Health inequalities are differences in health across the population, and between different groups in society, that are systematic, unfair and avoidable.
They are caused by the conditions in which we are born, live, work and grow. These conditions influence how we think, feel and act and can affect both our physical and mental health and wellbeing.
Which groups experience health inequalities?
Health inequalities can be experienced by people grouped by a range of different factors including:
- socioeconomic status and deprivation
- sharing certain protected characteristics
- belonging to vulnerable or excluded groups of society
- geography.
These factors often overlap, meaning people can fall into combinations of these categories. This can compound the severity of health inequalities experienced.
What are the effects of health inequalities?
Health inequalities can be seen and measured through differences in:
- prevalence of conditions and mortality
- behavioural risks to health such as smoking
- the wider determinants of health such as housing and employment
- access to care
- the quality and experience of healthcare services.
The impact of health inequalities was starkly exposed and exacerbated by COVID-19. This is because the pandemic showed how inequalities increase the risk of becoming ill among some groups in society.
Population groups commonly considered for health inequalities
Source: The King's Fund
How NICE can help you tackle health inequalities
Reducing health inequalities is a core part of our DNA. In fact it’s one of our core principles. So, our guidance supports strategies that improve population health as a whole, while offering particular benefit to the most disadvantaged.
We consider the protected characteristics stated in the Equality Act 2010. We also consider inequalities arising from socioeconomic factors and the circumstances of vulnerable groups of people. These include looked-after children and people who are homeless.
By incorporating our recommendations into your work, you can ensure the care you provide is:
- effective
- reduces inequalities
- makes efficient use of resources.
Reducing health inequalities is a core part of our DNA. In fact it's one of our core principles.
NICE and the adapted Labonte model
The government uses Labonte R Health promotion and empowerment: Practice Frameworks: Centre for Health promotion, University of Toronto; 1993, as a simple, but effective, map of the causes of health inequalities. This can guide effective strategies to reduce them.
System map of the causes of health inequalities - adapted Labonte model
Source: Public Health England
The model captures the various factors that impact on our health. It highlights where they come from and how they interact with each other. And it shows how interventions must focus on treating place, and not just people.
We have mapped our relevant guidance to this framework.
Factors that determine health and wellbeing
Use these dropdowns to view guidance and advice that directly relate to those factors that determine health and wellbeing.
Adapted Labonte mapping
Wider determinants of health
Employment and quality of work
NG146 Workplace health: long-term sickness absence and capability to work
NG13 Workplace health: management practices
QS202 Workplace health: long-term sickness absence and capability to work
QS147 Healthy workplaces: improving employee mental and physical health and wellbeing
PH13 Physical activity in the workplace
NG209 Tobacco: preventing uptake, promoting quitting and treating dependence Section 1.9
NG10 Violence and aggression: short-term management in mental health, health and community settings
NG90 Physical activity and the environment
Education and skills
PH40 Social and emotional wellbeing: early years
NG135 Alcohol interventions in secondary and further education
NG205 Looked-after children and young people
NG93 Learning disabilities and behaviour that challenges: service design and delivery
PH17 Physical activity for children and young people
NG223 Social, emotional and mental wellbeing in primary and secondary education
Housing
NG6 Excess winter deaths and illness and the health risks associated with cold homes
QS117 Preventing excess winter deaths and illness associated with cold homes
NG149 Indoor air quality at home
PH30 Unintentional injuries in the home: interventions for under 15s
PH29 Unintentional injuries: prevention strategies for under 15s
NG74 Intermediate care including reablement
CG161 Falls in older people: assessing risk and prevention
QS107 Preventing unintentional injury in under 15s
NG214 Integrated health and social care for people experiencing homelessness
Natural and built environment
NG70 Air pollution: outdoor air quality and health
NG149 Indoor air quality at home
QS181 Air pollution: outdoor air quality and health
NG90 Physical activity and the environment
PH31 Unintentional injuries on the road: interventions for under 15s
PH29 Unintentional injuries: prevention strategies for under 15s
Power and discrimination
NG108 Decision making and mental capacity
QS194 Decision making and mental capacity
CG189 Obesity: identification, assessment and management
NG93 Learning disabilities and behaviour that challenges: service design and delivery
QS101 Learning disabilities: behaviour that challenges
NG204 Babies, children and young people's experience of healthcare
Psycho-social factors
Isolation
NG32 Older people: independence and mental wellbeing
NG22 Older people with social care needs and multiple long-term conditions
PH16 Mental wellbeing in over 65s: occupational therapy and physical activity interventions
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
CG161 Falls in older people: assessing risk and prevention
PH50 Domestic violence and abuse: multi-agency working
QS116 Domestic violence and abuse
CG89 Child maltreatment: when to suspect maltreatment in under 18s
Perceived level of control
Health behaviours
Smoking
NG209 Tobacco: preventing uptake, promoting quitting and treating dependence
QS82 Smoking: reducing and preventing tobacco use
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
PH15 Cardiovascular disease: identifying and supporting people most at risk of dying early
Diet
PH11 Maternal and child nutrition
PH27 Weight management before, during and after pregnancy
QS24 Nutrition support in adults
PH53 Weight management: lifestyle services for overweight or obese adults
