reduced inequalities.

Involving marginalised groups in research can also help to address issues of power and control in the design process. By giving these groups a voice, we ensure their perspectives are heard and taken into account, rather than solutions simply being imposed by the system.
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Reaching those who need it most

One of the challenges of human centered design in healthcare is that many people who are most in need of healthcare services are also those who may have the least access to them. For example, people from low-income households may struggle to access healthcare services due to financial barriers, while people from remote areas may struggle to access healthcare services due to geographical barriers.

And as the World has gone digital, people with low digital skills are being left behind. It becomes harder to access health services if you struggle to book an appointment online or use the NHS app. Many of those most in need of healthcare are also those with the lowest digital skills.
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Amplifying needs

To address these challenges, we need to amplify the needs of these groups when we are  designing health services. For example, this might involve providing alternative access points for people who have difficulty accessing services online, such as phone or in-person appointments, as well as ensuring that digital services are intuitive and easy to use for people with low digital skills.

Reducing barriers to health services also involves designing them in a culturally sensitive way. By involving groups from across society in research and design phases, we ensure we take into account different cultural beliefs and practices, ensuring that services are designed in a way that is respectful and appropriate to these cultures.
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Examples

When we worked with NHS Gloucestershire to explore ways to reduce barriers to mental health support, we invested time and effort in working with vulnerable young people to design a new tool to help find support. Involving people with low digital skills led to the insight that for this group the tool would get most uptake if it also worked via text message. 

This approach led to the launch of a mental health support finder that is being used by thousands of young people every month and was awarded highly commended in the HSJ Healthtech Partnership of the Year awards.

Examples elsewhere of ways human centred design has been used to mitigate health inequalities include:

Maternity Services

In the UK, maternal mortality rates are significantly higher among women from ethnic minority backgrounds compared to white British women. To address this issue, the NHS has been using user-centered design to improve maternity services. This has included developing a toolkit for healthcare providers to improve cultural awareness and understanding, as well as involving women from ethnic minority backgrounds in the design of maternity services.

mDiabetes Program in India

The mDiabetes program in India is a text messaging program designed to raise awareness about diabetes and provide tips for diabetes prevention and management. The program was developed using user-centered design principles and has improved diabetes knowledge, increased self-care behaviors, and reduced diabetes risk particularly among people from low-income backgrounds. 

Healthcare App for Disabled People in Canada

A healthcare app called 'Health Myself' was developed for people with disabilities in Canada, using user-centered design principles. The app allows people to access their medical records, book appointments, and communicate with their healthcare providers in a way that is accessible and user-friendly for people with disabilities. The result: better access to healthcare services and information, increased empowerment and autonomy.
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Broader strategy

Co-design and human centred design has an important role to play in mitigating health inequalities and has real impact, but it is by no means a silver bullet.

It needs to be a component of a broader strategy including policies that address social determinants of health, such as poverty, education, and housing, as well as efforts to address discrimination and promote social inclusion. Crucially, the funding needs to be in place.

We need to make sure healthcare services are accessible to everyone, regardless of their ethnicity, socio-economic status or digital skills.

"Of all the forms of inequality, injustice in health is the most shocking and inhuman." Dr. Martin Luther King