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Health inequalities in Scotland: now and in the future. Carol Tannahill Director Glasgow Centre for Population Health.

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Presentation on theme: "Health inequalities in Scotland: now and in the future. Carol Tannahill Director Glasgow Centre for Population Health."— Presentation transcript:

1 Health inequalities in Scotland: now and in the future. Carol Tannahill Director Glasgow Centre for Population Health

2 hat I’m going to cover What I’m going to cover A bit about patterns and trends A bit about explanations A bit about implications What I’m not going to coverWhat I’m not going to cover All types of health inequality

3 What we’re up against: history, geography and the life course

4 Mortality by social class 1911-1981 Mortality by social class 1911-1981 (Men, 15-64 yrs, E&W) (Marmot, 1986; OPCS, 1978) YearIIIIIIIVV 191188949693142 1921829495101125 1931909497102111 19518692101104118 19617681100103143 19717781104114137 19816676103116166

5 (Mackenbach, 2005)

6

7 Lifecourse effects Age adjusted relative rates of CVD mortality by father’s social class and smoking Smoking Father’s social class Other Current cigarette Non Manual 1 2.20 (1.66 – 2.93) Manual 1.80 (1.40 – 2.31) 3.11 (2.45 – 3.95) Davey Smith and Hart, AJPH 2002

8 20 th century trends in life expectancy in Scotland and 16 other Western European countries Males 30 40 50 60 70 80 19001910192019301940195019601970198019902000 Year of birth Life expectancy in years Scotland

9 Trends in life expectancy - males

10 All cause death rates, Men 0-64, 2001 (Leyland et al, 2007)

11 Glasgow City Inverclyde West Dunbartonshire Dundee City Renfrewshire Eilean Siar North Ayrshire North Lanarkshire All cause death rates, Men 0-64, 2001 30%

12 Death rate per 100,000 men age 15-29

13 The Scottish Health Survey (2003) The pattern of health inequalities is not always predictable

14 Self-reported cigarette smoking by SIMD quintile and sex

15 Accident rates per 100 children by SIMD quintile and age 1st2nd3rd4th5th 0-5 yrs 1317111420 6-10 yrs1514221722 11-15 yrs2916251934 All1916201725

16 Alcohol consumption by SIMD quintile and sex

17

18 A whistle-stop tour of some explanations

19 1. Global factors are at play Yeah but no but yeah but no but … Or, more scientifically, “necessary but not sufficient” Scotland does behave differently (ref Walsh and Taulbut in preparation)

20 Life expectancy - Ruhr

21

22 Life expectancy – N. Moravia

23

24 2. It’s about socio-economic status Yes – If Glasgow had the SES of the rest of Scotland, much of its health excess would disappear But – it would still have poorer mental health among women, higher levels of alcohol consumption, more long standing illness.. And – it’s already no different in terms of eg obesity (Gray, 2007)

25 3. Better services can sort it Remember remember the 7th of November (our last meeting)? Attention to how services are delivered can really make a difference We heard about partnerships, inequalities sensitive practice, NHS using its wider influence But we are against the inverse care law – especially for some of the more effective interventions

26 CHD PREVALENCE IN PRACTICE POPULATIONS UNDER 70 IN NHS GREATER GLASGOW CHDEMAsAngina No of Population deaths practices 1 Most deprived 9.146.26.7 24 82,502 210.740.86.4 26 81.927 38.334.65.9 20 82,163 48.034.05.6 20 90,407 58.727.55.0 27 79,680 66.222.24.5 20 82,795 76.721.74.2 21 84,456 84.918.63.7 21 84,922 92.915.33.0 13 89,007 10Most affluent 2.714.82.8 17 81,941 10:1 Ratio3.33.12.4

27 TRENDS IN STATIN PRESCRIBING IN PRACTICE POPULATIONS IN NHS GREATER GLASGOW BETWEEN 2001/2 AND 2004/5 Dispensed daily doses (millions) 2001/22004/5Increased 10 Most deprived 1.085.745.31 91.105.935.39 80.965.395.61 70.924.865.28 60.904.745.27 50.875.306.09 40.985.055.15 31.004.704.70 20.863.554.13 1 Most affluent 1.044.634.45 10:1 Ratio1.041.24

28 4. It all matters Yes Although some things seem to matter more than others (income, education, employment) And there may be some important underpinning factors (resilience, ‘control’, adaptability, etc)

29 Newton Mearns – G77 5

30 Dalmarnock – G40 4

31 And finally.. a bit about implications

32 Implications Globally things are getting worse and Scotland is behind the pack. What can we do? Influence out as well as in. Set realistic aspirations. Ensure our policies are inequalities proofed. Act on the causes behind the causes. Invest in resilience, adaptability, coping and control. Create environments conducive to health. Systematically deliver services in a way that reduces inequity.

33 “The omnipresence and persistence of health inequalities should warn against unrealistic expectations of a substantial reduction within a short period of time and by using conventional approaches. ” Mackenbach, JP (2005). ‘Health Inequalities: Europe in Profile’


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