PH47 Weight management: lifestyle services for overweight or obese children and young people
PH25 Cardiovascular disease prevention
CG189 Obesity: identification, assessment and management
PH42 Obesity: working with local communities
QS127 Obesity: clinical assessment and management
QS111 Obesity in adults: prevention and lifestyle weight management programmes
QS94 Obesity in children and young people: prevention and lifestyle weight management programmes
NG7 Preventing excess weight gain
PH35 Type 2 diabetes prevention: population and community-level interventions
Alcohol
NG135 Alcohol interventions in secondary and further education
CG100 Alcohol-use disorders: diagnosis and management of physical complications
PH24 Alcohol-use disorders: prevention
QS83 Alcohol: preventing harmful use in the community
QS11 Alcohol-use disorders: diagnosis and management
QS188 Coexisting severe mental illness and substance misuse
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
Substance misuse
CG51 Drug misuse in over 16s: psychosocial interventions
NG64 Drug misuse prevention: targeted interventions
CG52 Drug misuse in over 16s: opioid detoxification
PH52 Needle and syringe programmes
QS23 Drug use disorders in adults
NG46 Controlled drugs: safe use and management
Physical activity
NG90 Physical activity and the environment
PH17 Physical activity for children and young people
PH13 Physical activity in the workplace
PH44 Physical activity: brief advice for adults in primary care
PH54 Physical activity: exercise referral schemes
PH41 Physical activity: walking and cycling
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
NG7 Preventing excess weight gain
PH27 Weight management before, during and after pregnancy
QS183 Physical activity: encouraging activity in the community
QS84 physical activity for NHS staff, patients and carers
NG57 Physical health of people in prison
QS156 Physical health of people in prisons
Other health behaviours
NG183 Behaviour change: digital and mobile health interventions
PH6 Behaviour change: general approaches
PH49 Behaviour change: individual approaches
NG34 Sunlight exposure: risks and benefits
NG63 Antimicrobial stewardship: changing risk-related behaviours in the general population
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
NG218 Vaccine uptake in the general population
QS145 Vaccine uptake in under 19s
NG103 Flu vaccination: increasing uptake
QS190 Flu vaccination: increasing uptake
PH43 Hepatitis B and C testing: people at risk of infection
Physiological impacts
High blood pressure
NG136 Hypertension in adults: diagnosis and management
NG133 Hypertension in pregnancy: diagnosis and management
QS35 Hypertension in pregnancy
PH25 Cardiovascular disease prevention
PH15 cardiovascular disease: identifying and supporting people most at risk of dying early
QS100 Cardiovascular risk assessment and lipid modification
NG238 Cardiovascular disease: risk assessment and reduction, including lipid modification
Anxiety/depression
CG113 Generalised anxiety disorder and panic disorder in adults: management
CG159 Social anxiety disorder: recognition, assessment and treatment
NG116 Post-traumatic stress disorder
CG123 Common mental health problems: identification and pathways to care
CG31 Obsessive-compulsive disorder and body dysmorphic disorder: treatment
CG91 Depression in adults with a chronic physical health problem: recognition and management
QS8 Depression in adults: recognition and management
NG134 Depression in children and young people: identification and management
QS48 Depression in children and young people
CG123 Common mental health problems: identification and pathways to care
NG105 Preventing suicide in community and custodial settings
NG225 Self-harm: assessment, management and preventing recurrence
NG66 Mental health of adults in contact with the criminal justice system
NG222 Depression in adults: treatment and management
HTE8 Digitally enabled therapies for adults with depression: early value assessment
HTE9 Digitally enabled therapies for adults with anxiety disorders: early value assessment
Diabetes
NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management
QS125 Diabetes in children and young people
NG3 Diabetes in pregnancy: management from conception to the postnatal period
NG19 Diabetic foot problems: prevention and management
NG28 Type 2 diabetes in adults: management
PH35 Type 2 diabetes prevention: population and community-level interventions
PH38 Type 2 diabetes: prevention in people at high risk
NG17 Type 1 diabetes in adults: diagnosis and management
Obesity
QS127 Obesity: clinical assessment and management
CG189 Obesity: identification, assessment and management
PH42 Obesity: working with local communities
QS111 Obesity in adults: prevention and lifestyle weight management programmes
QS94 Obesity in children and young people: prevention and lifestyle weight management programmes
NG7 Preventing excess weight gain
PH27 Weight management before, during and after pregnancy
PH53 Weight management: lifestyle services for overweight or obese adults
PH47 Weight management: lifestyle services for overweight or obese children and young people
PH11 Maternal and child nutrition
Multimorbidity
NG56 Multimorbidity: clinical assessment and management
NG22 Older people with social care needs and multiple long-term conditions
QS132 Social care for older people with multiple long-term conditions
QS188 Coexisting severe mental illness and substance misuse
CG123 Common mental health problems: identification and pathways to care – in depression section
Mapping NICE guidance to Core20PLUS5
We’ve mapped relevant NICE guidance and advice to NHS England’s Core20PLUS5 for children and young people, and for adults.
Core20PLUS5 – children and young people
Download a PDF of the above Core20PLUS5 children and young people infographic.
Source: NHS England.
Asthma
Shared learning examples (case studies)
Liverpool Healthy Homes programme: delivering NICE Guideline NG6 'Excess winter deaths and morbidity and the health risks associated with cold homes'. Liverpool Healthy Homes Programme (HHP) acts as a central hub; addressing wellbeing, the causes of health inequalities and tackling poor housing conditions, primarily through the use of surveys carried out by advocates in area based schemes, and Environmental Health Practitioners utilising the Housing Health and Safety Rating System and a large network of referral partners.
