What is meant by ‘health inequalities’ • Provide evidence of health inequalities in Scotland and the UK in terms of: - geographic location - social class - gender - ethnicity Note: Health inequalities are usually measured in terms of life expectancy, mortality (death) rates or morbidity (illness) rates.

What are Health Inequalities? There is a great deal of evidence to show that some groups of people are more likely to enjoy better health and have longer life expectancy than others i.e. everyone’s health is not equal. Four ways in which health inequalities can be demonstrated (life expectancy or mortality/morbidity) are by: 1. Geographic location within Scotland, the UK and also within Dundee/Tayside. 2. Social class i.e. between wealthiest and poorest. 3. Gender between males and females. 4. Ethnicity between different ethnic groups.

GEOGRAPHY AND HEALTH INEQUALTIES There is a clear North-south divide in the health of the British public. FEB 2006 - a health inequalities study by CACI (an information service company) made headlines in Scotland. The herald said - “Scotland: sick man of the UK with 22 of the top 25 illness areas”

GEOGRAPHY AND HEALTH INEQUALTIES Caci report – 2006 The report found that Scots are more likely to: Suffer long-term illness Take less exercise Be more overweight Spend more on alcohol and cigarettes Scotland has the highest death rate from lung cancer and life expectancy is lower than England & Wales.

GEOGRAPHY AND HEALTH INEQUALTIES There are clear differences between Scotland and England but also within cities and specific wards. Aberdeen, a prosperous city, had 5 wards in the top 25 unhealthy areas according to the CACI report. Glasgow had 6 areas and Dundee 3. For a long time people in richer areas of Glasgow like Bearden live on average 10 years longer than their neighbours in Drumchapel.bearsden glasgow - Google Maps

GEOGRAPHY AND HEALTH INEQUALTIES Different geographical locations are evidence of inequalities in health. However the causes are not geographic but linked to poverty and social class.

Evidence of Health Inequalities – Geographic location: Life Expectancy in the UK Regions and by Gender, 2008

Evidence of Health Inequalities – Geographic location: Life Expectancy in the UK & Gender, 1985-2007

Evidence of Health Inequalities – Life expectancy (years) at birth UK, Scotland, Tayside and Dundee 1999-2001 Males Females UK 75.0 80.2 Scotland 73.1 78.6 Tayside 73.9 79.2 Angus 74.7 78.9 Dundee City 71.8 78.0 Perth & Kinross 75.4 80.7

Evidence of Health Inequalities – Geographic location: Life Expectancy, Gr. Glasgow and Clyde 1991-2006

Inequalities in health and social class THE BLACK REPORT This was published in 1980 and was the most thorough study ever made of the link between health and social class. Unfortunately most recent reports confirm that its finding are still relevant today. It concluded that the general health of the population had improved but differences between the rich and poor were widening.

Inequalities in health and social class THE BLACK REPORT It stated that poor people are more likely to: Smoke and drink too much Eat poor diets Live in damp cold houses The areas they live in have more accidents (high rise) More likely to develop heart disease and cancer Be fatter

Inequalities in health and social class THE ACHESON REPORT 1997 – the chief medical Officer, Sir Donald Acheson produced a report that said the same thing as the Black report, 17 years later. Within Scotland, the gap between life expectancies for rich and poor had widened. Those in the most deprived areas are twice as likely to die from heart disease. Suicide rates are higher among poorer people, especially young men and these have increased.

Evidence of Health Inequalities – Social Class: Cancer deaths in under 75s in Scotland & most deprived areas

Inequalities in health and social class THE 3 CITIES REPORT – 2010 This appeared in the Journal of public health and the research was based on Glasgow, Manchester and Liverpool. It concluded that health issues in Glasgow/West of Scotland were a combination of decades of unemployment and factors including family, poverty, chronic stress, relationship issues, attitude and behaviour. In other words – it is not all down to class and poverty, it is also behaviour and lifestyle choices like smoking, drinking, junk food, lack of exercise.

GENDER AND HEALTH INEQUALITIES In general women live longer than men. Why? Women are less likely to die in childbirth. Males are more likely to injured or killed in accidents or violent situations. Men are more likely to suffer from lung cancer and heart disease. Women are more likely to visit the doctor. Men are 3 times more likely to die in road accidents.

GENDER AND HEALTH INEQUALITIES Although men die younger, women in general suffer more health problems (higher morbidity rates) than men. BIOLOGICAL Women's reproductive role causes ill health – childbirth, contraception, periods, abortion & menopause. POVERTY Women are more likely to suffer the effects of poverty. For example, women may have to accept low-paid jobs, head lone-parent families and may be expected to take on the caring role for elderly and disabled relatives. Women (24%) in Scotland are more likely to live in poverty than men(13%). Mortality rates also increase for women in the lower classes. Therefore social class and income have a significant impact on women's health.

GENDER AND HEALTH INEQUALITIES AGEING In the UK 70% of those over 75 are women. However women have more ill health. Therefore women are expected to live around 70 years in good health and 10 in poor health. Men are on average expected to live 68 years in good health and 7 in poor health.

ETHNICITY & HEALTH Just as in the population as a whole, poverty has an important impact on health in ethnic minorities. DISEASES & DIET Ethnic minorities differ in their risk of suffering from certain diseases. Pakistanis, Bangladeshi’s and Indians are more likely to suffer from Diabetes than the white population. They are also more likely to suffer heart disease. This may be in part due to differences in diet due to cultural or religious requirements. CULTURE The Muslim religion does not permit the drinking of alcohol. Social customs among some groups do not approve of women smoking.

Evidence of Health Inequalities – Ethnicity and Morbidity: Limiting Long-Standing Illness, 2001

ETHNICITY & HEALTH The 1999 Health survey for England found that members of all ethnic minority groups were less likely to drink alcohol than the general population and those who did consumed smaller amounts. For women the figures were higher. Ethnic group % of non drinkers General population 7% Black Caribbean men 13% Chinese men 30% Indian men 33% Pakistani men 91% Bangladeshi men 96%

ETHNICITY & HEALTH Other factors: All ethnic minorities are less likely to exercise. Ramadan – Muslims can fast for up to 30 days and this has a negative effect on those suffering from diabetes. Some fail to access health care due to language difficulties or cultural barriers. For example some Asian communities find it hard to accept help from someone outside their community.

Cautionary Note Although there is an abundance of evidence to support the existence of health inequalities, this does not mean that any one individual can be ‘pigeon-holed’ regarding their health. There are many other factors which affect the health and life expectancy of an individual including: - biological/family history - personal lifestyle choices - the physical and social environment - access to health service

Evidence of Health Inequalities Official reports that have demonstrated the existence of health inequalities in the UK include: - Black Report 1980 (first health inequalities report) - Acheson Report 1998 - Caci Report 2006 Register General Annual Household Survey The General Lifestyle Survey, formerly known as the General Household Survey (GHS), is a multi-purpose continuous survey carried out by the ONS collecting information on a range of topics from people living in private households in Great Britain. This information is used by government departments and other organisations for planning, policy and monitoring purposes and to present a picture of households, family and people in Great Britain.

TASK: Complete the activities on page 58 of text book. Homework – Essay question on page 58.