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Why are inequalities in health greater now than at any times since the 1920s? Danny Dorling Talking Points Lecture,10 th  February 2010 Medical School Lecture Theatre 2, University of Sheffield Organized by Yorkshire and Humber Teaching Public Health Network and co-hosted by the School of Health and Related Research (ScHARR)  Thanks to all who contributed to this lecture, especially the Worldmapper group (Graham Allsopp, Anna Barford, Benjamin Hennig, Mark Newman [University of Michigan], John Pritchard and Ben Wheeler [University of Cornwall]), Bethan Thomas and George Davey Smith [University of Bristol] for the most recent work on inequalities in Britain, and to Dan Vickers and Dimitris Ballas who helped with some of the others on the work on inequalities in Sheffield. Watch the full lecture as a video-multimedia presentation at http://sasi.group.shef.ac.uk/presentations/healthinequalities/
Why are inequalities in health greater now than at any times since the 1920s? ,[object Object],[object Object],[object Object],Three Parts
Answers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Are they? ,[object Object],[object Object],[object Object],[object Object]
Worldwide ,[object Object],[object Object],[object Object],[object Object],[object Object]
Global Life Expectancy (years) Dorling, D. et al. BMJ 2006;332:662-664 Copyright ©2006 BMJ Publishing Group Ltd. Global life expectancy slope index of inequality between nation states (in years). Black triangle shows estimated index in 2000-5 with impact of AIDS removed
GDP development 1955-2000s ,[object Object],[object Object],Decadal growth rates (in GDP) 1973 1969 1968 1977
Age of Death: Infants (aged under 1) ,[object Object]
Age of Death: 1-4 ,[object Object]
Age of Death: 5-9 ,[object Object]
Age of Death: 10-14 ,[object Object]
Age of Death: 15-19 ,[object Object]
Age of Death: 20-24 ,[object Object]
Age of Death: 25-29 ,[object Object]
Age of Death: 30-34 ,[object Object]
Age of Death: 35-39 ,[object Object]
Age of Death: 40-44 ,[object Object]
Age of Death: 45-49 ,[object Object]
Age of Death: 50-54 ,[object Object]
Age of Death: 55-59 ,[object Object]
Age of Death: 60-64 ,[object Object]
Age of Death: 65-69 ,[object Object]
Age of Death: 70-74 ,[object Object]
Age of Death: 75-79 ,[object Object]
Age of Death: 80-84 ,[object Object]
Age of Death: 85-89 ,[object Object]
Age of Death: 90-94 ,[object Object]
Age of Death: 95-99 ,[object Object]
Age of Death: 100+ ,[object Object]
Causes of death trends illustrate what is possible with medical progress and an NHS ,[object Object],Source: Very old graph from: A New Social Atlas of Britain (Wiley 1995), page 154: http://sasi.group.shef.ac.uk/publications/new_social_atlas/chapter5.pdf NHS
Sheffield – A tale of two cities Now, turn from the world to a single city in the middle of Britain. How have inequalities in life chances changed here over time and inequalities in health responded? This report was an attempt to collate most of what we know about spatial inequalities in Sheffield. And how they have changed since the late 1960s, the earliest date have much date for. www.shef.ac.uk/sasi http://www.sasi.group.shef.ac.uk/ research/sheffield/
Unemployment inequalities tell us a lot Source: A Tale of two Cities. The Sheffield Project. http://www.sasi.group.shef.ac.uk/research/sheffield/
Life Expectancy 1851-1900 by Registration District (years) ,[object Object],1851-60 1861-70 1871-80 1881-90 1891- 1900 Sheffield 34 33 35 38 39 Eccleshall 40 40 42 43 46 GAP 6 7 7 5 7
Average life expectancy in Sheffield ,[object Object],[object Object]
Inequalities in life expectancy in Britain ,[object Object],[object Object]
Inequalities in life expectancy in Britain ,[object Object],[object Object]
Poverty, deprivation and health: the dose-response has been known for many years  Source: Modified graph from Shaw, Dorling, Gordon & Smith (1999): The widening gap. Health inequalities and policy in Britain. The Policy Press. Bristol. Scatterplot of standardized mortality ratio for deaths under 65 and % of households living in poverty ( Breadline Britain  index), for parliamentary constituencies (Britain (1991-1995) 0  5  10  15  20  25  30  35  40  45 250 200 150 100 50 0 % Poverty SMR <65
Mortality Patterns in Britain 1921-2005 Rates of inequality fell then rose from 1973 ,[object Object],1 0.9 1.2 1.1
Mortality Patterns in Britain 1921-2005 Some more unusual maps are need to see:
Mortality Mosaics: SMR 1921-1925 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1926-1930 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1931-1935 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1936-1939 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1950-1953 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1959-1963 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1969-1973 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1981-1985 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1986-1990 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1991-1995 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 1996-2000 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Mortality Mosaics: SMR 2001-2005 ,[object Object],Created by John Pritchard http://sasi.group.shef.ac.uk/research/mortality_mosaics/
Inequalities in premature mortality here is another way of looking at the rates ,[object Object],Note that the time periods vary due to data limitations; in particular, there is a large gap between 1939 and 1950. For 1990 (included in 1990-92), 1991 population figures were used. For 2006 (included in 2004-06), 2005 mid-year estimates (the latest available at small area geography) were used. Note that the final column does not follow on but overlaps; it is the latest 3 years for which mortality data were available for all of Britain.
Polarisation even for the rarest causes Poverty and Murder in Britain ,[object Object],Source: Data from Dorling, Gordon, Hillyard, Pantazis, Pemberton, &Tombs (2008): Criminal obsessions: why harm matters more than crime. Second Edition. London: Centre for Crime and Justice Studies. http://www.crimeandjustice.org.uk/
And it is worth remembering what the key causes now are: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Underlying inequalities in health is Income inequality in Britain: the trend ,[object Object],What the richest 1% get (post tax)
From this The most harmful cost of inequality ,[object Object],Best and worse off area – differences from average Inequality in health – premature mortality
What to do?  - read somebody else’s book! ,[object Object],Image Source
What to do? ,[object Object],[object Object],[object Object],[object Object],[object Object],www.polyp.org.uk Source: http://risingtide.org.uk/book/print/269
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Credits www.polyp.org.uk
Watch the full lecture as a video-multimedia presentation at http://sasi.group.shef.ac.uk/presentations/healthinequalities/ The original slides are available as a free downloadable PowerPoint file on http://sheffield.ac.uk/geography/staff/dorling_danny/lectures.html

