Health Inequalities Update

The UK Health Forum is dedicated to keeping up to date with the latest information and evidence around the prevention of non-communicable disease. This update briefing is intended to give you an overview of the latest reports, research, data that have been published in relation to health inequalities. Research articles are retrieved via searching PubMed and table of contents updates from selected journals. Grey literature- non commercial, unpublished documents, organisational and governmental reports, guidelines and data reports- are pulled from the latest additions to the UKHF Prevention, Information & Evidence (P.I.E) eLibrary. If you would like to be updated more frequently, please visit the Health Inequalities tab on our Information dashboard. (LINK)

Health Inequalities Update

Issue 3 2015 UKHF Research & Information Services

Research

About this update The Health Inequalities Update is a quarterly bulletin that will keep you up to date with the latest news, research and grey literature – non commercial, unpublished organisation and governmental reports, data sets, case studies and toolkits – related to health inequalities. The research is sourced through PubMed searches and table of contents updates from selected journals. Grey literature is retrieved from the Health Inequalities section of the UK Health Forum (UKF) Prevention Information & Evidence eLibrary which is compiled by the UKHF Research and Information Services (RIS) team. To ensure you receive all future Health Inequalities Updates, sign up to our Prevention Information & Evidence (P.I.E) briefing, it’s free! For more updates visit the Health Inequalities tab on the UKHF Information Services dashboard. About the UK Health Forum The UKHF, a registered charity, is both a UK forum and an international centre for the prevention of non-communicable diseases (NCDs) including coronary heart disease, stroke, cancer, diabetes, chronic kidney disease and dementia. Our work is focused on up-stream measures to address the shared modifiable risk factors for these conditions. We undertake policy research and advocacy to support action by government, the public sector and commercial operators. Our RIS team is dedicated to providing up-to-date news and resources about the prevention of NCDs to all those concerned with public health improvement. UK Health Forum Fleetbank House 2-6 Salisbury Square London, EC4Y 8JX www.ukhealthforum.org.uk www.ukhealthforum.org.uk UK Health Forum

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Contents About this Update……………………………………………………….………….….……………………1 About the UK Health Forum.………………………………….….………….…………….…….…………1 Research ......................................................................................................................................................................... 3 Grey Literature ................................................................................................................................................................ 6 Data and statistics .......................................................................................................................................................... 8 Further resources.........................................................................................................................................................10

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Research GBD 2013 Mortality and Causes of Death Collaborators (2015) Global, regional, and national agesex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet; 385:9963, 117-171. http://bit.ly/1MpS7ft Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. The authors used the results to assess whether there is epidemiological convergence across countries. For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries.

Liu JJ, Davidson E, Bhopal R, White M, Johnson M et al. (2015) Adapting health promotion interventions for ethnic minority groups: a qualitative study. Health Promotion International; online first. http://bit.ly/17asi2w Adaptation of health interventions has garnered international support across academic disciplines and among various health organizations. Through semi-structured interviews, the authors sought to explore and understand the perspectives of 26 health researchers and promoters located in the USA, UK, Australia, New Zealand and Norway, working with ethnic minority populations, specifically African-, South Asian- and Chinese-origin populations in the areas of smoking cessation, increasing physical activity and healthy eating, to better understand how adaptation works in practice. The authors drew on the concepts of intersectionality, representation and context from feminist, sociology and human geography literature, respectively, to help us understand how adaptations for ethnic groups approach the variable of ethnicity.

Ljungdahl S, Bremberg SG. (2015) Might extended education decrease inequalities in health? – a meta-analysis. The European Journal of Public Health; advance access. http://bit.ly/1Fh6MaO A meta-analysis was performed of European studies where the health effects of extended compulsory or secondary level education on low-educated individuals were investigated. Twenty-two relevant publications were identified. The meta-analysis indicated statistically

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significant favourable effects of educational reforms on rates of mortality, self-reported poor health and obesity. The effects were, however, small, 1-4%. An educational reform that typically added one educational year in the least educated group was associated with a mean 2.1% reduction in mortality in men before age 40. This effect might be compared with the total educational gradients of mortality rates in Swedish men at ages 30-64. One extra year of education after compulsory education corresponds to a 41% reduction in mortality, which is 20 times more than the absolute effect of education found in this meta-analysis.

Komro KA, Burris S, Wagenaar AC. (2014) Social determinants of child health: Concepts and measures for future research. Health behaviour and policy review; 1:6, 432-445. http://bit.ly/19neZNq This review examines the effects of family economic security policies on child and family health outcomes, formulates a framework for possible mechanisms of effect, and introduces our policy surveillance system to measure changes in state laws affecting social determinants of health. The authors carried out a comprehensive review of the published literature on family economic security policies and health outcomes. There is a paucity of studies examining effects of economic policies on child and family health behaviours and outcomes; moreover, even fewer investigate causal pathways from policy to mediating changes in social and physical conditions or health behaviours. State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child wellbeing.

