The impact of the English National Health Inequalities strategy on inequalities in mortality at age 65: a time-trend analysis
Quick-read summary
England has an ageing population, with inequalities in mortality (deaths) and life expectancy widening between more and less deprived places in recent years.
Evidence suggests that the English Health Inequalities Strategy (implemented between 1999 and 2010 following recommendations from the 1998 Acheson Inquiry) has been successful in narrowing inequalities in a range of health measures. However, no studies so far have specifically looked at the impact of the strategy on older age groups.
More about the Acheson Inquiry
The report of the Independent Inquiry into Inequalities in Health (chaired by Sir Donald Acheson) was published in 1998. The purpose of the inquiry was to inform the development of the then (Labour) government’s public health strategy and, in particular, to contribute to the forthcoming white paper, Our healthier nation.
The report made a number of specific recommendations on a range of areas relating to health, environmental and social factors.
The strategy included several measures that had specific relevance to older age groups:
- An increase to state pensions (via improved value of the universal state pension and the Minimum Income Guarantee)
- Winter fuel payments for people 60+
- Free TV licenses for people 75+
- Free bus passes for people 60+
- An increase in NHS funding (NHS services are used more by older people because of their additional health needs) and specific additional funding to more deprived areas
This research looked at patterns in mortality rates for the age 65-69 group from 1991 to 2019. Mortality rate is the ratio between deaths and individuals in a specified population and during a particular time period.
It found that absolute inequalities* in mortality improved significantly during the strategy, and then worsened significantly in the period following the end of the strategy.
*Follow this link for an explanation of the term ‘absolute inequalities’
What is the issue?
We have an ageing population in England. Improvements in life expectancy and mortality have begun to stall, and inequalities have begun to widen in recent years. Evidence suggests past government inequalities strategies have been successful in improving inequalities in other age groups and outcomes. No studies have yet looked at how such strategies affected older age groups.
Research summary
- We use publicly available routine data to look at local authority level mortality rates over time by area deprivation
- We mapped the trends in mortality rates over time, and then mapped both relative and absolute inequalities in mortality
- We then ran a model to see how inequalities changed during the strategy
- Finally, we ran some tests to check whether these results differed if we used slightly different years, and whether the results changed by different age groups
What the research found
- Mortality rates for the age 65-69 group improved throughout the whole time period (1991-2019)
- Absolute inequality between mortality rates at age 65-69 in the most deprived 20% of areas, compared with the rest of areas improved over the health inequalities strategy (2000-2010) by an average of 9.66 fewer deaths per 100,000 per year
- However, absolute inequality was significantly worse in the period after the strategy ended (2011-2019) by an average of an additional 12.84 deaths per 100,000 per year
- Additional tests suggested that the improvements seen during the strategy were likely not due to boosts to pensions alone
Why is this important?
- The population continues to age and inequalities in health and life expectancy continue to widen in England
- Governments recognise that these pose issues for the wellbeing and productivity of the population, as well as for healthcare provision
- Our results suggest government wide, multifaceted strategies to address health inequalities can also be successful in reducing inequalities older age groups
Who is this evidence useful for?
This evidence is especially useful to policy makers, particularly in countries with high inequality and ageing populations.
What’s next?
- Our research adds to the evidence that government health inequalities strategies are important and can be successful in reducing inequalities
- Future efforts to reduce inequalities in older age groups should prioritise both sufficient income levels and the provision of adequate funding of health and social services, especially in the most deprived areas
- Future research should try to understand inequalities in mortality by gender over this period and assess any specific role for pensions.
Get in touch about this research
Lead researcher name: Andrew Kingston
Email address: andrew.kingston@ncl.ac.uk
Link to full paper
This work was co-authored by Dr Natalie Bennett, who was a Research Fellow funded by the NIHR ARC North East and North Cumbria at the time of developing the research. It was also co-authored by Professor Clare Bambra, Inequalities Lead for the NIHR ARC North East and North Cumbria.