|
Background
The 1980s saw an increase in the regional differences in mortality
rates in Britain. At the same time, inequalities in death rates
within areas of cities like Bolton, Brighton and Bristol also became
more pronounced. These trends have focused attention on the spatial
polarisation of mortality and whether it is connected to the widening
variations in health between rich and poor in Britain.
Changes in access
to owner-occupied and rented accommodation may have contributed
to the spatial polarisation of mortality during the 1980s. This
was a decade in which the supply of council housing declined sharply,
with the result that medical factors may have become a more important
criterion for the allocation of council housing. Poor health may
also have acted as a barrier to owner-occupation. As housing choices
become more dependent on both health and wealth, it is possible
that poorer people in poorer health move to high-mortality areas
and regions while richer people in better health move to lower-mortality
areas and regions. Such a process would contribute to the geographical
polarisation of health. Additionally, the area in which people live
may have a subsequent effect on their physical or mental health.
Aims and
Objectives
This project will investigate:
- whether the
spatial polarisation of mortality has continued through to 1994-1995,
and whether it applies to all sex and age groups and for all main
causes of death;
- how closely
the spatial divergence in mortality rates by area reflects the
divergence in wealth;
- the mechanisms
underlying the observed patterns in mortality rates, and in particular,
the impact of social policy and social changes over the last two
decades.
It will thus
contribute answers to the wider question of why there are persisting
and widening socio-economic variations in health in Britain.
Study Design
The study will draw on a number of sources of data to shed light
on the nature and causes of the spatial polarisation of mortality.
These include regional and area data on mortality and data from
the British Household Panel Study (BHPS). The Office for National
Statistics will also be commissioned to carry out an analysis of
longitudinal data on tenure and health from the Longitudinal Study.
In addition,
interviews with council tenants, owner occupiers, mortgage lenders
and those responsible for local authority housing allocation will
be conducted to elicit the nature of the relationship between access
to housing and the spatial polarisation of health.
As differences in health by area are likely to have far reaching
implications for individuals, families and communities, in addition
to searching for causes, the project will also look at effects.
This will be done by conducting life history interviews, providing
details of the experiences of those people often only represented
in statistics. These interviews will be carried out with individuals
from areas with high and with low mortality rates.
Policy Implications
The results of this research will be of interest to policy makers,
housing and health practitioners, government advisers as well as
other members of the academic community and the public in general
and will have implications for policy concerning health, housing
and the personal social services. The results will be disseminated
in a variety of formats, ranging from newspaper articles to a series
of papers in academic and practitioner journals, conferences and
meetings with user groups. A full report will be made publicly available
and a book covering all aspects of the research will be published
upon completion of the project.
Project Summary
Geographical inequalities in health, and between richer and poorer
areas in particular, are recognised to be an enduring feature of
health inequalities in the UK. Tackling these geographical inequalities
is central to the UK's broader strategy to reduce health inequalities.
In February 2001, the government set two national targets to reduce
health inequalities. One of these was to reduce the gap in life
expectancy between areas with the lowest life expectancy and the
population as a whole by at least 10% by 2010.
The project
focused on recent trends in geographical inequalities in health
(for analyses of historical trends in geographical inequalities
see Southall's project). It examined the spatial polarisation of
mortality in Britain in the 1990s at national and local levels.
It also investigated the mechanisms which underlie it. The objectives
were addressed through analyses of mortality data and census data.
In addition, two local studies (Oxford and Brighton) were undertaken
to shed light on the processes producing local variations in mortality.
Particular attention was given to the contribution of housing to
variations in health between areas.
Key findings
- The spatial
polarisation of mortality which began in the late 1970s/early
1980s has continued into the late 1990s.
- Geographical
inequalities in premature mortality now stand at the highest levels
yet recorded.
- Regions of
Britain now have some of the highest mortality in the European
Union. The highest SMRs are found in regions in Northern England
and the industrial belt of Scotland. The geographical polarisation
observed within Britain is also apparent within the wider European
context: inequalities may, to a large extent, be driven by the
increasing inequality within Britain.
- Policies
which have produced increased income inequality and poverty have
helped to drive the polarisation of mortality. The geographical
polarisation of health chances has been precipitated by a polarisation
of life chances, in terms of employment opportunities, income
and living standards. The health gap is now such that, in the
period 1994-1997 in Britain, 24% of deaths of people aged 15-64
would not have occurred had the mortality rates of the least deprived
decile of the population applied nationally; almost one quarter
of all deaths can now be attributed to unfavourable socio-economic
circumstances.
- Housing wealth
is strongly related to greater life expectancy. At the extremes,
the homeless have death rates which are 25 times the national
average. The death rates of bed and breakfast residents are four
to five times those of the housed population; death rates for
hostel residents are seven times greater; and the death rates
for rough sleepers are 25 times greater than the death rates of
the housed population. At the extremes, people living in the most
salubrious housing in Britain (those holding over £100,000
of equity in their properties) can expect to live, on average,
more than twice as long as those sleeping rough on the streets.
- The migration
of people moving out of declining areas and into booming areas
has contributed to the spatial polarisation of mortality. Places
where the size of the total population has shrunk have higher
mortality on average than places where the population has grown.
This suggests that people react to economic decline: those people
who can leave are less likely to be living in poverty than those
who remain.
- The two case
studies (Oxford and Brighton) provided evidence of high rates
of morbidity and mortality in those who fall outside the normal
tenure categories - those who are homeless and vulnerably housed.
Postcode mapping established that deaths among young adults were
clustered at the locations of hostels for the homeless.
|
