Inequalities in life expectancy: Changes over time and implications for policy

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Our health is determined by a complex mix of factors including income, housing and employment, lifestyles and access to health care and other services. There are significant inequalities in health between individuals and different groups in society.

These inequalities are not random. In particular, there is a ‘social gradient’ in health; neighbourhood areas with higher levels of income deprivation typically have lower life expectancy and disability-free life expectancy. This relationship (known as the ‘Marmot curve’) formed an important part of the independent and influential report on health inequalities, Fair society, healthy lives (the Marmot Review).

Inequalities in life expectancy assesses how the Marmot curve has changed over time and what that tells us about the success or otherwise of government policy on inequalities in health over the period 1999–2003 to 2006–10. This study brings together, for the first time at a small area level, data on a wide array of variables for 6,700 areas of England on wider determinants, lifestyles, demographics and public service variables widely thought to be significant in determining health and health inequalities.

Key findings

  • The Marmot curve for life expectancy got flatter between 1999–2003 and 2006–10, which implies that the relationship between income deprivation and life expectancy got weaker over that period.
  • Other factors, in particular employment, housing deprivation, and income deprivation among older people and some lifestyle factors such as binge drinking and fruit and vegetable consumption are the most important in explaining differences in life expectancy between areas in 2006-10.
  • Low employment, housing deprivation and smoking are among the factors that distinguish areas with persistently low life expectancy over time.
  • ‘Place’ remains important over and above these general findings and relationships. 

Policy implications

  • There needs to be a much more nuanced and integrated policy response to inequalities in health. There are some early signs of this integrated approach, but beyond this, we argue for a more coherent approach to inequalities in health delivered through population health systems that more strongly integrate NHS services with other public services and approaches to public health.
  • Austerity, and, as importantly, the policy reaction to it, will have consequences for health inequalities. NHS and wider government policy needs to refocus on inequalities in health, if some of the positive findings that happened over the 2000s are not to be lost.
  • Some places and parts of the country seem to do better or worse than our general analysis predicts. How policies are translated at area and community level needs to take into account the local knowledge, history and experience that no high-level analysis can provide.

Comments

Victoria

Position
Account Manager,
Organisation
CACI
Comment date
11 August 2015
Downloading to read publicity on Workforce Acorn

Prof. Minesh Khashu

Position
Prof. of Perinatal Health,
Organisation
NHS
Comment date
12 August 2015
At a population level, the most important determinant of health is socioeconomic. The most important determinant of socioeconomic status is education.
The most effective long term prevention strategy is minimising health inequalities through social and educational upliftment.

Marjorie Dixon-Rice

Position
Retired community nursing manager,
Organisation
N/A
Comment date
13 August 2015
It is not all about money, though obviously money helps. Why not be more proactive and take health education to where it will target the people who would benefit most. Maybe a health promotion team in unemployment offices, The weight , B.P and advice on healthy eating could be dispensed with monitory benefits.

Nayab Nasir

Position
Doctor,
Organisation
Public Health
Comment date
16 August 2015
As much as socioeconomic and other factors are very important however what sits at the heart of each determinant is "awareness" and "attitude" at the population. E.g. NHS health check is a free programme providing timely risk assessment of Cardiovascular diseases to every one of age 40-74 to reduce inequalities and CVD. If people have the grasp about the wider aim of the programme and are willing to make the healthy life style changes, inequalities would reduce in its own healthy pace. This is just one example of the effort and resources put to reduce inequalities.

John Kapp

Position
Director,
Organisation
Social Enterprise Complementary Thaerapy Company SECTCo
Comment date
16 August 2015
I agree that education if the most important intervention to reduce inequalities, particularly if combined with meditation, such as the Mindfulness Baseed Cognitive therapy (MBCT ) 8 week course, see my papers on section 9 of www.reginaldkapp.org

Julie Hirst

Position
Public Health Specialist,
Organisation
Derbyshire County Council
Comment date
20 August 2015
I fully agree.

Ted Schrecker

Position
Professor of Global Health Policy,
Organisation
Durham University
Comment date
25 August 2015
In a new book How Politics Makes Us Sick (Palgrave Macmillan), my colleague Clare Bambra and I comment on the 'neoliberal epidemic' of austerity and why it threatens population health. Under current policies of systematically redistributing income and wealth upward and magnifying inequalities of economic opportunity, I dread the body count in 2020.

Toya Sapkota

Position
PhD Public Health Research Student,
Organisation
John Moors University
Comment date
03 September 2015
We take life as granted until we get into trouble except inborn elements- individual. Trend of longevity, states failed to identify and address demographic changes and needs, widening gorge of socioeconomic disparity, fading social and cultural values resulted - frustration, isolated, introvert, insecurity - leading towards more inequality in life expectancy. Controlling mechanism like prescribing compulsory exercise, healthy life-style, redesigning integrated health and wellbeing policies could be some steps to reduce the inequality.
Will definitely read the book.

Kenneth Williams

Position
Personal Trainer/ Nutritionist,
Organisation
Complementary Body Science
Comment date
25 December 2015
Good day to address these inequalities requires a more direct approach if to be successful and achieve beneficial results. Apart from the factors such as locations and employment, sensible affordable eating and a exercise program in terms of the benefit of exercise basically comes down to education a project supported by the NHS and conducted by exercise professionals and nutritionist/ dietitians. Advertise and promoted in these areas would have a significant impact. As for the NHS, health screening again it is limited to library's and does not get to real target audience, intervention/prevention is the way forward.

Ubah

Position
Teacher,
Organisation
Barking and Deganham College
Comment date
16 March 2016
I would like to have more information about the current policies on the Health and Social Care

Anni Hat

Position
private individual,
Comment date
12 August 2017
monitory
adj. Conveying an admonition or a warning: a monitory glance.
n. A letter of admonition, such as one from a bishop or an ecclesiastical court.

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