Health Inequalities

What are Health Inequalities?

Nationally, over the last century there have been considerable improvements in public health. Life expectancy in this country is now the highest it has ever been and infant mortality is at an all time low. This change has been brought about by a range of factors, particularly improvements in housing, environmental quality and education as well as significant technological advances within the health service. Despite this, the gap in health between those at the top and bottom of the social scale has widened. For example, in the early 1970's the mortality rate of working age men was almost twice as high for those in the lowest social group when compared to the highest. By the early 1990s the gap had widened to almost three times.

Figure 1: The Widening Mortality Gap

* 1979-83 excludes 1981

England and Wales. Men of working age (varies according to year either aged 15 or 20 to age 64 or 65)

Note: These comparisons are based on social classes I and V only.

Source: Office for National Statistics

Whilst healthcare has an important role to play, health inequalities are not just a health service issue. Many of the major determinants of health lie beyond the reach of the NHS, in people's living and working conditions and their health-related behaviour. Factors that influence health status and determine health inequalities are many and varied and include:

Physical and social environment including housing quality, the workplace and the wider urban and rural environment
Natural biological factors, such as age, gender and ethnicity
Behaviour and lifestyles, such as smoking, alcohol consumption, diet and physical exercise
Access to health care

Some differences in health status are unavoidable, being the result of genetic and/or biological differences in individuals. However, many are avoidable, resulting from a complex interplay of factors including social and community networks, general socio-economic, cultural, lifestyle and environmental conditions. Any one of these factors can adversely affect a person's health.

The term 'underlying determinants of health' is commonly used to describe social and economic factors that can have an adverse effect on an individual's health. Figure 2 illustrates the main underlying determinants of health.

Figure 2: Determinants of Health

Dahlgren and Whitehead Model Diagram

Consequently, most public and private, voluntary and community organisations have an important role to play, as health partners, in helping people stay in good shape, both physically and mentally.

National targets to reduce Health Inequalities

There is a national commitment to reduce health inequalities among the population. The national targets to improve the population's health are:

By 2010, increase the life expectancy at birth in England to 78.6 years for men and 82.5 years for women
Substantially reduce mortality rates by 2010 (from Our Healthier Nation baseline 1995-97):

From heart disease and stroke and related diseases by at least 40% in people under 75, with a 40% reduction in the inequalities gap between the 20% of areas with the worst health and deprivation indicators and the population as a whole
From cancer by at least 20% in people under 75, with a reduction in the inequalities gap of at least 6% between the 20% of areas with the worst health and deprivation indicators and the population as a whole
From suicide and undetermined injury by at least 20%

Reduce health inequalities by 10% by 2010 as measured by infant mortality and life expectancy at birth (2004 floor target)
Tackle the underlying determinants of ill health and health inequalities by:

Reducing adult smoking rates (from 26% in 2002) to 21% or less by 2010, with a reduction in prevalence among routine and manual groups to 26% or less (2004 floor target)
Halting the year on year rise in obesity among children under 11 (from the 2002-04 baseline) in the context of a broader strategy to tackle obesity in the population as a whole (2004 floor target)
Reducing the under 18 conception rate by 50% by 2010 (from the 1998 baseline) as part of a broader strategy to improve sexual health

Health Inequalities in Staffordshire

Health inequalities exist both within and between Districts of Staffordshire

All Cause Mortality is higher in Cannock Chase (692 per 100,000 population) than the county (628) and national (610) rates.
Staffordshire (212 per 100,000 population) has an above average(205) mortality rate from all Circulatory diseases, the worst Staffordshire districts are Cannock Chase (237) and East Staffordshire (227).
Mortality from cancer in Staffordshire is similar to the national rate both Cannock Chase and Tamworth experience notable high mortality.
The prevalence of diabetes is higher in the North Staffordshire PCT area.

Click the link to download the PDF icon Joint Strategic Needs Assessment Jan 08

What Is Effective in Reducing Health Inequalities?

In order to effectively reduce health inequalities, some key approaches need to be taken by the Government, public sector organisations, voluntary and community organisations and the private/business sector. These are:

Partnerships to develop a systematic approach to tackling inequalities.
Working strategically to influence key investors and decision makers to make sustainable changes.
Influencing commissioning, policy, service development and professional practice at grass roots level.
Establishing and sustaining partnerships to gain commitment for change by making explicit the contribution that others can make towards achieving national and local targets.
Finding creative ways of involving the relevant target groups so that they are effectively engaged in defining problems and developing workable solutions in partnership with professionals.
Piloting innovative ways to work in and with disadvantaged communities.
Innovating to outperform on current best practice.
Collecting and collating local epidemiological and other data to identify areas of need and priority target groups.
Explicitly targeting resources (people, time and money) at areas of highest inequality e.g. the young and the old in areas of greatest deprivation.
Rolling out effective interventions according to level of need.
Disseminating good practice locally, regionally and nationally.
Increasing understanding of the underlying causes for inequalities for health amongst, local decision makers/commissioners and partner agencies.
Working to maximise the levels of inward investment from a range of sources to support innovative approaches to tackling inequalities.

Reversing the trends in inequalities will take some time, making the requirement for immediate action imperative. The government produced: 'Tackling Health Inequalities: A Programme for Action' in 2003. This sets out plans to achieve the national health inequalities targets and to address the underlying causes of health inequalities. Its key themes are:

Supporting families, mothers and children
Engaging communities and individuals
Preventing illness & providing effective treatment & care
Addressing the underlying determinants of health

This document provides examples of good practice to reduce inequalities in health.

Click the link to download 'Tackling Health Inequalities: A Programme for Action'.

Click the link to download the Microsoft Word file icon Health Inequalities Bulletin produced by the NHS

The following links below also provide further information and evidence on health inequalities and suggested programmes and developments to tackle them effectively.

http://www.idea-knowledge.gov.uk/

http://www.socialexclusionunit.gov.uk/

www.nice.org.uk

www.hpromo.northstaffs.nhs.uk/promoting-health/index.htm

Last Modified: 20/11/2008 16:30:45
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