Where are our health inequalities?

Health inequality exists across Devon, for different groups of people and for different reasons.  At its simplest level, the variation in life expectancy across the county is stark.  Table 5.1 shows the most recent information for the life expectancy gap at ward level.

Table 5.1:  Overall, shortest and longest average life expectancy in years (LE) at birth by ward, Devon local authority districts, 2009 to 2013.

DistrictDistrict LEShortest LELongest LEGap (years)
Ward NameLENameLE
East Devon82.8Exmouth Littleham80.0Newton Poppleford and Harpford89.69.6
Exeter81.8Newtown77.4Topsham85.98.5
Mid Devon83.0Cullompton North79.6Upper Culm85.96.3
North Devon81.5Ilfracombe Central74.6Chittlehampton87.713.1
South Hams82.9Totnes Bridgetown79.0Marldon86.77.7
Teignbridge82.1Newton Abbot: College78.8Kerswell-with-Combe86.17.3
Torridge81.8Kenwith79.6Three Moors89.29.6
West Devon82.1Okehampton West79.7Milton Ford86.16.4
Devon82.3Ilfracombe Central74.6Newton Poppleford and Harpford89.615.0

Source: Primary Care Mortality Database 2014 and Office for National Statistics Mid-Year Population Estimates

Health inequality may be most frequently linked to socio-economic deprivation but it affects all sectors of society – because factors such as gender, ethnicity, sexuality and disability all can be associated with health inequality.  These variations are considered in more detail in this chapter of this report.  The Equality Act 2010[] established a legal duty of equality for the people with the following characteristics which are known as “protected characteristics”:

  • age
  • disability
  • gender reassignment
  • marriage and civil partnership
  • pregnancy and maternity
  • race
  • religion or belief
  • sex (gender)
  • sexual orientation

The Act also includes a legal duty, on public sector organisations to which the legislation applies, “when making decisions of a strategic nature about how to exercise its functions, have due regard to the desirability of exercising them in a way that is designed to reduce the inequalities of outcome which result from socio-economic disadvantage”.

Recommendations

R5.1Support reductions in health inequality by efforts to increase the prosperity of Devon, and schemes which increase people’s financial independence.
R5.2The NHS must do more to improve the health of the worst-off in Devon, to meet its statutory responsibility for reducing health inequality.
R5.3Commission a targeted approach to oral health promotion so that those children and young people most at risk of dental decay are helped to improve and maintain their oral health.
R5.4Target screening and disease detection programmes to increase uptake from people who are socio-economically deprived or who may be more susceptible for reasons of ethnicity, sexuality or disability.
R5.5Develop a strategy to target preventive interventions at younger populations who have a greater chance of developing ill-health in later life.
R5.6Enable personalised health and care interventions much earlier to prevent the consequences of multi-morbidity on quality of life and on the use of health and care services.
R5.7Capitalise on the opportunities presented by a universal primary care service to identify and manage pre-frailty.
R5.8Implement the recommendations of the lesbian, gay, bisexual and transgender (LGBT) needs assessment.
R5.9Undertake a detailed needs assessment of children in care, to include their own perspective of health, wellbeing and support needs, including recognition of their vulnerability to sexual exploitation.
R5.10Implement multi-agency approaches to preventing homelessness and supporting those homeless people who have the most complex needs.
R5.11Ensure the prioritisation of public mental health and mental health as a health and wellbeing priority.
R5.12Reduce the number of section 136 detentions by Devon and Cornwall Police by providing better access to emergency mental health services.