Sheffield Equality Group
21 October 2010
Health Inequalities in Sheffield
Jeremy Wight
Director of Public Health
Health inequalities in Sheffield
•
•
•
•
Inequalities present and past
Causes of health inequality
What can and are we doing about it?
Last thoughts
Slope Index Chart for Life Expectancy by Deprivation Decile
Sheffield PCT, Males, 2004-2008
Slope Index = xxx 95% Confidence Interval = ( xx, yy)
Life Expectancy at Birth (years)
95.0
90.0
85.0
80.0
75.0
70.0
65.0
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Percentage of population, ranked by IMD2007 score from most deprived to least deprived
SOURCE: IMD2007, PH Mortality, PH Births, PHR
NHS Sheffield, Public Health Analysis team, V 0.2, 9th October 2009
Health inequalities in 1892
District
All age
mortality
/ 1000
Fairer
Sheffield,
Healthy
Lives
Infant mortality
Sheffield West
24.15
198.0
Sheffield North
27.65
270.3
Sheffield South
22.24
222.2
Sheffield Park
22.33
201.2
Brightside
20.20
206.1
Attercliffe
21.17
266.6
Nether Hallam
08.90
198.9
Upper Hallam
14.60
100.0
Eccleshall
17.80
158.1
All Sheffield
20.75
205.3
Health inequalities in 1987
What do we mean by health
inequality?
• Analysis by:
– Geography
– Income
– Class
– ‘Community of interest’
• Analysis of:
– Mortality / life expectancy
– Other measures of health and wellbeing
What are the causes of health
inequality?
•
•
•
•
Causes of death
Causes of disease
Causes of the causes
Residential sorting?
Causes of death (m)
Male
Attributable LE gap Proportion of
(yrs)
gap
Coronary Heart Disease
0.5
19.8%
Lung Cancer
0.2
9.3%
Chronic Obstructive Airways Disease
0.2
8.9%
Other Cardiovascular Diseases
0.2
6.2%
Other Accidents
0.1
5.0%
Chronic Cirrhosis of the Liver
0.1
5.0%
Suicide & Undetermined Injury
0.1
4.5%
Pneumonia
0.1
3.9%
Other Digestive Diseases
0.1
3.9%
Stroke
0.1
3.6%
Deaths Under 1 Year of Age *
0.1
5.3%
All other
0.6
24.6%
Causes of death (f)
Female
Attributable LE gap (yrs)
Proportion
of gap
Lung Cancer
0.3
14.8%
Chronic Obstructive Airways Disease
0.2
14.2%
Coronary Heart Disease
0.2
14.1%
Stroke
0.1
8.4%
Other Respiratory Diseases
0.1
5.8%
Other Cardiovascular Diseases
0.1
5.7%
Pneumonia
0.1
5.0%
Chronic Cirrhosis of the Liver
0.1
4.5%
Ill-Defined Conditions
0.1
4.4%
Diseases of the Nervous System
0.1
3.1%
Deaths Under 1 Year of Age *
0.0
0.8%
All other
0.3
19.2%
Causes of disease
•
•
•
•
•
Smoking
Physical inactivity
Poor diet
Alcohol
Drugs
Causes of the causes
•
•
•
•
•
•
Cheap and illicit tobacco (smuggling)
Absolute and relative poverty
Unemployment and underemployment
Poor housing
Low educational achievement
Low aspiration
Inequality in wellbeing
• Nic Marks – New Economics Foundation
Diminishing marginal returns
of well-being to income
Life satisfaction and Household income in the UK
Life Satisfaction (0-10)
8.00
7.50
7.00
6.50
6.00
5.50
5.00
£140,000
£120,000
£100,000
£80,000
£60,000
£40,000
£20,000
£0
Household total net income
Diminishing marginal returns
of well-being to income
Life Satisfaction and Income Quintiles
8.5
Life Satisfaction (0-10)
8.0
7.5
7.0
6.5
Average Social Connection
6.0
5.5
5.0
4.5
4.0
Low Income
Low-Medium
Income
Medium
Income
High-Medium
Income
High Income
What are we doing about it?
