Friday, 11 February 2011

New health inequalities data

I was shocked, really shocked, when I saw the data we commissioned the London Health Observatory to collect to give us a baseline for measuring health inequalities in the future. In my review of health inequalities Fair Society, Healthy Lives, published a year ago, we called for a social determinants of health approach to reducing health inequalities. We emphasised the life course. If every child has a good start in life, then his or her chances of succeeding through primary and secondary school, achieving good and fair employment, and living a healthy life right to the end is vastly increased.

The London Health Observatory pulled together the figures for all 150 so-called 'upper tier' local authorities - the ones which will be tasked with overseeing public health under the Coalition Government's proposals. The statistics reflect five key indicators as laid out in Fair Society, Healthy Lives, as being important to monitor over time as a marker of health inequalities: life expectancy at birth, disability free life expectancy; children reaching a good level of development at age five; young people not in employment, education or training (NEET), and the percentage of people in households receiving means tested benefits. Additionally, we included an index showing the slope of the gradient in social inequalities within each local authority area for: life expectancy at birth, disability free life expectancy at birth, and the percentage of people in households receiving means tested benefits. The higher the value of the index, the greater the inequality.

My shock arose because of the proportion of children not achieving a good level of development at age five: 44%. And, of course, there are marked social and geographic variations in that measure. We are failing our children and it will have a devastating effect on health inequalities. There is no question that inequalities in society are, in large measure, responsible for inequalities in early child development.

We have a moral obligation to ensure all children have a good start in life. And a big part of that is parenting. If parents can't parent properly because they are poor, depressed, pressed in by circumstances, then we need to be there to support those parents. A simple intervention like reading to children every day is something that, if parents can't do it, others could step in and help. It can and would make a huge difference. There are data from Canada that suggest half the deficit in readiness for school associated with low income can be reversed by reading to children daily.

Turning to life expectancy at birth, we continue to see the unacceptable gap across the country. Variation across England between local authorities is 11 years for men and 10 years for women. Inequality in male life expectancy between the poorest and most affluent areas within each local authority exceeds nine years for around half of the local authorities in England; the comparable figure for inequality in female life expectancy is six years. Westminster has the widest within area inequality gap, just under 17 years for men, and 11 years for women.

The gap (strictly, the ends of the slope) in disability free life expectancy between the poorest and most affluent areas within each local authority exceeds 10 years for around half of the local authorities in England; the comparable figure for inequality for females is nine years. The widest level of inequality in disability free life expectancy is 20 years for men and 17 years for women living in The Wirral.

The number of young people (aged 16-19) not in employment, education or training (NEET) in the three months to January 2010 is an average of 7%, rising to 14% for those living in Redcar and Cleveland. And the average number of people in households on means tested benefits is 16%, with the figure rising to 41% in Tower Hamlets, London. The widest inequality gap is 61% for young people living in Blackburn and Darwen.

These data represent the baseline measurements for tackling health inequalities, using a social determinants approach. We want local authorities to use these measures to monitor changes. Health inequalities not only cost people's lives and health, they cost society tens of billions of pounds in lost productivity, healthcare and welfare payments. It's been put to me implementing the sort of recommendations in Fair Society, Healthy Lives  in straitened economic circumstances is going to be difficult, but, for example, reading to children is not an expensive intervention.