Identify current patterns of ill health and inequality in the UK. Explain probable causes of the current patterns of ill health and inequality in the UK (M1)

Identify current patterns of ill health and inequality in the UK (P3)

Explain probable causes of the current patterns of ill health and inequality in the UK (M1)

Although people are living longer than ever before, with mortality rates fallen over the last 50 years, unacceptable inequalities in health still persist but have changed. Over the last century Public health issues were dominantly childhood deaths from illness and infectious diseases, problems that have now been eradicated such as small pox or controlled such as measles, mumps and rubella. Public health issues in the current times have change to more lifestyle issues such as diet, smoking, exercise and consumption of alcohol, causing a rise in deaths from cancers, coronary heart disease, and stoke as well as public health issues such as diabetes and obesity. Although on average we are living healthier and longer lives, health and life expectancy are not shared equally across the population. These inequalities affect the whole of society and they can be identified at all stages of the life course from pregnancy to old age, and subsequently into next generations.

“The weight of scientific evidence supports a socio-economic explanation of health inequalities, this traces the roots of ill health to such determinants as income, education and employment as well as to the maternal environment and lifestyle” (Acheson Report, Synopsis)

In 2004 the government published a report ‘The Public Health White Paper- Choosing Health: making healthier choices easier’, that recognised that interest in health was increasing and recommended a new approach to public health. The document acknowledged the role for government in talking the wider causes of ill health and inequality as well as recognising the need to support and empower individuals to make changes in their own lives. The white Paper stated:

“Public Health Observatories will produce reports designed for local communities which will support directors of public health in promoting public health in their area”

As a consequence of this report the Public Health Observatories was commissioned by the Department of Health to produce annual health profiles for each local authority in England. These health profiles provide information on health for each local council using key health indicators, which enables comparisons locally, regionally and over a period of time. They help local councils and the NHS decide where to target resources and tackle health inequalities in their local areas. The white paper also asked for an annual health profile for the whole of England, which was first published in 2006. This national health profile provides an opportunity for certain people such as local councillors and directors of public health to compare data from their own local health profile and will influence their planning, commissioning and delivery of public health programmes. The Health Profile of England 2008 showed that the main patterns of ill health the needs to be tackled in the UK today are: Smoking, tooth decay, physical inactivity, teenage pregnancy, harmful drinking, vehicle road traffic accidents, crime and violence and especially child obesity, obesity in both males and females, diabetes in adult males and females and chlamydia, which the report shows have all increased from previous years. There seems to be one factor that’s constant in contributing in all the above factors of ill health and that’s money.

“Inequalities in health exist, whether measured in terms of mortality, life expectancy or health status; whether categorized by socio-economic measures or by ethnic group or gender.” (Acheson Report)

There is a concern about the rise of childhood obesity, and the implications of obesity persisting into adulthood. Childhood obesity is one of the most serious public health challenges of the 21st century. The health consequences of obesity can be both physical and physiological, leading to the possibility of diabetes, liver or heart disease, social isolation, low-self esteem and a more likely hood for respiration problems such as asthma.

“Overweight and obese children are likely to stay obese into adulthood and more likely to develop noncommunicable diseases like diabetes and cardiovascular disease at a younger age, overweight and obesity, as well as their related diseases, are largely preventable. Prevention of childhood obesity therefore needs high priority.” (World Health Organisation)

Overweight and obesity contain many issues of inequalities, with people from the lowest socio-economic groups being most at risk, this is mainly due to ‘food poverty’ but over factors could contribute such as education, access and transport. Food poverty exists when households have a much lower disposable income, with prioritising their income firstly to household bills and rent, having restricted spending on food. This means they are having to buy more efficiently, obtaining more grams of food of any type per pound spent as this works out you are getting the most amount of food for your money. Also food in supermarkets tend to be much cheaper and cover a wide range than in the smaller shops, this means that in some cases cheap and varied food is only accessible to those that have private transport or are able to pay the cost of public transport.

“ People on low incomes eat less healthily partly because of cost, rather than lack of concern or information. Therefore increased availability of affordable healthy food should lead to improved nutrition in the least well off”

(Acheson report)

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(Acheson report)

Children’s tooth decay is also becoming an increasing problem; dental problems are more common in deprived areas compared with affluent communities. Tooth decay shows directly poor dental hygiene, but also indirectly poor children’s health and diet. The link between diet and nutrition to health and inequalities in health is, based on the fact that higher rates of nutritional related diseases are more common in disadvantaged groups. Tooth decay is more prevalent in children in lower socio-economic groups, and children in these groups have higher intakes of sugary foods and drinks. Many diseases are linked to a diet low on fruit and vegetables and high in sugary salty foods. This whole pattern of poor diet, tooth decay, obesity, and weight related diseases and poor nutritional related diseases are more common in lower-socio-economic groups. There is an association between obesity in adults and mortality, decreasing life expectancy up to nine years. Obesity can cause diabetes, which is also on the rise in the UK. Statistics show that the elderly and ethnic populations suffer from diabetes the most.

