Key Health Data for the West Midlands 2001
Chapter 12: Inequalities, Focusing on the early years
List
of Tables
List
of Figures
Main Body
8: Perinatal Mortality
9: Crime
10: Sports Facilities
11: Housing Quality
12: Inequalities, Focusing on the early years
12.1 Introduction
Addressing the issues of poverty and inequity of access to services remain priorities for the Government, however, measuring what is meant by inequality is complicated by the range of actors involved. It has been noted these include education, employment, housing, crime, transport, as well as health services. Some of these have already been described in other chapters, in particular crime (Chapter 9) and housing (Chapter 11). This chapter looks to illustrate some of the information available on other actors, in particular education, early years and employment.
The Government have set two National Health Inequalities Targets:
- Starting with children under one year, by 2010 to reduce by at least 10 per cent the gap in mortality between manual groups and the population as a whole.
- Starting with HAs, by 2010 to reduce by
at least 10% the gap between the quintile of areas with the lowest life
expectancy at birth and the population as a whole.
The chapter starts by presenting the variation in life expectancy for Men and Women across the West Midlands, which is the second of the National Inequality targets set by the Government. The Chapter then goes on to look at some of the underlying drivers that are believed to influence peoples' longevity. In particular it looks at the variation in educational attainment across the region measured by Key Stage 2 results and successful applications to University. In regard to the important early years of development the chapter reports on one government initiative Sure Start and the issue of teenage pregnancy. These indicators can be seen as the drivers to providing a secure foundation for later development and enhancing the opportunities available to children.
In previous Key Health Data we have reported on the use of social security data to monitor inequalities as they provide annual updates on relative inequalities at ward level. Therefore they can provide a more relevant indicator of improvement or decline than deprivation indices produced from the decennial census, such as the Townsend score. In this year's report, we have included statistics on Family Credit as it fits into the direction of this chapter, which is looking at education and the early years.
The Chapter finishes with two small area maps showing the geographical variation in childhood deprivation and education as described by the Indices of Local Deprivation.
12.2. Life Expectancy
Table 12.1 shows the variation across the West Midlands in Life Expectancy. The range in life expectancy is from 72.44 years in the Heart of Birmingham to 79.52 years in Solihull for Males. For females the range is from 78.52 years in Rowley Regis & Tipton to 84.33 years in Solihull.
These figures were calculated the West Midlands
Public Health Observatory for this year's report.
| Table 12.1. Life Expectancy in years, by PCT | |
12.3. Sure Start
Sure Start is a cornerstone of the Government's drive to tackle child poverty and social exclusion. The aim of Sure Start is to work with parents-to-be, parents and children to promote the physical, intellectual and social development of babies and young children - particularly those who are disadvantaged - so that they can flourish at home and when they get to school, and thereby break the cycle of disadvantage for the current generation of young children. It is planned to do this by:
- setting up local Sure Start programmes to improve services for families
with children under four
- spreading good practice learned from local programmes to everyone involved in providing services for young children.
By 2004, there will be at least 500 Sure Start local programmes across England. They will be concentrated in neighbourhoods where a high proportion of children are living in poverty and where Sure Start will attempt to help them to succeed by pioneering new ways of working to improve services.
Within Sure Start there are a number of objectives of which Objective 2 relates to improving health, in particular, by supporting parents in caring for their children to promote healthy development before and after birth.
Targets
The government has set a number of delivery targets of which the following relate directly to health these are:
- Parenting support and information to be available for all parents in Sure Start areas.
- All local programmes to give guidance on breast feeding, hygiene and safety.
- A 10 per cent reduction in children in
the Sure Start area aged 0-3 admitted to hospital as an emergency with
gastro-enteritis, a respiratory infection or a severe injury.
Table 12.2 lists the Sure Start schemes across the West Midlands, for more details of local programmes visit the sure start web pages (www.surestart.gov.uk).
In the subsequent analyses, the statistics
for hospital admissions for the three conditions (gastro-enteritis, a
respiratory infection or a severe injury - length of stay longer than
2 days) have been calculated for the resident PCT populations from HES
for the year 1999/2000, as a guide to the task ahead. Table
12.2 lists the statistics by StHA and Tables 12.3
to 12.6
by PCT.
12.4. Teenage pregnancy
The Issues:
- Across England, there are nearly 90,000
conceptions a year to teenagers; around 7,700 to girls under 16 and
2,200 to girls aged 14 or under. Roughly three-fifths of conceptions
- 56,000 - result in live births.
- It is far worse in the poorest areas and
among the most vulnerable young people, including those in care and
those who have been excluded from school.
- Teenagers who do not use contraception
have a 90 per cent chance of conceiving in one year and those who do
not use condoms are also exposed to a range of sexually transmitted
infections (STIs). In a single act of unprotected sex with an infected
partner, teenage women have a 1 per cent chance of acquiring HIV, a
30 per cent risk of getting genital herpes and a 50 per cent chance
of contracting gonorrhoea.
- Of those who do get pregnant, half of
under 16s and more than a third of 16 and 17 year olds opt for abortion
- that means just over 15,000 under 18s a year having an abortion.
- Teenage parents are more likely than their
peers to live in poverty and unemployment and be trapped in it through
lack of education, child care and encouragement.
