1 Tackling Health Inequalities: Update and Inclusion Health programme ��������� health Martin Gibbs Health Inequalities Unit Department of Health Inclusive Health and Wellbeing Conference 29 November 2011
2 Policy context Health inequalities: Tackling health inequalities is a Government priority, part of a wider focus on fairness and social justice. Everyone should have the same opportunities to lead a healthy life, no matter where they live or who they are. As well as helping people live longer, healthier and more fulfilling lives, we aim to improve the health of the poorest fastest .
3 Policy context ��������� health Inclusion Health: The health needs of the most vulnerable people are being addressed through the Inclusion Health programme, which will focus on improving access and outcomes for vulnerable groups.
������������������������� ��������������������������������������������������������������������� Three year average Life Expectancy at birth 1999-01 to 2008-10 for males, comparing England and the areas which had the worst health and deprivation* England Areas which had the worst Change since 1999-01: ����������������������� health and deprivation Absolute gap has risen by 0.1 years Absolute gap between the 80 areas which had the worst health and deprivation and England 78.6 78 78.3 77.9 2.1 77.7 2.2 77.3 2.2 2.1 76.9 2.0 76.5 76.5 76 76.2 2.0 76.1 76.0 2.0 75.8 75.7 2.0 75.6 1.9 75.3 2.0 74.9 74.5 74 74.2 74.1 73.7 72 70 0 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 * Local authorities which had the worst health and deprivation, based on life expectancy and mortality data for 1995-97 and the 2004 Index of Multiple Deprivation. Change since 1999-01 and gap figures are calculated based on life expectancy figures rounded to 2 decimal places. Source: ONS
�������������������������� ��������������������������������������������������������������� �!����� Three year average Life Expectancy at birth 1999-01 to 2008-10 for females, comparing England and the areas which had the worst health and deprivation* England Areas which had the worst Change since 1999-01: ����������������������� health and deprivation Absolute gap has risen by 0.2 years Absolute gap between 85 the areas which had the worst health and deprivation and England 83 82.6 82.3 1.7 82.0 1.6 81.8 81.6 1.7 81 1.6 81.1 1.6 80.9 80.9 80.7 1.6 80.7 80.7 1.5 80.4 80.4 1.5 1.5 80.2 1.5 79.9 79.6 79.4 79 79.2 79.2 78.9 77 75 0 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 * Local authorities which had the worst health and deprivation, based on life expectancy and mortality data for 1995-97 and the 2004 Index of Multiple Deprivation. Change since 1999-01 and gap figures are calculated based on life expectancy figures rounded to 2 decimal places. Source: ONS
6 What is the health inequalities challenge? By socio-economic classes Condition by socio-economic group (rate per 1,000 reporting long-standing condition by socio-economic group of household reference person General Household Survey 2006) CHD Higher than (Lung) Cancer expected need Cancers Diabetes Neurotic disorders Expected level Psychotic of need given disorders population size Asthma Epilepsy Stroke Lower than COPD expected need Renal Drug dependence I - II - Managerial IIIN - skilled IIIM - skilled IV - partly V - unskilled Alcohol Professional (non-manual) (manual) skilled dependence & technical Socio-economic class
7 What is the health inequalities challenge? How do we compare - males Life expectancy (LE) at birth, males: by deprivation twentieth in England & Wales, 1999-2003 vs Japan Total gain in months of life across deprivation twentieths required to increase E&W LE to Japan average = 528 mths (based on 2001 position) 85 Potential months of life gained in deprivation twentieth (by increasing LE to 2001 Japan average): - - - 1 4 5 8 14 17 22 25 30 36 42 44 50 55 60 71 79 80 Japan (2007) Japan (2001) Life expectancy (years) E&W (2006-08) E&W (1999-03) 75 70 79.1 78.7 78.5 78.0 77.8 77.7 77.4 76.9 76.7 76.3 76.0 75.6 75.1 74.6 74.4 73.9 73.5 73.1 72.2 71.5 65 60 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Deprivation twentieth (1 = least deprived; 20 = most deprived) Source: ONS (LE for E&W and deprivation tw entieths, based on w ards); OECD (LE for Japan). Note that methodology used to calculate LE may differ slightly betw een ONS and OECD.
