Health inequalities in the UK are well documented. But few conditions expose their scale as clearly as chronic obstructive pulmonary disease (COPD).
COPD is a serious, progressive lung disease that affects around 1.4 million people in the UK, with around two million more living undiagnosed.
However, her story is not just a clinical need. It is shaped by where people live, the air they breathe, the work they do and the opportunities available to them.
Seen through this lens, respiratory health becomes more than a medical issue, it becomes a barometer of inequality, providing a clear and measurable way to understand how disadvantage is distributed in society.
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There is a clear social gradient: people in more deprived areas are more likely to develop the disease earlier and experience worse outcomes. For example, those in the most deprived communities are more than twice as likely to be admitted to hospital for respiratory conditions, including COPD, than those in the least deprived.
This reflects a range of risk factors, including higher smoking rates, poorer air quality and exposure to harmful living and working conditions. Geography reinforces this pattern, with higher rates often seen in post-industrial cities and coastal communities, areas that have long faced economic and social challenges. These patterns show that inequality is not abstract, it is visible, measurable and deeply rooted in the country.
COPD captures both cause and effect. The same factors that increase risk also shape how early the disease is diagnosed and how well it is managed. After all, how long do people live?
However, its impact extends far beyond health. COPD contributes significantly to long-term illness, which in turn affects workforce inactivity, especially in areas that already face economic challenges and lower employment opportunities.
More than 2.5 million people in the UK are currently out of work due to long-term illness, the highest level on record.
One in four of the 3.4 million people living with COPD are of working age and the condition is estimated to cost the UK economy around £1.9 billion each year through lost productivity, healthcare use and informal care, with COPD accounting for 24 million lost working days each year.
This creates a vicious cycle. Poor health limits people’s ability to work, reducing income and opportunities, which in turn reinforces deprivation and increases exposure to drivers of ill health.
At the system level, the consequences are profound. Labor inactivity limits productivity, slows local growth and increases pressure on public services. Improving respiratory health is not only a clinical priority, but an important driver of productivity and a critical tool for supporting inclusive economic growth.
Those most affected by COPD are often those already served by the health system. They face barriers to early diagnosis, access to care and effective long-term management, meaning many are diagnosed later, when the disease is more advanced.
This worsens outcomes and puts avoidable pressure on the NHS; COPD accounts for 130,000 hospital admissions a year, equivalent to the population of a city like Exeter, making it the second most common cause of hospital admissions in England each year.
Without targeted interventions, these inequalities will widen as the underlying drivers of deprivation, environmental exposure and unequal access to care continue to persist.
There is growing recognition of the need to address place-based inequality, particularly in communities that feel left behind economically and socially. Respiratory health must be central to this agenda, providing a clear opportunity to improve health while supporting a stronger workforce and economy.
COPD provides a measurable way to identify where inequality is most acute and where action is most urgently needed.
Encouragingly, some parts of the country are already demonstrating what is possible. In some regions, targeted community case-finding and diagnostic centers are enabling early diagnosis and reduced hospital admissions.
One example is the Respiratory Transformation Partnership (RTP) – a new national coalition – bringing together the NHS, the Office for Life Sciences, health innovation networks, patient groups and four key industry partners, including Sanofi.
This initiative represents a deliberate system-wide investment in the way respiratory care is designed, delivered and scaled across the NHS. Together, these examples show that inequality is not inevitable, it can be reduced with the right focus, investment and coordination.
The challenge now is to scale up what works, ensuring that best practices are not confined to pockets of the system, but are consistently rolled out across the country.
Addressing COPD will require action at multiple levels. A step change is needed in the way the condition is identified and managed, alongside improved access to treatment and support.
A key priority is to improve diagnosis, especially in areas of higher prevalence and where patients are more likely to be diagnosed later. Access to testing needs to be consistent across the country, supported by a proactive approach to identifying those at risk and greater support for primary care to improve diagnostic accuracy.
There is also growing interest in how data and digital tools, including artificial intelligence, can help address this. Used responsibly, these tools can support clinicians to identify people at risk earlier and target interventions more effectively.
Their value lies in helping the system operate faster and more consistently, reducing avoidable hospital admissions and variation in care. They should support clinical judgment, not replace it.
This should be matched by a stronger focus on helping people stay well for longer. Access to pulmonary rehabilitation and primary care remains uneven, with many patients lacking the support needed to manage their condition effectively outside hospital.
Expanding community-based services, strengthening self-management, and prioritizing prevention will be critical.
At the same time, access to specialized care must become more timely and sustainable. Closer integration between primary and secondary care, alongside greater use of community, mobile and virtual services, can help reduce delays and ensure patients receive the right care at the right time, no matter where they live.
Without a coordinated approach along the way, existing disparities in access and outcomes will continue to persist and grow.
However, clinical care alone is not enough. Wider drivers of respiratory health such as smoking, air quality, housing and occupational exposure must also be tackled through co-ordinated action across government, the NHS, local authorities and industry.
A more targeted, country-based approach will be key, directing resources to areas of greatest need and using data to track progress and results. COPD is more than a disease.
It is a signal of where inequality is most deeply rooted. Improving respiratory health offers a tangible opportunity to reduce inequality, support labor force participation and foster more inclusive economic growth.
The question is not whether we can afford to act; that is if we can afford not to.
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