Table 1

Addressing inequality from within health systems

Proposed actionWhat is it?How to do it
Screening for social risk factorsThe identification of patients who may benefit from greater support in one or more areas, including poverty, food insecurity, violence, unemployment and housing problems.Do ask, but ask sensitively. A useful resource of validated and adapted tools for this purpose can be found at:
As part of this we advocate gathering data through this process to make visible to local policymakers the need for greater support for children and families.
Social prescribingReferral for non-medical interventions to address the wider determinants of health identified through screeningReferral pathways may not exist; demand them locally; connect and partner with local third sector organisations for more joined-up care
On-Site Provision:
(A) In the Clinic
Some healthcare settings now hold basic provisions, including food, clothing and sanitary products, or access to community-based workers for children and families in desperate situations and without recourse to funds.Examples: fresh fruit in clinics; grab bags for vulnerable children; on-site financial advisers or link workers to facilitate access to benefits and local resources including food banks
(B) In the Emergency Department (ED)ED attendances can be a ‘cry for help’ and present opportunities to engage a wider range of support and follow-up to meet the needs of vulnerable children.Examples include Oasis youth violence and harm reduction support.
Refocusing local service provisionHow can local research and Quality Improvement (QI) efforts be conducted in ways that matter to both service users and health professionals so as to have the best chance to do good?Examples: Addressing poverty in clinical practice. Based on the initial work of trainee paediatricians in a London district general hospital to develop clinical surveillance tools and advice for the emergency department, there is now a growing network of clinicians using QI methodology to tackle inequality within health systems.
For more, see: and
Whole-system changeChildren and Young People’s Health Partnership is an integrated model of primary, secondary and community care that improves outcomes for children with the greatest need by meeting children and families where they are.