Quantifying health inequalities in England (The Health Foundation, 15 August 2022)

Summary

Non-communicable illness is responsible for 88% of the burden of disease in England, with the majority falling most heavily on the poorest in society. The COVID-19 pandemic has highlighted pervasive socioeconomic, ethnic and geographical health inequalities in our society. But quantifying health inequalities can be difficult due to the complexities of comparing people with multiple different long-term conditions (multimorbidity) and assessing the implications for their health care needs.

In this analysis from the The Health Foundation, a novel tool known as the Cambridge Multimorbidity Score was used to assess the relative impact of different patterns of diagnosed illness on people and their use of the health care system. 

Content

Key points

• Health inequalities are complex and growing, yet firm evidence on their extent and trajectory is few and far between. There is a vital need to quantify health inequalities in order to better focus policies designed to address them.
• This analysis uses a novel approach to explore the extent of diagnosed health inequalities across different population groups in England. The Cambridge Multimorbidity Score, developed by clinicians and academics, assesses the relative impact of different patterns of illness on people and their health care needs. Access to patient data linking primary care and hospital records allowed the authors to provide a more detailed picture of variations in diagnosed illness by age, socioeconomic status, ethnicity and region in England.
• We know from previous research that, on average, people living in more deprived areas have shorter lives and spend more time living with diagnosed long-term illness. This analysis shows, on average, a 60-year-old woman in the poorest area of England has diagnosed illness equivalent to that of a 76-year-old woman in the wealthiest area. She will spend more than half (43.6 years) of her life in ill health compared with 46% (41 years) for a woman in the wealthiest areas.
• People living in poorer areas also have greater levels of multiple diagnosed illness (multimorbidity). Large inequalities in the burden of disease are concentrated within a few diagnosed conditions, including chronic pain, diabetes, COPD, anxiety and depression, alcohol problems and cardiovascular disease.
• Inequalities in health start at an early age, with higher rates of diagnosed mental health conditions, chronic pain and alcohol problems starting to develop as early as the late teens and early twenties. These health inequalities then continue to grow and change across the life cycle, through working age and into old age.
• Once we standardise for different age distributions across ethnicities, we find higher levels of diagnosed ill health among people of Pakistani, Bangladeshi and black Caribbean ethnic backgrounds than for people from white ethnic backgrounds.
• This analysis adds to previous research on the north-south health divide: people living in the north of England have the highest health care needs due to diagnosed morbidity once adjusted for age. Four conditions – chronic pain, alcohol problems, COPD and cardiovascular disease – account for 83% of the inequality in diagnosed illness between the North East (region with the highest levels of illness) and the East of England (region with the lowest levels of illness).