- The death rate for the babies of teenage
mothers is 60 per cent higher than for babies of older mothers and they
are more likely to have low birth weights, have childhood accidents
and be admitted to hospital. In the longer term, their daughters have
a higher chance of becoming teenage mothers themselves.
Data presented here (see Table 12.7 and Figure 12.1) are from ONS, and represent the most readily available data on this issue. Currently no data is available by PCT nor StHA.
| Table 12.7. Under 18 conceptions, numbers and rates by top-tier local authorities and outcome, 2000 | |
| Table 12.8. Under 18 conceptions, numbers and rates by health authorities and outcome, 2000 | |
12.5. Claimant data - Family Credit
In previous KHD, we have reported on Income support, Disability Attendance
Allowance (KHD 2000). In this years report we report on the variations
in Family Credit claims across the West Midlands, as it has a specific
child related qualifying constituent. Unfortunately there is no routine
way to define the population denominator by which comparative rates can
be calculated; therefore we report the raw counts and the relative proportions
by age, sex and the number of dependents. More and more such data is being
regarded as a useful contemporary measure of deprivation, and therefore
for monitoring the success of interventions in 'realtime' rather than
at 10 yearly intervals as provided by the Census.
Family Credit is a weekly tax-free Social Security benefit for working people who are responsible for bringing up at least one child under the age of 16 (or under 19 in full-time education). The claimant or their partner must be working for 16 hours or more a week. The amount of Family Credit that a working family can get depends on the number and ages of the children; net earnings and other income.
The ward level data has been aggregated to PCT group to provide a relative comparison of one measure of income based deprivation. Table 12.9 presents the data in terms of number of claimants and Table 12.10 as the proportion of the population in specific demographic groups.
| Table 12.9. Family Credit claimant counts by PCT, by age, sex and dependants | |
| Table 12.10. Proportion of Family Credit claimants by PCT, by age, sex and dependants | |
12.6. Educational attainment
Educational attainment in this report is illustrated using two measures Key Stage 2, which reflects the success of early years education and University applications which the Government see as vital in improving peoples' longer term wealth.
Key Stages
Under the Education Reform Act (1988) a National Curriculum has been progressively introduced into primary and secondary schools. For all subjects measurable targets have been defined for four key stages, corresponding to ages 7, 11, 14 and 16. Pupils are assessed formally by their teachers and by national tests in the core subjects of English, and mathematics.
Key Stage 2 tests are taken in the top year of primary school (age 11).
Results are grouped into three categories:
- Below level 4 - the target level ('low KS2'),
- At Level 4 ('mid KS2')
- And above level 4 ('high KS2').
| Table 12.11. Proportions of students achieving certain Key Stage 2 Levels | |
University admissions
The data shown is for successful applicants to a UK University. The range was in 1998 from 76.5 per 1,000 people aged 18-19 to 200.1 in South Warwickshire.
| Table 12.12. Successful university applicants, Rate per 1,000 people aged 18 or 19, 1998 | |
12.7. Geographical Variations in Inequalities
Indices of Local Deprivation
The Department of Environment, Transport and the Regions (DETR) commissioned the Indices of Local Deprivation to provide local authorities and others with essential information about their areas and the nationwide picture. They are composed of a number of domains of which two have direct relevance to the content of this chapter, Education, Skills and Training and a subset of the income domain, childhood deprivation. For further information on the Indices of Deprivation visit the DLTR's regeneration website: http://www.regeneration.dtlr.gov.uk/research/id2000/index.htm.
The Child Poverty Index
This Child Poverty Index is a sub-set of
the Income Domain. The Income Domain includes people of all ages, whereas
the Child Poverty Index is for 0-16 year olds only and is constructed
from the following measures:
- Children in Income Support households (DSS) for 1998
- Children in Income Based Job Seekers Allowance households (DSS) for 1998
- Children in Family Credit households (DSS) for 1999
- Children in Disability Working Allowance households (DSS) for 1999
Figure 12.2. shows this measure at ward level. The range is from 1.87 to 79.79 (average 26.15) across the region, the national range is 0.54 to 88.71 (average is 26.47).
Education, Skills and Training
This domain measures education deprivation
in as direct a way as possible. This is measured by the lack of qualifications
amongst adults and children of different ages in a local area. Indicators
of children aged 16 and over who are not in full time education and the
proportion of 17 year olds who have not successfully applied for higher
education have also been included. Both of these participation measures
are important aspects of area deprivation. The domain is composed of:
- Working age adults with no qualifications for 1995-1998
- Children aged 16 and over who are not in full-time education (Child Benefit data - DSS) for 1999
- Proportions of 17-19 year old population who have not successfully applied for HE (UCAS data) for 1997 and 1998
- KS2 primary school performance data for 1998
- Primary school children with English as an additional language (DfEE) for 1998
- Absenteeism at primary level (all absences, not just unauthorised) (DfEE) for 1998
Figure 12.2 shows this measure at ward level. The range is from -2.4 to 2.63 (average 0.11) across the region, the national range is -2.86 to 3.08 (average is 0.0).
|
Figure 12.1. Childhood Deprivation, Index of Deprivation 2000 |
|
Figure 12.2. Education Deprivation, Index of Deprivation 2000 |
| Table 12.13. Key to figures 12.1 and 12.2 | |
[ Chapter 11 | Top | Chapter 12 ]
For more information please
contact Carol Richards on
0121 414 3368
© Department of Public Health
and Epidemiology, University of Birmingham