Health inequalities: place-based approaches to reduce inequalities

Public Health England | July 2019 | Health inequalities: place-based approaches to reduce inequalities

Public Health England (PHE) has published Health inequalities: place-based approaches to reduce inequalities; the aims of the ‘place-based approaches for reducing health inequalities’ are to:

  • reinforce a common understanding of the complex causes and costs of health inequalities
  • provide a practical framework and tools for places to reduce health inequalities

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Place-based approaches for reducing health inequalities: foreword and executive summar

Place-based approaches for reducing health inequalities: main report

More documents available from PHE

See also:

PHE blog

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