The statistics that demonstrate why the long-term plan really needs to tackle health inequalities…

I want to continue exploring the long-term plan and the size of the task facing the NHS if it really wants to tackle inequalities of health outcomes. Today I’m doing this in the light of some statistics to which I was referred last week (“Socioeconomic inequalities in avoidable mortality, England and Wales: 2001 to 2016” published by the Office for National Statistics (ONS) 13 July 2018).

However much figures improve for the survival of the richest, they will not be sufficient to hit national targets without considerable improvement in the survival rates of the poorest. To hit NHS targets these inequalities will have to be reduced.

The ONS regularly comments on death and its causes by using the concept of “avoidable mortality”. Paragraph 3 of the report explains,

“Avoidable mortality refers to deaths from causes that are considered avoidable in the presence of timely and effective healthcare or public health interventions. For most of the causes of death included in our definition there is an upper age limit of 74 years.”

“Overall avoidable mortality can be divided into two sub-categories, ‘amenable to healthcare’ and ‘preventable’.”

This is an interesting combination of ideas. What realistically could you expect from timely and effective healthcare to reduce mortality (what is “amenable to healthcare” intervention) and what could public health have achieved (what is “preventable”)?  Both interventions are what you might expect from our society and both have, over recent years, ensured that there has been considerable improvement in avoidable mortality rates.

“Overall avoidable mortality rates have improved over the last 16 years for both England and Wales. However, avoidable mortality rates in the most deprived areas have not improved as quickly as those in the least deprived areas. This could be because these areas have not benefitted as much from improvements in mortality from cardiovascular and respiratory diseases.”

(paragraph 2 – Statistician’s comment)

This is a source of pride for the NHS and public health – over 16 years all that work to improve health and healthcare outcomes has worked. But, unsurprisingly, it’s worked better for the well-off than for the poor. Just to be clear, it has been better for poorer people too – just not by as much as for the more affluent.

“Although, the mortality rate for males in the most deprived areas nearly halved between 2001 and 2016 (from 301.5 to 155.4 deaths per 100,000) it remained significantly and sizeably higher than the rate in the least deprived areas. This pattern was also observed for females.”

(paragraph 4 “Relationship between avoidable mortality and deprivation in England.”)

When statisticians say that something is significantly and sizeably higher – they mean “this is a lot”. These statistics break the promise of equality in which the NHS says it believes.

And the gap in avoidable mortality has worsened,

“In 2001, males in the most deprived areas were 3.5 times more likely to die from an avoidable cause than those in the least deprived areas; in 2016, this had grown to 4.5 times more likely.”


This is both shocking and unsurprising. Death statistics for people in poorer areas are worse now than they were 15 years ago.

Since the NHSE/I long-term plan now clearly aims to do something about this, the ONS has helpfully broken down the statistics by CCG area. Which means that both NHS and local authorities in these localities know what they have to achieve in the 10-year plan.

An example from the 2016 figures,

CCG Avoidable mortality
NHS Barking and Dagenham 154.8
NHS Durham Dales, Easington and Sedgefield 144.1
NHS Richmond 89.0


(Data extracted from the ONS dataset “Avoidable mortality by Clinical Commissioning Groups in England and Health Boards in Wales”.)

I’ve used these three areas because although the first two are very different in many ways in one they are similar. They are both poor.

The third is very different from the other two because it is richer

When the plan expires in 10 years’ time this will this be different.