Mithen J, Aitken Z, Ziersch A, Kavanagh AM. (2015) Inequalities in social capital and health between people with and without disabilities. Social Science & Medicine; 126, 26-35. http://bit.ly/18k6HWA Using data from the General Social Survey 2010 of 15,028 adults living in private dwellings across non-remote areas of Australia, the authors measured social capital across three domains: informal networks (contact with family and friends); formal networks (group membership and contacts in influential organisations) and social support (financial, practical and emotional). They compared levels of social capital and self-rated health for people with and without disabilities and for people with different types of impairments (sensory and speech, physical, psychological and intellectual). They found that people with disabilities were worse off than people without disabilities in regard to informal and formal networks, social support and self-rated health status, and that inequalities were greatest for people with intellectual and psychological impairments.

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Moonesinghe R, Bouye K, Penman-Aguilar A. (2014) Difference in health inequity between two population groups due to a social determinant of health. International Journal of Environmental Research and Public Health; 11:12, 13074-13083. http://bit.ly/1vydJM1 Similar to the individual-level risk factors such as behavioural and biological risk factors that influence disease, the researchers consider social determinants of health such as the distribution of income, wealth, influence and power as risk factors for risk of disease. They operationally define health inequity in a disease within a population due to a risk factor that is unfair and avoidable as the difference between the disease outcome with and without the risk factor in the population. The difference in health inequity could be larger than the difference in health outcomes between the two populations in some situations. Compared to health disparities which are typically measured and monitored using absolute or relative disparities of health outcomes, the methods presented in this manuscript provide a different, yet complementary, picture because they parse out the contributions of unfair and avoidable risk factors.

Oshio T, Kan M. (2014) Multidimensional poverty and health: Evidence from a nationwide survey in Japan. International Journal for Health Equity; 13:128. http://bit.ly/1CzGv1j It is well known that lower income is associated with poorer health, but poverty has several dimensions other than income. In the current study, we investigated the associations between multidimensional poverty and health variables. Using micro data obtained from a nationwide population survey in Japan (N = 24,905), we focused on four dimensions of poverty (income, education, social protection, and housing conditions) and three health variables (self-rated health (SRH), psychological distress, and current smoking). We examined how health variables were associated with multidimensional poverty measures, based on descriptive and multivariable logistic regression analyses. Unions as composite measures of multiple poverty dimensions were more useful for identifying individuals in poor SRH or psychological distress than a single dimension such as income. In comparison, intersections of poverty dimensions reduced the coverage of individuals considered to be in poverty and tend to be difficult to justify without any explicit policy objective. Meanwhile, education as a unidimensional poverty indicator could be useful for predicting current smoking.

This is a selection of the latest research. More can be viewed on the Health Inequalities section of our dashboard and in the Prevention Information & Evidence eLibrary

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Grey Literature DRIVERS (2015) DRIVERS project. DRIVERS, Brussels. http://bit.ly/1Eg0BAg Three reports published by the DRIVERS project detail the scientific work carried out by teams at University College London/UCL Institute of Health Equity, the Department of Medical Sociology at Universitat Deusseldorf, and the Centre for Health Equity Studies (CHESS) at Stockholm Universitet on early child development and working conditions, and income and social protection. The three reports are: Social inequalities in early childhood health and development, evidence and policy implications; Working conditions and health inequalities, evidence and policy implications; The role in income and social protection for inequalities in health, evidence and policy implications.

LVSC (2015) Health Inequalities in London: Developing joint solutions to achieve better health outcomes for all. Event report. LVSC, London http://bit.ly/1EDo4v2 Through presentations, case studies and interactive workshops, the event aimed to provide a better understanding of the current health & care structures and how these impact on health inequalities. The overall aims of the seminar were to: Explore the board range and complexities of health inequalities in London; explore mechanisms and levers to enable the voluntary and community sector, policy makers and commissioners to more effectively work together to reduce health inequalities, achieve better health outcomes and ultimately effect change. Links to presentations are within the report.

Memorandum of Understanding (MOU) to support joint action on improving health through the home. (2014) United Kingdom. http://bit.ly/1E5BzWp This MoU sets out: shared commitments to joint action across government, health, social care and housing sectors, in England; principles for joint-working to deliver better health & wellbeing outcomes and to reduce health inequalities and; the context and framework for cross-sector partnerships, nationally and locally, to design and deliver: healthy homes, communities and neighbourhoods and integrated and effective services that meet individuals', their carer's/carers' and their family needs.

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Padley M, Valadez L & Hirsch D (2015) Households below a minimum income standard: 2008/9 to 2012/13. Joseph Rowntree Foundation, York. http://bit.ly/1L2ROns The Minimum Income Standard (MIS) defines an ‘adequate’ income based on what the public think people need for a minimum acceptable living standard. The proportion of people living in households with an income below MIS increased by nearly a third between 2008/09 and 2012/13.

