Place, disadvantage and outcomes Dr Angela Donkin Life expectancy - PowerPoint PPT Presentation

Place, disadvantage and outcomes Dr Angela Donkin

Life expectancy and disability free life expectancy, males - based on 2011 Census Life expectancy and disability-free life expectancy (DFLE) at birth, males by neighborhood deprivation, England, 1999 – 2003 and 2009-2013

Life expectancy and disability free life expectancy, females - based on 2011 Census Life expectancy and disability-free life expectancy (DFLE) at birth, females by neighbourhood deprivation, England, 1999 – 2003 and 2009-2013

Average number of years with a disability by sex for most, least and median deprivation small areas (MSOAs), 1999-2003 and 2009-2013 Males Most deprived Median Least deprived Gap 1999-2003 19.0 14.0 10.8 8.2 2009-2013 20.0 15.0 11.8 8.2 Females 1999-2003 22.0 16.5 13.2 8.8 2009-2013 23.5 18.2 15.2 8.3 Life expectancy is increasing but healthy life expectancy not keeping up – spending more years in ill health, and those in deprived areas many more years.

Well being • 4.8% of adults aged over 16 had low levels of life satisfaction in 2014-15, compared to 5.6% the previous year • Low levels of life satisfaction worse in more deprived areas. • Ranged from 2.8% in Bath and North East Somerset, to 8.7% in Wolverhampton.

Policy Objectives: The Social Determinants of Health A. Give every child the best start in life B. Enable all children, young people and adults to maximise their capabilities and have control over their lives. C. Create fair employment and good work for all D. Ensure a healthy standard of living for all E. Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill-health prevention

Look at the Inequalities Indicators Table….. • It depicts the Marmot indicator scores for the most deprived, average, and least deprived areas. • For every indicator there is a clear pattern… scores are generally better in the least deprived areas and worse in the most deprived areas. • Clustering of disadvantage. • In Blackpool men live until 54.9 in good health, compared to 71.4 in Wokingham. • Not all bad – children eligible for FSM do better in early years in more deprived areas.

Some current SDH issues…

Increase in numbers not able to afford a healthy life.

Greener living environments: lower health inequalities, England Deaths from circulatory disease Income group 4 is most deprived Source: Mitchell & Popham, Lancet 2008

Lower usage of green space in more deprived areas Proportion of residents who visited the natural environment in the last 7 days for exercise or health reasons 45.0 40.0 % 35.0 30.0 25.0 20.0 % use 15.0 10.0 5.0 0.0 0.00 10.00 20.00 30.00 40.00 50.00 Least Deprived Most Deprived Monitor of Engagement with the Natural Environment, Natural Health England, September 2013  In England, 15.3% had visited the natural environment from March 2012 to February 2013. • Green space important for more deprived communities-impact on CVD, and mental health.

Fast food chains more common in deprived areas: England and Scotland Mean number of fast food outlets* per 100000 people 8 7 6 5 4 3 2 1 0 5 (most 4 3 2 1 (least deprived deprived) Index of multiple deprivation quintile (*McDonald’s, Burger King, KFC and Pizza Hut) Macdonald et al 2007

SDH issues for those in multiply disadvantaged groups…

A study of homeless people in Edinburgh found that 19 • 20% have never been employed • 50% had no friends or confidants • 40% had been sexually abused • 60% had been physically abused • 40% had spent time in prison • 70% had at least one diagnosable Personality Disorder A report by Crisis 20 states that only 38% of rough sleepers have any form of qualification , compared to 66% of the general population. … Need to focus on reducing abuse in childhood, improving education for all and ensuring work/life pathways for those with no qualifications.

Reasons for entering sex work Source Platt and others 7 For every extra year of 4.1 Debts/survival/other education the likelihood 6.8 of entrance into prostitution reduced by Domestic Made to work by 6.9 someone/give to 12%. Migrant 2.9 other Another study found that from a sample of 200 0 sex workers, 60% had Drugs 9.7 been sexually abused or victimized by incest. 13 Homelessness is also 31 Studies/saving 12.6 considered a significant factor, given that this is often tied up with drug 10 Social life use and mental illness. 16.5 Secure accommodation is necessary to provide Household 48.3 the stability to address expenses/ support 51.5 family these problems. 14 0 10 20 30 40 50 60 %

If lack of income and early years abuse drive homelessness and sex work, you would expect to see higher prevalance in deprived neighbourhoods/ areas with high costs of living and those with poorer early years and safeguarding records… Could focus strategies for reduction of these conditions in these neighbourhoods,

Level of development at end of reception The percentage of children achieving a good level of development at the end of reception 2013/14, IMD 2015 80.0 Percentage reaching a good level of 70.0 development at age 5 60.0 50.0 40.0 30.0 20.0 10.0 0.0 0 5 10 15 20 25 30 35 40 45 Area level of deprivation, IMD 15 Least deprived Most deprived All pupils FSM pupils • In 2013/14 - 60.4% of all children and 44.8% of pupils eligible for free school meals achieved a ‘good level of development’, compared to 51.7% and 36.2% respectively in 2012/13. • There was a significant improvement across all English regions. • The gap between all and FSM pupils was greater in more advantaged areas and tended to narrow with increasing area deprivation. • Gap ranged from 4.2 in Hackney to 29.5 in Bath and North East Somerset. • But nearly half of all upper tier local authority areas reduced in-area inequalities between 2012/13 and 2013/14.

Some differences in English regions… E.g. the South East has significantly improved against 6 indicators. But - NEET - Households in fuel poverty - Households unable to afford an acceptable standard of living significantly worsened. No significantly worse indicators for the North West , but 9 indicators significantly better.

Regional figures available for each local authority online

Discussion • How can the use of the social determinants of health model be applied to Issues of multiple deprivation.. E.g. homelessness, sex work, substance abuse? • What is the interplay between the conditions in which people are born, educated, work (or not) and individual behaviour?

Thank you Contact details a.donkin@ucl.ac.uk