Long-Term Monitoring of Health Inequalities: Headline Indicators - October 2012

Introduction

This publication updates the headline indicators from the Long-Term Monitoring of Health Inequalities^[1] report. This is the fifth annual update of these data.

In 2007, a Ministerial Task Force on Health Inequalities led by the Minister for Public Health was established to identify and prioritise practical actions to reduce the most significant and widening health inequalities in Scotland. The Task Force recognised the need to monitor progress in tackling health inequalities in the longer term as well as managing short- and medium-term progress.

A short life technical advisory group was set up in early 2008 to advise the Task Force on long-term monitoring of health inequalities (see Annex 1 for membership of this group). The remit of this group was to explore how best to measure health inequalities and which high level indicators should be monitored over time. The group's recommended indicators were:

Headline indicators of inequalities in health outcomes

• Healthy Life Expectancy at birth
• Premature Mortality from all causes aged under 75 years
• Mental Wellbeing of adults aged 16 years and over
• Low birthweight

Indicators of inequalities in morbidity and mortality from specific causes for specific age groups

• Coronary Heart Disease
  • first ever hospital admission for heart attack aged under 75 years
  • deaths aged 45-74 years
• Cancer
  • incidence rate aged under 75 years
  • deaths aged 45-74 years
• Alcohol
  • first ever hospital admission aged under 75 years
  • deaths aged 45-74 years
• All-cause mortality aged 15-44 years

Details of the definitions and sources for these indicators are provided in Annex 2. Note that the time periods for which data are available for these indicators vary.

Recommended measurement approaches to monitoring health inequalities

The expert group recognised that different types of measure give insight into different aspects of inequalities. The recommended approach therefore uses a combination of measures, with the aim of giving a fuller understanding of the inequalities concerned.

• Relative Index of Inequality (RII): How steep is the inequalities gradient? This measure describes the gradient of health observed across the deprivation scale, relative to the mean health of the whole population.
• Absolute gap: How big is the gap? This measure describes the absolute difference between the extremes of deprivation - the rate in the most deprived minus the rate in the least deprived group.
• Scale: How big is the problem? This measure describes the underlying scale of the problem, puts it into context and presents past trends at Scotland level.

Detailed descriptions of these measures are provided in Annex 3. In the absence of individual level data on socio-economic circumstance, which the group identified as the ideal but acknowledged is not yet possible, an area based index based on income and employment has been used to define "deprivation". Details about the reasons for this and the way that this index was calculated are provided in Annex 3.

The expert group also advised that these indicators and measures were recommended for long-term monitoring of health inequalities due to deprivation at Scotland level. Monitoring of health inequalities due to other factors (such as age, gender or ethnicity for example) would require different indicators and measures. Similarly, the group advised that these recommended indicators and measures would not necessarily be the most appropriate for long-term monitoring of health inequalities at a local level.

The report of the Ministerial Task Force, Equally Well^[2] (published in June 2008), recommended that these indicators and measures should be adopted and a report published. The first report was published in September 2008 and updates were published in September 2009, October 2010 and October 2011. This report represents the fifth of a series of annual publications.

Recommendations from the Technical Advisory Group, June 2012

In June 2012 there was a further meeting of the technical advisory group to review methodology and the range of published indicators. The meeting focussed on two main areas. The first of these was a proposal that the assumption of a linear relationship between deprivation and each indicator be tested, and possibly replaced by a non-linear model if appropriate^[3]. The second issue surrounded whether the existing range of indicators was appropriate^[4].

On the issue of applying a non-linear spline model to the measurement of relative deprivation, it was agreed that no changes would be made to the methodology. While the alternative had some technical merits it was felt to be too complex for this report; and its lack of consistency over time had drawbacks for long-term monitoring.

On the range of reported indicators, it was agreed that the low birthweight indicator should be supplemented by an additional indicator of appropriate weight for gestational age (including high birthweight babies). This will be included in the 2013 annual report when data are available for this indicator. It was also agreed that mortality rates from each of the three most common types of cancer should be investigated separately to total cancer mortality. This is because there may be distinct patterns of inequality for different cancer types. This matter will be investigated over the coming year and, if appropriate, new indicators may be introduced in the 2013 report.