Diabetes
NICE guidelines
NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management
NG19 Diabetic foot problems: prevention and management
NG203 Chronic kidney disease: assessment and management
NG7 Preventing excess weight gain
PH47 Weight management: lifestyle services for overweight or obese children and young people
NICE quality standards
Shared learning examples (case studies)
Young Adult Diabetes: Engaging to improve; outcomes of the young adult clinic restructure. Royal Liverpool & Broadgreen University Hospitals NHS Trust redesigned their young adult diabetes clinic to achieve their vision of having a structured, patient-led, flexible clinic service. Aims included improving access to the clinic service to increase engagement and establishing a local peer-support platform to aid in patient empowerment and self-management
Epilepsy
NICE guidelines
NICE quality standards
Oral health
NICE quality standards
Shared learning examples (case studies)
Designed to Smile - working to improve oral healthcare for children. The Designed to Smile Programme is a key element of the National Oral Health Improvement Plan, covering all of Wales, focused on targeting settings in areas of high need and is supplemented by raising awareness of the importance of oral health and encouraging a whole-school approach. Focuses on effectively reducing levels of decay by applying fluoride to children’s teeth by means of supervised tooth brushing and/or the application of fluoride varnish and the application of fissure sealants.
Mental health
NICE guidelines
NG134 Depression in children and young people: identification and management
NG223 Social, emotional and mental wellbeing in primary and secondary education
NG69 Eating disorders: recognition and treatment
CG123 Common mental health problems: identification and pathways to care relates to care for people aged 18 and over with common mental health problems, with a focus on primary care, however includes useful recommendations on Improving access to services.
NG87 Attention deficit hyperactivity disorder: diagnosis and management
CG128 Autism spectrum disorder in under 19s: recognition, referral and diagnosis
CG185 Bipolar disorder: assessment and management
CG78 Borderline personality disorder: recognition and management
CG77 Antisocial personality disorder: prevention and management
CG155 Psychosis and schizophrenia in children and young people: recognition and management
NG225 Self-harm: assessment, management and preventing recurrence
CG159 Social anxiety disorder: recognition, assessment and treatment
CG31 Obsessive-compulsive disorder and body dysmorphic disorder: treatment
NG135 Alcohol interventions in secondary and further education
PH24 Alcohol-use disorders: prevention
NG53 Transition between inpatient mental health settings and community or care home settings
NICE quality standards
QS142 Learning disability: identifying and managing mental health problems
QS48 Depression in children and young people
QS39 Attention deficit hyperactivity disorder
QS102 Bipolar disorder, psychosis and schizophrenia in children and young people
QS188 Coexisting severe mental illness and substance misuse
Shared learning examples (case studies)
Innovative ways of engaging with Black and Minority Ethnic (BME) communities to improve access to psychological therapies. As part of the Government's Improving Access to Psychological Therapies (IAPT) agenda, group-based interventions have been rolled out through local mental health services across England. NICE guidance CG90 for recognition and management of depression in adults, has recommended group therapy for those with persistent sub-threshold depressive symptoms or mild to moderate depression. In pursuit of this agenda and recognising that BME communities face particular and culturally sensitive barriers to accessing these services, Birmingham and Solihull Mental Health NHS Foundation Trust, through the local ‘Birmingham Healthy Minds’ initiative, has adapted their local service. They have developed a culturally sensitive treatment group where patients can feel that their ethnic, cultural and spiritual beliefs were understood by the group facilitator and where specific barriers to access for these communities are addressed.
Transforming Mental Health Care for Children and Young People with Long-Term Conditions: Mental Health and Psychological Wellbeing Drop-In Centre. Great Ormond Street Hospital for Children NHS Foundation Trust’s project aims to evaluate the clinical and cost effectiveness of NICE compliant low intensity psychological interventions for emotional and behavioural problems to children with physical illnesses at Great Ormond Street Hospital. Identifying mental ill-health and offering evidence-based treatment in conjunction with physical health treatment will immediately facilitate integrated care and ensure equitable access to treatment.
General priniciples
NICE guidelines
NG204 Babies, children and young people's experience of healthcare
NG44 Community engagement: improving health and wellbeing and reducing health inequalities
NG183 Behaviour change: digital and mobile health interventions
PH6 Behaviour change: general approaches
PH49 Behaviour change: individual approaches
If you would like a copy of the detailed mapping, including the specific recommendations focussing on areas of health inequality, please email healthinequalities@nice.org.uk.
Maternity
Ensuring continuity of care for women from Black, Asian and minority ethnic communities and from the most deprived groups.
Antenatal care (NG201) covers the routine antenatal care that women and their babies should receive. It aims to ensure that pregnant women are offered regular check ups, information and support.
Antenatal and postnatal mental health: clinical management and service guidance (CG192) covers recognising, assessing and treating mental health problems in women who are planning to have a baby, are pregnant, or have had a baby or been pregnant in the past year.
Antenatal care (QS22) covers the routine antenatal care that women and their babies should receive during pregnancy. It describes high-quality care in priority areas for improvement.
Tools to put our guidance into practice
Use our Schedule of antenatal appointments
Read the NICE impact report on maternity for highlights on progress made by the healthcare system in implementing NICE guidance.
Severe mental illness
Ensure annual physical health checks for people with SMI to at least nationally set targets.
Bipolar disorder: assessment and management (CG185) covers recognising, assessing and treating bipolar disorder (formerly known as manic depression) in children, young people and adults.
Bipolar disorder in adults (QS95) covers recognising, assessing and managing bipolar disorder in adults (aged 18 and over) in primary and secondary care. It describes high-quality care in priority areas for improvement.
Psychosis and schizophrenia in adults (QS80) covers treating and managing psychosis and schizophrenia in adults (aged 18 and over) in primary, secondary and community care.
Promoting health and preventing premature mortality in black, Asian and other minority ethnic groups (QS167) covers promoting health and preventing premature mortality among black, Asian and other minority ethnic groups.
Tools to put these recommendations into practice
Quality standard service improvement template helps providers make an initial assessment of their service compared with a selection of quality statements, recording an action plan and monitoring quality improvement over time.
Bipolar disorder: assessment and management (CG185) baseline assessment template, can be used to evaluate current practice and plan actions to meet the recommendations.
