Widening inequality of health in northern England, 1981-91

Abstract

Objective-To identify relative and absolute changes in mortality in the Northern region of England between 1981 and 1991. Design-1981 and The decline in the relative position of the poorest areas was particularly great, and there was no narrowing ofinequalities across the remainder ofthe socioeconomic spectrum. In absolute terms, there were improvements in mortality in all age categories in the most affluent areas. In the poorest areas improvements in the 55-64 age group were balanced by increased mortality among men aged 15-44, a slight rise among women aged 65-74, and static rates among men aged 45-54.Conclusions-These results re-emphasise the case for linking mortality patterns with material conditions rather than individual behaviour.

Increasing inequalities in health: Is it an artefact caused by the selective movement of people?

“…The answer is a guarded 'no'. This study has demonstrated increases in the geographical disparities in health status that were not due to migration and therefore confirmed the overall conclusions of previous studies within England and Wales of widening inequalities in health during the 1990s (Dorling et al, 2001;McLoone & Boddy, 1994;Phillimore et al, 1994;Shaw et al, 2005). However, it is clear that selective migration makes an important contribution to these increases, so we believe the current methodology for assessing changes in inequalities should not be used in isolation, as an indication of the magnitude of these changes or for assessing the success or otherwise of policies to reduces health inequalities.…”

“…We have concentrated on mortality as this has been the outcome measure in most papers relating to widening health inequalities (Dorling, 1997;Dorling et al, 2001;McLoone & Boddy, 1994;Phillimore et al, 1994;Shaw et al, 2005) and used a 10-year period as this is the usual period of comparison.…”

“…The changes in mortality gradients were examined across deciles of deprivation that had been determined and fixed at the start of the study period. This is the method used by some researchers such as McLoone and Boddy (1994) and Phillimore et al (1994), though others formed new deciles based on a ranking of the constituent wards at the time of the follow-up period (Dorling et al, 2001). We assume that conclusions regarding the effects of migration apply in either situation.…”

“…This has important implications as the repeat ecological design is the methodology used to demonstrate a widening of socioeconomic and health inequalities between areas, both in the UK (Dorling, 1997;Dorling, Davey Smith, & Shaw, 2001;McCarron, Davey Smith, & Wormsley, 1994;McLoone & Boddy, 1994;Phillimore, Beattie, & Townsend, 1994;Shaw, Davey Smith, & Dorling, 2005;Staines & Cartwright, 1995) and elsewhere (Geronimus, Bound, & Waidmann, 1999;Michelozzi et al, 1999). It is also the way that the Departments of Health in England and Wales assessed the progress of their policies to reduce health inequalities (Department of Health, 2005).…”

Incidence of childhood diabetes mellitus in Yorkshire, northern England, is associated with nitrate in drinking water: an ecological analysis

“…The 1991 Census is the first decennial census to provide information on ethnicity [17]. The latter four parameters were used to calculate the Townsend score, a measure of socioeconomic status with high indices indicating lower socioeconomic status [18]. Area-based population densities were calculated for children (0-16 years old) by dividing the respective populations in each ED by the area in hectares.…”