Health inequalities in Britain: continuing increases up to the end of the 20th century.

BACKGROUND AND METHODS Socioeconomic inequalities in premature mortality in Britain increased over the second half of the 20th century, particularly from the early 1970s onwards. The magnitude of mortality differentials reflects the trend in income inequality, which has also undergone a dramatic increase over the past quarter century. The present British government have emphasised their commitment to reducing health inequalities. For example the Minister of Health, Alan Milburn, has stated that “Our ambition is to do something that no government—Tory or Labour—has ever done. Not only to improve the health of the nation, but also to improve the health of the worst off at a faster rate”. A set of targets for the reduction of health inequalities has been presented. To monitor progress in this regard we have produced updated analyses of premature mortality rates running through to the end of 1999. The mortality data are the Office for National Statistics digital records of all deaths in England and Wales, and equivalent records from the General Register Office (Scotland). The full postcode of the usual residence of the deceased was used to assign each death to the parliamentary constituency in which the deceased usually lived. The death data were provided for single years since 1990 and have been grouped into two year aggregates. Poverty was indexed by a modified version of the Breadline Britain index, based on lack of basic amenities and car access, unskilled and semi-skilled manual occupations, unemployment, non-owner occupier households, and lone parent households. This is a validated indicator of deprivation. Parliamentary constituencies were ranked according to the poverty measure and divided into equal population size deciles on the basis of this ranking. The same ranking deciles, based on 1991 census data, are used for each of the time periods. Standardised mortality ratios (SMRs) were calculated separately for men and women for these deciles, using their overall age specific mortality rates for England and Wales for the periods under consideration. Population by age group and sex have to be estimated for parliamentary constituencies in the 1990s. The Office for National Statistics (ONS) and General Record Office (Scotland) produce mid-year population estimates for years up to 1999 at local authority district level. In order to maintain a geographical base consistent with previous studies of Britain’s health gap, these district level estimates were extrapolated to electoral ward level, and then aggregated to parliamentary constituencies. The interpolation was based upon population estimates for 1996 that were available at electoral ward level, and was carried out such that Wij = (Pij*Cij)+Yij, where Wij is the 1999 ward level population count for age group i and sex j, Pij is the proportion of the 1996 district level population count for age/sex group ij resident in ward W, Cij is the change in district level population count 1996–1999 for age / sex group ij from National Statistics and General Register Office (Scotland) mid-year estimates, and Yij is the 1996 ward level population count for age/sex group ij.