Invisible health inequalities: indirect discrimination and the life course approach

The NHS and the wider UK public health strategy have adopted a life course approach, aiming to provide timely, appropriate care across the lifespan to reduce health inequalities. However, implicit forms of age-related discrimination continue to influence how healthcare is delivered. Often embedded in clinical norms, service design, and data collection priorities, these biases can result in gaps in provision and contribute to inequitable health outcomes—even when they are not overt or intentional. 

Evidence indicates that older adults may face assumptions about limited benefit, leading to reduced referrals or delayed treatment. Adolescents frequently encounter fragmented and poorly coordinated mental health services, while women in midlife often struggle to access adequate care for menopause and chronic pain. These patterns often intersect with other structural disadvantages—such as those related to ethnicity, socioeconomic status, or digital exclusion—exacerbating health inequalities and undermining trust in the health system. 

This project aims to develop a clearer understanding of how health systems can better identify and respond to age-related biases, particularly as they intersect with social disadvantage, in order to support truly inclusive care across the life course. It will involve two stages: (i) an empirical phase, using selected case studies to examine how indirect and institutional forms of discrimination manifest in practice; and (ii) a normative phase, offering an ethical analysis of how these forms of discrimination ought to be addressed through more just and inclusive policy and service design.