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Health inequalities in Scotland: now and in the future.

Health inequalities in Scotland: now and in the future. Carol Tannahill Director Glasgow Centre for Population Health. A bit about patterns and trends A bit about explanations A bit about implications What I’m not going to cover All types of health inequality. W hat I’m going to cover.

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Health inequalities in Scotland: now and in the future.

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  1. Health inequalities in Scotland: now and in the future. Carol Tannahill Director Glasgow Centre for Population Health

  2. A bit about patterns and trends A bit about explanations A bit about implications What I’m not going to cover All types of health inequality What I’m going to cover

  3. What we’re up against:history, geography and the life course

  4. Mortality by social class 1911-1981(Men, 15-64 yrs, E&W) (Marmot, 1986; OPCS, 1978)

  5. (Mackenbach, 2005)

  6. (Mackenbach, 2005)

  7. Smoking Father’s 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) Lifecourse effectsAge adjusted relative rates of CVD mortality by father’s social class and smoking Davey Smith and Hart, AJPH 2002

  8. 80 70 60 Life expectancy in years 50 40 30 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 Year of birth 20th century trends in life expectancy in Scotland and 16 other Western European countries Males Scotland

  9. Trends in life expectancy - males

  10. All cause death rates, Men 0-64, 2001 (Leyland et al, 2007)

  11. All cause death rates, Men 0-64, 2001 Glasgow City Inverclyde 30% West Dunbartonshire Dundee City Eilean Siar Renfrewshire North Ayrshire North Lanarkshire

  12. Death rate per 100,000 men age 15-29

  13. The pattern of health inequalities is not always predictable The Scottish Health Survey (2003)

  14. Self-reported cigarette smoking by SIMD quintile and sex

  15. Accident rates per 100 children by SIMD quintile and age

  16. Alcohol consumption by SIMD quintile and sex

  17. Alcohol consumption by SIMD quintile and sex

  18. A whistle-stop tour of some explanations

  19. Yeah but no but yeah but no but … Or, more scientifically, “necessary but not sufficient” Scotland does behave differently (ref Walsh and Taulbut in preparation) 1. Global factors are at play

  20. Life expectancy - Ruhr

  21. Life expectancy - Ruhr

  22. Life expectancy – N. Moravia

  23. Life expectancy – N. Moravia

  24. Yes – If Glasgow had the SES of the rest of Scotland, much of its health excess would disappear But – it would still have poorer mental health among women, higher levels of alcohol consumption, more long standing illness.. And – it’s already no different in terms of eg obesity (Gray, 2007) 2. It’s about socio-economic status

  25. Remember remember the 7th of November (our last meeting)? Attention to how services are delivered can really make a difference We heard about partnerships, inequalities sensitive practice, NHS using its wider influence But we are against the inverse care law – especially for some of the more effective interventions 3. Better services can sort it

  26. CHD PREVALENCE IN PRACTICE POPULATIONS • UNDER 70 IN NHS GREATER GLASGOW • CHD EMAs Angina No of Population • deaths practices • 1 Most deprived 9.1 46.2 6.7 24 82,502 • 2 10.7 40.8 6.4 26 81.927 • 3 8.3 34.6 5.9 20 82,163 • 4 8.0 34.0 5.6 20 90,407 • 5 8.7 27.5 5.0 27 79,680 • 6 6.2 22.2 4.5 20 82,795 • 7 6.7 21.7 4.2 21 84,456 • 8 4.9 18.6 3.7 21 84,922 • 9 2.9 15.3 3.0 13 89,007 • Most affluent 2.7 14.8 2.8 17 81,941 • 10:1 Ratio 3.3 3.1 2.4

  27. TRENDS IN STATIN PRESCRIBING IN PRACTICE POPULATIONS • IN NHS GREATER GLASGOW BETWEEN 2001/2 AND 2004/5 • Dispensed daily doses (millions) • 2001/2 2004/5 Increased • 10 Most deprived 1.08 5.74 5.31 • 9 1.10 5.93 5.39 • 8 0.96 5.39 5.61 • 7 0.92 4.86 5.28 • 6 0.90 4.74 5.27 • 5 0.87 5.30 6.09 • 4 0.98 5.05 5.15 • 3 1.00 4.70 4.70 • 2 0.86 3.55 4.13 • 1 Most affluent 1.04 4.63 4.45 • 10:1 Ratio 1.04 1.24

  28. Yes Although some things seem to matter more than others (income, education, employment) And there may be some important underpinning factors (resilience, ‘control’, adaptability, etc) 4. It all matters

  29. Newton Mearns – G77 5

  30. Dalmarnock – G40 4

  31. And finally.. a bit about implications

  32. Globally things are getting worse and Scotland is behind the pack. What can we do? Influence out as well as in. Set realistic aspirations. Ensure our policies are inequalities proofed. Act on the causes behind the causes. Invest in resilience, adaptability, coping and control. Create environments conducive to health. Systematically deliver services in a way that reduces inequity. Implications

  33. “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’

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