Hull Public Health 

The Deep, Hull The Guildhall, Hull King William Statue, Market Place, Hull City Hall, Hull Spurn Lightship, The Marina, Hull

 

 

Inequalities


Documents

The main documents providing information on inequalities and deprivation are as follows:

JSNA
Hull JSNA Toolkit
Index of Multiple Deprivation 2010 Report
JSNA Ward Profiles 2013
JSNA Hull Atlas

The health equity audits examined 'need' (measured by incidence, prevalence, hospital admissions, mortality, survival, quality of care, etc) in relation to age, gender, deprivation (and other factors where data was available) to assess the extent of health inequalities in relation to specific diseases:

Stroke Equity Audit – September 2011
Hypertension Equity Audit – February 2011
Chronic Obstructive Pulmonary Disease Equity Audit – December 2010
Diabetes Equity Audit – October 2008
Mental Health Equity Audit – March 2007
Cancer Equity Audit – July 2006
Coronary Heart Disease Equity Audit – September 2005

The majority of the other documents include information on deprivation. See Deprivation for more information about these documents.

Each of the local Adult and Young People Health and Lifestyle Survey and Social Capital Survey reports examine the health status and the prevalence of lifestyle and behavioural risk factors in relation to deprivation. The Social Capital Surveys also include information on social networks and social support which can influence health, quality of care and health inequalities. The Director of Public Health Annual Reports all discuss deprivation and the effect on health, life expectancy and mortality rates. The local analysis of the Public Health Outcomes Framework indicators, detailed within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here), Public Health Outcomes Framework Summary assesses deprivation and inequalities across the wards in relation to each indicator where information is available. The 2011 Census includes some measures of deprivation such as household deprivation, overcrowding, etc, and the distribution of the Index of Multiple Deprivation are presented at ward level within and JSNA Hull Atlas. The JSNA Hull Atlas also includes the values of the indicators for the most deprived and least deprived quintiles which can be compared with the indicators mapped at ward level.

Back to top


Background

Reducing (health) inequalities is a key aim both nationally and locally. The Public Health Outcomes Framework document "Improving outcomes and supporting transparency", published in January 2012, places emphasis on health inequalities.

"The framework will be focused on the two high-level outcomes we want to achieve across the public health system and beyond. These two outcomes are:

1. Increased healthy life expectancy.
2. Reduced differences in life expectancy and healthy life expectancy between communities.

These outcomes reflect the focus we wish to take, not only on how long we live – our life expectancy, but on how well we live – our healthy life expectancy, at all stages of the life course. Our second outcome focuses attention on reducing health inequalities between people, communities and areas in our society. We are using both a measure of life expectancy and healthy life expectancy so that we are able to use the most reliable information available to understand the nature of health inequalities both within areas and between areas."

The Public Health Outcomes Framework also included other indicators grouped around four domains:

i) Improving the wider determinants of health
ii) Health improvement
iii) Health protection
iv) Healthcare public health and preventing premature mortality

All of the objectives within each of these domains included "reducing health inequalities" or "reducing the gap between communities".

Back to top


Factors Influencing Inequality

Unemployment, poor housing, lack of qualifications, crime, debt, lack of transport, air pollution and many other social and environmental factors all indirectly affect the health of the population. Different scales and scores have been produced which attempt to measure deprivation. In general, in relation to national averages, Hull has a higher unemployment rate, more poor housing, residents qualified to a lower level, higher levels of crime, etc. Increased deprivation means that there is poorer health, but this is compounded as poor health also affects other measures such as employment and motivation to improve employment, education and the person's environment such as housing. In addition, those who live in the most deprived area are more likely to have risk factors for ill health such as smoking, poor diet, lack of exercise, etc. It is also generally more difficult to change lifestyle behaviour if the environment is more stressful resulting from poorer employment prospects and housing, increased debt, relationship problems, etc.

Back to top


Assessing Need

Owing to the relationship between deprivation and ill health, one would expect 'need' for healthcare to increase as deprivation increases, and that a positive relationship would be obtained say between rates of hospital admissions or treatment and deprivation. If such a relationship did not exist, then it could mean that treatment is not reflecting 'need' and that there may be inequity present. This type of analysis has been undertaken in the Health Equity Audits. The majority of analyses completed within the Hull JSNA Toolkit reports and other documents, such as the Surveys, include an analysis by deprivation.