• What has worked in the past – CIRC
• Fairer Sheffield, Healthy Lives
<75 Circulatory M ortality Rate s
% de cre ase in rate re lativ e to 1997-1999
0%
19982000
19992001
20002002
20012003
20022004
20032005
20042006
-10%
-20%
-30%
-40%
-50%
-60%
Most Deprived ED Quintile
Sheffield
Public Health Analysis Team, Sheffield PCT
Male Life Expectancy Gap
Male Life Expectancy Gap between Most Deprived Neighbourhood Quintile and Sheffield
4.0
Life Expectancy Gap (Years)
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
Actual gap
1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2013- 20142001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
3.4
3.4
3.1
2.9
2.8
3.0
3.2
3.2
Exponential projection
3.0
2.9
2.9
2.9
2.8
2.8
2.7
2.7
2.7
2.6
Linear projection
2.9
2.9
2.9
2.8
2.8
2.7
2.7
2.7
2.6
2.6
3.2
3.1
3.1
3.1
2010 Target Gap
3.4
3.4
3.4
3.3
3.3
Actual gap
Source: Public Health Analysis Team, Sheffield PCT ( 5 year rates)
3.3
3.2
3.2
Exponential projection
Linear projection
2010 Target Gap
Female Life Expectancy Gap
Female Life Expectancy
Gap between Most Deprived Neighbourhood Quintile and Sheffield
3.5
Life Expectancy Gap (Years)
3.0
2.5
2.0
1.5
1.0
0.5
0.0
-0.5
Actual gap
1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2013- 20142001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
2.9
2.4
2.3
2.2
2.0
1.8
1.8
1.8
Exponential projection
1.5
1.3
1.2
1.0
0.9
0.7
0.6
0.4
0.3
0.1
Linear projection
1.5
1.3
1.1
1.0
0.8
0.7
0.5
0.3
0.1
0.0
2.7
2.7
2.6
2.6
Target Gap
2.9
2.9
2.9
2.8
2.8
Actual gap
Source: Public Health Analysis Team, Sheffield PCT( 5 year rates)
2.8
2.8
2.7
Exponential projection
Linear projection
Target Gap
Fairer Sheffield, Healthy Lives
Fairer Sheffield, Healthy Lives
Health Inequalities Action Plan
2010-2013
Fairer Sheffield Healthy Lives
• Based on Marmot report
• 6 areas for action:
– Give every child the best start in life
– Enable all to maximise capabilities and have control
over their lives
– Create fair employment and good work for all
– Ensure a healthy standard of living for all
– Create and develop healthy and sustainable places
and communities
– Strengthen the role and impact of ill health prevention
What would a really radical
approach look like?
• Shuffling and re-distributing the population
• Equalising incomes
• De-normalising tobacco smoking in all parts of
society
• De-criminalising currently illegal drugs
• Random allocation of school places across the
City
Conclusions
• Health inequalities are deeply ingrained in the
unequal nature of society
• As public health leadership moves from the NHS
to local authorities, it is vital that links with
General Practice are not lost
• Efforts to reduce inequalities must focus on
improving the health of disadvantaged
communities
• There have been huge improvements in the
health of disadvantaged communities, even if
health inequalities have not reduced as much as
we would wish.
Closing the health gap
in Sheffield
Danny Dorling
7pm Thursday 21st October 2010
Domino Hall, Sheffield Cathedral
Health inequalities have exercised people in Sheffield for many years.
This extract below is from ‘Sheffield Targets’ thanks to Geoff Green for
sending me a copy of the 1987 pamphlet, in which it said:
Here is the map then. No average is now below age 65, but
the gap is now much larger in terms of life expectancy
Average life expectancy varies by 20 years at the extreme (for
women). For men the gap has more than doubled to 16 years.
But these are all figures from below the economic crash and
before the spending cuts and their effects on inequality
12/03/2016 © The University of Sheffield
National Government policy had been here – more reviews and
yet more reviews but income inequalities rising slowly (6.1:1 to
7.2:1 between quintile groups 1997-2008 in the UK)
Then came the spending review
October 20th 2010 – we were
told how savings would be
made:
One of the first
announcements was that new
tenants of council and other
social housing will now have
to pay at least 80 percent of
market prices in rent. In one
stroke millions of low paid
families are to be excluded
from living in hundreds of
towns, cities and villages
where they no longer earn
enough to “deserve” to be.
Housing benefit will not be
paid for people under the age
of 35 who live alone—this
previously applied only to
those under 25.
There would be a 10 percent
cut in council tax benefit for
those who can not afford to
live in certain areas.
Are the few remaining people
living on modest incomes
near affluent suburbs or in
economically successful
towns and villages to be
cleansed away?
It could be the greatest threat
The best-off fifth of society will
lose just 1 percent of their
entitlements to public services
and spending, the lowest losses
of any group.
A million people currently on
employment and support
allowance due to ill health will
each loose £2,000 a year if they
cannot find a job.
With the state pension age rising
rapidly to 66 years. Only those
with private provision can now
retire at the normal age. Public
sector pensioners will have £1.8
billion removed from them by
2014-15. Pension credits will be
frozen for three years.
No family on benefits is to receive
more than the income of an
average family in work, no matter
what the circumstances of their
children. If you are poor—or are
made poor when you lose your
job or have a pay cut forced on
you—and have three or more
children, you may need to leave
your town for a new life in a
cheaper area, away from where
the remaining well paid work is.
People with worse health will
have to move to poorer areas.
The health service is being cut
Provision for the NHS did not
include the extra costs of the
1946 baby boomers retiring,
or the cost of new
privatisations being
introduced there (which were
not even in the Tory
manifesto – but are now
taking place).
