2: Inequalities and Deprivation

Contacts

Preface

Contents

List of Tables
List of Figures

Abbreviations

Main Body

1: Boundaries and Populations
2: Inequalities and Deprivation
3: Ethnicity and Health
4: Environmental Hazards
5: Health related behaviour
    of young people
6: Accidents
7: Cancer
8: Teeth and fluoridation
9: Coronary Heart Disease
10: Communicable diseases

Appendices

2.1    Deprivation Indices

Traditionally the Townsend score has been used in health studies. This appeared in the 1998 Key Health Data report (Cummins et al 1998) and is reproduced for comparison. This section is intended to give an indication of how the West Midlands performs when several of the popular deprivation indices are applied. It is not intended to say which one is best. For a discussion about which index to use in a health setting see Mackenzie et al 1998.

Each section includes a brief introduction to the index and then examines its geographical distribution by ward. Indices are often standardised so it is important to know the source of the index and to what geographical area it was standardised to.

2.2    Townsend Score

The Townsend score is a measure of multiple deprivation that is calculated for an area of residence. The score is calculated by combining four 1991 census variables:

• Percentage of households that were not owner occupied
• Percentage of households with no car
• Percentage of households with more than one person per room (overcrowding)
• Percentage of persons who were unemployed

Calculated using West Midlands health area as a population base, the larger the number, the more an area is deprived.

Figure 2.1 Townsend score by ward.

2.3    Index of Local Deprivation (IoLD)

Originally known as "The Index of Local Conditions" (from 1991 data), this is provided by the Department of the Environment, Transport and the regions (DETR).

Re-calculated in 1998, three difference spatial scales are used ; local authority district, ward and enumeration district (Department of the Environment Transport and Regions, 1998). It is designed to be most useful at the LA district level, to enable professionals to look at overall deprivation (the value of the index for a single district) and how pockets of deprivation might be distributed at sub-district level (the values for the wards that make up that district). The results at ward level only are reported here.

Some non-census variables available from local government social services databases were used to calculate the index for LA districts, making comparisons between 1991 and 1998 more interesting and valid. It shows how reliance on the decennial census is waning as social service databases become sophisticated enough to be analysed nationally at suitable spatial scales. Non-census variables were unavailable for areas as small as wards but work is underway to enable such data to be collected. As the health service begins to work more closely with local and regional government these timely social indicators should become more useful. Census variables used in the 1998 index were:

• Unemployment
• Children in low earning households
• Households with no car
• Households lacking basic amenities
• Overcrowding
• 17 year olds no longer in full time education

The individual variables are standardised, transformed and summed. Only positive constituent variables are summed to give an overall index score. The 1998 score is used in this document.

 A West Midlands Low Pay unit document gives a comprehensive description of the 1991 Index of Local Deprivation in the West Midlands (West Midlands Low Pay Unit, 1997).

Figure 2.2 Index of Local Deprivation by ward.

2.4    Underprivileged Area Score

Often referred to as the "Jarman score", the underprivileged area score (UPA) is an area-based measure of additional workload or pressure on the services of GPs (Jarman, 1983; Jarman, 1984). GPs UK wide were surveyed and asked to give weighting to variables depending on how important they figured in their workload. These census variables were normalised, standardised and weighted and then summed to give a score for a geographical area.

The variables and their weighting can be seen in table 2.1.

Table 2.1 Variables and weightings

An average is by definition zero because of the standardisation. Ward UPA scores range from about minus 50 to about plus 70. The 5% of wards with scores of 30 or above have been defined by the Government as being 'deprived areas' (Jarman, 1983; Jarman, 1984) and patients from these areas registered with a GP attract a deprivation payment. These are calculated using England and Wales as a population base.

Figure 2.3 Underprivileged Areas scores by ward

2.5    Carstairs Index

Developed for the Scottish health experience, this is very similar to the Townsend score but replaces the non-owner occupation variable with one concerning social class (Carstairs and Morris R, 1989; Carstairs and Morris R, 1991). The higher the number the more deprived an area is. It is calculated using England and Wales as a population base.

• Unemployment
• Overcrowding
• Non car ownership
• Social class

Figure 2.4 Carstairs index by ward

2.6    Rural Deprivation

For several decades, residents in this region have aspired to live outside the metropolitan area, creating pressures for growth in the more rural areas. This dispersal is encouraged by the increase in car ownership and usage. Net outward migration from the metropolitan area is still running at twice the level assumed in Regional Planning Guidance (West Midlands Joint Committee, 1999). While many people who move to the more rural parts of the region are relatively affluent, rural deprivation affecting the indigenous population and particularly affecting poor access is a particular issue in some areas of the region. This may not be adequately reflected in the standard indicators.