Back to top


Reports Examining Inequality

As mentioned above, there are a range of documents where deprivation and/or inequality have been examined. There are also lists of documents for specific topic and areas of interest as follows:

Back to top


Benchmarking

Comparator Areas gives details of the comparator areas which are similar to Hull and have been used for benchmarking within the Hull JSNA Toolkit reports and other local reports. Various factors such as population, ethnicity, deprivation, housing stock, etc are examined in relation to the characteristics of Hull and the Comparator Areas throught the Hull JSNA Toolkit documents. These comparator areas are also used within the local analysis of the Public Health Outcomes Framework indicators, and the list can be seen within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here).

The general practices in Hull differ with regard to their registered population in terms of deprivation and age of patients. Whilst general practices can be compared, it is better and easier to try to compare like-with-like. As a result, the general practices in Hull have been grouped according to the average deprivation score of their patients and the average age of their patients. The General Practice Comparator Groupings document provides further details.

The Hull City Council Customer Profiles were produced using the methodology from a Leeds University PhD project, which involved cluster analysis of a number of 2001 Census variables at lower layer super output area level. The ten classifications that were produced were largely defined by housing tenure and age. Life expectancy and under 75 all cause mortality rates have been examined within Hull JSNA Toolkit: Life Expectancy and Hull JSNA Toolkit: Mortality in relation to these Customer Profile types. These have recently been updated using information from the 2011 Census.

Back to top


Deprivation

For a list of documents which include information on deprivation, which is the majority of the local reports, see Deprivation. This includes details on the Index of Multiple Deprivation (IMD), children in poverty, benefit claimants, changes in the IMD, prevalence of disease and lifestyle and behavioural risk factors, 2011 Census measures, inpatient admissions, mortality, etc.

Back to top


Environmental Factors and Housing

For a list of documents which include information on environmental factors and housing, see Environmental Factors and Housing. This includes details on housing, pollution, sustainable development, fuel poverty, noise, transport, etc.

Back to top


Geo-demographic Segmentation

Various classification models of different characteristics of residents have been produced. These classifications use various data to create groups of people who are deemed to be similar with regard to certain characteristics. The information used to assess the similarity of the people differs depending on the classification system, and the information is not divulged by the companies producing the classifications. However, in general, the type of information used are responses from the Census, and information relating to employment, car ownership, financial behaviour, health and hospital admissions, shopping behaviour, and for health specifically information from food consumption, and health and lifestyle surveys. Most of this information is applied at output area or postcode level. The derived groups are generally targeted or treated differently, based on their characteristics (lifestyle, attitudes or behaviour etc), in terms of marketing of commercial products (which could include health-related care or public health).

Some of the local documents include information on some geo-demographic classifications such as ACORN, Sport England, Healthy Foundations and Hull City Council's Customer Profiles (housing types) which incorporate an element of deprivation and can be used to assess potential inequalities. See Geo-demographic Segmentation for more information

Back to top


Health Equity Audits

The health equity audits also examined 'need' in relation to deprivation and details are given in the following reports:

Stroke Equity Audit – September 2011
Hypertension Equity Audit – February 2011
Chronic Obstructive Pulmonary Disease Equity Audit – December 2010
Diabetes Equity Audit – October 2008
Mental Health Equity Audit – March 2007
Cancer Equity Audit – July 2006
Coronary Heart Disease Equity Audit – September 2005

Back to top


Labour Market

Information on the labour market including unemployment, benefit claimants, qualifications, employment groupings, earnings and sickness absence rates are given in Hull JSNA Toolkit: Deprivation and Associated Measures. Employment status is also given in Hull JSNA Toolkit: Deprivation and Associated Measures from the Department for Work and Pensions, and employment status was collected as part of the local Surveys. The prevalence of risk factors, such as not eating 5-A-DAY, alcohol consumption, physical activity, obesity, and smoking are given in relation to employment status within Hull JSNA Toolkit: Diet, Hull JSNA Toolkit: Alcohol Consumption, Hull JSNA Toolkit: Exercise, Hull JSNA Toolkit: Overweight and Obesity, and Hull JSNA Toolkit: Smoking.

There are a number of indicators associated with the labour market within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. They include the percentage of 16-18 year olds not in education, employment or training (NEETs), gap in employment rates between those with a long-term health condition and the general population, gap in employment rates between those with a learning disability and the general population, gap in employment rates between those with a serious mental illness and the general population, and sickness absence rates.

Socio-economic classification, employment status and number of hours worked, usual method to travel to work, lone parents with dependent children and their employment, and approximated social grade is given at ward level from the 2011 Census in the JSNA Hull Atlas.

