Key Health Indicators
Determinants of Health
The 1998 Independent
Inquiry into Inequalities in Health report concluded that:
"the
weight of scientific evidence supports a socio-economic explanation of
health inequalities. This traces the roots of ill health to such determinants
as income, education and employment as well as material environment and
lifestyle".
Dahlgren and Whitehead’s model (below) highlights some of the main factors
determining the health of our regional and local populations.
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| Source: G Dahlgren and M Whitehead, Policies and strategies to promote social equity in health, Institute of Futures Studies, Stockholm, 1991 |
Age, sex and genetic make-up undoubtedly influence people’s health potential,
but are fixed. Other factors in the surrounding layers of the model can
potentially be modified to achieve a positive impact on population health:
- individual lifestyle factors such as smoking habits, diet and physical
activity have the potential to promote or damage health;
- interactions with friends, relatives and mutual support within a
community can sustain people’s health;
- wider influences on health include living and working conditions,
food supplies, access to essential goods and services, and the overall
economic, cultural and environmental conditions prevalent in society
as a whole.
Regional and local comparative data are available which relate to some
of the determinants of health described above. These data are described
in the following sections.
Indicators
Indices of Deprivation
2004
The Office of the Deputy Prime Minister (ODPM) commissioned the Social
Disadvantage Research Centre (SDRC) at the Department of Social Policy
and Social Research at the University of Oxford to update the Indices
of Deprivation 2000 (ID 2000) for England. Following two extensive public
consultations, an academic peer review and a significant programme of
work, the new Indices of Deprivation 2004 were produced in 2004.
The new Index of Multiple Deprivation 2004 (IMD 2004) is a measure of
multiple deprivation and is made up of seven Domain Indices, which are
as follows:
- Income
- Employment
- Health Deprivation and Disability
- Education, Skills and Training
- Barriers to Housing and Services
- Crime
- Living Environment
There are 354 local authorities in England and each can be given a score
(average score) and a rank on the index of multiple deprivation. The
lower the rank, the more deprived the district (1 would be most deprived,
354 the least deprived). Scores and ranks for East Midlands Local Authorities
are provided below.
IMD 2004 gives a measure of "Extent", which is defined as
the proportion of a district’s population living in the most deprived
Super Output Areas (SOAs) in the country.
Income/poverty
One of the seven Domain Indices which make up the IMD 2004 is the Income
Deprivation Domain. The purpose of this Domain is to capture the proportion
of the population experiencing income deprivation in an area.
Scores are derived from counts of people in families in receipt of means
tested benefits. Scores for local authorities are counts of individuals
experiencing income deprivation, i.e. they give an indication of the
absolute rather than the relative level of income deprivation.
More extensive datasets and reports relating to income and poverty in
the East Midlands are available from the Office of National Statistics
(ONS) Neighbourhood Statistics pages and Intelligence
East Midlands.
Employment/unemployment
For the majority of people, unemployment tends to have a significant
adverse effect on both physical and mental health. One of the seven Domain
Indices which make up the IMD 2004 is the Employment Deprivation Domain.
This domain measures employment deprivation conceptualised as involuntary
exclusion
of the working age population from the world of work. This is seen as
distinct from income deprivation to which lack of employment may lead.
The indicators in the employment deprivation domain of IMD 2004 constitute
non-overlapping counts of those excluded from the labour market through
unemployment, ill health or disability.
Scores for local authorities reflect the absolute rather than
the relative level of employment deprivation. Scores for East
Midlands local authorities are provided below.
Extensive data on employment were collected in Census 2001. Comparative
data for East Midlands local authorities on the percentage of people
employed, unemployed, long term unemployed and permanently sick/disabled
can be accessed from the links below:
Other employment indicators for the East Midlands are available below:
More extensive local data on employment and unemployment are available
from the Annual Local Labour Force Surveys website and from the NOMIS
website:
In 2002, the East Midlands Observatory (now Intelligence East
Midlands) commissioned a research project, undertaken
by the Centre for Regional and Economic
and Social Research at Sheffield Hallam University to examine the issue
of hidden unemployment in the region:
Education and Training
Education helps equip people with skills for adopting a healthier lifestyle
as well as enhancing their ability to secure opportunities for employment.
Census 2001 provided data on the proportion of people aged 16-74 with
qualifications at different levels. Data for East Midlands local authorities
can be accessed below.
Information on educational attainment is available by East Midlands
Local Education Authority (LEA) below.
Reducing the gap in educational attainment between looked after children
(in the care of local authorities) and children as a whole is a particular
national policy priority. Information on this issue is available
in a Statistical Bulletin from the Department for Education and Skills.
Information is presented below on qualifications attained by care leavers
compared to all school leavers in East Midlands local authority areas.
The “education deprivation” domain of ID2000 provides a composite measure
focused on lack of qualifications amongst adults and children of different
ages in a local area. Indicators of children aged 16 and over who are
not in full time education and the proportion of 17 year olds who have
not successfully applied for higher education are also included. Data
for ward level only can be accessed via the website of the Office of the
Deputy Prime Minister.
Local authority level indicators of educational attainment and other
aspects of education and training are available via the “East
Midlands Knowledge” pages on the Intelligence East Midlands website.
Crime and fear of crime
Crime affects not only the health of individual victims but also community
life. Fear of crime is also a very real phenomenon influencing health
and well-being. People may make adjustments to their lifestyles and behaviour
as a result of an experience of crime or fear of crime such as not going
out after dark; not going out alone; avoiding certain areas; not using
public transport; avoiding young people; etc. The spatial concentration
of crime in particular neighbourhoods means that the adoption of these
avoidance measures can weaken social ties and undermine social cohesion.
The 1998 Crime and Disorder Act established a statutory duty for local
authorities and police to work with other relevant agencies including
local NHS bodies to form local Crime and Disorder Partnerships (CDRPs)
and implement a strategy for tackling crime and disorder. There 40 such
partnerships
in the East Midlands.
Further information on crime in the East Midlands is available from
the Home Office, particularly the “Crime in England and Wales” series
which combines the reporting of police
recorded crime and the British Crime
Survey (BCS) results. The police recorded and BCS figures
are a complementary series that together provide a better picture of
crime than could be obtained from either series alone. Some information
on fear of crime is collected in the BCS and is available from this source.
Access to local
health care services
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Number of GPs per 100,000 population, by PCT, March
2003 and September 2003 |
|
Percentage
of patients waiting four hours or less in A&E
from arrival to admission, transfer or discharge by PCT 2003/04 |
|
Proportion of patients on waiting list that have been waiting more
than 6 months for treatment, by PCT, Quarter 3 2003/04 |
|
Proportion of patients on waiting list that have been waiting more
than 3 months for treatment, by PCT, Quarter 3 2003/04 |
|
Emergency admissions rate for asthma and diabetes per 100,000 population,
by PCT, 2002 |
|
Flu
vaccine uptake figures for people aged 65 and over by Primary
Care Trust 2004/05 |
Housing
Other determinants of
health
The section of Key Health Indicators relating to Determinants
of Health currently has notable gaps. Other important determinants
of health include:
- a healthy, safe work environment
- clean air and water and good sanitation
- integrated and affordable transport systems
- supportive communities
Other priority areas within Investment for Health are individual lifestyle
factors which include physical activity, diet, smoking and obesity and
links to separate sections on these areas can be found below: