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Poverty
and Health [top]
Last week saw the publication of
the second annual report about the changing welfare state from the Department
of Social Security ‘Opportunity for All. One year on: making a difference.’ Twelve
months after the government set out its programme for tackling poverty and social
exclusion, this report outlines the progress that has been made towards achieving
the vision of a fair and decent society where nobody is held back by disadvantage
or denied opportunity.
The report uses indicators that capture
the impact of the government policies and describes progress made so far with
children; people of working age; older people and communities.
Many of the indicators demonstrate
an improving situation. The proportion of children living in workless households
in the UK has fallen from 17.3% in 1999 to 15.8% in 2000. The proportion of children
aged eleven achieving level four or above in the Key Stage 2 tests for literacy
and numeracy goes up continuously between 1996 and 2000, from 57% to 75% for English
and from 54% to 72% for Maths The number of people sleeping rough has gone down
by 36% from 1,850 in June 1998 to 1,180 in June 2000. Many indicators for the
elderly show some improvement but do not demonstrate the same level of progress.
The proportion of pensioners living in households with relatively low incomes
increased slightly from 21% to 23% between 1996/97 and 1998/99 on the before housing
costs measures although they remained broadly constant at 27% after housing costs
were taken into account. The proportion of older people helped to live at home
in England through the provision of intensive community based services declined
from 83/1000 in 1996/97 to 71/1000 population aged 65 and over in 1998/99.
The report shows average figures
for the whole country, but the improvements are not enjoyed by all, as the figures
hide the increasing inequalities experienced by many.
http://www.dss.gov.uk
Poverty
and Health in the North West [top]
At the end of August the Department
of the Environment, Transport and the Regions published its latest Indices of
Deprivation 2000. Full information about the indices including individual ward
data can be obtained from; http://www.regeneration.detr.gov.uk/
The indices for the North West are available on the North West Public Health Observatory
web site; http://www.nwpho.org.uk/pages/frameset/frameset_SOC.HT
Each indicator is a composite score
from six domains representing different aspects of deprivation, including poor
health and disability. The indicators use up to date information from 1998 or
later. The ‘average of ward scores’ for each local authority correlate well with
the Townsend scores (Pearson’s Produce Moment Coefficients of Correlation = 0.82)
but are said to be better indicators of poverty.
These data were correlated with health
data from each local authority taken from the ‘Compendium of Clinical Indicators’
produced by the Centre for Public Health Monitoring for 1998. (Previously known
as the Public Health Common Data set.)
‘Sig’ indicates the level of significance
of the correlation.
* indicates that the correlation
is significant at the 5% level
** indicates that the correlation
is significant at the 1% level
ns indicates that the correlation
is not significant
For each local authority in the North
West, (including High Peaks, even though only a portion of its population is officially
in the North West Region,) poverty as described by the ‘average of ward scores’
was correlated with various age standardised death rates.
Table 1 The link between
poverty and premature death in the North West
|
Poverty defined
by the average ward scores correlated with
the following age standardised death rates;
|
Pearson correlation
co-efficient
|
Sig
|
| coronary health disease
in people aged under 65 years |
0.91
|
**
|
| lung cancer in all persons
aged less than 75 years |
0.90
|
**
|
| lung cancer in males
aged less than 75 years |
0.89
|
**
|
| lung cancer in females
aged less than 75 years |
0.80
|
**
|
| years of life lost due
to lung cancer in males up to age 75 years |
0.79
|
**
|
| stroke in people aged
between 35 and 64 years |
0.72
|
**
|
| years of life lost due
to lung cancer in females up to age 75 years |
0.65
|
**
|
| accidents in children
from age 0 – 14 years |
0.32
|
*
|
| stroke in people aged
between 65 and 74 years |
0.32
|
*
|
| colorectal cancer in
people aged between 35 and 64 years |
0.31
|
*
|
| colorectal cancer in
people aged between 65 and 74 years |
0.25
|
ns
|
| colorectal cancer in
people aged over 75 years |
0.06
|
ns
|
| accidents in people
aged over 65 years |
0.04
|
ns
|
| stroke in people aged
over 75 years |
-0.31
|
ns
|
This chart shows the poverty and
early death from Coronary Heart disease in the North West
For each local authority
in the North West, (including High Peaks, even though only a portion of its population
is officially in the North West Region;) poverty as defined by rank of income
scale was correlated with the following age standardised death rates.
Table 2 Further links between
poverty and premature death in the North West
|
Poverty defined
by the rank of employment correlated with age standardised death rates for;
|
Spearman’s rho
|
Sig
|
| lung cancer in males
aged less than 75 years |
-0.77
|
**
|
| stroke in people aged
between 35 and 64 years |
-0.76
|
**
|
| lung cancer in females
aged less than 75 years |
-0.63
|
**
|
| stroke in people aged
between 65 and 74 years |
-0.38
|
*
|
| colorectal cancer in
people aged between 35 and 64 years |
-0.35
|
*
|
In each case a very similar
result was found for ‘rank of employment’ with each of the above death rates
A correlation coefficient is a measure
of linear association and can take any value from –1 to +1. A correlation coefficient
of 1 (+ or -) indicates perfect association between the two variables. Spearman’s
rank co-efficient uses the ranked position of income to calculate the correlation.
The most deprived is ranked lowest, which explains the negative value of the co-efficients
when rank is used. The nearer a correlation co-efficient is to zero, the less
likely it is that there is any linear relationship between the two factors. A
significant correlation suggests an association between the two factors studied.
The highest degree of association was found between the average of ward scores
in each local authority area and death due to coronary heart disease in people
aged less than 65 years. (See chart above.) R squared was 0.84 indicating that
approximately 84% of the premature deaths from coronary heart disease can be attributed
to poverty. This indicates a very close relationship between poverty and early
death due to heart disease in the North West. 
