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Understanding health inequalities in Medway

Summary :: Our health inequalities :: Understanding health inequalities in Medway

Inequalities in mortality

By looking at broad disease categories it is possible to understand where the greatest contributors to health inequalities lie. Figure 1 shows that higher levels of mortality are experienced by the most deprived quintile in Medway.

Cancer is the main cause of morality in Medway, but there is a relativity small difference in the mortality rates between the most and least deprived quintiles in Medway.

The main contributors to mortality inequalities in Medway are circulatory disease and respiratory disease, which both have significantly higher mortality rates for the most deprived quintile in Medway compared to the least deprived quintile (2012-2016).[1]

Figure 1: Cause-specific mortality rate profiles for the most and least deprived quintiles in Medway, 2012-2016
Figure 1: Cause-specific mortality rate profiles for the most and least deprived quintiles in Medway, 2012-2016

Inequalities in life expectancy

The Segment Tool [2] identifies the percentage of the life expectancy gap in men and women caused by specific disease areas. It can be seen in figure 2 that the biggest contributor to the life expectancy gap for both sexes is circulatory disease followed by respiratory disease.

Figure 2: Life expectancy gap between the most and least deprived quintiles in Medway, by broad cause of death
Figure 2: Life expectancy gap between the most and least deprived quintiles in Medway, by broad cause of death, 2012-2014 [2]

In 2012-14, the causes of death that contributed most to the inequalities gap in Medway for men were coronary heart disease (CHD) at 18.5%, external causes (excluding suicide) at 12.2%, and chronic obstructive airways disease at 10.4%. For women the main contributors were chronic obstructive airways disease at 15.8%, CHD at 11.7%, and circulatory diseases (excluding CHD and stroke) at 10.7%.[2]

Changes in health inequalities over time

The Health Profiles provide charts that show changes in health inequalities over time. These charts show the changes in death rates in people under 75 (early deaths) between the most and least deprived quintiles in Medway; figure 3 for men and figure 4 for women.[3]

There are marked differences in early death rates between the most and least deprived quintiles in Medway for both sexes. Individuals living in the most deprived quintile in Medway have a higher early death rate than those living in the least deprived quintile.

The early death inequality gap appears to be widening for both men and women since 2012, however there has been a larger widening of the gap for men.


Figure 3: Early deaths from all causes: men
Figure 3: Early deaths from all causes: men [3]
Figure 4: Early deaths from all causes: women
Figure 4: Early deaths from all causes: women [3]

NOTE: Data from 2010-12 onwards have been revised to use IMD 2015 to define local deprivation quintiles (fifths), all prior time points use IMD 2010. In doing this, areas are grouped into deprivation quintiles using the Index of Multiple Deprivation which most closely aligns with time period of the data. This provides a more accurate way of discriminating changes between similarly deprived areas over time.[3]

Causes of health inequalities

The causes of health inequalities are complex, but there appears to be 3 main areas that contribute to the differences in health between different socio-economic groups:


• Variation in quality of health care
• Differences in lifestyle factors, such as smoking, nutrition and exercise
• Wider determinants of health, such as poverty, housing and education [4]

Variation in the uptake and quality of health and social care

Figures 5 and 6 show that emergency admissions to hospital for all causes is associated strongly with deprivation status whereas elective admissions are not. Research shows that this is likely to be because uptake of preventive services, such as screening, is worse in more deprived areas. Also people from deprived areas are less likely to visit their GP early on when they have symptoms of ill health and more likely to attend A&E at a later stage of illness.

Figure 5: Emergency Admissions All Causes by Medway Practices
Figure 5: Emergency Admissions All Causes by Medway Practices [5]
Figure 6: Elective Admissions All Causes by Medway Practices
Figure 6: Elective Admissions All Causes by Medway Practices [5]

Differences in lifestyle

Lifestyle issues including smoking, obesity and alcohol are key contributors to high mortality rates of the major killers. Smoking in particular is a key contributor to health inequalities. Figure 7 shows the difference between the most and least deprived quintiles in Medway for lung cancer mortality rates.[1]

Figure 7: Age-specific lung cancer mortality rates for the most and least deprived quintiles in Medway, 2012-2016
Figure 7: Age-specific lung cancer mortality rates for the most and least deprived quintiles in Medway, 2012-2016

Wider social determinants of health

Providing quality and equitable health services is important and so is encouraging lifestyle change. However we also know that providing good quality health and health improvement services won't reduce health inequalities as much as we'd wish for. This is because the causes of ill health are rooted in what are called the 'wider' or 'social' determinants of health, i.e. physical environment, social environment, economic environment, etc.

The Marmot Review (2010), which pulled together all the evidence as to the most effective ways of tackling health inequalities supports this view. Marmot says: “Action on health inequalities requires action across all the social determinants of health”.

The review notes six policy objectives most of which are directly related to the wider determinants of health which could be expected to have the biggest impact on reducing health inequalities.


• Give every child the best start in life
• Enable all children, young people and adults to maximise their capabilities and have control over their lives.
• Create fair employment and good work for all
• Ensure healthy standard of living for all
• Create and develop healthy and sustainable places and communities
• Strengthen the role and impact of ill health prevention

The Marmot indicators which were shown in a previous section (Summary -> Our health inequalities -> Medway in a national context) give an indication of how Medway is doing compared with national rates on some of these issues.

Taking deprivation as an overall marker for social determinants of health, the IMD 2015 gives an indication of how these are distributed in Medway.

Maps showing the distribution of deprivation for each Medway ward can be found in the Health and social care profiles (page 18). See Profiles -> Health and social care profiles


References

[1]   Medway Public Health Intelligence Team. Primary Care Mortality Database Analysis
[2]   Public Health England. Segment Tool
[3]   Public Health England. Medway Health Profile 2017
[4]   House of Commons Health Committee. Health Inequalities: Third Report of Session 2008-09
[5]   East of England Public Health Observatory. National General Practice Profiles Tool