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Why are inequalities in health greater now than at any times since the 1920s?

  • 1. Why are inequalities in health greater now than at any times since the 1920s? Danny Dorling Talking Points Lecture,10 th February 2010 Medical School Lecture Theatre 2, University of Sheffield Organized by Yorkshire and Humber Teaching Public Health Network and co-hosted by the School of Health and Related Research (ScHARR) Thanks to all who contributed to this lecture, especially the Worldmapper group (Graham Allsopp, Anna Barford, Benjamin Hennig, Mark Newman [University of Michigan], John Pritchard and Ben Wheeler [University of Cornwall]), Bethan Thomas and George Davey Smith [University of Bristol] for the most recent work on inequalities in Britain, and to Dan Vickers and Dimitris Ballas who helped with some of the others on the work on inequalities in Sheffield. Watch the full lecture as a video-multimedia presentation at http://sasi.group.shef.ac.uk/presentations/healthinequalities/
  • 2.
  • 3.
  • 4.
  • 5.
  • 6. Global Life Expectancy (years) Dorling, D. et al. BMJ 2006;332:662-664 Copyright ©2006 BMJ Publishing Group Ltd. Global life expectancy slope index of inequality between nation states (in years). Black triangle shows estimated index in 2000-5 with impact of AIDS removed
  • 7.
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  • 27.
  • 28.
  • 29.
  • 30.
  • 31. Sheffield – A tale of two cities Now, turn from the world to a single city in the middle of Britain. How have inequalities in life chances changed here over time and inequalities in health responded? This report was an attempt to collate most of what we know about spatial inequalities in Sheffield. And how they have changed since the late 1960s, the earliest date have much date for. www.shef.ac.uk/sasi http://www.sasi.group.shef.ac.uk/ research/sheffield/
  • 32. Unemployment inequalities tell us a lot Source: A Tale of two Cities. The Sheffield Project. http://www.sasi.group.shef.ac.uk/research/sheffield/
  • 33.
  • 34.
  • 35.
  • 36.
  • 37. Poverty, deprivation and health: the dose-response has been known for many years Source: Modified graph from Shaw, Dorling, Gordon & Smith (1999): The widening gap. Health inequalities and policy in Britain. The Policy Press. Bristol. Scatterplot of standardized mortality ratio for deaths under 65 and % of households living in poverty ( Breadline Britain index), for parliamentary constituencies (Britain (1991-1995) 0 5 10 15 20 25 30 35 40 45 250 200 150 100 50 0 % Poverty SMR <65
  • 38.
  • 39. Mortality Patterns in Britain 1921-2005 Some more unusual maps are need to see:
  • 40.
  • 41.
  • 42.
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  • 51.
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  • 55.
  • 56.
  • 57.
  • 58.
  • 59.
  • 60. Watch the full lecture as a video-multimedia presentation at http://sasi.group.shef.ac.uk/presentations/healthinequalities/ The original slides are available as a free downloadable PowerPoint file on http://sheffield.ac.uk/geography/staff/dorling_danny/lectures.html

Notas del editor

  1. Watch the full lecture as a video-multimedia presentation at http://sasi.group.shef.ac.uk/presentations/healthinequalities/ The original slides are available as a free downloadable PowerPoint file on http://sheffield.ac.uk/geography/staff/dorling_danny/lectures.html
  2. Watch the full lecture as a video-multimedia presentation at http://sasi.group.shef.ac.uk/presentations/healthinequalities/ The original slides are available as a free downloadable PowerPoint file on http://sheffield.ac.uk/geography/staff/dorling_danny/lectures.html