“The prevalence of diabetes was much higher among some ethnic minority communities than in the general population. In black Caribbean and Indian men, the prevalence of diagnosed diabetes was more than twice that found in the general population. The prevalence for Black Caribbean and Pakistani women were two and a half times that of the general population.”

(Health Survey for England 2007)

This could be for a number of reasons: (National Statistics)

Nearly half (48%) of the total minority ethnic population of the UK live in the most deprived areas of London and deprivation is strongly linked to poor health and diet.
The ethnic population tend to have much larger families with a higher proportion of lone parent families.
People in the minority ethnic groups in the UK have much higher unemployment rates meaning limited income and lower social class.

There are also differences in diet by gender, this may be because women may be more likely to under report the quantity of their diet than men, and they are also more likely to diet. The amount of dieting women and the pressures by media types are a major, concern especially to young women. Nutrition and diet before and during pregnancy can have important long term affects on the health of the next generation.

Lack of Exercise and especially physically inactivity in children is a lifestyle risk factor and has a major effect on health, weight problems and obesity. Physical activity during childhood has a range of benefits including health growth and development, improved concentration, behaviour and self-esteem the benefits of exercise continue well in to adult life, reducing some of the risk factors for diseases such as coronary heart disease, diabetes and osteoporosis. Participation in physical activity in childhood can help to establish a physically active lifestyle in later life.

“Physical inactivity, (a lack of physical activity) is an independent risk factor for chronic diseases, and overall is estimated to cause 1.9 million deaths globally.”

(World Health Organisation)

Barriers to physical activity vary between ages, gender, socio-economic status and a range of other factors such as feelings of self-consciousness preventing participation. Also parental concerns about neighbourhood safety can be a barrier to childhood physical activity as their perception as the environment to be unsafe can prevent outdoor activity, especially if there is a restricted access to opportunities such as after school clubs and physical activity within schools.

“ Schools in more disadvantages areas are more likely to have a poor physical environment for both pupils and staff, and resource allocation may not be matched adequately to their greater need” (Acheson Report)

Older people may experience pain, fatigue, mobility and sensory impairments as health barriers to physical education as well as restricted opportunities within their communities. Education can also be seen as a barrier to physical activity as there may be a lack of knowledge and understanding of the relationship between exercise and health.

Deprivation is one of the main and most important determinants of health inequality in the United Kingdom, with major differences between areas and social classes. Many reports have shown the association of increasingly poor health with increasing deprivation. If deprivation inequalities decrease, health inequalities are also likely to decrease.

“ Health inequality runs throughout life, from before birth into old age. It exists between social classes, different areas of the country, between men and women, and between people with different ethnic backgrounds. But the story of health inequality is clear: the poorer you are, the more likely you are to be ill and to die younger. That is true for almost every health problem.”

(Saving Lives: Our Healthier Nation)

Growing up in poverty and in a lowest social class damages children’s health and well-being and so affects their future health and life chances as adults. A child who has been born into or grown up in poverty is strongly linked to poor child health, future adult ill health, higher rates of mortality, limited education, low-birth weights, childhood obesity, teenage pregnancy and mental ill health. Infant mortality rates are highest among the lowest social groups and children from this group are five times more likely to die from an accident than those in the top social class.

Hackney Health Profile 2009- “Overall the health of people living in Hackney is worse than the England average. Almost 90% of people living in Hackney live in an area classified as being within the bottom fifth of the most deprived areas of England… Amongst children the level of poverty, obesity, teenage pregnancy, achievement in GCSE’S and physical activity are all worse than the England average”

Kensington and Chelsea Health Profile 2009- “The health of people living in Kensington and Chelsea is generally better than the England Average. The levels of teenage pregnancy, smoking in pregnancy and physical activity in children are better than the national average”

Both these places are within built up areas close to the city of London. Hackney being a deprived area and Kensington and Chelsea an area with generally a much higher social class. Both these profiles prove that there is a close link between poor health and deprivation also that a child being brought up in poverty is a severe determinant of their health. There are higher rates of ill health in all areas where social deprivation has been identified; this is because of social deprivation causing trends of ill-health. E.g. poverty has been strongly linked to teenage pregnancy, and then that child being more likely to become a teenage mother as well, so it becomes a cycle that is hard to get out of. Education is influenced by the quality of the schooling the children receive and their family socio-economic group. Poverty is strongly linked to poor education, which influences income, housing and a higher chance of unemployment, which in turn is linked to poor health and health inequalities. Being in poverty becomes a trap that is difficult to break free from. Deprivation inequalities explain why there is such a big gap between affluent areas and deprived areas, as deprivation has an unavoidable affect on your health. Homelessness is associated with severe poverty and is a social determinant of health. Homelessness is linked to adverse health education, and social outcomes especially for children.

