Major study outlines wide health inequalities in England

A 60-year-old woman in the poorest areas of England has a level of ‘diagnosed illness’ equivalent to that of a 76-year-old woman in the wealthiest areas, according to new research by the Health Foundation. While a 60-year-old man in the poorest areas of England will on average have a level of diagnosed illness equivalent to that of a 70- year-old man in the wealthiest areas. 

People living in the most deprived parts of England are diagnosed with serious illness earlier and die sooner than their peers in more affluent areas, a major new study finds. 

The Health Foundation, an independent charity, calls on the next Prime Minister to prioritise action to reduce health inequalities – citing polling from Public First that finds this is a key issue for 2019 Tory voters in red wall areas especially.  

Previous studies into the extent of health inequalities in England have largely relied on people’s self-reported health. This new analysis uses linked hospital and primary care data to examine socioeconomic, regional and ethnic variations in the prevalence of diagnosed long-term illnesses. These include diabetes, cardiovascular disease, chronic pain, and mental health conditions such as anxiety and depression. The analysis also uses the Cambridge Multimorbidity Score to assess the relative impact of different patterns of illness on people and their health care needs.  

The study finds: 

• For most of their lives, people in the poorest areas of England, on average, have more diagnosed illness over 10 years earlier than those in the richest areas.  

• While inequality in life expectancy is greater for men than for women, women face greater disparity in the amount of time spent with diagnosed illness. On average, a 60-year-old woman in the poorest areas of England will have a level of diagnosed long-term illness equivalent to that of a 76-year-old woman in the wealthiest areas.  

• A woman living in the poorest areas has a life expectancy five years shorter than those in the wealthiest areas. She will spend more than half (44 years) of her shorter life in ill health compared to 46% (41 years) for a woman in the wealthiest areas.  

• A 60-year-old man in the poorest areas of England will on average have a level of diagnosed illness equivalent to that of a 70-year-old man in the wealthiest areas. He will be expected to live up to the age of 78, dying nine years earlier than someone in the wealthiest areas (87).  

• The socioeconomic inequality in life expectancy for men is such that, despite spending a greater share of their lives with diagnosed illness (46% compared with 44%), men in the most deprived areas spend less time living with diagnosed illness (36 years compared with 38 years in the least deprived areas).   

The analysis also looks in detail at: 

• Age: Children and young people in poorer areas (the under 20s) are much more likely to be living with conditions such as asthma, epilepsy, and to experience alcohol problems, while people in their 20s see diagnosed chronic pain, alcohol problems and anxiety and depression. From 30 onwards, disparities in diabetes, COPD and cardiovascular disease (CVD) rates grow and overtake anxiety and depression, although there is still growing inequality in chronic pain and alcohol problems. In older age, these health inequalities manifest through inequalities in chronic pain, COPD, diabetes, cardiovascular disease, and dementia.  

• Ethnicity: The analysis also finds significant ethnic disparities in diagnosed illness. People from Pakistani, Bangladeshi and black Caribbean backgrounds are found to have higher levels of long-term illness than the white population, once the data had been standardised for age. People from Pakistani and Bangladeshi backgrounds have the highest age-standardised rates of diagnosed chronic pain, diabetes and cardiovascular disease. However, the white population has the highest levels of diagnosed anxiety or depression, and alcohol problems. White people are also more likely to be living with cancer. The study’s authors note that this could be due to the increased survival rates associated with cancers that are more prevalent in this group and due to more diagnoses resulting from greater access to cancer screening in the white population. 

• Region: people living in the North East and North West have the highest health care needs due to long-term illness once the data had been standardised for age. In the North East particularly, there are high levels of diagnosed chronic pain and alcohol problems. These issues are important for voters in ‘red wall’ areas. Separate research by Public First for the Health Foundation, published in July, finds that 37% of 2019 Conservatives voters would be less likely to vote Conservative if the government drops its manifesto commitment to reduce life expectancy inequalities.  

The Health Foundation calls on candidates to be the next Prime Minister – Liz Truss and Rishi Sunak – to ensure that they commit to addressing these issues in the forthcoming Health Disparities White Paper.