Inequalities in health exist, whether measured in terms of mortality, life expectancy or health status; whether categorised by socioeconomic measures or by ethnic group or gender. Recent efforts to compare the level and nature of health inequalities in international terms indicate that Britain is generally around the middle of comparable western countries, depending on the socioeconomic and inequality indicators used. Although in general disadvantage is associated with worse health, the patterns of inequalities vary by place, gender, age, year of birth and other factors, and differ according to which measure of health is used.
Death rates have been falling over the last century, from a crude death rate of 18 per thousand people in 1896 to 11 per thousand in 1996. Over the last 25 years, there have been falls in death rates from a number of important causes of death, for example lung cancer (for men only), coronary heart disease and stroke. Life expectancy has risen over the last century, but not all life is lived in good health. Healthy life expectancy - the measure of average length of life free from ill health and disability - has not been rising; the added years of life have been years with a chronic illness or disability, also the proportion of people reporting a limiting long standing illness has risen from 15 per cent to 22 per cent since 1975 and the proportion reporting illness in the two weeks previous to interview has nearly doubled from 9 per cent to 16 per cent. There is a slight increase in the proportion of people consulting the NHS.
A number of different measures can be used to indicate socioeconomic position. These include occupation, amount and type of education, access to or ownership of various assets, and indices based on residential area characteristics. There has been much debate as to what each indicator actually measures, and how choice of indicator influences the pattern of inequalities observed. For example, measures based on occupation may reflect different facets of life for men compared to women, and for people of working age compared to older people or children.
Mortality - Over the last twenty years, death rates have fallen among both men and women and across all social groups. However, the difference in rates between those at the top and bottom of the social scale has widened. For example, in the early 1970s, the mortality rate among men of working age was almost twice as high for those in class V (unskilled) as for those in class I (professional). By the early 1990s, it was almost three times higher. This increasing differential is because, although rates fell overall, they fell more among the high social classes than the low social classes. Between the early 1970s and the early 1990s, rates fell by about 40 per cent for classes I and II, about 30 per cent for classes IIIN, IIIM and IV, but by only 10 per cent for class V. So not only did the differential between the top and the bottom increase, the increase happened across the whole spectrum of social classes.
Both class I and class V cover only a small proportion of the population at the extremes of the social scale. Combining class I with class II and class IV with class V allows comparisons of larger sections of the population. Among both men and women aged 35 to 64, overall death rates fell for each group between 1976-81 and 1986-92 (table 3). At the same time, the gap between classes I and II and classes IV and V increased. In the late 1970s, death rates were 53 per cent higher among men in classes IV and V compared with those in classes I and II. In the late 1980s, they were 68 per cent higher. Among women, the differential increased from 50 per cent to 55 per cent.
These growing differences across the social spectrum were apparent for many of the major causes of death, including coronary heart disease, stroke, lung cancer and suicides among men, and respiratory disease and lung cancer among women.
Death rates can be...
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