A Qualitative Comparative Analysis of factors associated with trends in narrowing health inequalities in England (original) (raw)
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The Lancet, 2015
In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond.
Inequalities in mortality and illness in Trent NHS region
Journal of Public Health, 1999
Background The Department of Health is encouraging health authorities to improve health status by tackling health inequalities. We defined ward level spatial health variations in Trent National Health Service Region, England, investigated urban and rural inequalities, and examined the relationship with deprivation, to identify the extent of small area health inequalities and to establish whether a quantifiable difference exists between urban and rural health as affected by deprivation. Method A small area ecological study design was adopted and ward level (n = 591) standardized ratios were calculated (population aged <75, n = 3 900 000) for specific causes of death and limiting long-term illness. A classification was devised to assess ward health inequalities according to an urban-rural dimension. Deprivation was measured using the Townsend Index and the relationship with mortality and illness was analysed using Pearson product moment correlation. Results Wide variations in mortality and illness were evident at ward level, being widest for accident mortality (standardized mortality range 0-508). Stroke mortality accounted for the largest proportion of wards with standardized mortality ratios over 125 (36.2 per cent). Relative deprivation correlated strongly with limiting long-term illness (r = 0.82) and all-cause mortality (r = 0.68) across Trent, and in both urban and rural environments. Conclusion The study set health inequalities within a regional context for Trent as an initiative to coincide with the Government's proposed health strategy for the next few years. Wide health inequalities were evident in Trent and the association between deprivation and health was of a similar magnitude in urban and rural wards. This small area approach allows health authorities access to ward level information in order to inform key debate on tackling health inequalities and distributing resources in relation to need.
The Lancet
Background Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile. Methods We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters. Findings The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791-15 875] in Blackpool to 6888 [6145-7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990-2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer's disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258-2356]) was higher than for ischaemic heart disease (1200 [1155-1246]) or lung cancer (660 [642-679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health. Interpretation These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response. Funding Bill & Melinda Gates Foundation and Public Health England.
International Journal of Health Geographics, 2011
at reducing health inequalities. For example, should efforts to address deprivation be focused not only on areas of high deprivation but also on areas that have high levels of deprivation and strong relationships between deprivation and mortality? Delivering for Health, a key health policy document in Scotland, promotes health interventions in the poorest areas as one approach to reducing health inequalities: "...NHS Scotland can do more itself to break the link between deprivation and poor health. We need not only a sustained effort to promote good health and good health care, but also to target our resources at areas of greatest need." [18]. This paper raises questions about the strength and uniformity of such linkages across the regions of Scotland and what it means from a policy perspective. How uniform is the linkage across the regions of Scotland? What should the policy response be if such linkages are not uniform across Scotland?
The measurement of inequities in health: Lessons from the British experience
Social Science & Medicine, 1990
There has been an acrimonious debate about trends in inequality in health in the U.K. over the last couple of years. Whilst the acrimony is highly specific to the U.K. context, the terms of the debate contain general lessons for others who would venture into the same territory. This paper has focused on problems with using occupational classifications, with using groups of different size, with assessing trends in inequalities in death, with the measurement tool employed, with comparing patterns of ill-health and with the framework of explanation.
Journal of Epidemiology & Community Health, 1996
Study objective -To assess the nature of the relation between health and social factors at both the aggregated scale of geographical areas and the individual scale. Design and setting -The individual data are derived from the sample of anonymised records (SAR) from the census of 1991 in Great Britain, and are combined' EVIDENCE FOR COMPOSITIONAL AND CONTEXTUAL EFFECTS IN HEALTH DIFFERENCE
Journal of Public Health, 2018
Background The Equal North network was developed to take forward the implications of the Due North report of the Independent Inquiry into Health Equity. The aim of this exercise was to identify how to reduce health inequalities in the north of England. Methods Workshops (15 groups) and a Delphi survey (3 rounds, 368 members) were used to consult expert opinion and achieve consensus. Round 1 answered open questions around priorities for action; Round 2 used a 5-point Likert scale to rate items; Round 3 responses were re-rated alongside a median response to each item. In total, 10 workshops were conducted after the Delphi survey to triangulate the data. Results In Round 1, responses from 253 participants generated 39 items used in Round 2 (rated by 144 participants). Results from Round 3 (76 participants) indicate that poverty/implications of austerity (4.87 m, IQR 0) remained the priority issue, with long-term unemployment (4.8 m, IQR 0) and mental health (4.7 m, IQR 1) second and th...
Deprivation and cause specific morbidity: evidence from the Somerset and Avon survey of health
BMJ, 1996
Objective-To investigate the association between cause specific morbidity and deprivation in order to inform the debates on inequalities in health and health services resource allocation. Design-Cross sectional postal questionnaire survey ascertaining self reported health status, with validation of a 20!/o sample through general practitioner and hospital records. Setting-Inner city, urban, and rural areas of Avon and Somerset. Subjects-Stratified random sample of 28 080 people aged 35 and over from 40 general practices. Main outcome measures-Age and sex standardised prevalence of various diseases; Townsend deprivation scores were assigned by linking postcodes to enumeration districts. Relative indices of inequality were calculated to estimate the magnitude of the association between socioeconomic position and morbidity. Results-The response rate was 85 3%. The prevalence of most of the conditions rose with increasing material deprivation. The relative index of inequality, for both sexes combined, was greater than 1 for all conditions except diabetes. The conditions most strongly associated with deprivation were diabetic eye disease (relative index of inequality 3*21; 95% confidence interval 184 to 5.59), emphysema (2.72; 167 to 4.43) and bronchitis (2.27; 1-92 to 2.68). The relative index of inequality was significantly higher in women for asthma (P< 0.05) and in men for depression (P<0.01). The mean reporting of prevalent conditions was 107 for the most deprived fifth of respondents and 0*77 in the most affluent fifth (P < 0.001). Conclusions-Material deprivation is strongly linked with many common diseases. NHS resource allocation should be modified to reflect such morbidity differentials.
Regional inequalities in premature mortality in Great Britain
Premature mortality exhibits strong spatial patterns in Great Britain. Local authorities that are located further North and West, that are more distant from its political centre London and that are more urban tend to have a higher premature mortality rate. Premature mortality also tends to cluster among geographically contiguous and proximate local authorities. We develop a novel analytical research design that relies on spatial pattern recognition to demonstrate that an empirical model that contains only socioeconomic variables can eliminate these spatial patterns almost entirely. We demonstrate that socioeconomic factors across local authority districts explain 81 percent of variation in female and 86 percent of variation in male premature mortality in 2012–14. As our findings suggest, policy-makers cannot hope that health policies alone suffice to significantly reduce inequalities in health. Rather, it requires strong efforts to reduce the inequalities in socioeconomic factors, or living conditions for short, in order to overcome the spatial disparities in health, of which premature mortality is a clear indication.