Lung cancer and stroke came next
and again very high correlation coefficients were found in the younger age groups,
further indicating a close relationship between poverty and early death. There
was also a significant association between poverty and deaths from accidents in
children, but not in older people.
There was a slightly significant
association between poverty and colorectal cancer in people aged between 35 and
64 years but the coefficient was small (Pearsons’s 0.31, Spearman‘s –0.35) No
significant association was found in any other groups. In fact there was a slight
(non significant) negative correlation, especially for women of all ages possibly
indicating a slightly decreased risk of dying from colorectal cancer for people
living in poverty. It might be interesting to explore this further at some other
time.
Poverty
and Social Exclusion[top]
A report funded and published on
the 11th of September by the Joseph Rowntree Foundation on ‘Poverty and social
exclusion in Britain’ written by researchers from the Universities of Bristol,
Loughborough, York and Heriot –Watt with fieldwork undertaken by the office for
National Statistics (ONS) produces a rather different picture. According to this
report, poverty rates in Britain have risen sharply over the last few years. The
report’s findings on deprivation are based around the proportion of people who
cannot afford what are considered to be necessities. Items defined as necessities
are those that more than 50% of the population believes ‘all adults should be
able to afford and which they should not have to do without.’ The findings show
that the general British public holds ideas about necessities that go beyond the
basic material needs such as food, water and shelter. People feel that social
customs, obligations and activities such as the ability to celebrate Christmas,
attend weddings and funerals and buy presents for family / friends once a year
are all necessities. The discrepancy between this report and the government report
is that poverty in this case is defined according to expectations. As the overall
economic position of the country improves, things that were once considered luxuries
are increasingly likely to be considered necessities and those left behind feel
the deprivation more acutely and suffer social exclusion. The following are some
of the necessities that people are most likely not to have and can’t afford. Regular
savings (of £10.00 per month) for rainy days or retirement (25%); a holiday away
from home once a year not with relatives (18%); money to keep home in a decent
state of decoration (14%); ability to replace or repair broken electrical goods
(12%), a small amount of money to spend on self weekly (13%); damp free home (6%);
fresh fruit and vegetables daily (4%); warm waterproof coat (4%).
According to this report, by the
end of 1999 a quarter (26%) of the British population were living in poverty measured
in terms of low income and multiple deprivation. The proportion of households
living in chronic long term poverty (lacking three or more necessities and classifying
themselves as genuinely poor now ‘all the time’ and also having lived in poverty
in the past either ‘often’ or ‘most of the time’) fell from 4% of households to
2.5% of households. The report concluded that since 1990, poverty appears to have
become more widespread, but not to have deepened.
Child Poverty
Perceived needs for children were
determined by parents who took part in the survey. Although nearly all parents
thought that ‘new properly fitted shoes’; ‘a warm waterproof coat’; and ‘fresh
fruit and vegetables daily’ were necessities, one in every 50 children went without
them. The poverty rates of children were higher among those;
- In households without any paid
workers
- In lone-parent families
- With a large number of siblings
- With household members suffering
long-standing illness
- Of non-white ethnicity
- Living in local authority housing
- In households in receipt of Jobseeker’s
Allowance or Income Support
This study supports the findings
of another Joseph Rowntree report published in March 1999 looking at ‘Child poverty
and its consequences’ which also suggested that looking at averages can be misleading
and that the effects of poverty fall disproportionately on children. This report
concluded that the economic position of families strongly affects the present
and future welfare of children and that today’s high level of child poverty is
likely to have continuing negative effects and produce economic and social difficulties
into adulthood which then feed through to the next generation.
Reducing
Health Inequalities in Britain [top]
On the 25th September a new study
for the Joseph Rowntree Foundation on the ‘health gap’ found that policies to
reduce inequalities in income and wealth, achieve full employment and eradicate
child poverty have the potential to prevent more that 10,000 premature deaths
each year – including more than a thousand child deaths. Researchers from the
Universities of Leeds and Bristol found that the highest number of ‘excess’ deaths
occur in the poorest areas and that more children die in areas where child poverty
is highest.
The authors suggest that if deprived
areas moved closer to the characteristics of an average area, there would be fewer
premature deaths. Government policies to tackle poverty and social exclusion could
therefore have a major impact in making Britain more equal in health as well as
income and wealth. Using statistical projections the report says that;
Returning inequalities in income
and wealth to their 1983 levels through redistribution would prevent around 7,500
annual deaths in the under 65s.
Achieving ‘full’ employment (where
no one was receiving long-term unemployment benefit) would prevent some 2,500
premature deaths per year
Reaching the Government’s target
of eradicating Child Poverty within a generation would save the lives of around
1,400 children under 15 each year.
These reductions in premature deaths
would be concentrated in the most disadvantaged areas. A combination of all three
policies would lead to a reduction of around 56% of the excess deaths in areas
with above average premature mortality rates. A mild redistribution of income
would be the most valuable policy to implement. In terms of the proportion of
lives saved, the eradication of child poverty would have the biggest impact.
A summary of these reports together
with details about how to purchase the full reports are available on the Joseph
Rowntree Foundation web site; http://www.jrf.org.uk/home.asp
(Click
here to view map)
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The
North West Public Health Observatory web site is now fully operational. The Government's
White Paper "Saving Lives: Our Healthier Nation" outlines a series of functions
for each of the Regional Public Health Observatories:
Observatory
in partnership with National Health Service Organisations within the North West.
The objective of the NWPH site is to provide a centralised web based resource
linking Public Health and other related sites within the Region, the UK and the
world. Have a good browse around and see what you can find. Check out the web
site to find out more about the clinical indicators for the North West mentioned
last time.