It is not as clear as it appears that health inequalities are widening.
See my rapid response to the BMJ report
http://bmj.bmjjournals.com/cgi/eletters/331/7514/419
which read:
The difference in years of life expectancy does indeed increase
considerably over time. However, the relative difference does not. If we
take the ratio of the life expectancy for men, lowest 5th over all men,
the ratios are 0.974, 0.973, 0.973, and 0.973 for the four periods. For
women they are 0.982, 0.981, 0.980, 0.980. So the ratios go down, i.e.
there is an increasing discrepancy, but not by very much.
Proportionately, things look very stable.
Looked at another way, life expectancy for all men increased by 2.2%
over this period, for men in the lowest 5th of local authorities it
increased by 2.1%. Life expectancy for all women increased by 1.3%, for
the lowest 5th by 1.1%. Things improved for all groups and in similar
ratios.
It is not as clear as it appears that the class difference is growing.
Of course, either way it is not shrinking.
Martin
Janet Shapiro wrote:
>Wednesday's Guardian report indicated below.
>
>Janet
>
>----- Original Message -----
>From: "Alex Scott-Samuel" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Friday, September 09, 2005 6:41 AM
>Subject: UK health inequalities - Guardian report
>
>
>What's the prognosis?
>
>Twenty-five years ago the Black Report revealed huge health
>inequalities in the UK and was 'buried' by the then
>Conservative government. Last month, Labour quietly slipped
>out its own report, showing the problem is getting worse.
>Mary O'Hara finds the public health community increasingly
>frustrated
>
>Wednesday September 7, 2005
>The Guardian
>
>Dr Mary Shaw Scientific director, South West Public Health
>Observatory
>
>The release of the report on health inequalities, Tackling
>Health Inequalities - Status Report on the Programme for
>Action on August 11 was reminiscent of the deliberately
>covert release of the Black Report on August bank holiday
>Monday in 1980. This latest report appeared at a time when
>the official responsible, Caroline Flint, minister for
>public health, was on holiday and her deputy was
>unavailable. Even stranger, the press release referring to
>the report deflected attention from the key finding of
>widening inequalities in life expectancy and infant
>mortality by headlining the 12 "early adopter sites" which
>will be the first areas to have "health trainers". The
>circumstances of the report's release, however, should not
>be allowed to detract from its main message, that health
>inequalities have widened. The fear that the hushed-up
>release of this report raises is that the bold statements
>and unprecedented promises of Labour's first years in power
>have now been overtaken by the individualistic rhetoric of
>behavioural prevention and "choosing health". Nowhere in the
>report is there mention of measuring, let alone directly
>tackling, the static or widening inequalities in income and
>wealth that New Labour has presided over.
>
>Danny Dorling Professor of human geography, University of
>Sheffield
>
>This is a new low for New Labour. It took eight years to get
>around to it and this is what happens. It is sad to think
>that Margaret Thatcher signed up to targets in 1985 to
>reduce health inequality by 25% by the year 2000, yet look
>where we are. The areas with the highest life expectancy 10
>years ago are the places that have seen the biggest increase
>in life expectancy since. Wealth lets you get health. The
>areas that have benefited most are those that voted
>Conservative in 1997. It is fair to say though, that New
>Labour has done a lot. We are not about to become like
>America. Look at the preface [to the government's report on
>inequality last month], it is amazing how brazenly they
>ignored the key issues. It is odd that they tried to release
>it quietly when they did - during recess and on the
>anniversary of the Black Report. I think this will become
>New Labour's Black Report.
>
>David Hunter Chair of the UK Public Health Association
>
>This government came in with a commitment to reduce health
>inequalities. Since 1997, it has become obsessed with the
>NHS, with disease and cures, and not with health. The
>government thinks there is no political mileage in tackling
>health inequalities. It affects the disadvantaged, the
>dispossessed and the marginalised, and they don't tend to
>vote. Rather than moving toward the European model - where
>they are trying to protect people in the long term - we are
>moving more toward the US model.
>
>Professor John Ashton NHS North West region director of
>public health
>
>Since 1997, some progress has been made. The question is
>whether policies are joined up enough. In 1948 there was a
>universalist approach [to public health]. Since 1979, we
>have had targets and selective intervention. It has made it
>much harder to determine if the people who need the help
>most are really getting it. There are targets for improving
>health inequalities by 2010 but you have to ask if it is
>possible to meet this if the next two years are spent
>distracted by yet another reorganisation of the NHS. The
>issue is not to say this government has failed. We have to
>create a system that is robust enough for the challenges we
>now face: social justice and sustainability. The big
>inequality opening up is not just length of life, it is
>quality of life. A lot of working class people are living
>into their 70s but often with multiple conditions, compared
>with middle-class people who often get to their 80s before
>problems emerge. Turning the current situation around will
>be difficult. The challenge is to work out how we get back a
>vision of a good society.
>
>Alex Scott-Samuel Senior lecturer in public health,
>Liverpool University and joint chair of the Politics of
>Health Group
>
>There has been a lot of rhetoric [on health inequalities],
>especially since Labour first came in, but we now see that
>these are not working. Material factors still underlie
>inequality and these are not going to change as long as we
>are following the policies of the World Bank. Income
>inequalities are still at the same level as in the 1980s.
>That is the greatest indictment of the government. I would
>like an acknowledgment that some of the reasons for widening
>inequalities are down to Labour's economic and public
>policies. And I would like to see an independent commission
>with the aim of looking at how all areas of policy impact on
>health inequality.
>
>Geoff Rayner Academic and former chair of the UK Public
>Health Association
>
>What's so different about now, compared to when the Black
>Report came out, is that we live in a consumer society.
>There is no language of paternalism any more. The government
>has adopted the language of the market to sell public health
>policy as well as buying into a philosophy of the market.
>The state - as opposed to governments - needs to protect
>people, and we need a state structure for intervention that
>is agreed upon, one that doesn't change with a government or
>a new health minister.
>
>· Tackling Health Inequalities: Status Report on the
>Programme for Action is at http://heh.pl/&1Vr
>
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--
***************************************************
J. Martin Bland
Prof. of Health Statistics
Dept. of Health Sciences
Seebohm Rowntree Building Area 2
University of York
Heslington
York YO10 5DD
Email: [log in to unmask]
Phone: 01904 321334
Fax: 01904 321382
Web site: http://www-users.york.ac.uk/~mb55/
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