Education and Health

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Education and Health

• Dr Julia Verne
• Director
• South West Public Health Observatory
• j.verne_at_swpho.org.uk

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The role of education

• Education is vital to health. People with low
  levels of educational achievement are more likely
  to have poor health as adultsBy improving
  education for all we will tackle one of the main
  causes of inequality in health
• (Department of Health 1999, Saving Lives Our
  Healthier Nation)

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Key issues

• What is Health
• Educational achievement and deprivation/social
  exclusion
• Deprivation/social exclusion and disease
• Mortality
• Morbidity
• Risk factors
• Education and increased health risk
• Access to Health Services

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What is health?

• WHO defines health as
• a state of complete physical, mental and social
  wellbeing, and not merely the absence of disease
  or infirmity

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Fields of Positive Health (Well-being)

• Feeling vital, full of energy
• Having good social relationships
• Experiencing a sense of control over ones life
  and ones living conditions
• Being able to do things one enjoys
• Having a sense of purpose in life
• Experiencing a connectedness to community

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Inequalities in morbidity

• 17 of social class 1 men aged 45 - 64 report
  limiting longstanding illness
• 48 of social class 5 men aged 45-64 report
  limiting longstanding illness

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The Importance of employment
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• Work related mortality and morbidity is a
  significant contributory factor to socioeconomic
  differences in risk of morbidity and mortality
  particularly in relation to accidents,
  dermatitis, certain lung diseases, and
  musculoskeletal diseases

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Construction industry

• 7 of UK workforce
• 30 of reported accidents
• 14,000 p.a injured on construction sites
• But 44 non-fatal accidents reported
• 100 deaths p.a
• ½ prosecutions by HSE

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• occupational exposure responsible for 1/3 cancer
  incidence difference between high and low social
  classes
• responsible for 1/2 difference in lung and
  bladder cancer incidence

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Socio-economic inequalities in cancer survival

• Patients from affluent neighbourhoods do better
  even after adjustment for stage at presentation
• Overall survival is estimated to be 11-13 worse
  in the lowest deprived compared to the most
  affluent
• Non of 47 different types of cancer showed a
  survival advantage for patients in the most
  deprived group (Cancer Survival Trends, ONS)
• For 20 of the 47 cancer types the gap in survival
  was significantly lower both at five years and
  one year.
• More than 5000 deaths per year could be prevented
  if social class inequalities were prevented.

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Percentage of adults aged 16 and over who smoke,
by socio-economic group and gender, England, 1998
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Prevalence of obesity in men and women from each
of the six social classes measured by the Health
Survey for England 1998
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Weekly intake of fruit and vegetables by income
(National Food Survey Trends 2000)
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Spending on food rich and poor

• The poorest 10 of households spend the highest
  proportion of their income on food 21 of income
  versus 14 for the richest 10 of households
• A couple on income support with two children
  receive less than 163 per week but would need to
  spend 61 of that on food to satisfy basic
  government healthy eating guidelines
• The poorest households spend around 25.50 a week
  on food, compared with 106 for the richest

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Poverty and nutrition

• Working households eat 85 more vegetables than
  workless households
• One third of unemployed men ate fruit 5-6 days
  per week compared with half of employed men
• In 1997 a survey found that 1in 20 mothers
  sometimes went without food to meet the needs of
  their children
• Lone mothers on income support were 14 times more
  likely to go without than mothers in two parent
  families not on benefit

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Access and availability

• In deprived neighbourhoods only 14 of households
  have access to a car
• gt1/4 have long term illness restricting mobility
• young children
• crime, rising rents competition forcing closure
  of small local stores
• healthy foods cost around 24 more in small
  stores than supermarkets

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Why are there inequalities in Cancer?

• Knowledge risk factors, signs and symptoms
• Attitudes - the locus of control
• Behaviour risk factors, acceptability of
  screening
• Access - the inverse care law
• Variations in treatment

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Infant mortality rates by deprivation
1991-1997Source ONS
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Age-standardised mortality rates for suicide and
undetermined injury by deprivation, country and
region, ages 15-64 Great Britain
1991-1993Source ONS
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Alcohol misuse and social exclusion

• 50 rough sleepers alcohol reliant
• gt50 male prisoners and gt33 female
• Of those attending alcohol services
• 36 unemployed
• 18 homeless/temporary accomodation