Inequalities in
Health
and Health Care
Provision
UK
National Inequalities in Health
AGE ADJUSTED MORTALITY RATES: By selected Cause & Sex, 2003
(Rate per 100,000 Population)
Heart
Diseases
CVD
Cerebrovascular
disease
Cancer
Road Traffic
Accidents
Suicides and
Open Verdicts
182
206
231
196
70
78
88
74
242
253
287
248
9
9
11
15
14
19
26
17
155
175
193
174
121
128
150
126
233
239
275
238
3
2
4
4
4
4
9
3
Males
England
Wales
Scotland
N. Ireland
Females
England
Wales
Scotland
N. Ireland
www.statistics.gov.uk
Death Rates and Infant Mortality
Rates per 1,000, per country (2003)
Death Rate
per 1000
population
Infant Mortality
Rate per 1000
population
England
10.1
5.3
Wales
11.5
4.1
Scotland
11.6
5.1
Northern Ireland
8.5
5.3
United Kingdom
10.3
5.3
General Register Office for Scotland
Main Points
In all causes of mortality:

rates are higher in Scotland than anywhere
else in the UK.

rates are higher for both males and females in
Scotland than anywhere else in the UK.

only in road traffic accidents do males in
Northern Ireland fare worse than in Scotland.
Main Points
In terms of rates of mortality:

Scotland has the highest death rate per 1000
population and the level is 1.3/1000 above the
national average.

Infant mortality rates, however in Scotland are
lower than the national average of 5.3/1000,
and those for England and Northern Ireland.
Causes of death by gender, 2003, UK
% Men
29%
12%
4%
16%
39%
Respiratory
disease
Indjuries &
poisoning
All other causes
Cardiovascular
disease
Cancer
% Women
25%
14%
2%
21%
38%
www.statistics.gov.uk
NHS Expenditure by country in the
UK {2002-3 (bmj.com 2005) and 2004-5}
Per capita
(£)
2002-3
Per capita
(£)
2004-5
England
£1085
£1249
Wales
£1186
£1287
Scotland
£1262
£1533
Northern Ireland
£1214
£1371
Percentage population and per capita spend on
health in countries in the UK (2004-5)
% of total
UK population
Per capita
public spend
on health
England
83.7%
£1249
Wales
4.9%
£1287
Scotland
8.5%
£1533
Northern Ireland
2.9%
£1371
www.ic.nhs.uk/
www.statswales.wales.gov.uk/
www,dhsspsni.gov.uk/
www.isdscotland.org
Relative level of health care spend on a
per capita basis per country (2004-5)
The UK average = 100
England
97%
- 3%
Wales
104%
+ 4%
Scotland
114%
+ 14%
Northern Ireland
107%
+7%
www,dhsspsni.gov.uk/
Number of Health Service Staff per
10000 people per country (2003-4)
England
259
Wales
231
Scotland
294
Northern Ireland
276
www.ic.nhs.uk/
www.statswales.wales.gov.uk/
www,dhsspsni.gov.uk/
www.isdscotland.org
Availability of hospital beds and
health staff in UK countries (2003)
Hospital
Staff per 1000 population
beds per
1000
Medical Nursing
GPs
population & dental
England
3.8
1.4
5.6
0.57
Wales
5
1.4
6.4
0.61
Scotland
6
1.8
7.4
0.76
Northern
Ireland
4.9
1.6
7
0.63
www.ic.nhs.uk/
www.statswales.wales.gov.uk/
www,dhsspsni.gov.uk/
www.isdscotland.org
Findings

Statistics on mortality rates and morbidity rates
confirm that:
–
There is a clear north-south divide in the health
of the British public
–
Death rates are higher in Scotland than in
England and Wales
–
Death rates are highest in Scotland for both male
and females.
But
–
More money is spent on health care provision in
Scotland than in England and Wales.
Inverse Care Law

Areas which experience the worst ill
health – Scotland followed by Northern
Ireland – receive the most money on
health care provision and manpower.

Areas which experience the least ill health
– England and Wales – receive the least
money on health care provision and
manpower.

This is called the ‘Inverse Care Law’.
But…..

More money is spent on health care provision
in Scotland than in England and Wales.

In other words there is no correlation between
the incidence of ill health and the allocation of
financial and manpower resources put into
health care.
Lack of Correlation
Is this lack of correlation between the
incidence of ill health and the allocation of
financial and manpower resources in health
care provision:
a reflection of the disparity in where the
resources and manpower are targeted?
or
a reflection of the greater needs of people in
Scotland?
Inequalities in Health Care Provision

Studies show that wide variations in health care
provision do exist within the UK.
Guardian Newspaper extract (October 1999)
‘’Rather than having a National Health Service, it is as if we have
dozens of independent health services, all operating under different
rules and using different criteria.
In some parts of the country you’ll be booked into a specialist
cancer hospital which will spend thousands on chemotherapy drugs
even though the success rates for some drugs for cancer are
miniscule; in others you’ll be told that your time is up even though
there are plenty of well proven cures which might well succeed’’.
Nigella Lawson
Geographic Imbalance (2004-5)

The NHS spends about £1,533 each year on
each person in Scotland.

The NHS spends about £1249 each year on
each person in England.
Inequalities in Health Care Provision
(2001)
Geographic imbalance in NHS provision.

In Scotland there are:
– 51 consultants for every 100,000
– 75 GPs for every 100,000
– 808 nurses for every 100,000.

In England there are:
– 39 consultants for every 100,000
– 56 GPs for every 100,000
– 620 nurses for every 100,000.
Comparison of NHS provision
between Scotland and England (2001)
900
800
700
600
500
England
Scotland
400
300
200
100
0
Consultants
GPs
Nurses
Regional Imbalance in Funding in
England (2001)

Average national rise in funding was 4.2%.

Isle of Wight received a rise in funding after
inflation of 3.6%. Yet it has the highest
proportion of elderly and the lowest household
income in England.

London Authority of Kensington, Chelsea and
Westminster received 5.9% after inflation.
NHS costs within England (2001)

The cost of a hospital operation can vary by up
to 20 times within England.

A lung transplant can cost between £2,488 and
£31,430.

A hip replacement can cost between £354 and
£7,784 depending on where you live.
The Anomaly?

The variations in the allocation of financial and manpower
resources throughout the UK are not the sole cause of
inequalities in health.

If that were the case then Scotland, which receives the
highest level of spending and manpower, should be the
healthiest part of the UK – but it is the worst.

Also, there are areas in Scotland and Northern Ireland which
compare favourably with the healthiest areas in England.

There are parts of London that have levels of ill health as bad
as the worst areas in Glasgow.

Within Glasgow there are huge differences in health in areas
barely one mile apart.
The Reasons?

Scotland needs its extra healthcare expenditure to
overcome unfavourable factors which work against
delivering comparable health outcomes.

Higher levels of deprivation which exist in
Scotland.

Higher levels of rurality and remoteness which
make it more difficult to ensure adequate access to
healthcare for people in remote areas of Scotland
such as the Western Isles and more expensive
than in urban and central belt areas.
The Evidence (2005)

For example NHS spending per head of
population in 2004-5 in Lothian was £1199
compared with £2076 for the Western Isles.
This represents a difference of £877 per
capita.

The average cost per in-patient case in
Shetland is £3759 whereas in Greater
Glasgow it is £2806.
www.isdscotland.org
See BBC News PowerPoints for articles on inequalities
in health care provision.
•Patients face geographical care lottery
•GPs under pressure
•Patients don’t listen to their doctors
•Millions ‘illiterate’ about health
Courtesy of www.bbc.co.uk