There have been considerable improvements in the nation’s health during the past 50 years. Life expectancy at birth continues to increase, the numbers of infants dying during the first year of life have fallen, whilst rates of premature mortality from the three major killers – cancer, circulatory disease and respiratory disease – all continue to fall.
Whilst these improvements have undoubtedly benefitted everyone in the United Kingdom, not everyone has benefitted to the same extent. Across a range of illnesses and diseases, men, women and children living in disadvantaged circumstances continue to experience more ill health and disability and higher levels of mortality compared with people from more affluent areas. In spite of these widespread improvements, the UK continues to be shaped and driven by inequalities in health.
Health inequalities refer to differences in people’s health and arise from inequalities in the social determinants of health – these are the daily conditions in which people are born, grow, live, work and age.1 Genetic factors, lifestyle choices, education, housing, employment and access to healthcare services are all examples of the social determinants of health.
Health inequalities are preventable and unjust and have a huge impact because they result in people who are materially disadvantaged experiencing poorer health and shorter lives. To improve health for everyone and to reduce unfair and unjust inequalities in health, actions, strategies and interventions to address the social determinants of health are required.
Local health and inequalities
Stoke-on-Trent is characterised by high levels of deprivation and is currently ranked the 14th most deprived local authority (out of 326) in England. Nearly 133,000 people (over half the population) live in areas classified as being among the top 20% most deprived in England (map 1).
The health of people in Stoke-on-Trent is generally worse than the England average. Life expectancy at birth for both men and women is lower than the England average, as are levels of healthy life expectancy. Premature mortality (deaths under the age of 75) from the three major killers – cancer, circulatory disease, respiratory disease – are all significantly higher compared with England, as is the infant mortality rate.
Breastfeeding rates are worse than England, as are levels of smoking during pregnancy and teenage conceptions. Levels of excess weight (among children and adults) are worse than England, more local people are physically inactive and levels of smoking and smoking related deaths remain above the England average.
In regards to local health inequalities, life expectancy is 9.8 years lower for men and 6.9 years lower for women living in the most deprived areas of Stoke-on-Trent than in the least deprived areas (maps 2 & 3). These differences are reflected in higher premature mortality rates (from all causes) among men and women living in the most deprived areas of the city.
In regards to some of the key social determinants of health – child poverty, fuel poverty, school readiness, educational attainment, homelessness, employment and unemployment – outcomes in Stoke-on-Trent are significantly worse compared with England.
Staffordshire as a whole is far less deprived than Stoke-on-Trent, although pockets of high levels of deprivation exist across the majority of the main towns in the county (map 1).
The health of people in Staffordshire is varied compared with the England average. Life expectancy at birth for both men and women is similar to the England average, as are levels of healthy life expectancy. Whilst the infant mortality rate is significantly higher compared with England, premature mortality rates from the three major killers are lower in Staffordshire compared with England.
Teenage conceptions rates are worse than England, as are levels of excess weight (among adults). Hospital stays for self-harm along with hospital stays for alcohol-related harm are also significantly worse than England.
In regards to inequalities in health, life expectancy is 6.4 years lower for men and 6.4 years lower for women living in the most deprived areas of Staffordshire than in the least deprived areas (maps 2 & 3). As with Stoke-on-Trent, these inequalities are reflected in higher premature mortality rates (from all causes) among men and women in the most deprived areas of the county.
Unlike Stoke-on-Trent, across a range of key social determinants of health, outcomes for Staffordshire as a whole are similar or better compared with England.
1 Fair Society, Healthy Lives: The Marmot Review (2010)