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. The Indices of Multiple Deprivation 2019 rank Stoke-on-Trent as the 13th most deprived local authority (out of 317) in England (Figure 1). Over half of areas in Stoke-on-Trent (51%) are classified among the most deprived 20% in England, and approximately one-third of areas (32%) fall in the most deprived 10%.1
Figure 1. Deprivation profile for Stoke-on-Trent
Source: Ministry for Housing, Communities & Local Government, 2019 https://drive.google.com/drive/folders/1h37V9N2oFapjeHZV1u5m8Wlr6KyP3CVd
The health of adults in Stoke-on-Trent is worse than the England average across a range of indicators. Life expectancy is 3.2 years and 2.9 years below the national average in men and women, respectively. Premature mortality is higher for all causes, cardiovascular disease and cancer. Compared with the national average, smoking prevalence higher (18.7 vs 14.4%), fewer adults meet physically active recommendations (57.4 vs. 66.3%) and overweight/obesity prevalence is far higher (72.8 vs. 62.0%).
Data on infant and child health in Stoke-on-Trent also illustrate the scale of the health challenge. Teenage smoking rate is high (17.5% vs. 10.6% for England), breastfeeding initiative rate is low (60.1% vs. 74.5% for England), and infant mortality is the one of the highest in the country (7.5 per 1000 vs. 3.9 per 1000 for England).
There is also health inequality within the city. Life expectancy is 8.2 years lower for men and 7.2 years lower for women in the most deprived areas of Stoke-on-Trent compared with the least deprived areas.
For the wider determinants of health, almost 1 in 4 Stoke-on-Trent children are in low income families (vs. 17.0% for England), educational attainment is below the national average, and unemployment and statutory homelessness rates are higher.2
Staffordshire as a whole is far less deprived than Stoke-on-Trent, but pockets of deprivation exist (Figure 2).
Figure 2. Deprivation profile for Staffordshire
Source: Ministry for Housing, Communities & Local Government, 2019
The health of people in Staffordshire compared with the England average varies across health indicators3. Life expectancy at birth for men and women is similar to the England average, as is healthy life expectancy. Premature mortality rates from the three major killers are lower in Staffordshire than England overall.
Rates of overweight/obesity in adults and alcohol-related hospital admissions are significantly worse than England, whereas physical activity levels are similar to, and smoking rates are lower than the national average (12.2 vs. 14.4%).
Data in relation to infant and child health show a similarly mixed picture. While infant mortality rate (5.0 vs 3.9 per 1000) and rates of smoking in pregnancy are above the national average, teenage pregnancy and obesity in children are similar to those for whole of England.
Unlike Stoke-on-Trent, across a range of key social determinants of health, outcomes for Staffordshire as a whole are similar to, or better than, those for England. For example, 13.2% (18,820) of children live in low income families and 0.3 per 1000 are classified as homeless (vs. 0.8 per 1000 in England).
1 Public Health England. Public Health Profiles https://fingertips.phe.org.uk/static-reports/health-profiles/2019/e06000021.html?area-name=stoke-on-trent
2 Public Health England. Public Health Profiles https://fingertips.phe.org.uk/static-reports/health-profiles/2019/e06000021.html?area-name=stoke-on-trent
3 Public Health England. Public Health Profiles https://fingertips.phe.org.uk/search/infant%20mortality#page/1/gid/1/pat/6/par/E12000005/ati/102/are/E10000028/iid/91430/age/27/sex/1