There is a strong link between cigarette smoking and socio-economic groups. Smoking has been identified as the single biggest cause of inequality in death rates between rich and poor in the UK. Smoking accounts for over half of the difference in risk of premature death between social classes. Death rates from tobacco are two to three times higher among disadvantaged social groups than among the better off. Long-term smokers bear the heaviest burden of death and disease related to their smoking including certain cancers.

“Tobacco smoking is estimated to be responsible for approximately 30% of cancer deaths in the UK” (Cancer Research)

In Britain in 1948 smoking was extremely prevalent especially in men with 82% of men smoking some form of tobacco. Since the 1970’s smoking prevalence has fallen rapidly and a survey in 2007 showed that around a fifth 22% of men aged 16 and over were reported as smokers. The same survey reported that in 2007 20% of women aged over 16 were reported as smokers. Inequalities in smoking consist of age, socio- economic groups, and location and ethnic groups.

Age- In Great Britain the highest rates of smoking are in the 20-24 age group, with 32% of people in this category being reported as smokers. The prevalence of smoking declines with age, with 14% of people over 60 being smokers. There has also been an increasing rate of adolescent smokers with girls having consistently higher rates than boys. Factors that encourage children to smoke include having parents, siblings or peers who smoke, being in a one-parent family, having a poor academic record and being exposed to tobacco advertising. There is also evidence that a younger age of smoking initiation increases the risk of lung cancer.
Socio-economic group- Before the dangers of cigarette smoking were widely known, smoking prevalence varied little by socio-economic group. In the UK today there are clear differences. With smoking being a key contributory factor to health inequalities between socio-economic groups and accounts for a major part in the differences in life expectancy between these groups.

A table to show the percentage of smokers within socio-economic groups and gender (National Statistics 2007)

This chart shows that the higher socio-economic group the least likely you are to smoke, it also shows that more men smoke than women.

Ethnic group- Smoking rates vary considerably between ethnic groups and between men and women within these groups. All female ethnic groups are much less likely to smoke than the rest of the female population, but Bangladeshi and south East Asian men are more likely to smoke than the rest of the male population. As with the general population smoking prevalence in ethnic minority groups decrease with age with the exception of black Caribbean and south east Asian men.
Region- Men and women in the northeast are more likely to smoke than in any other region in England, this is probably mainly due to income deprivation with the North being affected by this the most out of the whole of England.

Teenage pregnancy is a significant public health issue in England. Teenage pregnancies are prone to poor antenatal health, babies with lower birth weights, and higher infant mortality rates. Teenage mothers are less likely to finish there education, less likely to find a good job, and more likely to end up as a single parent bringing there child up in poverty with also being more likely to receive benefits. Children born to teenage mothers run a much greater risk of poor health. Teenage pregnancy is an increasing social issue. High rates of teenage pregnancy may be caused by lower educational levels and higher rates of poverty. At the minute in the UK there are no statutory PSHE (personal, social and health education) within schools, which may explain why teenage pregnancies in the UK are so high. This is mainly due to funding within schools within areas where the need is the greatest, and also to do with education not keeping up to date with educating current social problems. Current sex and relationship education is too little too late and too biological. Teenage pregnancy is usually outside of marriage and carries a social stigma in many communities and cultures. In some societies early marriage and traditional gender roles are important factors in the rate of teenage pregnancies. In societies where adolescent marriage is uncommon, young age at first intercourse and lack of contraception may be factors in teenage pregnancy. The average amount of teenage pregnancies annually in the UK is 41.9 per 1,000 in 2007. The five areas with very high rates of pregnancy are Hartlepool, Hull, Salford; all within the North of England, Lambeth in Greater London and Great Yarmouth in the East of England. The area with the lowest rates of pregnancy was East Devon with only 5.3 women per thousand getting pregnant in 2007.

“Teenage girls living in deprived areas are four times more likely to fall pregnant than those living in more affluent areas”

(Acheson Report)

This Chart shows the number of women (15-17) getting pregnant annually from the areas of the highest rates of teenage pregnancies in England.

