This section outlines the major determinants of people's health. It traces the roots of ill health to such factors as income, education and employment as well as to the material environment and lifestyles.

The key aims of the Government’s Green Paper “Our Healthier Nation”(1) are to increase the length of people’s lives and to reduce health inequalities. It highlights the need for local strategies and alliances tailored to meet local health needs, a process in which local authorities, health authorities and primary care groups are expected to play a key role. For the first time, the government will require local policy makers to set targets for reducing health inequalities. Furthermore, local authorities are charged to improve the social and economic wellbeing of their communities.

The growing concern about health inequalities in the UK has been highlighted in the recently published report on Health Inequalities.(2) The report shows that although average mortality has fallen over the past 50 years, unacceptable inequalities in health persist. Many measures of health inequalities have either remained the same or have widened in recent decades. Such inequalities exist, whether measured in terms of mortality, life expectancy or health status; whether categorised by socio-economic measures, gender or geographical area.

What are the reasons for such inequalities? The weight of scientific evidence supports a socio-economic explanation. This traces the roots of ill health to such determinants as income, education and employment as well as to the environment and lifestyles.

Income – people living in poverty have poorer health, higher death and illness rates and shorter life expectancy. Income determines the range of choices available to people from where they live, what they eat, how much heating they use, to their ability to access leisure, health and other services. People on low income are more likely to be unemployed, lone parents, people with disabilities or pensioners and to live in social housing. Some minority ethnic groups are over-represented in the low-income group.

Education – plays a number of roles in influencing inequalities in health. Firstly, educational qualifications determine an individual’s employment chances, which in turn influence income, housing and other material resources. Secondly, education enables individuals to understand better the choices open to them and the consequences of such choices. Thirdly, education enables people to develop relationships, deal with conflict and develop practical skills such as budgeting.

Housing and Environment – shelter is a pre-requisite for health. Poor quality housing is associated with poor health. Dampness is associated with increased prevalence of asthma. Cold housing leads directly to hypothermia and to an excess in winter deaths. Homeless people have very high mortality rates, particularly those who are rough sleepers or hostel users. Psychological distress (depression and anxiety), infections and accidents are more prevalent in people living in bed and breakfast or other temporary accommodation.

Crime and fear of crime can affect the quality of people’s lives, although not everyone is at equal risk of becoming a victim of crime. Crime tends to be concentrated in areas of social deprivation with young men, older people and women more likely to be victims of crime.

Poor access to transport may limit work and training opportunities, access to cheaper shopping facilities, access to health and social care and to families and friends. Higher traffic volume leads to increased levels of air and noise pollution and higher rate of road traffic accidents. Air and water quality also are important factors influencing people’s health and are discussed in more detail in Section 4 of this report.

Lifestyles – behaviour factors such as smoking, diet, alcohol and physical activity vary between different socio-economic groups and have been implicated as either risk factors or causes of ill health. Diseases associated with lifestyles include cancers, coronary heart disease and strokes, accidents, caries and many others.

Inequalities in Health in Portsmouth and South East Hampshire - The subject of inequalities is wide ranging and previous public health annual reports and the Community Health Atlas(3) have analysed health inequalities in Portsmouth and South East Hampshire from the point of view of geographical, gender and age associations. This section will focus specifically on variations in death and ill health associated with lifestyles and access to health services.

To assess the extent of deprivation in the district, we have analysed routinely collected primary care, community and hospital utilisation information, the chronic disease database and the recently conducted 1999 Health and Lifestyle Survey(4). The Jarman score(5) and social class are used as indicators of deprivation. Thus each ward and GP practice were ranked according to their Jarman score. Ranked wards and practices were then divided into quintiles, with the extremes representing “most deprived” and “least deprived” (most affluent) wards or practices. Quintiles represent fifths of the population. These quintiles are then used to compare service provision in deprived and affluent wards. Four other indicators are used as a measure of the population’s health needs (limiting long term illness, low birth weight, mortality and the Mental Illness Needs Index (MINI)(6). These indicators were used because:

• Limiting long term illness (LLTI) is a good indicator of health need of the adult population.
• Low birth weight is of particular relevance to the health needs of the younger population.
• Mortality (as measured by the standardised mortality ratio) is highly correlated with several measures of ill health and with heavy use of services.
• Mental Illness Needs Index(6) - is a measure of relative need for acute mental illness services based on census indicators such as social isolation, poverty, unemployment, permanent sickness and temporary and insecure housing.

Wherever appropriate, analyses are carried out by local authority or primary care group.

References

1. Department of Health. Our Healthier Nation London: HMSO, 1998.

2. Acheson D. Independent Inquiry into Inequalities in Health, London: HMSO 1998.

3. Jorge E. Portsmouth and SouthEast Hampshire Community Health Atlas, 1996.

4. Portsmouth and South EastHampshire Health and Lifestyle Survey, SCPR, 1999.

5. Jarman B. Identification of under privileged areas. British Medical Journal 1983; 286: 1705-9.

6. Glover GR, Robin E, Emani J, Arabscheibani GR. A needs index for mental health care.. So. Psych & Psych Epidemiol. 33(2): 89-96, 1998.

Produced by Ann Edmeades, IT Services, Hampshire County Council
for Portsmouth and South East Hampshire Health Authority
© Copyright Portsmouth and South East Hampshire Health Authority 1998
Last Updated 1st September, 1999