People Experiencing Deprivation

Data Source: Segment Tool (phe.gov.uk)

Babies born in the most deprived areas are at an 80% higher risk of stillbirth and neonatal death compared to those living in the least deprived areas.

Women living in these areas are almost three times more likely to die themselves. As the level of deprivation increases, the risk of dying in pregnancy, birth or the year after birth increases.

Data shows there is an almost two-fold difference in mortality rates between women from Asian ethnic groups and white women, and they are also higher for black women. Black women are 40% more likely to experience a miscarriage than white women, and women living in deprived areas can have higher rates of stillbirths.

In 2017 The Nuffield Trust found children and young people with asthma, diabetes and epilepsy from the most deprived areas are consistently more likely to go to A&E and to need emergency hospital treatment than those from the least deprived areas. Emergency admission rates in the most deprived areas was:

• Asthma: double the rate of the least deprived among school-aged children (2005/6)
• Diabetes (all types): twice as likely among 20–24-year-olds (2015/16).
• Epilepsy: improving, with the most progress in reducing unplanned admissions for the most deprived groups.

Suggested causal factors included:

• The effect of wider social determinants of health and deprivation: housing, pollution, smoking, nutrition, educational attainment, and health literacy.
• Less timely recognition of illness and inadequate community management of illness: quality and accessibility of services; children and families’ ability to self-care and seek appropriate support.
• Deprived populations are less likely to access primary care: lower level of GP registration (particularly during adolescence), greater difficulty in getting a GP appointment, and poorer perception of the quality of primary care.

Recommendations included:

• Short term – health policies that engage and focus on families living in deprivation.

Long term – reducing economic and material deprivation and improving the social determinants of health

‘Poverty also expends emotional resources, and affects people’s ability to comprehend the future. Viewed through this lens, it’s possible to see how unhealthy behaviours such as smoking are used as quick fixes in stressful circumstances’ 

The Health Foundation

 

Deprivation

• Higher proportion of physical inactivity
• it can be three times more expensive to get the energy we need from healthy foods than unhealthy foods.
• Higher rates of unhealthy weight in adults where deprivation higher
• There is a strong association between deprivation and obesity in children.
• Smoking strongly linked to deprivation – rates vary 11.6% in Mid Suffolk to 16.8% Ipswich and 16.1% Tendring
• people living in the most deprived areas were more likely to be admitted to hospital for an alcohol related condition than those in the least deprived areas.

Employment

Shift workers are generally more at risk of being affected by sleep deprivation. Workers who saw more light between 8 am and 12 pm slept for, on average, 20 minutes longer and took around 27 minutes less to fall asleep than those who weren’t exposed to a significant amount of light.

The TUC estimate that 9% of employees in the East of England worked nights in 2021

Smoking rates are higher in routine and Manual workers – 15% in R&M workers in Tendring

• Participants living in the most deprived areas of the country were more likely (13.5%) to report not being able to afford to pay the charge than participants living in the least deprived areas (3.4%)
• Research by the Oral Health Foundation showed more than one-in-three (36%) UK adults admit that they are sacrificing dental visits in order to keep their bank balance in check.
• Just under two-in-three (59%) 18-24-year-olds freely admit to their financial inability to look after their mouth, teeth and gums.

• Band 2 treatments – Participants living in the most deprived areas of the country were more likely (13.5%) to report not being able to afford to pay the charge than participants living in the least deprived areas (3.4%) – This rises significantly for Band 3 treatment

A survey of secondary teachers by grassroots hygiene poverty charity Beauty Banks in partnership with the British Dental Association (BDA) showed the following results:

• 83% say they or their school have given students toothbrushes and toothpaste.
• 81% said there are children in their school who don’t have regular access to toothpaste.
• 40% said this leads to students being socially excluded by their peers because of oral hygiene issues. Half report children isolating themselves. One third have witnessed bullying directly.
• 25% say children miss school because of poor oral hygiene.
• 74% said children who don’t have regular access to oral health products have discoloured teeth. Half said children had noticeable tooth decay.
• 30% noted children in dental pain or suffering from halitosis.
• 31% of teachers who witness poverty in the classroom report said it effected their mental health. 1 in 4 are kept awake at night worrying about their students’ wellbeing.
• 38% report feeling helpless.

Prevalence of obesity varies by region and with gender, age, household income (in women but not men), education and socio-economic background, and ethnicity.

Deprivation: in the most deprived areas in England, prevalence of excess weight is 13 percentage points higher than the least deprived areas

Education and socio-economic background affect the prevalence of obesity. Reciprocally, obesity contributes to reinforcing existing social inequalities – Compared with non-obese people, obese people have poorer job prospects, are less likely to be employed, have more difficulty re-entering the labour market. They also earn about 10% less than their non-obese colleagues

Among people with no qualifications, rates of excess weight are 12 percentage points higher than among people with level 4 qualifications or higher (i.e. a degree)

Sir Michael Marmot highlighted in his Fair Society Healthy Lives report:

People in lower socioeconomic groups not only have shorter lives but they also spend more of their later years with a disability.