Psychosis and schizophrenia in adults: prevention and management (CG178) baseline assessment template, can be used to evaluate current practice and plan actions to meet the recommendations.
Rehabilitation for adults with complex psychosis (NG181) baseline assessment template, can be used to evaluate current practice and plan actions to meet the recommendations.
A case study from Bradford on Improving physical health for people with serious mental illness (SMI)
A case study from Central and North West London on Improving the physical health of people with serious mental illness: A quality improvement approach
The Lester UK Adaptation: Positive Cardiometabolic Health Resource is a Cardiometabolic Health Resource from the Royal College of Psychiatrists is an intervention framework for people experiencing psychosis and schizophrenia, supporting the recommendations relating to monitoring physical health in the NICE guidelines.
Respiratory
A clear focus on Chronic Obstructive Pulmonary Disease (COPD) driving up uptake of Covid, Flu and Pneumonia vaccines to reduce infective exacerbations and emergency hospital admissions due to those exacerbations.
Chronic pulmonary disease in over 16s: diagnosis and management (NG115) covers diagnosing and managing chronic obstructive pulmonary disease or COPD (which includes emphysema and chronic bronchitis) in people aged 16 and older.
Flu vaccinations: increasing uptake (NG103) describes ways to increase awareness and how to use all opportunities in primary and secondary care to identify people who should be encouraged to have the vaccination.
Vaccine uptake in the general population (NG218) supports the aims of the NHS Long Term Plan, which includes actions to improve immunisation coverage by GPs (including the changes to vaccinations and immunisations detailed in the 2021/2022 and 2022/2023 GP contracts) and support a narrowing of health inequalities.
Air pollution: outdoor air quality and health (NG70) covers road-traffic-related air pollution and its links to ill health. It aims to improve air quality and so prevent a range of health conditions and deaths.
Indoor air quality at home (NG149) covers indoor air quality in residential buildings. It aims to raise awareness of the importance of good air quality in people's homes and how to achieve this.
Flu vaccination: increasing uptake (QS190) covers increasing the uptake of flu vaccination among people who are eligible. It describes high-quality care in priority areas for improvement.
Air pollution: outdoor air quality and health (QS181) covers road-traffic-related air pollution and its impact on health. It describes high-quality actions in priority areas for improvement.
Tools to put these recommendations into practice
2 visual summaries based on Vaccine uptake in the general population (NG218)
A 2-page visual summary on actions to improve indoor air quality
Quality standard service improvement template helps providers make an initial assessment of their service compared with a selection of quality statements, recording an action plan and monitoring quality improvement over time.
Baseline assessment template used to evaluate current practice and plan activity to meet the recommendations.
Resource impact report and template estimate the costs or savings (resource impact) associated with technologies and guidelines so you can plan for and implement guidance.
Read the NICE impact report on respiratory conditions
Clinical knowledge summaries (CKS) provide primary care practitioners with a readily accessible summary of the current evidence base and practical guidance on best practice: COPD; Immunizations: pneumococcal; seasonal influenza; COVID vaccine.
myCOPD for managing chronic obstructive pulmonary disease (MTG68) is an app that helps people with COPD understand their condition and manage symptoms. It also has a pulmonary rehabilitation programme, so people can do this at home. myCOPD could be helpful for self-management and pulmonary rehabilitation in people with chronic obstructive pulmonary disease (COPD). There is currently not enough evidence to be able to recommend its use in the NHS. NICE recommends that further research should be done.
Take a look at the recommendations for research Flu vaccination: increasing update (NG 103).
Early cancer diagnosis
Early Cancer Diagnosis: 75% of cases diagnosed at stage 1 or 2 by 2028.
Suspected cancer: recognition and referral (NG12) covers the recognition and selection for referral or investigation in primary care of people of all ages, including children and young people, who may have cancer.
Suspected cancer (QS124) covers recognising and investigating symptoms of suspected cancer in primary care, helping you improve the quality of care you provide or commission.
Lung Cancer in adults (QS17) covers diagnosing and managing lung cancer in adults. It describes high-quality care in priority areas for improvement.
Breast Cancer (QS12) covers the care of people with breast cancer after they have been referred to a specialist team. It describes high-quality care in priority areas for improvement.
Dyspepsia and gastro-oesophageal reflux disease in adults (QS96) covers investigating and managing symptoms of dyspepsia (indigestion) and gastro-oesophageal reflux disease (heartburn or reflux) in adults (aged 18 and over).
Skin cancer (QS130) covers preventing, assessing, diagnosing and managing skin cancer (malignant melanoma and non-melanoma).
Brain tumours (primary) and brain metastases in adults (QS203) covers diagnosing, monitoring and managing any type of primary brain tumour or brain metastases in adults (aged 16 or over).
Ovarian Cancer (QS18) covers the recognition and initial management of ovarian cancer.
Pancreatic cancer (QS177) overs diagnosis of pancreatic cancer and management of pancreatic ductal adenocarcinoma in adults aged over 18.
Sarcoma (QS78) covers providing and organising services for people with sarcoma.
Tools to put these recommendations into practice
Quality standard service improvement template helps providers make an initial assessment of their service compared with a selection of quality statements, recording an action plan and monitoring quality improvement over time.
Baseline assessment template can be used to evaluate current practice and plan activity to meet the recommendations.
Case studies
An online cancer education platform for primary care which has been designed to improve cancer outcomes by facilitating earlier and faster diagnosis and improve patient experience. GatewayC: Improving early detection of cancer through e-learning for primary care.
Reflection of local experience and success of implementing NICE guidance for suspected cancer: recognition and referral (NG12) in Blackburn with Darwen CCG and East Lancashire CCG Overcoming the challenges of implementing the new NICE guidance for suspected cancer: recognition and referral.
