Cynnwys
- Key points
- Animated YouTube video
- Introduction
- National focus
- General health across the English regions and Wales
- General health over time in English regions and Wales
- English local authority comparisons
- Welsh unitary authority comparisons
- General health and area deprivation for small area groupings
- Inequality in England
- Inequality in Wales
- More Census analysis
- Background notes
1. Key points
In 2011, 81.2 per cent of people in England and Wales reported their general health as either ‘Very good’ or ‘Good’; in England it was 81.4 per cent and in Wales it was 77.8 per cent
People living in London and the South East region had the highest percentages of ‘Very good’ or ‘Good’ general health, and Wales and the North East region the lowest
In England and Wales, the gap between local authorities reporting the highest (Hart: 88.1 per cent) and lowest (Blaenau Gwent: 72.6 per cent) percentages of ‘Very good’ and ‘Good’ general health was 15.5 percentage points
The general pattern of better health in London and the South East region, and worse health in the Northern regions in 2001 is maintained in 2011
However, some traditionally deprived local authorities experienced a notable improvement in 2011; specifically Newham, Tower Hamlets, Hackney and Manchester
2. Animated YouTube video
A podcast explaining this analysis using audio commentary and graphical animations is available on the ONS YouTube channel.
Nôl i'r tabl cynnwys3. Introduction
This analysis describes the general health of the population of England and Wales; a complementary analysis released today by ONS describes activity limitations that are related to a health problem of disability.
This publication follows the 2011 Census Population and Household Estimates for England & Wales. The census provides estimates of the characteristics of all people and households in England and Wales on census day. These are produced for a variety of users including government, local and unitary authorities, business and communities. The census provides population statistics from a national to local level. This analysis discusses the results at national, regional, local and small area level.
Self-assessed health draws together an individual’s perception of all aspects of their health and wellbeing and is a useful indicator of general well-being and health-related quality of life.
Nôl i'r tabl cynnwys4. National focus
The 2011 Census1 included a question on general health2,3 and this information enables an assessment to be made about the nation’s health status and to make comparisons between areas within England and Wales.
Figure 1. General health
England and Wales, England, Wales, 2011, usual residents
Source: Census - Office for National Statistics
The 2011 Census in England and Wales shows that more than 26 million people reported their general health as ‘Very good’, and a further 19.1 million as ‘Good’; while only 2.5 million were in a ‘Bad’ state of health and a further 716,000 in a ‘Very bad’ health state. Therefore more than four-fifths of the population in England and Wales (81.2 per cent) reported their general health as either ‘Very good’ or ‘Good’ in 2011 (figure 1). In England the equivalent figure was 81.4 per cent, and in Wales it was 77.8 per cent, a 3.6 percentage point difference.
Notes for national focus
This publication follows the 2011 Census Population and Household Estimates for England & Wales. The census provides estimates of the characteristics of all people and households in England and Wales on census day. These are produced for a variety of users including government, local and unitary authorities, business and communities. The census provides population statistics from a national to local level. This short story discusses the results at national, regional, local and small area level.
A question on self-assessed general health was included in both the 2001 and 2011 Censuses. In 2001, each person in a household was asked to rate their general health over the last 12 months; the possible responses were ‘Good’, ‘Fairly good’ or ‘Not good’. In 2011 each person in the household was asked to rate their health in general; the possible responses were ‘Very good’, ‘Good’, ‘Fair’, ‘Bad’ and ‘Very bad’. Unlike simple indicators based on the presence or absence of disease, an important property of the general health status indicator is that it includes the entire spectrum of health states ranging from ‘Good’ to ‘Not good’ health.
Self reports are useful in indicating general well-being, health-related quality of life, the experience of long-term illness and the relative risks of future admission to hospital, impairment and mortality. Therefore the monitoring of general health over time is important for determining fitness for work, need for care and benefits and social capital. Self-assessed health draws together an individual’s perception of all aspects of their health and wellbeing.
5. General health across the English regions and Wales
Figure 2. General health by region
England and Wales, England, Wales, England regions, 2011, usual residents
Source: Census - Office for National Statistics
Download this chart Figure 2. General health by region
Image .csv .xlsAcross the English regions and Wales, the general health profile of London’s population was more favourable than any other region in 2011, with more than half (50.5 per cent) assessing their health as ‘Very good’, and a further third (33.3 per cent) as ‘Good’; only 5 per cent assessed their health as either ‘Bad’ or ‘Very bad’.
The younger age structure1 of London’s population partly contributes to this region’s more favourable health status. Other likely contributing factors are a healthy worker effect resulting from the job-creating regeneration occurring in London during the first decade of the 21st Century such as: construction of the Olympic Village; the improvements to the transport system; and investment in brown field sites such as Greenwich and the Isle of Dogs. In addition, the attraction of migrants from other parts of the UK and from abroad to take up these employment opportunities is also likely to affect the socio-demographic structure towards a more trained and skilful workforce and a younger age-structure.
