Review of Health InequalitiesReview of Health Inequalitiesat the local level at the local level

Maggie RaeHead of Health Inequalities & Head of Local Delivery11 May 2006

2010 Target

Wider Social

determinantsHealth Inequalities

Setting the target in context

Interpreting the evidence -What are the causes of early death in Spearhead areas?

The target can be delivered if actions are targeted at these causes of early death…

Males

35%

18%

15%

10%

5% 2%

10%

5%

Contribution to Life Expectancy Gap in Males Breakdown by disease, 2003

Females

30%

16%

21%

9%

5% 2%

11%

6%

Contribution to Life Expectancy Gap in Females Breakdown by disease, 2003

All circulatory diseases

All cancers

Respiratory diseases

Digestive

External causes of injury and poisoningInfectious & parasitic

diseases

Other

Deaths under 28 days

Main causes of deaths contributing to the Life Expectancy gap in Spearhead areas

Circulatory diseases account for the largest proportion of excess deaths in Spearhead areas, most of which is attributable to coronary heart disease (CHD) (70% in males and 63% in females).

Cancers and respiratory diseases, particularly lung cancer and chronic obstructive airways disease respectively, then account for a major proportion of the remainder of deaths.

The remaining third are attributable to a range of causes including injury, digestive, poisoning, infectious and parasitic diseases, and deaths under 28 days.

The pattern of causes of deaths contributing to the life expectancy gap in Spearhead areas is broadly similar for both males and females with cancers, circulatory and respiratory diseases accounting for over 65% in each.

The Impact – for males

1.0%

2.3%

1.0%

0.7%

1.2%

0.7%

2.1%

0.2%

1.4%

0.2%0.2%

8.9%

Fu

rthe

r mo

dellin

g o

f Oth

er a

ctions w

ill

ne

ed to

contrib

ute th

e re

main

ing

2.1%

11%

The Impact – for females

1.0% 1.4% 0.9%0.5%

3.2%

1.6%

5.6%

0.4%1.0%0.2%0.2%

10.4%

Fu

rthe

r mo

dellin

g o

f Oth

er a

ctions w

ill

ne

ed to

contrib

ute th

e re

main

ing

5.6%

16%

Universalist:• Smoking reduction in clinics – as at

present• Secondary prevention of CVD:75%

coverage of 35-74yrs• Primary prevention of CVD in hyptensives

under 75 yrs:20% coverage antihypertensivestatin therapy

The InterventionsTargeted:• Smoking cessation clinics: double

capacity in Spearhead areas for 2 years

• Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35-74 yrs

• Primary prevention of CVD in hypertensives under 75yrs:

40% coverage antihypertensives

statin therapy

• Primary prevention of CVD in hypertensives 75yrs +:

40% coverage antihypertensives

statin therapy

• Other*, including:Early detection of cancerRespiratory diseasesAlcohol related diseasesInfant mortality

Interventions to reduce the gap Actions to reduce deaths caused by cardiovascular disease (CVD) can reduce the gap in life expectancy but these will not be sufficient to deliver the targets. There is evidence that actions targeted at other cases of early death will be able to contribute enough to enable the target to be delivered but further work is needed to complete this modelling. It is, however, clear that the NHS can deliver the target if it uses this model (and later refinements to it) to reduce early deaths.

Expectation in the community is very low, we don’t demand.

Expectation in the community is very low, we don’t demand.

Doctor told me ‘I have other patients to see’. You feel like a nuisance.

Local people don’t talk about life expectancy, the news is so grim.

Local people don’t talk about life expectancy, the news is so grim.

The words are there from DH and then there’s real life.

The words are there from DH and then there’s real life.

I’m not ill, I’m just getting old (49 year old patient).

I’m not ill, I’m just getting old (49 year old patient).

Life expectancy? It’s the Cinderella target.Life expectancy? It’s the Cinderella target.

The public said…The professionals said…

Community engagement• We need clinical interventions to save people’s lives, but we also need to engage with people and give them a reason for living

Female vs male % point change in life expectancy gap, by local authority, 1995-97 to 2002-04

-4.00%

-3.00%

-2.00%

-1.00%

0.00%

1.00%

2.00%

-2.50% -2.00% -1.50% -1.00% -0.50% 0.00% 0.50% 1.00% 1.50% 2.00%

% point change in gap - female

% p

oin

t ch

an

ge

in g

ap

- m

ale

13 Spearhead areas are on track to deliver both male and female elements

29 are on track to deliver one element, less than 20% are on track

28 are off track for both elements

15 areas are on track to deliver the male element of the target

13 areas are on track to deliver the target

28 areas are off track for both elements of the target

14 areas are on track to deliver the female element of the target

Note: The changes needed in life expectancy vary but are very small in all areas.

60% of Spearhead areas are makingsome progress towards the target

Summary of life expectancy delivery status as of 2002-04

Summary of Spearhead Group status - number and % of Spearhead areas - local track to narrow life expectancy gap with England by 10%

by 2010

13

1514

28

19% 21% 20% 40%

0

5

10

15

20

25

30

Male and femalelife expectancy on

track

Male lifeexpectancy only

on track

Female lifeexpectancy only

on track

Male and femle lifeexpectancy both

off track

Num

ber

of

are

as

Initiatives to help reduce Health Inequalities

Health ChampionsCommunities for Health

Health TrainersLife Check

Antihypertensives and statintherapyEffective therapies in CVD

Smoking cessation

Other

Antihypertensives and statintherapy (>75 y)Antihypertensives and statintherapy (<75 y)Additional coverage of effectivetherapies in CVDSmoking cessation

Antihypertensives and statintherapy

Cancer screening

Obesity treatment

Smoking cessation

Respiratory illness

HIV

Hepatitis C

Sexual Health

Accidents

Immunisation

Physical activity

Healthy eating

Education

Income

Crime

Work/unemployment

Alcohol

Smoking ban

Housing

IMPACT OF INTERVENTIONS TO REDUCE THE LIFE EXPECTANCY GAP

2006 2010 PSA TARGET 2015 2020

NHS/OGD NHS/OGD NHS/OGD

ALL INTERVENTIONS START

but ……

Difference in % distribution of mortality between Spearhead Group and England in quinary age bands, 2002-04

-6.0%

-5.0%

-4.0%

-3.0%

-2.0%

-1.0%

0.0%

1.0%

2.0%

Female difference

Male difference

• There were approximately 13,700 additional deaths for 30 to 59 year olds in Spearhead groups, between 2002-04, compared to the national average for England

• The focus needs to be on reducing adult early deaths

• Action on the overall PSA target to reduce infant mortality will also help deliver the reduction in life expectancy gap target

Too many people in Spearhead areas are dying early