Completing the NICE baseline assessment tool (accompanying NG12) led to service improvements in referral of patients with breast symptoms from primary care to secondary care in Brighton and Sussex Universities NHS Trust Symptomatic Breast Referral Resource Suite: Enhancing the Suspected Cancer Recognition and Referral Process.
The London and South East Sarcoma Network (LSESN) Sarcoma Advisory Group has developed referral, diagnostic and treatment pathways to tackle late referral and diagnosis of sarcoma. Developing and communicating effective pathways for patients with sarcoma in London and south East England.
NICE-endorsed resources
Referral guidance for suspected cancer in children and young people The Children’s Cancer and Leukaemia Group (CCLG) has produced a booklet that accurately reflects recommendations in the NICE guideline on recognition and referral for suspected cancer.
Oesophageal cancer: early diagnosis course GatewayC has produced an e-learning resource on oesophageal cancer: early diagnosis which accurately reflects recommendations in the NICE guideline on recognition and referral for suspected cancer.
Ovarian cancer: early diagnosis course GatewayC has produced an e-learning course on ovarian cancer: early diagnosis, which accurately reflects recommendations in the NICE guideline on recognition and referral for suspected cancer.
Symptomatic Breast Referral Resource Suite (SBRRS) Brighton and Sussex University Hospitals NHS Trust has produced a referral pack that accurately reflects recommendations in the NICE guideline on suspected cancer. It also supports statement 1 in the NICE quality standard on breast cancer.
A guide for GPs: referring people under the age of 50 for bowel cancer investigation Bowel Cancer UK has produced a factsheet that accurately reflects recommendations in the NICE guideline on suspected cancer. It also supports statement 3 in the NICE quality standard on suspected cancer.
Brain tumour: early diagnosis course GatewayC has produced an e-learning course on brain tumour: early diagnosis, which accurately reflects recommendations in the NICE guideline on recognition and referral for suspected cancer.
Lung cancer: early diagnosis course GatewayC has produced an e-learning course on lung cancer: early diagnosis, which accurately reflects recommendations in the NICE guideline on recognition and referral for suspected cancer.
The Cancer Maps Dr Ben Noble, associate clinical cancer lead at East Midlands strategic clinical network, has produced a referral algorithm that supports the recommendations in the NICE guideline on recognition and referral for suspected cancer.
Paediatric Musculoskeletal Matters (PMM) Newcastle University has produced a learning resource that supports clinical assessment recommendations in the NICE guidelines on suspected cancer and child maltreatment. In addition it also supports the NICE technology appraisal guidance on abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis and tocilizumab for the treatment of systemic juvenile idiopathic arthritis.
Rapid referral guidelines Macmillan Cancer Support have produced a referral toolkit that supports all of the recommendations, apart from those relating to specific childhood cancers, in the NICE guideline on suspected cancer: recognition and referral.
PET-CT reporting training programme (lymphoma, head and neck cancer, lung cancer, oesophageal cancer modules). The Christie NHS Foundation trust has produced e-learning that accurately reflects several NICE recommendations relating to diagnosis.
NICE Medtech innovation briefings
ADXBLADDER for detecting bladder cancer (MIB180) This technology is used to detect bladder cancer in people with symptoms associated with malignancy and to monitor for recurrence within the urogenital tract during follow-up after transurethral resection of a bladder tumour.
URO17 for detecting bladder cancer (MIB250) This technology is a urine-based biomarker test to detect bladder cancer in people with symptoms of bladder cancer. It is also used to monitor for recurrence during treatment follow up.
NICE Impact reports
NICE impact report - diagnostic pathology reviews how NICE guidance is used to improve the health and care of people.
NICE impact report - prostate cancer considers how NICE’s evidence based guidance can contribute to improvements in the care of people with prostate cancer.
NICE impact report - lung cancer considers how NICE’s evidence based guidance can contribute to improvements in the care of people with lung cancer.
Clinical knowledge summaries (CKS) - Cancer provide primary care practitioners with a readily accessible summary of the current evidence base and practical guidance on best practice.
Read our recommendations for research on suspected cancer: recognition and referral (NG12).
Hypertension case finding and optimal management and lipid optimal management
Cardiovascular disease: identifying and supporting people most at risk of dying early (PH15) aims to reduce the number of people who are disadvantaged, dying prematurely by ensuring people have better access to flexible, well-coordinated treatment and support.
Hypertension in adults: diagnosis and management (NG136) covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes.
Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238) covers identifying and assessing risk of cardiovascular disease (CVD) in adults without established CVD. It covers lifestyle changes and lipid-lowering treatment (including statins) for primary and secondary prevention of CVD, and includes guidance for people who also have diabetes or chronic kidney disease.
Hypertension in adults (QS28) covers managing hypertension in adults. It includes diagnosis and investigations, treatment and specialist referral.
Cardiovascular disease and lipid modification (QS100) covers identifying and assessing cardiovascular risk in adults and treatment to prevent cardiovascular disease.
Tools to help put our guidance into practice
Hypertension in adults: diagnosis and treatment - a 2-page visual summary on the recommendations for diagnosing and treating hypertension.
How do I control my blood pressure? Lifestyle options and choice of medicines - Patient decision aid and user guide and data sources.
Taking a statin to reduce the risk of coronary heart disease and stroke: a patient decision aid.
Hypertension in adults: diagnosis and management (NG136) baseline assessment template can be used to evaluate current practice and plan actions to meet the recommendations.
Cardiovascular disease: risk assessment and reduction, including lipid modification (NG238) baseline assessment template can be used to evaluate current practice and plan actions to meet the recommendations.
Hypertension in adults (QS28) Quality standard service improvement template helps providers make an initial assessment of their service compared with a selection of quality statements, recording an action pklan and monitoring quality improvement over time.