The South East of England had a similar profile to London.
The North East region had the least favourable general health; only 44 per cent reported ‘Very good’ health and 7.4 per cent reported their health as ‘Bad’ or ‘Very bad’.
Wales’s general health profile was largely similar to the North East region.
A North-South divide in general health is often present with health improving in line with a southerly and easterly direction of travel.
These results have a consistent pattern seen in regional variations in other measures of health status such as life expectancy (1.33 Mb Excel sheet) and health expectancy published by the Office for National Statistics (ONS).
Notes for general health across the English regions and Wales
- Click into the link and select London in the left pyramid and another region or Wales in the right pyramid to compare age structure.
6. General health over time in English regions and Wales
Figure 3. Percentage change in 'Good' health between 2001 and 2011
English regions, Wales, 2001 to 2011, Usual residents
Source: Census - Office for National Statistics
Notes:
- Rounded Values
- Percentage change in ‘Good’ health between 2001 and 2011 is calculated by subtracting per cent ‘Good’ health in 2011 from per cent ‘Good’ health in 2001 and dividing the resulting figure by per cent ‘Good’ health in 2001 and multiplying by 100.
- Estimates for 2001 are based on a simulation to derive the categories 'Good' and 'Not good' general health because a different general health question was included in the 2001 Census to that included in the 2011 Census. Therefore comparisons with 2001 should be treated with caution.
Download this chart Figure 3. Percentage change in 'Good' health between 2001 and 2011
Image .csv .xlsWhen combining the categories into ‘Good’ and ‘Not good’ health1, (the former represented by the categories ‘Very good’ and ‘Good’; the latter represented by the categories ‘Fair’, ‘Bad’ and ‘Very bad’), a North-South divide is noticeable in 2011. London (83.8 per cent), the South East (83.6 per cent), the East of England (82.5 per cent) and the South West (81.4 per cent) all have higher percentages reporting ‘Good’ general health than the England average, while the North East (77.3 per cent), North West (79.3 per cent) and Yorkshire and the Humber (80.0 per cent) have lower percentages; the difference between top and bottom regions on health was 6.5 per cent.
How English regions and Wales compare with 20012,3 shows a variable picture (figure 3); those with the lowest percentages of people with ‘Good’ health in 2001 saw their rates fall between 2001 and 2011 and vice versa. The North East, North West, East Midlands, West Midlands and Wales experienced falls, but in other regions the rate increased, most notably in London and the south4.
Notes for general health over time in English regions and Wales
Comparability between 2001 and 2011 relies on a method, developed by ONS in 2009, which has been applied to translate the 2011 categories to the 2001 Census population; however, this method requires combining the categories into two health states:
a. ‘Good’ (representing those that would have reported their general health as either ‘Very good’ or ‘Good’) if the 2011 question had been asked in 2001, and
b. ‘Not good’ (those that would have reported their general health as ‘Fair’, ‘Bad’ or ‘Very bad’) if the 2011 question had been asked in 2001.
A direct comparison of general health status between 2011 and 2001 is not possible because of differences between the question asked in 2011 and in 2001.
ONS has developed a method to convert the 2001 question, which splits the 2001 population into two health states:
a. those whose general health is either ‘Very good’ or ‘Good’ representing a state of ‘Good’ general health; and
b. those whose general health is either ‘Fair’, ‘Bad’ or ‘Very bad’ representing a state of ‘Not good’ general health.
The absence of age structure breakdowns in these results means that the accuracy of creating the two health states of ‘Good’ general health and ‘Not good’ general health in 2001 is lessened. Therefore the comparison between 2001 and 2011 should be interpreted as an initial indication of change rather than definitive evidence. Further work using age-specific and age standardised measures will be undertaken by ONS later in 2013 to further refine the measurement of change between 2001 and 2011.
9. General health and area deprivation for small area groupings
The inequality that exists between populations is often explained in terms of area disadvantage. Measures of health status such as life expectancy and health expectancy are shown to be more favourable in some geographical locations than others and to be strongly patterned with material factors such as income, environment, housing quality, unemployment, access to services and education. These factors have been brought together into an index (such as the Index of Multiple Deprivation) which can be applied to small areas such as LSOAs to give a measure of relative material disadvantage experienced by a specific area compared with other areas.
In order to present a picture of general health and the scale of inequality that exists between populations, these small areas are amalgamated, on the basis of their relative level of disadvantage. The Index of Multiple Deprivation 2004 and 2010 in England, and the Welsh Index of Multiple Deprivation 2005 and 2011 in Wales, are used to group areas into tenths (deciles). Rates of ‘Good’ general health are then calculated for these deciles.
