WHO: Environmental health inequalities in Europe. Second assessment report (2019)

World Health Organization | June 2019 | Environmental health inequalities in Europe. Second assessment report (2019)

An assessment report from the World Health Organization (WHO) considers the distribution of environmental risks and injuries within countries and shows that unequal environment conditions, risk exposures and related health outcomes affect citizens daily in their lives wherever people, live, work and spend their time.

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Image source: euro.who.int

The report documents the magnitude of environmental health inequalities within countries through 19 inequality indicators on urban, housing and working conditions, basic services and injuries. Inequalities in risks and outcomes occur in all countries in the WHO European Region, and the latest evidence confirms that socially disadvantaged population subgroups are those most affected by environmental hazards, causing avoidable health effects and contributing to health inequalities.

The results call for more environmental and intersectoral action to identify and protect those who already carry a disproportionate environmental burden (Source: WHO).

Summary report 

Full publication available from WHO 

 

Preventable deaths and deprivation

These charts show that the risk of preventable deaths is at least three times higher for people living in the most deprived local areas compared to those living in the least deprived | The Health Foundation

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In May 2019 the Office for National Statistics published the latest statistics related to avoidable mortality and socioeconomic inequalities. This explores deaths that are considered avoidable in the presence of timely and effective health care (amendable mortality) or public health interventions (preventable mortality).

The data show that the risk of preventable deaths is at least three times higher for people living in the most deprived 10% of local areas compared to the least deprived 10%.

While the preventable mortality rate has fallen since 2001, its fallen at a faster rate for people living in the least deprived local areas. Between 2001 and 2017 it fell by 36% for the least deprived 10% of areas, but only 25% for the most deprived 10% of areas.

Full detail at The Health Foundation

Speaking plainly about about what makes us healthy

This article from the Health Foundation discusses how changing the conversation will help to build public understanding of how social determinants affect health.

The Health Foundation is currently working with the FrameWorks Institute to develop a deeper appreciation of the ways in which people understand and think about health, to develop more effective approaches to communicating evidence.

A recent Health Foundation briefing explored how people think about what makes them healthy. It identifies four main communication challenges that can act as barriers to wider public acceptance of the evidence on the social determinants of health, including:

  • broadening what is understood by the term health
  • increasing understanding of the role of the social determinants of health
  • increasing understanding of how social and economic inequalities drive health inequalities
  • generating an understanding of the policy action needed to keep people healthy.

The next stage of their work with the FrameWorks Institute will be to develop and test strategies to address these challenges.

In the meantime, the Health Foundation offers some general guidance to bear in mind when communicating to the public around prevention and health issues including:

  • Beware of gesturing towards the importance of individual choice or responsibility.
  • Avoid ‘crisis messaging’ as this can backfire by reinforcing people’s sense of fatalism and encouraging disengagement.
  • Use step-by-step, causal explanations of how social determinants affect health, and provide concrete examples to help deepen the public’s understanding.

Full article at the Health Foundation

Primary care networks and the deprivation challenge

The newly emerging primary care networks provide an opportunity to tackle health inequalities in England but, as Rebecca Fisher and Beccy Baird explain, they will have to be careful to avoid perpetuating the problem | via BMJ

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In the face of a growing health gap between rich and poor in England, the NHS long-term plan explicitly commits to a focus on “health inequality reduction.” The roots of socioeconomic inequalities lie deep within communities, and general practice—itself rooted in communities—is key to addressing the problem. As practices scrabble to organise themselves into primary care networks, making meaningful progress towards reducing health inequalities requires these networks to be part of the solution. But unless a combination of quirks, oversights, and loopholes in their design and contracting are addressed, there is a risk that they could perpetuate the problem.

Full article: Primary care networks and the deprivation challenge: Are we about to widen the gap? | Rebecca Fisher [The Health Foundation] | Beccy Baird [The King’s Fund] | BMJ

Socioeconomic inequalities in avoidable mortality in England and Wales: 2001 to 2017

Office for National Statistics | May 2019 | Socioeconomic inequalities in avoidable mortality in England and Wales: 2001 to 2017
The latest analysis of the impact of socioeconomic inequalities in avoidable mortality in the period during 2001 to 2017 shows that males and females from the most deprived areas in England and Wales were up to four times more likely to die from an avoidable death than those in the least deprived areas in 2017.  The Office for National Statistics has published Socioeconomic inequalities in avoidable mortality in England and Wales: 2001 to 2017, which presents figures for avoidable mortality in 2001 to 2017 for England and Wales using measures of multiple deprivation to measure socioeconomic inequalities.

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Commenting on the figures, Professor Dame Parveen Kumar, British Medical Association board of science chair said: “These latest figures…show that socioeconomic conditions continue to disproportionately impact on the health of people living in deprived areas.

“The decline in the rate of improvement in avoidable mortality is a particular cause for concern: 16% of male avoidable deaths in England 2017 occurred in those living in the most deprived areas, compared with 6% for those living in the least deprived areas.”

She continued: “The cost of this inequality is substantial, both in years of life lost and in costs to the economy and wider society. Clearly, more must be done to reverse this decline (via OnMedica).

  • In England, in 2017, 16% of male avoidable deaths were experienced by those living in the most deprived areas, compared with 6% in the least deprived areas; for females it was 14% and 7% respectively.
  • In Wales, in 2017, 13% of male avoidable deaths were experienced by those living in the most deprived areas, compared with 5% in the least deprived areas; for females it was 13% and 6% respectively.
  • In 2017, the absolute inequality in the rate of avoidable death between the most and least deprived areas; in Wales was 368.4 deaths per 100,000 males and 229.9 deaths per 100,000 females; in England, the rates were 358.3 and 205.5 respectively.
  • In 2017, males and females living in the most deprived areas in England were 4.5 and 3.9 times more likely to die from an avoidable cause than those living in the least deprived areas respectively.
  • In Wales, in 2017, males and females living in the most deprived areas were 3.7 and 3.8 times more likely to die from an avoidable cause than those living in the least deprived areas respectively.
  • The absolute difference in the rate of avoidable death caused by cardiovascular diseases between the most and least deprived areas narrowed between 2001 and 2017, but has widened for injuries in both England and Wales.
  • Between 2011 and 2017, avoidable deaths caused by injuries in the most deprived areas in England statistically significantly increased by 16% among females and 17% among males.
  • In England and Wales, there were greater annual improvements in avoidable mortality rates between 2001 and 2010 compared with 2011 and 2017; this was particularly noticeable among males living in the most deprived areas.
  • See also:

Read the full piece from OnMedica  Avoidable death four times as likely among the poor as among the well off

ONS report  Socioeconomic inequalities in avoidable mortality in England and Wales: 2001 to 2017

Gypsy Roma and Traveller communities ‘comprehensively failed’ by policy makers

Commons Select Committee | April 2019 | Gypsy Roma and Traveller communities ‘comprehensively failed’ by policy makers

A major new report by the Women and Equalities Committee reports in its findings that there has been a persistent failure by national and local policy makers to tackle long standing inequalities facing Gypsy, Roma and Traveller communities in any sustained way. The report entitled Tackling inequalities faced by Gypsy, Roma and Traveller communities explores inequalities faced by Gypsy, Roma and Traveller communities, umbrella terms describing diverse minority groups whose members experience very stark inequalities.

These are some of the worst inequalities that the inquiry heard about:

Education

  • Pupils from Gypsy or Roma backgrounds and those from a Traveller or Irish Heritage background had the lowest attainment of all ethnic groups throughout their school years (Govt Race Disparity Audit).

Health

  • Fourteen per cent of Gypsies and Travellers describe their health as “bad” or “very bad” – more than twice as high as white British people (2011 Census);
  • The health status of Gypsies and Travellers is much poorer than that of the general population, even when controlling for other factors such as variable socio-economic status and/or ethnicity;
  • Life expectancy is 10-12 years less than that of the non-Traveller population;
  • 42% of English Gypsies are affected by a long term condition, compared with 18% of the general population;
  • One in five Gypsy Traveller mothers will experience the loss of a child, compared with one in a hundred in the non- Traveller community (evidence submission from University of Bedfordshire)

Discrimination and hate crime

  • A survey carried out by Traveller Movement found that 90% of respondents had experienced discrimination and 77% had experienced hate speech or a hate crime

Tackling inequalities faced by Gypsy, Roma and Traveller communities highlights how Gypsy, Roma and Traveller people have the worst outcomes of any ethnic group across a huge range of areas, including education, health, employment, criminal justice and hate crime. The report of this two year inquiry makes 49 recommendations for change (Source: Commons Select Committee).

Read the report summary 

Read the full report 

See also:  Commons Select Committee News release 

 

Equality and Health Inequalities RightCare Pack

NHS England | December 2018 | Equality and Health Inequalities RightCare Pack

The Equality and Health Inequalities RightCare Pack considers measures of health inequality and aims to support CCGs and health systems to identify areas of improvement in promoting equality and reducing health inequalities. Previously such analysis has not been available at CCG level.

Each pack is based on 2016/17 data to ensure consistency with latest available year for Improving Access to Psychology Therapies (IAPT), one of the pilot programmes for these measures.  On this basis 207 packs have been produced, reflecting the number of CCGs in 2016/17; as such, some recently merged CCGs will receive more than one pack. The packs also complement the work of Public Health England (Source: NHS England).

NHS Rotherham CCG

NHS Sheffield CCG

Barnsley CCG

NHS Doncaster CCG

Full details from NHS England