1. The scale of health inequality in England; from region to local authority district, 2006–2008 Gbenga Olatunde and Andrew Yeap, 2011

2. What we’re going to talk about Introduction Health Expectancy at ONS Annual Population Survey Disability-Free Life Expectancy Analysis at National level Analysis by English Regions Analysis by Area Deprivation Analysis at Local Authority level

3. Health Expectancy at ONS Health Expectancy – years expected to be spent in a favourable or unfavourable health state from a given age Adds dimension of quality to Life Expectancy ONS produce two HE metrics: Healthy Life Expectancy (very good/good health) Disability-Free Life Expectancy (Limiting long-standing illness/disability) Annual production of HEs at National level using large-scale surveys: General Lifestyle Survey (covers GB) Continuous Household Survey (covers NI) Sample size not large enough to allow statistically meaningful comparisons at lower-level geographies

4. Annual Population Survey Collects data from private households around the UK Consists of waves 1 and 5 of the Labour Force Survey, and additional boost cases for England, Wales and Scotland Enables reliable analysis at lower level geographies Analysis based on cross-sectional component of the APS

5. Data Over 475 000 people aged 16 and over for 2006-08 Morbidity data from ONS Annual Population Survey (APS) Combined with mortality and population data to calculate DFLE according to the Sullivan method

6. Limiting long-standing illness or disability Do you have any health problems or disability that you expect will last for a year or more? ‘Yes/No’ If ‘Yes’ the respondent is then asked; Do these health problems or disabilities when taken singly or together, substantially limit your ability to carry out normal day to day activities? If you are receiving medication or treatment, please consider what the situation would be without the medication or treatment ‘Yes/No’ People responding ‘Yes’ to both questions were identified as having a limiting long-standing illness or disability

7. National level DFLE at age 16, APS 2006-08 48.146.9NI 46.845.6Scotland 46.145.3Wales 49.848.8England 49.348.4GB 49.348.3UK FemalesMales From age 16, males and females in the UK can expect just under 50 more years of life free from LLSI England possess the highest DFLE and Wales the lowest Inequality between highest and lowest DFLE is 3.5 years for males and 3.7 years for females

8. Health Inequalities: Disability-free life expectancy by English region, 2006-08 High Low High Low High Low High Low High Low High Low Men at age 16 44.2 years in North East 51.3 years in South East Women at age 16 45.2 years in North East 51.8 years in South East

9. Background Health inequalities have enormous social and economic costs. Clear need to monitor population health to assess impact of interventions If everyone in England had the same death and illness rates as the most advantaged, those dying prematurely as a result of health inequalities would have gained 2.8 million person-years free from limiting illness or disability Sub-national analyses previously restricted to Census data or large aggregations of survey data

10. Life expectancy (LE) and disability-free life expectancy (DFLE) for men and women at age 16; by area deprivation, 2006–2008 30 35 40 45 50 55 60 65 70 Years Increasing deprivation Men Women 40.8 54.065.658.054.6 42.068.763.4

11. Health Inequalities: Disability-free life expectancy by English local authority district, 2006–08 High Low High Low High Low High Low High Low High Low Men at age 16 41.2 years in Barnsley 56.8 years in Surrey Heath Women at age 16 41.7 years in Knowsley 60.2 years in Tandridge

12. Conclusions Substantial inequalities in LE and DFLE across areas for men and women Inequalities in DFLE much greater than in LE Inequality in LE and DFLE between least and most deprived areas greater for men than women For both men and women, the inequality in DFLE doubles with increasingly detailed geographical analysis

13. Future work Update the study: produce estimates for 2007–2009 Explore the use of other survey sources to provide proxy child data Use of the Integrated Household Survey to produce estimates at national and sub- national levels

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