Provision for education would
not maintain current rates of
spending per child once the
new privatised “free” school
costs are added in. University
places will be slashed. This
will change who lives where
and hence health inequalities.
As school budgets will also be
cut, in practise parents may
try even harder to live away
from more average areas – if
they can – raising health
inequalities higher again.
The educational maintenance
allowance for less well-off
children will be phased out,
another significant cut to
children’s finances which,
when combined with all the
chancellor’s other measures,
means that child poverty will
rise—despite what he
suggested in this speech
Redistribution to better-off
More affluent savers who lost
money they invested in
Equitable Life and the
Presbyterian Mutual Society
will soon receive £1.7 billion
from tax payers—mostly from
tax payers poorer than them.
Thus money is being
redistributed towards the
affluent.
There will be more property
for the affluent to buy with
these windfalls in affluent
areas, in villages and in
market towns, as the poor
vacate their homes for
cheaper places to live –
increasing inequality.
Local government will be
allowed to borrow more in
richer areas, against
expected business rates,
instead of Westminster
borrowing, so that the places
where business makes a lot
of money can be spruced up.
Local government in poorer
areas cannot make such
newly permitted borrowing.
Although there are a few
token schemes outside the
South East, most capital
spending is now concentrated
there as a result of the cuts.
This is a common response
• On 21 October, Teresa
Perchard, director of policy
at the Citizens Advise
Bureau, warned that
housing benefit changes
would “create a group of
nomads…maybe not
where the jobs are.”
• On the same BBC radio
programme, Alan Johnston
said that Osborne’s
speech was “unfair,
unwise and untruthful in
some of the statistics” and
that the chancellor was
“asking children to make a
bigger contribution than
the banks”.
• The former Conservative
chancellor, and current
secretary of state for
justice, Ken Clark (69),
had warned of a doubledip recession if cuts were
savage.
• Many younger people will
now go abroad to find work
or a university place. Many
of them will never return.
Poorer families will
struggle the most, but
fewer will be visible
through the windows of
ministerial cars
Think back to 1985 & WHO1
• In 1985 Margaret Thatcher signed
the WHO target to reduce
inequality by 25% by 2000.
• It increase by much more than
25%. She had not thought it would.
• The gap was measured between
areas for all age groups and for
infants by social class
• She believed in “trickle down”, in a
private sector lead recovery that
would bring prosperity to all, with
the worst-off benefitting the most as
the well-off already lived the
longest. She thought she was fair
• More people died young as a
result.
Conclusion – keep asking
Why are 16 or 20 countries better?
The latest UN report lists those
European countries currently having a
higher life expectancy than the UK as:
Iceland (almost 82 years),
Switzerland, Italy, France (81 years),
Sweden, Spain, Norway, Austria (to
almost 80 years), the Netherlands,
Germany, Ireland, Malta, Cyprus,
Finland, Belgium and Luxembourg.
People also live for longer than in
Britain in Australia, Canada and New
Zealand (and especially Japan), but
not in the United States (where
comparable life expectancy is only
79.1 years)
Of the richest 25 nations in the world
the UK is the 4th most unequal by income
inequality (90:10 ratio UNDP figures).
People do live slightly shorter lives
now in Greece, Portugal (more
economically unequal than the UK),
Denmark (where smoking is still very
common) and in Slovenia (78.2
years). All these figures are from
Table H of the most recent UNDP
human development report (2009)
and purport to be for around the year
2007.
Life expectancy is up in the UK, but
Increased economic inequality in the
UK would be expected to move our
rank position below one of these four
countries next, to slip from 20th place
to 21st or 22nd out of 25.
Is premature death a price worth
paying in the eyes of some policy
makers? – just “inevitable”….
An email – received today
“Oh Danny you are far far to nice and reasonable a person to really understand just how
callous and murderous this lot really are. They are the aristocracy and they really do
not 'give a ****' about the poor or even the middle class.”
“The best way to explain the effects of the changes to housing benefit is to quote the
Tory ministers own words i.e. which ministers say will force an exodus from London
and other areas with high property prices ? "it's the Highland clearances", one said”
“Their plan is a 'Highland Clearance' of London, the South East, Bath,
York, Bristol, Edinburgh, etc. This is not an accidental change it is a
deliberate planned strategy.”
… “about 50,000 households will be affected, with hundreds of thousands more hit by
the cap on housing benefit (which ministers say will force an exodus from London
and other areas with high property prices ? "it's the Highland clearances", one [Daily
Telegraph quoted but not named Tory minster] said).‘”
Cheers!
Source of ministerial quote: Ben Brogan, 2010, “Conservative party conference 2010:
Let battle commence”, Daily Telegraph, 6th October:
http://www.telegraph.co.uk/comment/columnists/benedictbrogan/8047179/Conservative-party-conference-2010-Let-battle-commence.html