Maps of premature deaths across England will help tackle variation, say public health chiefsBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3796 (Published 11 June 2013) Cite this as: BMJ 2013;346:f3796
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Ingrid Torjesen highlights the stark inequality in life expectancy visualized on the Longer Lives website (longerlives.phe.org.uk) . The North is painted red, and labelled with the ‘worst’ premature mortality, compared to the green fields of the South, with the ‘best’ premature mortality.
The north-south divide in life expectancy is nothing new [2,3]. What is new is that local authorities are now responsible for public health. Jeremy Hunt wants the data to be used to identify “local” public health challenges , but our analysis reveals the bigger picture.
In Figure 1 we use publicly accessible data [4,5] to illustrate the local authority budget cut per head (2010-11 to 2014-15) plotted against premature mortality. This shows that the largest spending cuts have occurred in the areas with the highest premature mortality, and that the cuts are systematically larger in the North of England.
How are local authorities supposed to reduce inequalities, in the face of austerity measures that are likely to do the opposite?
David Taylor-Robinson, MRC Population Health Scientist, University of Liverpool
Rachael Gosling, Consultant in Public Health, Liverpool Community Health NHS Trust
Dominic Harrison, Director of Public Health, Blackburn with Darwen Borough Council
Councillor Mohammed Khan OBE, Deputy Leader Blackburn With Darwen BC, Executive member for Health and Adult Social Care
Ben Barr, Senior Clinical Lecturer in Applied Public Health, University of Liverpool
1. Torjesen I. Maps of premature deaths across England will help tackle variation, say public health chiefs. BMJ 2013;346:f3796
2. Hacking JM, Muller S, Buchan IE. Trends in mortality from 1965 to 2008 across the English north-south divide: comparative observational study. BMJ. 2011 Feb 15;342:d508. doi: 10.1136/bmj.d508.
3. Whitehead M, Doran T. The north-south health divide. BMJ 2001:342:d584.
4. Guardian 2013. Council spending cuts: the north loses out to the south. http://www.guardian.co.uk/society/patrick-butler-cuts-blog/2013/jan/11/c... (accessed 20th June 2013)
5. Public Health England 2013. About the data. http://longerlives.phe.org.uk/about-data (accessed 20th June 2013)
Competing interests: No competing interests
This “shocking variation in early and unnecessary deaths” is not exactly a surprise to those working in public health. Inequalities in health is a well-established problem and there is a wealth of varied sources of information readily available.( e.g.1-4) It is now over 30 years since a World Health Organization global meeting at Alma-Ata where the delegates expressed the need for urgent action by all governments to tackle the “existing gross inequality in the health status” both between and within countries.(5)
We welcome Public Health England’s ‘Longer Lives’ project as it has the potential to be a driver for change both with professionals and the public. However, instead of focusing purely on negative indicators that is deaths, perhaps they should also have some positive ones, especially as they are trying to promote health.(6) The indicators will be used for planning (including determining priorities and allocating resources) so it is crucial that the correct set of indicators is chosen.
Positive health indicators can be identified in relation to individual health knowledge and behaviour, socio-economic conditions and the physical environment.(6) Examples of some positive indicators include: percentage of children undertaking enough exercise per week; percentage of homes with a working smoke alarm; percentage of adults having “5 a day”. At a higher level they can also be developed for example in relation to cycle lanes, swimming pools, and various workplace policies.
This type of health indicator can be used for monitoring and evaluation but also importantly for motivating the public and professionals to act. Instead of having a society focused purely on deaths perhaps it is now time to change the perspective and have a focus on health.
1) Black D., Morris J., Smith C., Townsend P. Inequalities in health: report of a Research Working Group. London: Department of Health and Social Security, 1980.
2) Acheson D. Independent Inquiry into Inequalities in Health Report. London: The Stationery Office, 1998
3) Mackenbach, J.P., Stirbu I., Roskam A.R., Schaap M.M., Menvielle G., Leinsalu M., and Anton E. Kunst. Socioeconomic Inequalities in Health in 22 European Countries. N Engl J Med 2008;358: 2468-81.
4) Marmot et al. The Marmot Review: Fair Society, Healthy Lives. Strategic review of health inequalities in England post-2010. London: The Marmot Review, 2010.
5) World Health Organization. Declaration of Alma-Ata. Geneva: World Health Organization, 1978
6) Catford JC. Positive health indicators – towards a new information base for health promotion. Community Medicine. 1983; 5: 125-132.
Competing interests: No competing interests