Long-term Monitoring of Health Inequalities - Headline Indicators - October 2010

Introduction

This publication is an annual update of headline indicators from the long term monitoring of health inequalities report, first published in September 2008.

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 advice was as follows:

Recommended headline indicators of inequalities in health outcomes

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

Recommended 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 (to capture large inequalities in mortality observed in this age group)

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.

Some of these indicators (healthy life expectancy, mental wellbeing, alcohol related hospital admissions and premature mortality from coronary heart disease in deprived areas) are also included in the National Performance Framework. Further information about these national indicators is available on the Scotland Performs website: http://www.scotland.gov.uk/About/scotPerforms

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, 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 (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 an update was published in September 2009. This report represents the third of a series of annual publications.

Revisions from previous years' reports

Since the publication of last year's report, the Scottish Index of Multiple Deprivation has been updated to SIMD09. All measures in this report relating to 2007 onwards are now based on SIMD09. Measures prior to 2007 are still based on SIMD06. In addition, the following changes have been implemented:

• Low Birthweight - The definition has been corrected to note that the figures include all babies rather than just those that reach full term. This correction does not affect the data for this indicator. The low birthweight data was always based on all births, but the definition stated in previous reports was incorrect.
• Coronary Heart Disease (first ever hospital admission for heart attack aged under 75 years; deaths aged 45-74 years) - The trend data has been revised after an error was spotted in the way rates were previously calculated.
• All-cause mortality aged 15-44 years - The trend data has been revised after an error was spotted in the way rates were previously standardised. Whilst this has a substantial impact on the level of the rates, the overall trend is relatively similar.
• Alcohol deaths aged 45-74 years - The trend data has been revised after an error was spotted in the way rates were previously standardised. Whilst this has a substantial impact on the level of the rates, the overall trend is relatively similar.