1. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Education and Health Dr Julia Verne Director South West Public Health Observatory j.verne@swpho.org.uk

2. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function The role of education ‘ Education is vital to health. People with low levels of educational achievement are more likely to have poor health as adults…By improving education for all we will tackle one of the main causes of inequality in health’ (Department of Health 1999, Saving Lives Our Healthier Nation)

3. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Key issues What is Health Educational achievement and deprivation/social exclusion Deprivation/social exclusion and disease Mortality Morbidity Risk factors Education and increased health risk Access to Health Services

4. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function What is health? WHO defines health as “ a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity”

5. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Fields of Positive Health (Well- being) Feeling vital, full of energy Having good social relationships Experiencing a sense of control over one’s life and one’s living conditions Being able to do things one enjoys Having a sense of purpose in life Experiencing a connectedness to ‘community’

6. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function

7. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function

8. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Inequalities in morbidity 17% of social class 1 men aged 45 - 64 report limiting longstanding illness 48% of social class 5 men aged 45- 64 report limiting longstanding illness

9. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function The Importance of employment

10. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Work related mortality and morbidity is a significant contributory factor to socioeconomic differences in risk of morbidity and mortality particularly in relation to accidents, dermatitis, certain lung diseases, and musculoskeletal diseases

11. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Construction industry 7% of UK workforce 30% of reported accidents ~14,000 p.a injured on construction sites But ~ 44% non-fatal accidents reported ~ 100 deaths p.a ~ ½ prosecutions by HSE

12. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function occupational exposure responsible for ~1/3 cancer incidence difference between high and low social classes responsible for ~1/2 difference in lung and bladder cancer incidence

13. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Socio-economic inequalities in cancer survival Patients from affluent neighbourhoods do better even after adjustment for stage at presentation Overall survival is estimated to be 11-13% worse in the lowest deprived compared to the most affluent Non of 47 different types of cancer showed a survival advantage for patients in the most deprived group (Cancer Survival Trends, ONS) For 20 of the 47 cancer types the gap in survival was significantly lower both at five years and one year. More than 5000 deaths per year could be prevented if social class inequalities were prevented.

14. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function

15. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function

16. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Percentage of adults aged 16 and over who smoke, by socio-economic group and gender, England, 1998

17. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Prevalence of obesity in men and women from each of the six social classes measured by the Health Survey for England 1998

18. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Weekly intake of fruit and vegetables by income (National Food Survey Trends 2000)

19. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Spending on food: rich and poor The poorest 10% of households spend the highest proportion of their income on food 21% of income versus 14% for the richest 10% of households A couple on income support with two children receive less than £163 per week but would need to spend £61 of that on food to satisfy basic government healthy eating guidelines The poorest households spend around £25.50 a week on food, compared with £106 for the richest

20. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Poverty and nutrition Working households eat 85% more vegetables than workless households One third of unemployed men ate fruit 5-6 days per week compared with half of employed men In 1997 a survey found that 1in 20 mothers sometimes went without food to meet the needs of their children Lone mothers on income support were 14 times more likely to go without than mothers in two parent families not on benefit

21. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Access and availability In deprived neighbourhoods only 14% of households have access to a car >1/4 have long term illness restricting mobility young children crime, rising rents competition forcing closure of small local stores healthy foods cost around 24% more in small stores than supermarkets

22. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Why are there inequalities in Cancer? Knowledge: risk factors, signs and symptoms Attitudes - the ‘locus of control’ Behaviour: risk factors, acceptability of screening Access - the inverse care law Variations in treatment

23. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Infant mortality rates by deprivation 1991-1997 Source: ONS

24. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Age-standardised mortality rates for suicide and undetermined injury by deprivation, country and region, ages 15-64 Great Britain 1991-1993 Source: ONS

25. South West Public Health Observatory Part of the South West Observatory, a wider regional intelligence function Alcohol misuse and social exclusion 50% rough sleepers alcohol reliant >50% male prisoners and >33% female Of those attending alcohol services: 36% unemployed 18% homeless/temporary accomodation