Considerable data on rural issues such as bus services and village amenities are available at a parish council level from the county councils and unitary authorities. The West Midlands Regional Forum of Local Authorities has identified 6 key services for rural areas and figure 2.5 shows the percentage of parishes in the Shires lacking these amenities. It can be seen that most parishes do not have a permanent shop, a post office, a school or a daily bus service and a large number do not have a pub, a weekly bus service or a village hall. Staffordshire seems to fare better than the other counties for most indicators but this may be an artefact of parish size. The average population of a parish in Staffordshire is over 2,500 while it is around 500 for Herefordshire and Worcestershire and 800 for Shropshire.

Figure 2.5 Percentage of parishes lacking selected amenities by County 1997

2.7    Government area based initiatives for local deprivation

The Government is responding to deprivation and inequalities with a number of initiatives, the most important of which are Health Action Zones, Education Action Zones, Employment Zones and Single Regeneration Budgets. These may coincide in some areas and there is an expectation that these initiatives will interact and collaborate.

2.7.1    Health Action Zones

Health Action Zones (HAZs) were introduced in April 1998 by the Department of Health and have the key objectives of reducing health inequalities, improving services and securing better value from the total resources valuable. HAZs bring together all those contributing to the health of the local population to develop and implement a locally agreed strategy for improving the health of local people. They involve local authorities, community groups, the voluntary sector and local businesses. HAZ status provides a framework for the NHS, Local Authorities and other partners to work together to achieve progress in addressing the causes of ill health and reducing health inequalities. Building on the success of area based regeneration partnerships HAZs seek to deliver measurable and sustainable improvements in the health of the public and in the outcomes and quality of services through better integrated treatment and care (NHS Executive, 1997).

HAZ status is long term, spanning a period of five to seven years, recognising the need for a strategic approach including addressing social exclusion. Tackling health inequalities is a key element of the latter. A Social Exclusion Unit has been set up in the Cabinet Office to co-ordinate and improve Government action. HAZs include areas of pronounced deprivation and poor health where the reshaping of services is a significant issue. HAZs should implement programmes that deliver improved health in some of the most deprived communities through collaborative working giving better health outcomes, improved services and more efficient use of resources.

To achieve the three broad strategic objectives of the programme it is important that HAZs :

• identify and address the public health needs of the local area;
• increase the effectiveness, efficiency and responsiveness of services;
• develop partnerships for improving people's health and relevant services, adding value through creating synergy between the work of different agencies;
• achieve synergy with other initiatives within the HAZ area such as Single Regeneration Budget schemes or Education Action Zones (NHS Executive, 1997)

There are four HAZs in the region see figure 2.6.

Figure 2.6 Health Action Zones West Midlands 1999

2.7.2    Education Action Zones

Education Action Zones (EAZs) were introduced in September 1998 by the Department of Education and Employment. An EAZ is based on a cluster of about twenty primary, secondary and special schools in a local area and is run by a forum of businesses, parents, schools, the local authority and community organisations. The zones develop ambitious action plans to meet improvement targets for pupils and schools and run for three to five years. These plans can include:

• increasing achievement and opportunities for pupils;
• increasing the number of pupils entering further education;
• improving pupil attendance and reducing exclusions from schools;
• providing a broader programme of out-of-school activities and improving the co-ordination of services to the community;
• reducing youth crime.

EAZs have priority access to many other initiatives such as:

• specialist schools;
• early excellence centres;
• Advanced Skills Teachers;
• literacy summer schools;
• family literacy schemes;
• out of schools hours learning activities;
• work-related learning;
• information and communications technology.

EAZs also receive annual grants (up to £500k p.a.) to cover running costs and for specific locally planned initiatives such as the adaptation of the National Curriculum, attracting outstanding educational leaders as heads of schools in zones through the use of flexible contracts, employing extra teachers and providing new incentives to attract outstanding teachers.

Twenty five zones have been approved including three in the region: two in Birmingham, (Aston and Nechells) and one in Herefordshire (South of the city and the large rural area towards the Black Mountains).

Forty-one bids were approved by the Secretary of State for the next draft of EAZs, including Coventry, Dudley, Sandwell, Stoke on Trent, Telford & Wrekin, Wolverhampton and Shropshire.

