4' Health Inequalities

1
4. Health Inequalities

• Royal College of Physicians of London
• Tobacco Advisory Group

2
Major cause of health inequalities

• Premature mortality
• Smoking accounts for more than half of the
  difference in risk of premature death between the
  social classes
• Smoking during pregnancy
• Social class V three times social class I
• Passive smoking at home
• 18 of children in social class I exposed
• 54 of children in social class V

3
Smoking and inequality in the UK
Smoking prevalence by class sex 1998.
60
Women
Men
50
40
Percent prevalence
30
20
10
0
I
II
III
III
IV
V
All
SOCIAL CLASS
General Household Survey 1998
4
Smoking and inequality in the UK
UK smoking prevalence by deprivation
80
70
60
50
1973
prevalence
40
1998
30
20
10
0
0
1
2
3
4
5
Least deprived
Most deprived
DEPRIVATION SCORE
General Household Survey 1998
5
Lung cancer deaths by social class
SMRs for lung cancer deaths in Men 24 64
England Wales
206
200
138
132
SMR (log scale)
100
87
61
50
45
I
II
III NM
III M
IV
V
social class
General Household Survey 1998
6
Quitting and deprivation

• 75 of all smokers want to quit
• People in low income not less motivated to stop
  smoking
• Desire to quit not related to higher stress
  deprivation levels
• More deprived smokers tend to be more heavily
  addicted

7
Motivation to quit by social class in adult
smokers in 1998
100
90
80
70
Want to quit
60
50
40
30
20
10
0
Professional
II
IIINM
IIIM
IV
Unskilled
SOCIAL CLASS
General Household Survey 1998
8
Smoking and inequality in the UK
UK smoking cessation by social class 1998
60
50
40
quit
30
20
10
0
Professional
II
III NM
III M
IV
Unskilled
General Household Survey 1998
9
Nicotine dependency and deprivation
Nicotine dependence by deprivation - saliva
cotinine levels
500
450
400
Saliva cotinine (ng/ml)
350
300
250
0
1
2
3
4
General Household Survey 1998
DEPRIVATION SCORE
10
Summary

• Social Deprivation is associated with
• Greater levels of smoking
• Higher rates of smoking-related disease
• Similar desire to quit as other groups
• Less chance of success in quitting
• Hence smoking is major contributor to
  inequalities in health