Health equity starts in the classroom: Why Social Science must help shape Medical Education
Health inequalities remain one of the most persistent challenges facing healthcare systems in the UK. Despite sustained policy attention and a growing body of evidence on the social determinants of health, people loosely defined as members of ‘inclusion health’ groups, continue to experience markedly poorer health outcomes, significant barriers to access to care, and shorter life expectancy than mainstream populations.
From a policy perspective, this raises an uncomfortable question: why do these inequalities endure despite repeated strategic commitments to address them? While undergraduate medical education has evolved to include population and public health, initiatives to widen participation and a focus on professionalism, social science research suggests that these developments have not yet translated into consistent preparedness among new doctors to work effectively with Inclusion Health populations. This is not a failure of intent, but of approach. Too often, medical education remains shaped by a biomedical paradigm that underutilises social science methods capable of informing how curricula are designed, delivered and assessed.
Understanding inequality
Sociology and social epidemiology have long demonstrated that health is produced through social structures and access to opportunities (the Social Determinants of Health) as much as through biology. Poverty, insecure housing, racism, gender inequality and immigration status interact over the life course to shape exposure to risk and access to care. However, it is through qualitative social science methods, including interviews, focus groups and ethnographic observation, that these structural forces become visible in everyday clinical encounters.
Interviews with people who experience social exclusion consistently reveal (see Greenfields and Rogers, 2020; Ryder and Trehan, 2020; UK Health Security Agency, 2025) how apparently routine aspects of healthcare appointment systems, referral pathways, language used in consultations can become barriers rather than enablers of care. These insights matter because curricula shape professional norms. If medical students primarily encounter Inclusion Health through abstract, stereotyped, case studies, the reading of textbooks, or optional teaching, they may never fully grasp how systems and interactions contribute to unequal outcomes. Social science methods however help ensure that education reflects lived realities rather than idealised models of care as well as mitigating against recycled misrepresentations, stereotypes or tropes about patients from inclusion health groups.
Listening to those least often consulted
Survey research with medical educators has an important role in mapping curriculum content and identifying variation across institutions. However, social science also highlights the limitations of relying solely on institutional perspectives. Inclusion Health populations are rarely asked how medical education can prepare future clinicians to work with them – or indeed how it fails to do so, as discussed in the literature review section of the 2025 ARU study.
Participatory and community-based research approaches seek to address this imbalance. By working with voluntary and community sector organisations, researchers can design studies that centre the perspectives of service users and frontline staff alongside those of educators. This approach consistently surfaces issues that are often under-explored in formal curricula.
A recurring theme in both literature and a strong theme within our empirical research is the importance of attitudes and relational skills. Inclusion Health community members frequently emphasise the need for medics to model non-judgemental behaviour, emotional preparedness and awareness of body language. These are not peripheral concerns. Psychology and interactional sociology show that trust is built, or eroded, through small, cumulative interactions. Medical education that does not explicitly address these risks perpetuating exclusion, even when clinical care is technically sound.
Co-production as an educational strategy
One of the most significant contributions of contemporary social science to education policy is the concept of co-production. Originating in public policy and participatory research methodologies, co-production involves sharing power over the design and delivery of interventions.
When applied to medical education, co-production moves beyond using lived experience as illustrative content. Instead, people with direct experience of exclusion contribute to shaping learning outcomes, teaching methods and assessment strategies. This might include co-developing composite case scenarios, advising on placement structures, or creating digital resources and immersive VR-based scenarios that challenge stereotypes while protecting dignity. Social science research has shown that co-produced educational materials are often more relevant, credible and ethically robust and importantly their use also surface practical considerations that are easily overlooked in more normative, top-down approaches to delivering teaching.
Rethinking placements and experiential learning
After completing co-designed and co-taught modules delivered in partnership with Inclusion Health communities, we argue that students should engage directly with such service users through participating in structured placements in voluntary and community sector organisations (VCSOs). These encounters should occur outside moments of crisis, allowing students to understand service users’ lives in context and enable them to build empathy, enhanced communication skills, and patient-centred practice, core competencies reflected in the GMC Outcomes for Graduates.
Currently, such placements are mostly optional via Student Selected Components (SSCs), limiting participation to a self-selecting minority. But to advance health equity they should be embedded in the core curriculum and, require formal assessment of the skills developed in such settings.
Evidence from educational and social work research clearly shows us the elements that constitute an effective placement. With these elements in place, along with scaffolded training and funding to support staff time when supervising students, NGOs would potentially be open to offering placements for medical students.
Assessment and accountability
Importantly, social science pedagogic practice can also challenge how learning is assessed. Traditional examinations are poorly suited to evaluating competencies such as empathy, reflexivity and cultural humility, which are crucial to effective engagement with under-served and inclusion health populations. In contrast, ‘social pedagogy’ which draws upon findings from educational sociology and psychology, suggest assessment approaches such as reflective portfolios, observed practice and structured feedback from community settings are more effective in measuring these crucial skills which impact on respectful relationship building between practitioner and patient. Indeed, these methods do more than measure learning; they also signal institutional priorities. Accordingly, when behaviours and the social context inherent in working in the field of Inclusion Health are assessed meaningfully, students understand that these are core professional competencies rather than optional interests or required ‘tick-box’ exercises.
Co-production, community engagement, and research ethics
There is also a role for Research Ethics Committees (RECs) reviewing applications for research with inclusion health groups. Many REC members working in hospitals or faculties of health are more familiar with standardised clinical research than with studies which utilise social science methods. This lacuna in understanding can create challenges for RECs when reviewing study design, assessing risk or considering the agency of members of groups deemed to be vulnerable. There is a risk that appropriate safeguards are either being overlooked, or alternatively can be so stringent that community members, researchers and civil society organisations report barriers to recruitment or meaningful engagement in studies, particularly where issues such as low literacy, language barriers, irregular migration status, or high levels of mobility impact participants. As such, RECs may benefit from guidance to help them adapt their processes, develop understanding of qualitative and participatory methodologies, and become confident in evaluating co-produced research (see Main Guide; People with Impaired Capacity; Gypsy, Roma, Traveller, Showmen and Boater (GTRSB); People Seeking Asylum or Who Have Refugee Status; People who are Unhoused)
From evidence to implementation
If reducing health inequalities is a genuine policy objective, we argue that social science cannot remain peripheral to medical education. Its theoretical approaches may explain inequality across multiple domains, but crucially social science methodologies make it visible, teachable and actionable. Interviews, surveys, ethnography and co-production do not simply generate evidence but in turn shape how future doctors understand their role within complex social systems.
Embedding social science more fully within medical education is not about diminishing biomedical expertise. It is about ensuring that clinical excellence is matched by social understanding so that healthcare systems are better prepared to meet the needs of those who have historically been least well served.
About the Authors:
Sanjiv Ahluwalia, GP and Dean of Anglia Ruskin Medical School, has worked in Barnet since 1999 and has led postgraduate medical training and educational transformation across primary care. His research explores how clinical education influences patient care, population health, and relational ethics, using both quantitative and qualitative methods. He is a member of the Inclusion Health research team in the Primary Care Research Centre at Anglia Ruskin University alongside colleagues Professor Margaret Greenfields, Sophie Coker, Professor Catherine Meads and Kristina Church.
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