The short answer is ‘yes’. The longer answer, inevitability, is: ‘it’s a bit more complicated than that…’
Just over a month ago, the ONS published the latest Health Index data for England covering the period from 2015 to 2021. The Health Index is one single figure that aims to estimate – and put a value on – the overall state of health in England (because healthcare is a devolved issue and data is collected differently in the devolved nations, it does not cover Scotland, Wales or Northern Ireland). It has been described as a ‘GDP for health’, but, for those of us who are data nerds, it is more like an ‘IMD (Index of Multiple Deprivation) for health’.
Health Index domains
The figure is calculated by pulling 56 health-related metrics from across government that are grouped into three different domains:
- Healthy People – relating to health outcomes
- Healthy Lives – relating to uptake rate of healthy (and unhealthy) behaviours
- Healthy Places – relating to wider environmental determinants of health
These are then subdivided into a series of subdomains with a series of indicators for each – the relationships between these are shown graphically in the diagram below:
(Note: all the diagrams in this blog are interactive, so feel free to have a play around!)
All the values are indexed to a baseline value of 100, representing the state of England in 2015; a higher number indicates a healthier score. For example, a value of 103 for a metric means that this metric is 3% healthier than the corresponding metric for England in 2015.
Health disparities across regions
With that in mind let’s take a look at the overall state of health in England in the period 2015 to 2021. Below is the overall health index for England across this period, which shows a small increase from 100 to 100.8, with a peak of 100.9 in 2018 and 2019. However, a single value without context isn’t very helpful, so by clicking the arrow you can overlay each of England’s regions onto the diagram.
When you do that, it’s clear that those regions with the best health in 2015 (the South East, South West and East of England) got healthier over the period, whilst those with poorer health in 2015 did not see the same improvement (with the North East and West Midlands each having worse health in 2021 than they did in 2015).
By re-indexing all of the metrics to 2015 (the third graph), it is possible to directly compare how regions have become healthier or unhealthier compared to England as a whole.
Health gains and losses
So, the health of England has increased, albeit marginally, between 2015 and 2021. A sensible question might be to ask, for which indicators has the health of England improved most in that period? By looking at the indicators that make up the Health Index we can see the largest increases in:
- Air pollution (improvement of 16.1%)
- Household overcrowding (improvement of 14%)
- Teenage pregnancy (improvement of 12.6%)
Whilst the three largest decreases are in the following:
- Disability (decrease of 9.6%)
- Feelings of anxiety (decrease of 9%)
- Personal crime (decrease of 6.8%)
Whilst it is tempting to create explanations that blame the decreases in these three on lockdowns and Covid-19, and they did all get worse during 2020, they were all >5% lower than the 2015 baseline in 2019.
When these indicators are grouped into the three larger domains of health, it becomes apparent that nearly all of the increase in health seen across England can be attributed to an increase in the ‘Healthy places’ domain, whilst the ‘Healthy people’ domain shows a slight decrease in health outcomes.
Urban and rural trends
Beyond just the regional data, the Health Index data is broken down into the 331 Upper and Lower tier local authorities of England (excluding the city of London and the Isles of Scilly). If those are mapped geographically, we see a few interesting trends. On the whole, cities are less healthy than rural areas, however there are swathes of rural countryside that are significantly less healthy than the national average, pointing to underlying health inequalities. For example, look at the areas between Scarborough and Newcastle in the North East, around the Wash from North Lincolnshire to West Norfolk, and across East Kent. Whilst a North-South divide does appear to be evident, the healthiest and unhealthiest places in the UK are both in the North, separated by a mere 60 miles (Harrogate and Blackpool, respectively).
Health and deprivation
One area in which there seems to have been no improvement is the relationship between health and deprivation. Deprivation in England is measured by the ‘Index of Multiple Deprivation’ (IMD) and, like the Health Index, is composed of an amalgamation of different variables like income, employment and crime (English indices of deprivation). For our purposes you simply need to know that a higher value indicates higher amounts of deprivation.
As you can see from the graph below, areas that are more deprived are consistently unhealthier, with the health gap between the most and least deprived quintiles increasing slightly between 2015 and 2021. Similarly, in the second graph a clear positive relationship is visible between a local authority being more deprived and being unhealthier. This health gap is clear across all three domains of health, suggesting no quick solution and underlining the scale of the challenge to achieve health equity across the country. Regardless of the cause we seem to be a long way from the Levelling Up White Paper’s aim of “people in places that were once struggling would … [live] longer, healthier and happier lives”.
Piecing it all together
So what can we conclude from all this? Well first, as mentioned at the start of this article, yes, England got slightly healthier between 2015 and 2021, with particular improvements in the areas of air pollution, household overcrowding and teenage pregnancy. But this improvement in health is not distributed equally across England, with some areas and local authorities less healthy than they were in 2015, and a clear relationship between how deprived an area is and how healthy it is. The establishment of the Office for Health Improvement and Disparities in October 2021 with its explicit aim to reduce health disparities, suggests focus on this issue, but it faces an uphill task.
As one final point, at the end of this article I’ve created a couple of interactive tools that you can use to explore the geographic and numerical distribution of the various domains, subdomains and indicators that make up the Health Index. If you’d like to explore the data further, all the health index data can be accessed here, including full explanations of the methodology used to generate the index, and the IMD data can be accessed here.
If you’d like to get in touch to discuss this blog and the data sources within it, please contact me at mtimms@sqw.co.uk.
If you’d like to get in touch and talk to us about our wider health-related work, please contact Lauren Roberts (lroberts@sqw.co.uk).