Deprivation strongly linked to mortality

Report from the Office for National Statistics reveals “sizeable and highly significant” absolute and relative inequalities in avoidable mortality between those living in the most and least deprived areas.


Main points

  • Avoidable, amenable and preventable mortality is strongly related to area deprivation in England and in Wales.
  • In England in 2015 there were 16,686 deaths from avoidable causes in the most deprived areas whereas there were less than half that number (7,247 deaths) in the least deprived areas.
  • In the most deprived areas of Wales there were 1,054 deaths from avoidable causes in 2015, compared with 509 deaths in the least deprived areas.
  • Absolute and relative inequalities in avoidable mortality between those living in the most and least deprived areas were sizeable and highly significant, but the excess was larger for males than females in all cases.
  • The largest relative inequality in avoidable mortality was for deaths from respiratory diseases which were 4.8 times (males) and 7.7 times (females) more likely in the most deprived populations compared with the least deprived.
  • The largest absolute difference in avoidable mortality between the most and least deprived deciles was from cardiovascular disease and cancer.

Full report: Measuring Socioeconomic inequalities in avoidable mortality in England and Wales: 2015


Psychosocial pathways and health outcomes

Overview of current evidence about the relationships between social determinants, psychosocial factors and health outcomes. | Public Health England

This report highlights the current evidence that exists about the relationships between social determinants, psychosocial factors and health outcomes.

It also provides a conceptual framework that focuses on the psychosocial pathways between factors associated with social, economic and environmental conditions, psychological and psychobiological processes, health behaviours and mental and physical health outcomes.

Preventing depression in low-income mothers

It is well-established that women in low-income households have an increased risk of developing mental health problems, in particular depression | The Mental Elf


Studies have found that these women are around twice as likely to develop the disorder compared with those from higher-income households (Hobfoll et al, 1995). Low-income women are also less likely to seek and receive appropriate treatment, in part because of the associated costs (Lennon et al, 2001).

For women who are mothers, this is especially consequential: parental depression has been linked with developmental, emotional and mental health problems in children (McDaniel et al., 2013). In the United States this has been highlighted as a public health concern, and it is increasingly being recognised that community-based services offer valuable opportunities to reach those for whom help is less accessible.

Head Start is a US government-funded service aimed at families at or below the federal poverty level with young children under five. They use a case-management structure to establish a healthy family environment in order to look after the child’s development and wellbeing. Depression affects almost half of the mothers at Head Start. A recent study by Silverstein et al. (2017) examines the efficacy of embedding a depression prevention strategy in the Head Start program.

How Early do Social Determinants of Health Begin to Operate?

From a life course perspective, important insights about how social determinants of health operate can be gained by analyzing the various forms that social climate can take in different life periods | Journal of Pediatric Nursing



  • Perceptions of power imbalance and exclusion affect children’s self-rated health as early as elementary school.
  • Social exclusion in school is associated with lower odds of “excellent or very good” or “good” self-rated health.
  • Rejection from peers is a more important determinant of children’s self-rated health than is physical aggression.

Full reference: Zhang, A. et al. (2017) How Early do Social Determinants of Health Begin to Operate? Results From the Fragile Families and Child Wellbeing Study. Journal of Pediatric Nursing. Published online: 10th July 2017

Cutting smoking rates could save NHS £67m a year

Study highlights the burden that smoking places on UK society, particularly on the poorest and least advantaged groups | OnMedica | Tobacco control


If smoking rates dropped to 5% in the UK by 2035, the NHS could save £67 million in just one year. This is according to research published this week in Tobacco Control.

Researchers at the UK Health Forum, commissioned by Cancer Research UK, examined the health and economic impact of the UK becoming ‘tobacco-free’ – where less than 5% of the population smoke. The study predicts that achieving this target would avoid nearly 100,000 new cases of smoking-related disease, including 35,900 cancers over 20 years.

The impact of this health improvement amounts to a saving of £67 million in direct NHS and social care costs and an incredible £548 million in additional costs to the economy in 2035 alone.

If today’s trends continue, around 15% of people from the most deprived groups are predicted to smoke in 2035, compared to just 2.5% from the wealthiest.

Read more via OnMedica

Full reference: Hunt D, Knuchel-Takano A, Jaccard A, et al. Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a ‘tobacco-free’ UK

Health care costs in the English NHS

The Centre for Health Economics in York has published ‘Health care costs in the English NHS: reference tables for average annual NHS spend by age, sex and deprivation group’.

Health care costs in the English NHS
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This paper describes how to calculate average health care costs broken down by age, sex and neighbourhood deprivation quintile group using the distribution of health care spending by the English NHS in the financial year 2011/12.

The results can be used by cost-effectiveness analysts to populate their extrapolation models when estimating future health care costs. The results will also be of interest to the broader community of health researchers as they illustrate how NHS spending is distributed across different subgroups within the population.

The analysis presented in this report indicates that health care costs at any given age are higher for those living in more deprived neighbourhoods than those living in more affluent neighbourhoods. Research looking at the social distribution of health has found that quality of life is also lower at any given age for those living in more deprived neighbourhoods than for those living in more affluent neighbourhoods.

Read the full report here

What does improving population health really mean?

The King’s Fund has published ‘What does improving population health really mean?’

Put simply, population health means the health outcomes of a defined group of people, as well as the distribution of health outcomes within the group.

The health of a population is influenced by a wide range of factors and the interactions between them. They include the local environment – such as the conditions in which people live and work; social and economic factors – like education, income and employment; lifestyles – including what people eat and drink, whether they smoke, and how much physical activity they do; and access to health care and other public and private services. Age, sex and genes make a difference to health too, as well as social networks and the wider society in which people live.

Population health
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The NHS has an important role to play in improving population health and must work with local government and other partners to develop more co-ordinated approaches to improving population health. At a local level, this should involve developing common aims for improving health, defining how these goals will be measured, and sharing resources to achieve them. It may also involve developing more systematic ways for NHS staff to identify people’s non-medical needs and work with others in the community to address them. STPs offer an important opportunity for the NHS and its partners to work together to achieve this.

But NHS and local government leaders can only do so much. A major factor outside their control is the political decisions made by government – for example, on welfare spending or housing policy –which have a major impact on people’s health. Short-sighted cuts to local government and public health budgets at a national level will make ambitions to improve population health harder to achieve.

Read the full text here