Cardiovascular risk assessment and lipid modification (QS100) Quality standard service improvement template helps providers make an initial assessment of their service compared with a selection of quality statements, recording an action plan and monitoring quality improvement over time.
Resource impact report and template associated with Hypertension in adults: diagnosis and management (NG136) may be helpful with business case development / costings.
Case studies
A community-centred pilot programme by the Race Equality Foundation to address health inequalities through targeted blood pressure awareness and testing in black African and Caribbean males. Community based approaches to addressing high blood pressure with black African and Caribbean men.
Local Clinical Effectiveness Group data demonstrated that blood pressure was not as well controlled in this group of patients compared to the rest of the population in City and Hackney CCG. Pharmacist led hypertension review project in Black (African and African-Caribbean origin) patients - Hackney CCG.
The East Berkshire CCG Medicines Optimisation Team used systematic audit to support practices in finding people who either had hypertension or were at risk of developing hypertension. Systematic case finding of people with hypertension – East Berkshire.
Further resources
NICE Clinical Knowledge Summaries (CKS) - hypertension provide primary care practitioners with a readily accessible summary of the current evidence base and practical guidance on best practice.
Read our recommendations for research on Hypertension in adults (NG136): diagnosis and management
NICE-endorsed resources
NHS England Statin intolerance pathway brings together multiple NICE guidance and technology appraisals into a single document, to support a consistent approach to the management of statin intolerance.
NHS England Lipid management national treatment algorithm and pathway - a summary of national guidance for lipid management for primary and secondary prevention of cardiovascular disease (CVD).
Smoking cessation
Tobacco: preventing uptake, promoting quitting and treating dependence (NG209) covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go.
Cardiovascular disease: identifying and supporting people most at risk of dying early (PH15) aims to reduce the number of people who are disadvantaged, dying prematurely by ensuring people have better access to flexible, well-coordinated treatment and support.
Tobacco: treating dependence (QS207) covers support and treatment to stop smoking and stop using smokeless tobacco, and harm-reduction approaches for people who are not ready to stop in one go. It describes high-quality care in priority areas for improvement.
Tools to help put our guidance into practice
Tobacco: treating dependence (QS207) Quality standard service improvement template facilitates an initial assessment of current service provision compared with a selection of quality statements; recording of an action plan and monitoring quality improvement over time.
Further resources
View our recommendations for research on Tobacco: preventing uptake, promoting quitting and treating dependence.
If you would like a copy of the detailed mapping, including the specific recommendations focussing on areas of health inequality, please email healthinequalities@nice.org.uk.
View our presentation on how our guidance supports the implementation of Core20PLUS5 (PowerPoint).
NICE and the Marmot Review
In 2008, Professor Sir Michael Marmot carried out a review of effective evidence-based strategies for reducing health inequalities in England.
- give every child the best start in life
- enable all children, young people and adults to maximise their capabilities and have control over their lives
- create fair employment and good work for all
- ensure healthy standard of living for all
- create and develop healthy and sustainable places and communities
- strengthen the role and impact of ill-health prevention.
We’ve mapped our guidance to each of these objectives.
Give every child the best start in life
Antenatal and postnatal health and care
QS115 Antenatal and postnatal mental health
CG192 Antenatal and postnatal mental health: clinical management and service guidance
NG3 Diabetes in pregnancy: management from preconception to the postnatal period
CG93 Donor milk banks: service operation
QS98 Nutrition: improving maternal and child nutrition
PH27 Weight management before, during and after pregnancy
PH11 Maternal and child nutrition
NG133 Hypertension in pregnancy: diagnosis and management
CG192 Antenatal and postnatal mental health: clinical management and service guidance
Child development
NG72 Developmental follow-up of children and young people born preterm
QS169 Developmental follow-up of children and young people born preterm
QS128 Early years: promoting health and wellbeing in under 5s
NG75 Faltering growth: recognition and management of faltering growth in children
NG205 Looked-after children and young people
QS31 Looked-after children and young people
CG89 Child maltreatment: when to suspect maltreatment in under 18s
QS128 Early years: promoting health and wellbeing in under 5s
NG223 Social, emotional and mental wellbeing in primary and secondary education
PH40 Social and emotional wellbeing: early years
Children’s physical and mental health
QS94 Obesity in children and young people: prevention and lifestyle weight management programmes
NG225 Self-harm: assessment, management and preventing recurrence
PH30 Unintentional injuries in the home: interventions for under 15s
PH31 Unintentional injuries on the road: interventions for under 15s
PH29 Unintentional injuries: prevention strategies for under 15s
QS107 Preventing unintentional injury in under 15s
NG87: Attention deficit hyperactivity disorder: diagnosis and management
CG170 Autism spectrum disorder in under 19s: support and management
NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management
NG69 Eating disorders: recognition and treatment
NG134 Depression in children and young people: identification and management
NG93 Learning disabilities and behaviour that challenges: service design and delivery
CG128 Autism spectrum disorder in under 19s: recognition, referral and diagnosis
QS55 Cancer services for children and young people
NG204 Babies, children and young people's experience of healthcare
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Wellbeing in early years and education
NG223 Social, emotional and mental wellbeing in primary and secondary education
PH40 Social and emotional wellbeing: early years
NG205 Looked-after children and young people
QS31 Looked-after children and young people
School/education-based guidance
NG223 Social, emotional and mental wellbeing in primary and secondary education
PH40 Social and emotional wellbeing: early years
NG205 Looked-after children and young people
