Mary Shaw

Indicators of socioeconomic position (part 1)

This glossary presents a comprehensive list of indicators of socioeconomic position used in health research. A description of what they intend to measure is given together with how data are elicited and the advantages and limitation of the indicators. The glossary is divided into two parts for journal publication but the intention is that it should be used as one piece. The second part highlights a life course approach and will be published in the next issue of the journal.

INcome inequality, the psychosocial environment, and health: comparisons of wealthy nations.

BACKGROUND The theory that income inequality and characteristics of the psychosocial environment (indexed by such things as social capital and sense of control over lifes circumstances) are key determinants of health and could account for health differences between countries has become influential in health inequalities research and for population health policy. METHODS We examined cross-sectional associations between income inequality and low birthweight, life expectancy, self-rated health, and age-specific and cause-specific mortality among countries providing data in wave III (around 1989-92) of the Luxembourg Income Study. We also used data from the 1990-91 wave of the World Values Survey (WVS). We obtained life expectancy, mortality, and low birthweight data from the WHO Statistical Information System. FINDINGS Among the countries studied, higher income inequality was strongly associated with greater infant mortality (r=0.69, p=0.004 for women; r=0.74, p=0.002 for men). Associations between income inequality and mortality declined with age at death, and then reversed among those aged 65 years and older. Income inequality was inconsistently associated with specific causes of death and was not associated with coronary heart disease (CHD), breast or prostate cancer, cirrhosis, or diabetes mortality. Countries that had greater trade union membership and political representation by women had better child mortality profiles. Differences between countries in levels of social capital showed generally weak and somewhat inconsistent associations with cause-specific and age-specific mortality. INTERPRETATION Income inequality and characteristics of the psychosocial environment like trust, control, and organisational membership do not seem to be key factors in understanding health differences between these wealthy countries. The associations that do exist are largely limited to child health outcomes and cirrhosis. Explanations for between-country differences in health will require an appreciation of the complex interactions of history, culture, politics, economics, and the status of women and ethnic minorities.

The widening gap. Health inequalities and policy in Britain.

Relentlessly, the wide health gap between different groups of people living in Britain continues to get even wider. This book presents new evidence (which was not available to the governments Independent Inquiry into Inequalities in Health) on the size of the gap, and the extent to which the gap is widening. In particular, new geographical data are presented and displayed in striking graphical form. It challenges whether the government is concerned enough about reducing inequalities and highlights the living conditions of the million people living in the least healthy areas in Britain. It presents explanations for the widening health gap, and addresses the implications of this major social problem. In the light of this evidence the authors put forward social policies which will reduce the health gap in the future. The widening gap synthesises all the information available to date and should be read alongside the report of the evidence presented to the Independent Inquiry into Inequalities in Health (Inequalities in health, The Policy Press, 1999) and by all those concerned with reducing health inequalities. Studies in poverty, inequality and social exclusion series

Smoking and Ill Health: Does Lay Epidemiology Explain the Failure of Smoking Cessation Programs Among Deprived Populations?

The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts. Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved.

Geographies of the agenda: public policy, the discipline and its (re)‘turns’

In the 1980s and 1990s, poverty and inequality in Britain increased, yet the discipline of (human) geography was apparently disinterested. This paper poses the question as to why part of the discipline turned its back on public policy and particularly issues of poverty and inequality. The aim of the paper is to encourage students and advocates of geography to think a little about what they are involved in (and to think about the role of academia more generally). Recent publications in a number of geography journals have revealed much angst among prominent geographers concerning the state of human geography and, in particular, its links to contemporary policy debate. However, while geographers discuss the debate, we argue that they are not a significant part of it. We take a critical turn and look at the debate that two geographers – Ron Martin and Doreen Massey – have raised within the light of wider debates on public policy, politics, quantification, academia and the policy agenda. We conclude that for many reasons there is unlikely to be a large shift towards policy-orientated research within human geography.

Health inequalities and New Labour: how the promises compare with real progress

Inequalities in health between rich and poor areas of Britain widened in the 1980s and 1990s, and the current government has repeatedly expressed its intention to reduce these inequalities. In this article, however, the authors report that inequalities in life expectancy have continued to widen, alongside widening inequalities in income and wealth, and argue that more potent and redistributive policies are needed

Places and health

This glossary aims to provide readers with some key conceptual tools with which to address the issue of place and health; it is hoped that it will provoke thought and debate on the range of ways that places are connected to health.

Migration and geographical inequalities in health in Britain

This paper explores the role of migration in creating geographical inequalities in mortality at the district level in Britain for the British Household Panel Study sample--a representative sample of 10264 British residents born after 1890 and enumerated in 1991. Analysis of the mortality rates of migrants showed that male migration accounts for nearly all the differences in mortality rates between districts. The BHPS was then utilised to look at the lifetime socio-economic characteristics of these migrants and to compare men and women. It was found that the health of both men and women moving from high mortality districts to low mortality districts could be explained by advantage over their lifetimes. The small proportion of men and women moving from low mortality districts to high mortality districts represent a very mixed group and their contribution, whilst small, is intriguing, as is the very different mortality rates of men and women in this group.

Mortality and migration in Britain, first results from the British Household Panel Survey

This study investigates the extent to which current geographical variations in mortality are influenced by patterns of migration since birth. It is based on a longitudinal study of migrants which consists of a representative sample of 10264 British residents born after 1890 and enumerated as part of the British Household Panel Study in 1991. Between 1991 and 1996, 527 of the study members died and these deaths were analysed by area of residence at birth and in 1991 at both the regional and local district geographical scales. These were compared with findings from the Office for National Statistics Longitudinal Study. The British Household Panel Survey sample replicates the results of work conducted on the Longitudinal Study which finds that geographical variations in age-sex standardised mortality ratios at the regional scale cannot be attributed to selective migration. However, for the British Household Panel Survey sample, the major geographical variations at district level could be attributed to selective migration. Geographical variations in mortality are not well understood. Restrictions on what it is possible to analyse in the Office for National Statistics Longitudinal Study may have resulted in the underestimation of the importance of local lifetime selective migration in producing the contemporary map of mortality variation across Britain. The British Household Panel Survey is a small, recent, but very flexible study, which can be used to investigate the effects of lifetime migration on mortality patterns for all of Britain. This first report of its results on mortality shows that it produces findings which accord with the much larger Longitudinal Study, but which can be taken further to show that selective migration over the whole life-course at the local level does appear to have significantly altered the geographical pattern of mortality seen in Britain today.

Hospital admissions, age, and death: retrospective cohort study

Abstract Objectives Ageing of the population brings the possibility of increased burdens for acute hospital services because of the marked increase in many common diseases with age. We aimed to examine the relation between age and use of acute services in hospitals in the period before death in a national sample of deaths in hospital. Design Retrospective cohort analysis of English hospital episode statistics database. Setting All NHS hospitals in England. Data set All post-neonatal deaths occurring in English NHS hospitals during financial year 1999-2000, with episodes of care in the previous three years determined through matching on sex, date of birth, and postcode. Main outcome measures Total bed days, mean and median length of stay. Results 253 799 in-hospital deaths were identified, representing about 45% of all deaths occurring in 1999-2000. Patients who died in hospital spent a median of 23 days in hospital in the three years before death; the median rose with age up to 45 years, but was fairly stable for ages 45 and above. The number of admissions to NHS hospitals in the three years before death averaged 3.6; this peaked at 10.4 in patients aged 5-9 years and decreased with age to 2.2 in those aged 85 and over. Conclusions The average number of bed days spent in hospital in the period before death does not increase with increasing age.