8 What is the health inequalities challenge? How do we compare - females Life expectancy (LE) at birth, females: by deprivation twentieth in England & Wales, 1999-2003 vs Japan Total gain in months of life across deprivation twentieths required to increase E&W LE to Japan average = 1056 mths (based on 2001 position) 95 Potential months of life gained in deprivation twentieth (by increasing LE to 2001 Japan average): 30 30 32 36 37 36 40 44 46 50 53 56 60 62 66 68 72 73 83 89 90 Japan (2007) Life expectancy (years) Japan (2001) 85 E&W (2006-08) 80 E&W (1999-03) 75 82.4 82.4 82.2 81.9 81.8 81.9 81.6 81.2 81.1 80.7 80.5 80.2 79.9 79.7 79.4 79.2 78.9 78.8 78.0 77.5 70 65 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Deprivation twentieth (1 = least deprived; 20 = most deprived) Source: ONS (LE for E&W and deprivation tw entieths, based on w ards); OECD (LE for Japan). Note that methodology used to calculate LE may differ slightly betw een ONS and OECD.
9 The deprivation gradient in life expectancy and DFLE means people in the poorest areas die 7 years earlier on average than in affluent areas, and the difference in DFLE is 17 years Life expectancy and disability free life expectancy at birth, persons by neighbourhood income level, England, 1999-2003 Age 85 80 75 70 65 60 Life expectancy 55 DFLE 50 Pension age in 2024 Poly. (DFLE) 45 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Neighbourhood Income Deprivation - Population Percentile Source: ONS …………………………………………………………………………..
10 Inclusion Health challenges • Homeless people have significantly higher levels of premature mortality and mental and physical ill health than the general population. • As many as 40% of rough sleepers have multiple concurrent health needs relating to mental, physical health and substance misuse • Of those registered at Cambridge Access Surgery, a homeless specialist GP practice, 2-3% died each year between 2003-2008 and the average age of those who died was 44. • Rough sleepers are 35 times more likely to commit suicide than the general population • Homeless people have higher rates of tuberculosis (TB), bronchitis, foot problems and infections than the general population
11 Inclusion Health challenges • Studies show that Gypsy and Traveller women live 12 years less than women in the general population and men 10 years less, although recent research suggests the life expectancy gap could be much higher • There is an excess prevalence of miscarriages, stillbirths and neonatal deaths in Gypsy and Traveller communities and high rates of maternal death during pregnancy and shortly after childbirth • A high prevalence of diabetes has been reported in Gypsy and Traveller communities, and a lack of community knowledge of the risk factors • 38% of Gypsies and Travellers have a long-term illness compared with 26% of age and sex matched comparators, even after controlling for socioeconomic status and other marginalised groups • Travellers are 3 times more likely to have chronic cough or bronchitis, even after smoking is taken into account
12 Inclusion Health challenges • Up to 95% of women in prostitution are problematic drug users • More than half of UK women in prostitution have been raped and/or seriously sexually assaulted. At least three-quarters have been physically assaulted • 23% of parlour workers and 27%of street workers report having received treatment for Chlamydia (compared to 3% of the general population) • Among offenders convicted for prostitution related offences, over 48% experienced psychological problems or depression compared to 33% of other offenders • 68% of women in prostitution meet the criteria for Post Traumatic Stress Disorder in the same range as victims of torture and combat veterans undergoing treatment
13 How are we moving ahead? • Health reforms – building into the new system • Inclusion Health • Ministerial Working Groups • Specific commitments for the most vulnerable - “Vision to end Rough Sleeping”
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