NG93 Learning disabilities and behaviour that challenges: service design and delivery
PH17 Physical activity for children and young people
NG90 Physical activity and the environment
NG135 Alcohol interventions in secondary and further education
NG223 Social, emotional and mental wellbeing in primary and secondary education
Child health behaviours
QS59 Antisocial behaviour and conduct disorders in children and young people
CG77 Antisocial personality disorder: prevention and management
QS70 Bedwetting in children and young people
NG55 Harmful sexual behaviour among children and young people
NG68 Sexually transmitted infections: condom distribution schemes
QS98 Nutrition: improving maternal and child nutrition
PH30 Unintentional injuries in the home: interventions for under 15s
PH31 Unintentional injuries on the road: interventions for under 15s
PH29 Unintentional injuries: prevention strategies for under 15s
QS107 Preventing unintentional injury in under 15s
PH51 Contraceptive services for under 25s
PH47 Weight management: lifestyle services for overweight or obese children and young people
PH17 Physical activity for children and young people
Domestic violence and abuse
CG89 Child maltreatment: when to suspect maltreatment in under 18s
QS116 Domestic violence and abuse
PH50 Domestic violence and abuse: multi-agency working
NG223 Social, emotional and mental wellbeing in primary and secondary education
Create fair employment and good work for all
QS147 Healthy workplaces: improving employee mental and physical health and wellbeing
NG 212 Mental wellbeing at work
QS84 Physical activity: for NHS staff, patients and carers
NG146 Workplace health: long-term sickness absence and capability to work
QS202 Workplace health: long-term sickness absence and capability to work
NG13 Workplace health: management practices
PH13 Physical Activity in the Workplace
NG209 Tobacco: preventing uptake, promoting quitting, and treating dependence
NG10 Violence and aggression: short-term management in mental health, health and community settings
Ensure a healthy standard of living for all
Please note that this category in the Marmot report covers issues such as income, income protection, poverty and debt, social mobility. As NICE does not have guidance directly addressing these issues, we have interpreted this as a healthy standard of living for all from the viewpoint of health inclusion and empowerment.
NG96 Care and support of people growing older with learning disabilities
NG93 Learning disabilities and behaviour that challenges: service design and delivery
QS101 Learning disability: behaviour that challenges
QS187 Learning disability: care and support of people growing older
QS142 Learning disability: identifying and managing mental health problems
NG66 Mental health of adults in contact with the criminal justice system
QS163 Mental health of adults in contact with the criminal justice system
NG57 Physical health of people in prison
NG105 Preventing suicide in community and custodial settings
QS156 Physical health of people in prisons
QS194 Decision making and mental capacity
NG108 Decision-making and mental capacity
NG6 Excess winter deaths and illness and the health risks associated with cold homes
Create and develop healthy and sustainable places and communities
Environment
NG70 Air pollution: outdoor air quality and health
NG149 Indoor air quality at home
QS181 Air pollution: outdoor air quality and health
NG90 Physical activity and the environment
PH31 Unintentional injuries on the road: interventions for under 15s
PH29 Unintentional injuries: prevention strategies for under 15s
Housing
NG6 Excess winter deaths and illness and the health risks associated with cold homes
QS117 Preventing excess winter deaths and illness associated with cold homes
NG149 Indoor air quality at home
PH30 Unintentional injuries in the home: interventions for under 15s
PH29 Unintentional injuries: prevention strategies for under 15s
NG74 Intermediate care including reablement
CG161 Falls in older people: assessing risk and prevention
QS107 Preventing unintentional injury in under 15s
NG214 Integrated health and social care for people experiencing homelessness
Community-based guidance
QS148 Community engagement: improving health and wellbeing
NG44 Community engagement: improving health and wellbeing and reducing health inequalities
NG102 Community pharmacies: promoting health and wellbeing
QS196 Community pharmacies: promoting health and wellbeing
CG93 Donor milk banks: service operation
PH42 Obesity: working with local communities
NG22 Older people with social care needs and multiple long-term conditions
Strengthen the role and impact of ill health prevention
Smoking
NG209 Tobacco: preventing uptake, promoting quitting and treating dependence
QS82 Smoking: reducing and preventing tobacco use
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
PH15 Cardiovascular disease: identifying and supporting people most at risk of dying early
QS207 Tobacco: treating dependence
Diet/weight management/obesity
PH11 Maternal and child nutrition
QS24 Nutrition support in adults
PH25 Cardiovascular disease prevention
QS111 Obesity in adults: prevention and lifestyle weight management programmes
QS94 Obesity in children and young people: prevention and lifestyle weight management programmes
CG189 Obesity: identification, assessment and management
PH42 Obesity: working with local communities
QS127 Obesity: clinical assessment and management
NG7 Preventing excess weight gain
PH53 Weight management: lifestyle services for overweight or obese adults
PH47 Weight management: lifestyle services for overweight or obese children and young people
PH27 Weight management before, during and after pregnancy
PH35 Type 2 diabetes prevention: population and community-level interventions
PH38 Type 2 diabetes: prevention in people at high risk
NG17 Type 1 diabetes in adults: diagnosis and management
NG28 Type 2 diabetes in adults: management
Alcohol
NG135 Alcohol interventions in secondary and further education
QS83 Alcohol: preventing harmful use in the community
QS11 Alcohol-use disorders: diagnosis and management
CG100 Alcohol-use disorders: diagnosis and management of physical complications
PH24 Alcohol-use disorders: prevention
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
QS188 Coexisting severe mental illness and substance misuse
Substance misuse
QS188 Coexisting severe mental illness and substance misuse
CG51 Drug misuse in over 16s: psychosocial interventions
NG64 Drug misuse prevention: targeted interventions
CG52 Drug misuse in over 16s: opioid detoxification
PH52 Needle and syringe programmes
QS23 Drug use disorders in adults
NG46 Controlled drugs: safe use and management
High blood pressure
PH25 Cardiovascular disease prevention
PH15 Cardiovascular disease: identifying and supporting people most at risk of dying early
