It has been five years since Professor Sir Michael Marmot’s ground-breaking work on health inequalities which showed that poorer areas had lower life expectancy and worse health. But how have health inequalities changed over time and what factors affect this?
Our most recent research, which builds on Marmot’s work, is the first time that the relationship between life expectancy and income has been analysed over time in this level of detail. We reviewed the role of several factors in explaining differences in life expectancy in small areas in England covering populations of about 7,000 people each.
While the relationship between income deprivation and life expectancy that Marmot found remains, it weakened. The gap in life expectancy between the 10% of areas with the least and most income deprivation shrank by 2.5 years between 1999-03 and 2006-10.
The research also confirmed that other factors such as unemployment, poor quality housing and deprivation among older people are strongly associated with low life expectancy, as are lifestyle behaviours such as higher levels of binge drinking and low levels of fruit and vegetable consumption.
In light of our findings, we argue that despite missing its high-profile target to narrow the gap in life expectancy between the most deprived areas of England and the rest of the country by the time it left office, it is now time to reassess the experience and actions of the last Labour government’s policies to address inequalities in health.
Over and above the general relationships between these factors and life expectancy, we found that “place” remains significant in explaining life expectancy. Our analysis showed how particular areas have persistently low and high life expectancy over time, which are not explained by other factors.
There is a geographical pattern to the areas that have persistently lower life expectancy. Areas around urban centres in the north do less well than anywhere else in England. There are also some hot spots of low life expectancy in coastal areas and in the Midlands.
Conversely, many of the areas with persistently high life expectancy are located in rural parts of the country with sparser populations. London has areas of both persistently high and low life expectancy.
The geographical analysis highlights the significance of place-based health inequalities. When compared with areas where place is not a significant factor in life expectancy, populations living in central London are almost 50 times more likely to have persistently high life expectancy over this period.
Those living in the suburbs of large cities in the south-west are 20 times more likely to have persistently high life expectancy. On the other hand, populations in parts of Yorkshire and Humber and the suburbs of the north-west are roughly twice as likely to have persistently low life expectancy over time.
Our findings reinforce the importance of local government policy to tackle inequalities in health. The correct policy response will differ depending on the local context. Areas with persistently low life expectancy require an even stronger focus on wider determinants of health such as housing, transport and employment.
In areas with persistently higher life expectancy, this means ensuring strong focus on the integration of health and social care with wider public services. For example, decent housing for a progressively ageing population will become increasingly more important.
It is important that local government maximises its influence over the wide variety of factors that determine the health of local communities, taking into consideration the unique circumstances affecting health in their local areas.
To view the report please visit: www.kingsfund.org.uk/publications/inequalities-life-expectancy