The level of inequality between the least and most deprived group of areas can then be estimated using the Slope Index of Inequality1. This statistic represents the inequality between the most and least deprived deciles of areas on the basis of the gradient of the best fitting line. The line indicates the level of health improvement needed by decile 1 to get to decile 10’s position on the hill and thereby narrow the inequality.
Notes for general health and area deprivation for small area groupings
- The Slope Index of Inequality (SII) assesses the absolute inequality between the least and most deprived tenths, taking account of the inequality across all adjacent area tenths, rather than focusing only on the extremes. It is calculated using weighted regression, which ensures the different population sizes of the area groupings is taken into account. The regression calculates a predicted slope which represents the extent of inequality across the whole population.
10. Inequality in England
In England there were 32,844 LSOAs with enumerated populations in 2011; use of the ONS Census Geography lookup file enables the total number of census LSOAs to be assigned an Indices of Deprivation 2010 score. These LSOAs were then ranked according to their level of deprivation and grouped into tenths (deciles), with each decile consisting of approximately 3,284 LSOAs. This method of determining the extent of inequality between populations that is related to their relative level of disadvantage better reflects the size of the inequality between the least and most deprived areas than the summary scores of local authorities used above. By using LSOA groupings, a more valid measure of the extent of inequality in health between area populations can be constructed using the Slope Index of Inequality1; a statistic which is able to take account of decile differences in population size and therefore the relative weight that should be placed on each decile.
In 2011 an 11.9 percentage point gap exists between the least and most deprived area deciles; in the most deprived areas, the rate of ‘Good’ health was only 75 per cent, whereas in the least deprived decile it was 86.9 per cent; however, the Slope Index of Inequality (figure 5), which takes account of the different population sizes across all deciles, refines this difference as slightly smaller at 11.4 percentage points, shown by the gradient of the purple line.
An interesting feature of this chart is the consistent incremental improvement in ‘Good’ health as the level of deprivation lessens; however, a higher increase occurs between deciles 9 and 10 and a higher decrease between deciles 2 and 1, while smaller differences occur between the intervening adjacent deciles.
Figure 5. General health by level of area deprivation (''Good" general health by deprivation deciles, showing the Slope Index of Inequality)
England, 2011, deprivation deciles
Source: Census - Office for National Statistics
Notes:
- Rounded values
- Slope Index of Inequality is calculated using weighted regression, which takes account of the different population sizes of the area deciles to derive a predicted slope which represents the extent of inequality across the whole population.
- Deprivation deciles based on the English Indices of deprivation 2010
Further analysis will be needed to support this provisional finding by comparing decile age structures and taking account of any future revisions to the Indices of Deprivation using 2011 Census data
Notes for inequality in England
- The Slope Index of Inequality (SII) assesses the absolute inequality between the least and most deprived tenths, taking account of the inequality across all adjacent area tenths, rather than focusing only on the extremes. It is calculated using weighted regression, which ensures the different population sizes of the area groupings is taken into account. The regression calculates a predicted slope which represents the extent of inequality across the whole population.
11. Inequality in Wales
In Wales there were 1,909 lower super output areas enumerated in the 2011 Census; the use of the ONS lookup file enables the total number of census LSOAs to be assigned a WIMD 2011 rank, with each decile consisting of approximately 191 areas.
Figure 6 shows the rates of ‘Good’ general health for each decile in 2011. As in England, health inequality in Wales is sizeable, a gap of 12.7 percentage points existed between the most and least deprived area deciles; however the Slope Index of Inequality1 suggests this is a slight underestimate and the true inequality is 13.5 percentage points. Among the most deprived area decile, ‘Good’ general health was only 71.6 per cent, 3.4 percentage points lower than the equivalent most deprived decile in England. Generally the Welsh deciles had lower percentages of ‘Good’ general health than the equivalent English deciles, but this may be partly influenced by the different measure of deprivation used in Wales.
Figure 6. General health by level of area deprivation (''Good" general health by deprivation deciles, showing the Slope Index of Inequality)
Wales, 2011, deprivation deciles
Source: Census - Office for National Statistics
Notes:
- Rounded values
- Slope Index of Inequality is calculated using weighted regression, which takes account of the different population sizes of the area deciles to derive a predicted slope which represents the extent of inequality across the whole population.
- Deprivation deciles based on the Welsh Index of Multiple Deprivation 2011
Further analysis will be needed to support this provisional finding by comparing decile age structures and taking account of any future revisions to the Welsh Indices of Deprivation using 2011 Census data
Notes for inequality in Wales
- The Slope Index of Inequality (SII) assesses the absolute inequality between the least and most deprived tenths, taking account of the inequality across all adjacent area tenths, rather than focusing only on the extremes. It is calculated using weighted regression, which ensures the different population sizes of the area groupings is taken into account. The regression calculates a predicted slope which represents the extent of inequality across the whole population.