Survey responders in the 2009 Social Capital Survey and 2011-12 and 2007 Health and Lifestyle Surveys were asked about their qualifications and household income. Not everybody wanted to, or could, answer the income question, so the responses could be biased, but the information is included within the survey reports:

Adult Health and Lifestyle Survey 2011-12 Main Report
BME Health and Lifestyle Survey 2011-12 Main Report
Adult Health and Lifestyle Survey 2007 Main Report
BME Health and Lifestyle Survey 2007 Main Report
Social Capital Survey 2009 Main Report

The Humber Data Observatory have completed ward profiles for each ward in Hull (and the Humber). These profiles include information on the labour market.

Figures on the number of benefit claimants are available from the Department for Work and Pensions, and are presented within Hull JSNA Toolkit: Deprivaion and Associated Measures which include those claiming benefits because they are unable to work or are unemployed, and information on the numbers of claimants by age (18-24, 25-49 and 40-64 years) and length of time out of work (up to 6 months, over 6 months and up to one year and over one year). For associated information, see Deprivation.

Back to top


Life Expectancy

Life expectancy at birth is calculated for different deprivation quintiles with rates presented in the JSNA and Hull JSNA Toolkit: Life Expectancy.

The JSNA Hull Atlas also includes the values of the indicators for the most deprived and least deprived quintile which can be compared with the indicators mapped at ward level which includes life expectancy.

Life expectancy and the "slope index of inequality", which measures the difference in life expectancy between deprivation groups, are both indicators within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. This information is also displayed within the JSNA Hull Atlas.

Back to top


Need and Health Inequalities

For diseases where equity audits have been undertaken and numbers of events (admissions and deaths) were sufficiently high for results to be reliable, health need in relation to deprivation has been examined by comparing 'need' using different measures to assess if similar levels of need are evident for each measure across the deprivation quintiles. For example, if prevalence is the same across all five local deprivation quintiles but mortality rates are higher in the most deprived quintile this suggests that there is inequity present or differences in diagnosis rates (higher rates of undiagnosed disease). Prevalence, hospital admissions and mortality were three of the measures of need that were used consistently, but for cancer there was information on incidence also available, while for coronary heart disease information on angiography and revascularisation (which are used diagnostically and for treatment respectively) were available. These measures of need were examined to assess if inequity was present. The results are summarised within the relevant disease-specific Hull JSNA Toolkit reprts and detailed within the equity audit reports:

Stroke Equity Audit – September 2011
Chronic Obstructive Pulmonary Disease Equity Audit – December 2010
Diabetes Equity Audit – October 2008
Cancer Equity Audit – July 2006
Coronary Heart Disease Equity Audit – September 2005

Back to top


Public Health Outcomes Framework

The two overarching indicators from the Public Health Outcomes Framework are increasing life expectancy and healthy life expectancy, and reducing health inequalities in life expectancy. Another indicator is child poverty. Further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. This information is also displayed within the JSNA Hull Atlas.

Where local data is available, the indicators in the Public Health Outcomes Framework have been examined in relation to deprivation and across the wards in Hull and further analysis is given within the following documents:

Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here)
Public Health Outcomes Framework Summary
Public Health Outcomes Framework Young People Report

Back to top


Slope Index of Inequality (SII)

The "slope index of inequality" (SII) measures the difference in life expectancy between the bottom and top deciles of deprivation based on the Index of Multiple Deprivation. This index has been calculated nationally for each local authority. Further details and trends are given in Hull JSNA Toolkit: Life Expectancy. The Life Expectancy Briefing Note 2009-11 presents the latest (2009-11) data for life expectancy data and latest (2006-10) data for the "slope index of inequality". The "slope index of inequality" is an indicator within the Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary.

Back to top


Wards

Other information on deprivation and associated measures is given at ward level in the JSNA Hull Atlas.

Back to top


References

The following are the two key documents relating to Improving Outcomes and Supporting Transparency (generally known as the Public Health Outcomes Framework):

Department of Health (2012). Improving outcomes and supporting transparency. Part 1: A public health outcomes framework for England, 2013-2016. London, Department of Health.
 
Department of Health (2012). Improving outcomes and supporting transparency. Part 2: Summary technical specifications of public health indicators, January 2012. London, Department of Health.

Other reports related to Improving Outcomes and Supporting Transparency are also available, including an Introduction to the Public Halth Outcomes Framework, Appendices to Part 1, Updates to the technical specifications, Progress up until March 2013 and an Equality Analysis.

Back to top