QS100 Cardiovascular risk assessment and lipid modification
NG136 Hypertension in adults: diagnosis and management
NG133 Hypertension in pregnancy: diagnosis and management
QS35 Hypertension in pregnancy
NG238 Cardiovascular disease: risk assessment and reduction, including lipid modification
Physical activity
NG90 Physical activity and the environment
PH17 Physical activity for children and young people
PH13 Physical activity in the workplace
PH44 Physical activity: brief advice for adults in primary care
PH54 Physical activity: exercise referral schemes
PH41 Physical activity: walking and cycling
QS84 Physical activity: for NHS staff, patients and carers
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
NG7 Preventing excess weight gain
PH27 Weight management before, during and after pregnancy
PH25 Cardiovascular disease prevention
QS183 Physical activity: encouraging activity in the community
NG57 Physical health of people in prison
QS156 Physical health of people in prisons
Oral Health
NG48 Oral health for adults in care homes
QS151 Oral health in care homes
QS139 Oral health promotion in the community
NG30 Oral health promotion: general dental practice
PH55 Oral health: local authorities and partners
CG19 Dental checks: intervals between oral health reviews
Mental health (ill health prevention)
QS137 Mental wellbeing and independence for older people
PH16 Mental wellbeing in over 65s: occupational therapy and physical activity interventions
QS50 Mental wellbeing of older people in care homes
NG225 Self-harm: assessment, management and preventing recurrence
NG222 Depression in adults: treatment and management
Immunisation and health protection
NG218 Vaccine uptake in the general population
QS145 Vaccine uptake in under 19s
NG103 Flu vaccination: increasing uptake
QS190 Flu vaccination: increasing uptake
PH43 Hepatitis B and C testing: people at risk of infection
Wellbeing of older people
CG161 Falls in older people: assessing risk and prevention
QS123 Home care for older people
QS137 Mental wellbeing and independence for older people
PH16 Mental wellbeing in over 65s: occupational therapy and physical activity interventions
QS50 Mental wellbeing of older people in care homes
NG22 Older people with social care needs and multiple long-term conditions
NG32 Older people: independence and mental wellbeing
QS132 Social care for older people with multiple long-term conditions
NG189 Safeguarding adults in care homes
QS117 Preventing excess winter deaths and illness associated with cold homes
NG96 Care and support of people growing older with learning disabilities
NG6 Excess winter deaths and illness and the health risks associated with cold homes
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
Sexual health (ill health prevention)
NG68 Sexually transmitted infections: condom distribution schemes
NG60 HIV testing: increasing uptake among people who may have undiagnosed HIV
NG55 Harmful sexual behaviour among children and young people
PH51 Contraceptive services for under 25s
QS157 HIV testing: encouraging uptake
NG221 Reducing sexually transmitted infections
General ill-health prevention
NG183 Behaviour change: digital and mobile health interventions
PH6 Behaviour change: general approaches
PH49 Behaviour change: individual approaches
QS107 Preventing unintentional injury in under 15s
NG34 Sunlight exposure: risks and benefits
QS61 Infection prevention and control
NG63 Antimicrobial stewardship: changing risk-related behaviours in the general population
NG16 Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset
Approaches to addressing health inequalities
The NHS 2022/23 priorities and operational planning guidance, sets a lead role for Integrated Care Systems in tackling health inequalities. It does this by building on the Core20PLUS5 approach. This highlights that people from socioeconomically deprived populations and certain ethnic groups experience poorer health. So, it's particularly important to focus preventative services on these groups.
The following NICE guidance can help integrated care systems when developing their approaches to addressing health inequalities:
NICE guidance
NG44/QS148: Community engagement: improving health and wellbeing and reducing health inequalities
PH6 Behaviour change: general approaches
PH49 Behaviour change: individual approaches
NG183 Behaviour change: digital and mobile health interventions
Case studies
Behaviour Change: Enabling Allied Health Professionals to have Healthy Conversations drawing on NICE Public Health Guidance for individual approaches to behaviour change (PH49) to deliver very brief, brief, extended brief and high intensity behaviour change interventions and programmes.
Blackburn with Darwen Integrated Wellbeing Service combined CCG funded condition management projects with a wide range of Public Health funded services as well as core Council to reduce Health Inequalities by helping people to make changes they wanted in their lifestyle to improve their health and wellbeing by offering practical advice and signposting into appropriate services.
Development of a Best Interest Decision Making Toolkit to support health and care professionals who work with those with cognitive impairment to achieve better outcomes. The toolkit demonstrates how to implement in practice, recommendations from NICE guidance NG108: Decision making and mental capacity and is used to structure, record, and evidence how a healthcare professional has worked in the best interest of a person.
Further resources
National Institute for Health and Care Excellence Primary Research Report 1: Community engagement – approaches to improve health: map of current practice based on a case study approach.
Shared decision making learning package Keele University and NICE have worked in partnership to develop an online learning package. This is suitable for all healthcare professionals and aims to equip people with the skills and knowledge they need to have good-quality shared decision-making conversations with the people they are caring for.
Standards framework for shared-decision-making support tools, including patient decision aids. A series of standards to support people using patient decision aids (PDAs) in assessing the usefulness and quality of a PDA. The framework will also be useful to those developing PDAs in enabling them to undertake a self-assessment of the quality of their tools and processes.
NICE-endorsed resource
Breaking Free Group has produced a confidential wellness and recovery support program for alcohol and drugs resource. Its content supports the implementation of recommendations in the NICE guideline on individual approaches to behaviour change. It also supports the NICE guideline on general approaches to behaviour change.
Contact us
For further information on our guidance and health inequalities please email healthinequalities@nice.org.uk.