• People living in financial hardship are at increased risk of mental health problems and lower mental wellbeing
• More deprived areas have a higher prevalence of SMI
• Around 40% of people in England who face multiple disadvantage – problems including homelessness, substance misuse and contact with the criminal justice system in any given year also have a mental health problem

Poorer people make more use of NHS services – especially emergency services

People from the most deprived areas tend to have more health problems, making them more likely to require admission to hospital

People living in the most deprived fifth of neighbourhoods in England have nearly two and a half times as many preventable emergency hospitalisations as people living in the least deprived fifth

Nuffield Trust compared indicators measuring the quality of NHS care for the 10% of people living in the most deprived areas and the 10% of people living in the least deprived areas of England to see how the results differ

– 4th from top inequality on list of inequality scores (after avoidable mortality and smoking) is the rate of admissions for ambulatory care-sensitive conditions. The gap between the most and least deprived hasn’t changed in over 10 years

As our population ages, there will be increased need for informal care, but there also a need for older people to stay in the workforce longer – Workers aged in their 50s and early 60s are more likely than any other age group to be juggling caring responsibilities and working. In 2016 to 2017, 65% of men and 60% of women aged 52 to 64 years who were carers were also in work

• Older people may also be particularly vulnerable: cold temperatures increase the risk of strokes and circulatory problems, lung problems, and hospital admissions.
• Cold temperatures lower strength and stability leading to an increase in the likelihood of falls and accidental injuries

Recent research by Asthma + Lung UK found:

• 90% of people with lung conditions have already made significant changes to their lives.
• Two thirds are buying and eating less food, which can lower people’s immunity, putting them at increased risk of viruses that trigger asthma attacks.
• One in 6 are cutting back on using their inhaler to make it last longer, one in 10 are using electrical devices such as nebulisers, less.
• Half say their lung condition is worse because of changes they’ve made.

A survey by the MS Society, Reduced to Breaking Point, found:

• 1 in 20 have used a food bank in the past year.
• Almost two-in-five people with MS who claim means-tested benefits surveyed can’t afford heating.
• Around 3 in 10 people with MS surveyed have had to reduce reducing or stop therapies or treatments.

Hospice care was reported by the National Survey of Bereaved People to provide the highest levels of quality of care. However, recently published research into inequalities in accessing hospice care in the UK and other countries highlighted a range of inequalities of access:

Certain groups are under-represented in accessing hospice care. These include:

• Those living in rural areas – exacerbated by costs and time travelling
• People living in deprivation – in particular if they lack health literacy and knowledge of services

Non-cancer conditions e.g., chronic chest and heart disease, dementia, frailty, cystic fibrosis, liver disease, and learning disabilities:

• Prolonged needs and difficulties in determining when in the terminal stage leads to late or no hospice referral.
• The needs of the growing numbers with multimorbidity and frailty presents a major challenge.

Non-hospice care can be a choice, rather than an inequality:

• Where care needs are better met by other services e.g., care homes.
• For those with longstanding trusting relationships with their GP and Community Nursing Team.
• Ethnic minority people with cultural and religious needs at the end of life may prefer their community’s care.
• However, those with concerns over social prejudice may have less access to hospice care, or specific care needs.

The research concluded that these inequalities are the responsibility of the whole health and social care sector and need a collaborative and innovative whole-systems approach.

Food insecurity is defined as being unable to reliably access sufficient, affordable and nutritious food. One in four households with children experienced ‘food insecurity’ in September 2022 – a 9.6 percentage point increase from January 2021 to that year.  Food price inflation reached 16.8% by January 2023, making it one of the largest drivers of inflation. The NHS Confederation has highlighted that, given the scale of increases in the cost of healthy food choices, and that if those circumstances were to continue we will see devastating and long-lasting impacts on people’s health and wellbeing.

Unhealthy diets increase the risk of chronic illnesses such as diabetes, cardiovascular disease, certain cancers and the likelihood of obesity.
Going hungry, even just a few times, is linked to decreased immunity and poorer mental and physical health, and can cause malnutrition, heart disease and fatigue.
Almost half of participants in a survey from The Money and Mental Health Policy Institute had reduced the number of meals they ate in a day and cut spending on essentials like food. Since that survey food price inflation continued to increase by 4 per cent. Survey respondents with recent experience of mental health problems also reported feelings of anxiety, depression and hopelessness as a result of the rising cost of living.
Over 40 per cent of households in receipt of Universal Credit are food insecure and over 60 per cent of people who referred to food banks in August 2022 had a disability or long-term health condition, which is around three times the rate of the general population.
It is estimated that malnutrition costs the NHS £19.6 billion a year.

NHS Confederation parliamentary briefing for Westminster Hall debate on tackling poverty and the cost of food – 01.03.2023.pdf

THE TOOTH HURTS – FEB 2023 (dentistry.co.uk)