“Measurement is radical” was my message yesterday at the Press Launch of our Two Year On monitoring report on health inequalities. By keeping robust measurements on the agenda, we can chart progress on health inequalities and their social determinants and make clear that we hold governments, and the wider society to account.
On publication of Fair society Healthy Lives in 2010 we developed a simple monitoring framework with two health measures: life expectancy and healthy life expectancy for men and women; and three social determinants to capture the life course: early child development, young people not in employment, education or training (NEET), and an adult poverty measure. We announced the baseline for that framework this time last year, thanks to our partnership with the London Health Observatory.
The Institute of Health Equity commissioned the LHO to provide data showing key indicators for monitoring health inequalities and the social determinants of health for the 150 ‘upper tier’ local authorities in England. We are able to compare and comment on any changes that have happened over the last year. As one could expect few changes in one year, I did not expect very much in the way of press interest. I am surprised at the wide coverage we got, validating the importance of monitoring to keep health inequalities on the agenda.
That said, there have been changes. Life expectancy continues to increase, as has been the trend over time, by about 0.3 years every year. Most important though and more worryingly, the inequalities in life expectancy also continue to rise. Inequalities within local authorities have increased in most of the 150. For men in 104 out of 150, and for women in 92 out of 150.
Children achieving a good level of development at age five has improved slightly on last year’s figures (59% of children are achieving a good level of development instead of 56%). But that’s nothing to celebrate. Because it means a staggering 41% of children are NOT achieving a good level of development. Good development scores show a close link with measures of deprivation – a social gradient in child development that runs from least deprived to most. And if we compare how this country is doing to others, the picture is clearer: we are doing very badly indeed.
Poor early child development and socioeconomic disadvantage predict poor performance through children’s whole school careers. Although there is an intimate link between deprivation and development there is variation around the line – at similar levels of poverty some areas do better than others. Last year when I visited Tower Hamlets to discuss child development, and showed data on the clear link between deprivation and school performance a director of education said: “we tell ourselves every day, poverty is not destiny”. It isn’t. We need to address poverty – the causes of the causes – and we need to focus on early child development and education.
Our next indicator: young people not in employment, education or training (NEET), age 16-19. Again a slight improvement on last year, and that improvement was seen in the majority of upper tier local authorities. So we’re having some success in getting 16 year olds to stay on at school or take part in training programmes. I ask myself why our data seems to be at odds with what’s reported in the news – that the NEETs figure has reached record levels at over 1 million. And we think that’s because we measure until 19 – it’s beyond age 19 that levels of NEET have increased so dramatically.
Our last indicator for the social determinants is the percentage of people in households on means tested benefits. There’s a slight reduction here, both in terms of actual receipt and the inequalities between neighbourhoods with different levels of deprivation. But what’s particularly interesting, and shocking, is the variation within local authorities.
I was asked by various members of the press this morning at our briefing what is going to happen to health inequalities as a result of the Coalition Government’s policy changes. Of course, I am concerned, particularly in relation to cuts in local authority funding of early years. But that’s an important part of our mission – to watch, evaluate and comment. And with our robust monitoring framework, which of course we will update where appropriate according to government policy changes, we can comment in confidence.
For more information on the data, please see our website.