Getting to the Roots of Health Inequality

Dai Davies argues that occupational therapists’s holistic approach to care can play a key part in health equity.

No person comes alone when they first access health and social care services.

They come with a story, a set of circumstances and a cultural background that have shaped their lives and affected their health and wellbeing. 

There is no escaping the fact that Covid 19 has hit the poorest neighbourhoods in Wales the hardest.

Many people are unfortunately caught up in a complex web of health inequalities where the area you were born in can have a direct effect on how long they live. These inequalities have been long known but have been amplified by the recent pandemic. There is no escaping the fact that Covid 19 has hit the poorest neighbourhoods in Wales the hardest.

We, the Royal College of Occupational Therapists (RCOT), represent around 1900 Occupational Therapists who provide health & social care services throughout Wales.

Our members report they are seeing patients with greater needs and complexity. Older people who have been left in cold damp housing, children who have missed therapy in school and family members having to choose between staying at home to care for a loved one or returning to work to provide an income. This has had a direct impact how occupational therapists deliver their services

Wales does have a strong policy and legislative background in working towards equality. However our members worry the operational realities have yet to catch up with the legislative rhetoric. There are so many obvious pressures and challenging demands on the Welsh public purse that addressing health inequalities and their causes may not be seen as an immediate priority by health and social care providers. The complexity of tackling these societal issues and the range of organizations required to work together to do so also put health inequalities in the ‘too difficult pile’.

As part of Occupational Therapy Week 2021, RCOT is publishing a new report, Roots of Recovery. It offers practical steps to highlight where occupational therapists can be deployed to maximum effect to help build health equity, and – long-term – we want to show that this will help alleviate pressure on NHS and social care budgets in Wales

We are arguing that access to occupational therapy needs to be early and easy, from the cradle to the grave. It needs to be fair to population groups who have been known to struggle to gain access to services they require.

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Occupational therapy is still predominantly accessed through secondary and tertiary services.  Our services should be targeted where it has the greatest impact. Providing early interventions at primary care, working in schools to support children’s emotional & physical wellbeing, designing rehabilitation services that meets the needs of the whole person. The Welsh government’s own long term plan, A Healthier Wales, talks at length about moving services closer to their communities. This should be accelerated.

Solutions are shaped by drawing organisations together with a shared understanding of the needs and wishes of the local population. Services and workforces need to reflect the culture of the communities that they serve and have a shared understanding of the desired outcomes for the community and the service.

“What matters” becomes an artificial performance measure rather than what matters to the individual experience of a person. 

Occupational therapists are trained not to merely address the health condition(s) in front of them but to support the person looking at all the environmental, cultural, and social factors that exist in a person’s life to make them who they are. 

The “what matters to you” conversations are a fundamental cornerstone of Welsh health and social care delivery, but too often operational pressures are focused on getting the person quickly through the system. “What matters” becomes an artificial performance measure rather than what matters to the individual experience of a person. 

“How can we help you return to work?” “Is your home suitable for your needs?” “ How can we support you return to activities that you enjoy and love?” These are some of the questions that we should be asking alongside focused questions on a person’s medical condition.

We want Welsh government, NHS leaders and social care commissioners to act. We believe that a long-term strategy which targets resources towards the allied health professions will expand not only health provision, but also the vital rehabilitation services needed as we continue to deal with the legacy of the pandemic.


All articles published on the welsh agenda are subject to IWA’s disclaimer.

Dai Davies is Professional Practice Lead for Wales for the Royal College of Occupational Therapists.

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