The Scottish Parliament Health and Sports Committee (2014) Report on Health Inequalities. The Scottish Parliament. http://bit.ly/1FRQ4Mx A new report from Holyrood's Health Committee is the result of a two year inquiry investigating health inequalities in Scotland. The report shows that the millions of pounds spent on health promotion campaigns have only widened health inequalities as middle class Scots were more likely to respond to the campaigns.

UCL Institute of Health Equity and UNDP (2014) Ensure healthy lives and well-being for all: Addressing social, economic, and environmental determinants of health and the health divide in the context of sustainable human development. UCL, London. http://bit.ly/1MpSvKW This project, initiated by UNDP Regional Bureau for Europe and the Commonwealth of Independent States (RBEC) in 2013, is a systematic analysis of whether, how and in which ways UNDP’s development projects address social, economic and environmental determinants (SEEDs) of health and health equity (H/HE).

This is a selection of the latest grey literature. More can be viewed on the Health Inequalities section of our dashboard and in the Prevention Information & Evidence eLibrary

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Data and statistics Centre for Health Geoinformatics (2014) An atlas of health inequalities in Ireland from 2006-2011. Centre for Health Geoinformatics, Ireland. http://bit.ly/1DXJ1CV As part of a research project funded by the Health Research Board, the CHG has been investigating health inequality in the Republic of Ireland. They have developed an interactive atlas to explore health inequalities in Ireland from 2006 to 2011.

Glasgow Centre for Population Health (2014) Understanding Glasgow: Indicators project. Glasgow Centre for Population Health, Glasgow. http://bit.ly/17FK4vj The Glasgow Indicators project allows you to view life expectancies in Glasgow with indicators from health, poverty, education and other perspectives.

Health and Social Care Information Centre (2014) Health Survey for England, 2013. Health and Social Care Information Centre, Leeds. http://bit.ly/1DXIukH Key findings of the annual survey include: 24 per cent of men and 17 per cent of women reported they were current smokers. Current smoking was highest among adults aged 25-34 (37 per cent of men and 24 per cent of women) and 3 per cent of adults were currently using e-cigarettes (vapourisers); and a further 2 per cent of men and 1 per cent of women were currently using other nicotine delivery products but not e-cigarettes. Office for National Statistics (2015) Alcohol-related deaths in the United Kingdom, registered in 2013. Office for National Statistics, London. http://bit.ly/1Bh52wV

Key findings include: In 2013 there were 8,416 alcohol-related deaths registered in the UK, an age standardised rate of 14.0 deaths per 100,000 population. A small increase of 49 deaths compared to 2012 did not change the overall rate; 66% of alcohol-related deaths in the UK in 2013 were among males and for both sexes, the UK death rates were highest among those aged 60-64 years (45.3 deaths per 100,000 males and 22.4 per 100,000 females).

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Public Health England (2015) Public Health Profiles, Updated Indicators. Public Health England, London. http://bit.ly/1DgassM To maintain compatibility with the other PHE products, the following indicators have been updated in the online Health Profiles: Deprivation, Children in poverty (under 16s), Obese children (Year 6), Recorded Diabetes, Excess winter deaths (three year), Life expectancy at birth (Male), Life expectancy at birth (Female).

This is a selection of the latest data and statistics. More can be viewed on the Health Inequalities section of our dashboard and in the Prevention Information & Evidence eLibrary

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Further resources European Portal for Action on Health Inequalities - This portal includes information about key initiatives, policies and resources on Health Inequalities across Europe. Equity Action - On this website you can find information and data about health inequalities in the EU and Member States, examples of relevant policies and practices and an extensive overview of useful resources UCL Institute of Health Equity - The Institute was launched in November 2011, to build on previous work to tackle inequalities in health led by Professor Sir Michael Marmot and his team, including the ‘Commission on Social Determinants of Health’ and ‘Fair Society Healthy Lives’ (The Marmot Review). Current work includes a review of Social Determinants of Health and the Health Divide for the WHO European Region. WHO Policy Briefs – This is a series of policy briefs that describe practical actions to address health inequities, especially in relation to tobacco, alcohol, obesity and injury. ncdlinks.org – The ncdlinks.org platform connects over 2,000 individuals who are working on urgent issues caused by non-communicable diseases. The platform offers the space for unique international communities of practice to share information and build on their broad range of expertise to form opinion, influence and push for global communication and action P.I.E eLibrary - You can search the Prevention Information & Evidence (P.I.E) eLibrary for grey literature about health inequalities and more related to the prevention of non-communicable disease. The associated Prevention Information & Evidence briefing service is a weekly updated of the latest additions to eLibrary. The briefing can be tailored by topic area so that you only receive updates of interest to you.

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