Web Site: http://www.dfee.gov.uk/edaction/intro.htm

 2.7.3    Employment Zones

Employment Zones (EZs) will be launched by the Department of Education and Employment in April 2000, and are designed to address the significant numbers of people out of work for considerable periods. Such long-term unemployment is concentrated in relatively few areas and the Government believes that co-ordinating and focusing existing resources on these locations can make a major impact. EZs pool funds for training, employment service support and benefit and aim to use these flexibly to help people get and retain work. The zones concentrate on people twenty-five years and over claiming Jobseeker's Allowance for at least twelve months in six areas including Birmingham and for those claiming for at least eighteen months in another eight areas. Each individual agrees an action plan with their own personal adviser and has access to a personal job account which can be drawn upon by participants and their advisers e.g. to pay for a particular training course or buy a suit for interview.

The zones will run for two years.

Web Site: http://www.dfee.gov.uk/ez/index.htm

2.7.4    Single Regeneration Budget (SRB)

The Single Regeneration Budget (SRB) brought together a number of programmes from several Government Departments with the aim of simplifying and streamlining the assistance available for regeneration. It provides resources to support regeneration initiatives in England carried out by local regeneration partnerships, which are expected to involve a diverse range of organisations. They should harness the talent, resources and experience of local business people, the voluntary sector and the local community.

The SRB is administered at regional level by the Regional Development Agencies. The priority is to enhance the quality of life of local people in areas of need by reducing the gap between deprived and other areas, and between different groups. It is intended to support initiatives that build on best practice and represent good value for money. The types of bid supported differ from place to place according to local circumstances but they will all include some or all of the objectives set out below:

• enhance the employment prospects, education and skills of local people;
• address social exclusion and enhance opportunities for the disadvantaged;
• promote sustainable regeneration, improving and protecting the environment and infrastructure, including housing;
• support and promote growth in local economies and businesses;
• tackle crime and drug abuse and improve community safely.

There have been five annual bidding rounds for SRB resources. On 15 July 1999, the Deputy Prime Minister announced details of successful bids under SRB Round 5. 163 schemes were approved worth over £1 billion nationally in SRB support over their lifetime of up to seven years. This is intended to also attract over £2.4 billion in other public and private investment. This is in addition to over 600 schemes under Rounds 1- 4 which already stand to receive over £3.4 billion of SRB money over their lifetime of up to seven years. The West Midlands had eleven projects approved for 1998/99 with a total value of £3.8m and has eighteen projects approved for 1999/2000 with a total value of £3.6m (See tables 2.1 and 2.2). The total value of the SRB projects funded in the region to date is over £87m. Tables 2.2 and 2.3 give brief descriptions of the projects with more detail provided in Appendices 1 and 2

Web site : http://www.regeneration.detr.gov.uk/srb/index.htm

Table 2.2 Single Regeneration Budget Projects West Midlands 1998/99

Table 2.3 Successful SRB Bids West Midlands 1999/2000

Fig 2.7 Value of SRB funding by Health Authority 1999/2000 (£000)

REFERENCES

Carstairs, V. and Morris R (1989) Deprivation,mortality and resource allocation. Community Medicine 11, 364-372.

Carstairs, V. and Morris R (1991) Deprivation and Health in Scotland, Aberdeen University Press.

Cummins, C., Kirk, A., Saunders, P., Stevens, A. and Wilson, R. (1998) Key health data for the West Midlands 1998. DPHE 3, University of Birmingham: Department of Public Health and Epidemiology.

Department of Health (1999) Reducing health inequalities: an action report. London: Department of Health.

Department of the Environment Transport and Regions (1998) The 1998 Index of Local Deprivation:patterns of deprivation and 1991-6 change.Regeneration research Summary no 21.

Jarman, B. (1983) Identification of underprivileged areas. British Medical Journal 1705- 1709.

Jarman, B. (1984) Underprivileged areas:validation and distribution of scores. British Medical Journal 1587-1592.

Mackenzie IF, et al (1998) 'My ward is more deprived than yours'. Journal of Public Health Medicine 20,

NHS Executive (1997) EL(97)65 Health Action Zones-Invitation to Bid. Leeds: Department of Health.

West Midlands Joint Committee (1999) Provisional West Midlands Local Transport Plan. pp.3-4.

West Midlands Low Pay Unit (1997) Measuring Deprivation in the West Midlands Region.

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