Why is tackling health inequality so important

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Why is tackling health inequality so important?

• Carol Tannahill
• Director
• Glasgow Centre for Population Health

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What Im going to cover

• A bit about data
• A bit about analysis
• A bit about implications
• What Im not going to cover
• All types of health inequality

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Historical data
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Mortality by social class 1911-1981 (Men, 15-64
yrs, EW) (Marmot, 1986 OPCS, 1978)
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Lifecourse effectsAge adjusted relative rates
of CVD mortality by fathers social class and
smoking

• Smoking
• Fathers social class Other
  Current cigarette
• Non Manual 1
  2.20 (1.66 2.93)
• Manual 1.80 (1.40 2.31)
  3.11 (2.45 3.95)

Davey Smith and Hart, AJPH 2002
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The Scottish Health Survey (1998)

• The pattern of health inequalities
• is not always predictable

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Prevalence of cigarette smoking (age
standardised)by social class of chief income
earner
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Accident rates per 100 children by social class
of chief income earner
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Alcohol consumption by social class of chief
income earner
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Body mass index (BMI), by social class of chief
income earner
Men Women
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Trends in health inequalities

• The trends show no consistent pattern over the
  last decade
• (see Report of the Measuring Inequalities in
  Health Working Group, 2003. Comparisons are
  between the top and bottom 20 of postcode
  sectors.)

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Indicators

• Smoking during pregnancy
• Dental health of children
• Adult smoking
• CHD mortality lt75 years
• Life expectancy
• For each, are inequalities narrowing, widening or
  staying the same?

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5 core indicators

• Smoking during pregnancy
• significant narrowing of inequalities
• Dental health of children
• no significant change
• Adult smoking
• no significant change

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5 core indicators (contd)

• CHD mortality lt75yrs
• significant increase in inequalities for males,
  increase (NS) for females
• Life expectancy
• inequalities have widened for males and remained
  fairly constant for females

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A whistle-stop tour of explanations
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Material deprivation/income?

• What features of society predispose to, or
  buffer, a relationship between income and health?
• Neo-materialism money as a tool for coping?
• Social structures and supports?
• Psychosocial factors?
• Prolonged and unresolved stress?

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• It is the experiences associated with hierarchy
  or status, and the way they are interpreted by
  the individuals that matter, rather then
  hierarchical position per se.
• Evans, 2002

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And finally.. a bit about implications
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Implications

• For the content and focus of policy
• For debate about what sort of society we want
• For how, where and what services are delivered
• For finding approaches that release individual
  and community assets
• For building and sharing evidence of what works

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• The omnipresence and persistence of health
  inequalities should warn against unrealistic
  expectations of a substantial reduction within a
  short period of time and by using conventional
  approaches.
• Mackenbach, JP (2005). Health Inequalities
  Europe in Profile