Ill health is a class and gender issue
I’ve been thinking a bit about the Inequality in Healthy Life Expectancy statistics, published today. These figures show life expectancy and healthy life expectancy, broken down by gender and by how deprived the areas are where people live. Among other things, they show why defending benefits and services for people who are disabled or in poor health is more important for people in deprived areas and more important for women.
As we might expect, there is a clear gender difference, with women living longer than men in all deciles. (*) And there is a deprivation gradient for both sexes, with life expectancy shorter the more deprived areas are:
We also get these differences when we come to healthy life expectancy. (**)
Now, I’d like you to notice three things about these charts. One is that the HLE gap between men and women is much smaller – indeed, in the very poorest areas, healthy life expectancy is slightly lower for women than for men. The average gap in life expectancy for all ten deciles is 3.8 years, but for healthy life expectancy this gap is about 7 months.
I’d also like to point out that deprivation is related to a much bigger difference in LE and HLE than sex. Compared to the average gap of 3.8 years between women and men, the life expectancy gap between the top and bottom decile is 9.1 years for men and 6.8 years for women. Compared to an average female – male gap of 0.6 years for healthy life expectancy, the gap between the top and bottom deciles is 18.2 years for men and 19.3 years for women. Life expectancy has been growing at about three months every year for men and a bit less for women, which makes the most deprived areas more than 30 years behind the least deprived.
This inequality is more pronounced at the bottom end of the scale than the top:
|Gap between||Healthy life expectancy||Life expectancy||Healthy life expectancy||Life expectancy|
|Top & 5th||3.7||7.2||2.8||6.8|
|Bottom & 5th||5.4||11.1||4.1||12.5|
The third is that the gradient from most to least deprived is much more pronounced for healthy life expectancy: how deprived the area you live in is makes much more difference to healthy life expectancy than to life expectancy. Not only is there a gradient in how long people live, but also in the proportion of their lives spent in good health:
Or, to put it another way, here’s the gap (in years) between life expectancy and healthy life expectancy for women and men in each of the deprivation deciles:
For locations in the bottom four deciles, the gap between healthy life expectancy and life expectancy is 23.3 years for women and 19.3 years for men; for locations in the 5th to 7th deciles the gap is 17.6 and 14.9 years and for the top 3 deciles 15.3 and 12.9 years.
Deprivation is linked to health and this issue is even more pressing for women than for men. This means that services (and, to some extent, benefits) for people who are in poor health are more significant for deprived areas – and that the horrific cuts affect more deprived areas most.
There’s also an issue about how politicians and the media think about people who aren’t in good health. Most of us assume that the places we live and work and the people we see every day are typical. In the less deprived areas, people not in good health will be a smaller proportion of the people you normally meet; even the older people you meet will be more likely to be in good health. Most politicians and journalists don’t live in deprived parts of the country, so they may well imagine that good health is more common than is in fact the case. And that will mean that they underestimate the damage caused by cuts in benefits and services for people in poor health.
Just a few days ago the New Policy Institute published excellent research showing that official statistics are likely to be undercounting the number of disabled people in poverty by one million. Not being in good health is not the same thing as disability (which is a social phenomenon, not a medical one) but the two are obviously linked. If we have misleading statistics combined with a perceptual bias, it is possible that we may have a part of the explanation for the indifference to the harm being done by the cuts.
(*) These figures are for areas in England in 2010-12, allocated to ‘deprivation deciles’ using the English Index of Multiple Deprivation.
(**) Healthy Life Expectancy is the number of remaining years that a resident of one of the areas in that decile can expect to live in very good or good general health. These figures are for life expectancy and healthy life expectancy at birth.