Hartlepool Public Health Profile- 47% of residents living in Hartlepool live in the most deprived areas of England, life expectancy is worse for both males and females and obese children and teenage pregnancies are much worse than the England average.

Hull Public Health Profile- The health of people in Hull is worse than the England average, there are health inequalities by deprivation, with over 50% of residents living in one of the most deprived areas of England.

Salford Public Health profile- The health of people in Salford is worse than the England average, including deprivation, adults who smoke and adults who are obese. The health of children and young people is worse than the England average, including teenage pregnancy and smoking in pregnancy.

Lambeth Public Health Profile- The health of people in Lambeth is poorer than the England Average. Over half of Lambeth’s residents live in areas classified as being amongst the fifth, most deprived areas of England. The teenage pregnancy rate in Lambeth is the highest in England being almost double the national average.

Great Yarmouth Public Health Profile- The health of people in Great Yarmouth is significantly worse than the England average. There are higher levels of drug misuse, deprivation, and diabetes. The rates of teenage pregnancy, breast feeding, and physical activity in children at school is significantly worse than the England average.

East Devon Public Health Profile- The health of people in East Devon is generally better than the England average, as well as life expectancy. The health of children in East Devon is generally better than the England average, as well as rates of teenage pregnancy and smoking.

This shows that there is a clear link between teenage pregnancies, health in general and deprivation, the North as a whole is the second deprived area of England and this is where three of the areas which have the most teenage pregnancies within the whole of England. All three areas had worse health than the England average. As well as Lambeth, suffering from the highest rates of pregnancy. Lambeth also being one of the most deprived areas in England and also having a worse than average health. Great Yarmouth has also got high levels of Deprivation and significantly worse health. Whereas, East Devon where there are the least amount of teenage pregnancies annually, have better health and life expectancy than the England average.

Crime and fear of crime can affect the quality and health of people’s lives. Crime and violence doesn’t just cause physical injuries, but can make victims angry, shocked, leave them living in fear and leave them feeling feel like they have had their privacy invaded. Crime tends to be concentrated in areas of social deprivation and housing estates within cities are more likely to have high levels of crime and violence compared to housing in rural areas. Young men as well as being the most common perpetrators of crime are the most likely victims of crime, especially physical assault. Also older people especially women are more likely to be victims of theft; this is likely to be due to their venerability. People from minority ethnic groups are at a greater risk of violent crime and racial harassment. Fear of crime can also be a cause of mental distress and social exclusion. In particular women and older people tend to worry more about becoming victims, especially in areas of high crime rates and this may prevent them from engaging in social activities. The fear of crime makes social exclusion worse especially those that live in disadvantaged areas.

“People who suffer from poor health are more likely to be victims of crime than those in good health, however this may be because of the association of disadvantage with both victimisation and poor health, rather than poor health causing victimisation.” (Acheson report)

Social factors, and poverty and income inequality are important underlying causes of crime. Income inequality is related to crime via social cohesion, there are less and less societies and communities working together on the same levels, with people living in the same neighbourhoods being split by social stratification.

“People relate closely to their neighbourhoods, and are likely to be healthier when they live in neighbourhoods where there is a sense of pride and belonging, Evidence particularly from the World Health Organisation shows how social cohesion and strong social networks benefit health.”

(Saving Lives Our Healthier Nation)

Harmful drinking is a significant public health problem in the UK, and is associated with a wide range of health problems including brain damage, alcohol poisoning, liver disease, mental ill health, and social problems. There are particular risks associated with drink driving, alcohol consumed in the workplace and drinking during pregnancy. Alcohol related problems contribute to social and health inequalities.

Motor vehicle traffic accidents are a major cause of preventable deaths and morbidity particularly in younger age groups. For children and for men mortality rates for motor vehicle traffic accidents are higher in lower socio-economic groups and men are three times more likely to have a motor vehicle traffic accident than women.

“Pedestrian death rates for children in social class V are five times higher than for those in social class I, and are higher for boys than girls.”

(Acheson Report)

Some disadvantaged groups, such as children from families without a car, are more likely to make journeys by foot, cross more roads than those who have access to a car and consequently are exposed to higher risks of pedestrian accidents.

My research has shown me that there are many patterns and determinants of socio-economic inequalities in health and the chances of living in good health are unequal. The chances are much higher for people in more advantaged circumstances than for those further down the socio-economic ladder. It is your socio-economic position, linked to other factors such as income and area, which in turn are linked to environmental factors such as lifestyle, housing and education, that contribute to determine your overall health outcome.