Intended for healthcare professionals


Maps of premature deaths across England will help tackle variation, say public health chiefs

BMJ 2013; 346 doi: (Published 11 June 2013) Cite this as: BMJ 2013;346:f3796

Re: Maps of premature deaths across England will help tackle variation, say public health chiefs

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

17 June 2013
Michael C. Watson
Associate Professor in Public Health.
Emily Clare Watson, GP Registrar, Barnsley Hospital, Barnsley S75 2EP.
University of Nottingham
Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA