Health inequalities: Income deprivation and north/south divides
Carl Baker from the House of Commons Library uses the new health dashboard to explore how patterns of disease prevalence in England relate to income deprivation, and ask whether there is a north/south divide in the health of the population
Want to find out how healthy your area is? The House of Commons Library has launched a new local data dashboard to help you look up neighbourhood-level data on conditions such as diabetes, depression, asthma and obesity. Using GP data from NHS Digital, the dashboard can be used to examine how health conditions vary in different parts of England. It has been published on commonslibrary.parliament.uk under ‘local data’ and using the drop-down menu, you can browse for the prevalence of seven conditions while comparing constituency-level data to national and regional averages.
In this article we look at the bigger picture, taking on two questions: how do patterns of disease prevalence in England relate to income deprivation? And is there a north/south divide in the health of the population?
It’s widely recognised that social and economic factors impact on people’s health. In our analysis of NHS data we found that areas with more income deprivation are more likely to have a range of health conditions including serious mental illness, obesity, diabetes, and learning disabilities. The chart below shows the highest and lowest instances of this ‘income deprivation gap’.
A positive number on the chart above shows that the condition tends to be higher in areas with high income deprivation than in areas with low income deprivation. For example: in the most deprived areas, one in every 165 people have GP-diagnosed learning disabilities – compared with one in every 272 people in the least deprived areas. This means people living in the most deprived areas are 65% more likely to have a learning disability. By contrast, atrial fibrillation (irregular heart rate) affects 1 in 67 people in the least deprived areas but 1 in 48 people in the most deprived – a gap of -28%.Some conditions, like dementia, are much more common in older people. Areas with older populations also tend to be less income-deprived. This is likely to explain why (for example) dementia is more common in less-deprived areas.
Deprivation gaps vary in different regions of England, as the table below shows. In the East of England, the obesity gap between the most and least deprived areas is 18%. But in London, it is 78%. Similarly, for Chronic Obstructive Pulmonary Disease (lung diseases such as bronchitis) – in the South East people living in the most deprived areas are 77% more likely to have such a disease, while in the West Midlands the gap is 19%.
Income deprivation is, of course, not the only wider social determinant of health – so there are likely to be other factors at work here which also help to explain variations, such as the makeup of the population, environmental factors and the labour market.
The Library's dashboard allows you to look at a national overview of prevalence for seven selected health conditions. We have picked seven (out of around 20 monitored by NHS Digital) as they affect large numbers of people and show different patterns across the country. You may notice that some conditions tend to be higher in the north of England (e.g. North East, North West, and Yorkshire & Humber) than in the south of England (e.g. South West, South East, and London).
But if we only look at regional data then we can sometimes miss important variation. For instance, the North West of England includes large metropolitan areas like Manchester and Liverpool, but also sparsely populated rural areas in Cumbria which have very different populations. In addition, the South East covers both affluent areas in the Home Counties and less affluent areas in Kent. The tables below look at prevalence in 20 smaller ‘sub-regions’ which divide each region into two or three units of 2-4 million people (with the exception of the North East, which was already within this range). This helps us to get a clearer picture of which conditions have a north-south divide.
COPD rates are higher in the north
While asthma and dementia do not show substantial north-south divides, COPD does. All five of the highest sub-regions for prevalence of chronic lung conditions are in the north of England. In addition, all five sub-regions with the lowest prevalence are in London and the South East.
Highest depression rates in Inner London
The north of England makes up three of the top five sub-regions for depression prevalence, four for epilepsy, and three for serious mental illness (e.g. schizophrenia or bipolar disorder). For serious mental illness, however, Inner London has substantially higher prevalence than any other sub-region. Serious mental illness is the only disease to see a northern sub-region among the lowest prevalence – North Yorkshire & Humber has the third-lowest rates.
Prevalence of peripheral arterial disease, which NHS England describe as a build-up of fatty deposits in the arteries restricting blood supply to leg muscles, is highest in the north – all five of the top sub-regions are in the north of England. Like dementia, high blood pressure is related to age (as well as other factors). So regions of England with a higher proportion of older people (such as Dorset, Devon & Cornwall and West Midlands Outer) rank highly here alongside the North East and Lancs & Cumbria. It is not straightforward to link demographic factors to the occurrence of all diseases listed.
For GP-recorded obesity, the North East has higher prevalence than any other sub-region, and is joined by two other northern sub-regions in the top five ranks. Once again, there is only one appearance of a northern sub-region in the lowest five ranks – Greater Manchester for high blood pressure, probably owing to its younger-than-average population. Note that not all cases of obesity are recorded by GPs and these figures are an underestimate of true prevalence (which is estimated to be 29% in England).
Carl Baker is a Senior Library Clerk specialising in Social and General Statistics. The Library’s analysis is based on underlying data from NHS Digital’s Quality and Outcomes Framework 2017/18, which includes information from GP practices on the number of people registered who have a range of health conditions. Visit the dashboard for a description of methodology.