How integrated care systems address health inequalities

Key messages

• integrated care systems place increasing emphasis on health inequalities within strategic plans
• place-based working and collaboration beyond traditional health and care boundaries offer potential to address wider determinants of health
• integrated approaches may improve equity in access to services and support healthier behaviours
• there is substantial variation across systems in how inequalities are defined, prioritised and addressed
• many plans lack detailed strategies or clear metrics to evaluate progress on equity
• in some systems, equity appears as a secondary aim rather than a central organising principle.

Policy implications

• neighbourhood health and care approaches may need clearer accountability for equity outcomes
• consistent frameworks and metrics could support comparability and learning across systems
• partnerships with non-health sectors require deeper and more sustained engagement
• equity may need to be embedded as a core principle rather than an add-on within system plans.

Gaps

• limited evidence on whether stated strategies translate into measurable reductions in inequalities
• lack of longitudinal evaluation of integrated care system approaches
• limited insight into how neighbourhood-level action aligns with system-wide equity goals.

Commentary
This paper highlights the ambition within integrated care systems to address health inequalities through place-based and integrated approaches. The neighbourhood focus and emphasis on cross-sector collaboration provide a foundation for tackling not only access to services, but also the wider social determinants that shape health outcomes.

However, the analysis reveals uneven commitment and capacity across systems. While some integrated care systems articulate clear intentions around equity, others lack detailed strategies or measurable goals. From a care equity perspective, this variability risks reinforcing geographic disparities rather than reducing them.

The findings also suggest that collaboration with non-health partners is inconsistent. Where partnerships are underdeveloped, opportunities to influence housing, employment and community infrastructure may be missed, limiting the potential impact of neighbourhood health and care.

Importantly, the paper raises questions about whether equity is driving system design or being addressed retrospectively. Without embedding equity as a core organising principle, integrated care systems may struggle to translate place-based working into meaningful reductions in inequality.

Overall, the study indicates that neighbourhood health and care has significant potential to support equity, but this depends on the depth of strategic commitment, clarity of measurement and the strength of cross-sector partnerships within integrated care systems.