1. Introduction to Health Inequalities Charlotte Fellows

2. Introduction What are health inequalities? Introduction to inequalities in London Sources of data/information on health inequalities 2

3. What are health inequalities? Unjust differences in health outcomes between different groups of society e.g. Geographic areas Ethnic groups Socio-economic groups Gender Disability Sexual orientation 3

4. Spectrum of inequality

5. Early Years – Percentage achieving a good level of development at age 5, England 2011 Source: DfES

6. Gap in years of female life expectancy between most and least deprived fifths of English population 5.2 year gap 5.8 year gap Source: Office for National Statistics

7. Health inequalities in London Long history of examining social and health inequalities in London 7

8. Two different areas of London (1886-1903) Whitechapel Mayfair/Fitzrovia http://booth.lse.ac.uk/static/a/4.html#i

10. Whitechapel Mayfair

11. Life expectancy, males, 2006-10 Whitechapel Tower Hamlets Mayfair Westminster England 78.3 years

12. Life expectancy, males, 2006-10 Whitechapel Tower Hamlets LE 76.0 Mayfair Westminster England 78.3 years

13. Life expectancy, males, 2006-10 Whitechapel Tower Hamlets LE 76.0 Mayfair Westminster LE 83.2 England 78.3 years

14. Westminster – the inequality within

15. Tower Hamlets – the inequality within

16. KIT Sources of data/information on health inequalities PHOF Segment tool Marmot indicators Health inequalities analysis tool 16

17. Public Health Outcomes Framework Improving outcomes and supporting transparency – Part 1A A public health outcomes framework for England 2013 – 2016 states that: “The Public Health Outcomes Framework will focus attention on reducing health inequalities and promoting equality” Also “…the majority of indicators in the framework have potential to impact on inequalities and we aspire to make it possible for all indicators to be disaggregated by equalities characteristics and socio-economic analysis wherever possible…” This is the long term aim for equalities/inequalities data within the PHOF 17

18. PHOF overarching indicators – baseline data Healthy life expectancy for upper tier LAs – 2009-11 Life expectancy at birth – 2009-11 SII in life expectancy within England – 2009-11 (provisional) SII in life expectancy within upper tier LAs – 2009-11 (provisional) Gap between life expectancy in each LA and the England life expectancy value. 18

19. The Segment Tool Provides information on the causes of death that are driving inequalities in life expectancy at local area level. Shows the percentage contribution of the causes of death to the life expectancy gap, and number of excess deaths for two comparisons: 1. The gap between the local authority as a whole and England as a whole. 2.The gap between the most deprived quintile of the selected local authority and the least deprived quintile of the local authority. Based on 2009-11 data All upper tier local authorities in England included 19

21. Marmot Indicators Not updated in 2013. Next update planned mid- 2014. PHE working with Institute of Health Equity to scope indicators for next release. 21

22. Health inequalities analysis tool Absolute/relative range Linear regression slope Weighted linear regression slope Slope index of inequality Relative index of inequality Gini coefficient Absolute/relative concentration index 22

23. Links to resources London Knowledge and Intelligence team: www.lho.org.uk www.lho.org.uk PHOF data tool: http://www.phoutcomes.info/http://www.phoutcomes.info/ The Segment tool: http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Segme nt/TheSegmentTool.aspx http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Segme nt/TheSegmentTool.aspx Marmot indicators: http://www.lho.org.uk/viewResource.aspx?id=17019 http://www.lho.org.uk/viewResource.aspx?id=17019 Health inequalities analysis tool: Not yet published 23