Official Statistics

Health Inequalities Dashboard: statistical commentary, March 2023

Updated 30 August 2023

Applies to England

Main findings

This update of the Health Inequalities Dashboard provides latest data to help assess progress in addressing inequalities for key public health indicators in England.

Child Health

The rate of infant mortality has not changed in England since 2013 to 2015 and remained at 3.9 deaths per 1,000 live births in 2019 to 2021. In 2019 to 2021, the infant mortality rate in the most deprived areas of England was 2.4 times higher than in the least deprived areas. This inequality gap has not changed significantly since the start of the time series in 2010 to 2012.

The percentage of low birth weight term babies in England has remained stable over the last 10 years and in 2021 it was 2.8%. In 2020, the percentage of term babies who were low birth weight was 2.1 times higher in the most deprived areas of England compared with the least deprived areas. This inequality gap has also remained stable over the last 10 years.

The prevalence of children living with obesity has increased over time. For 4 to 5 year olds, the percentage living with obesity has been increasing since 2014 to 2015, while for 10 to 11 year olds, prevalence has been increasing since the start of the time series in 2006 to 2007. Prevalence for both age groups increased significantly during the COVID-19 pandemic in 2020 to 2021. Prevalence fell in 2021 to 2022 but remained significantly higher than before the pandemic. Prevalence of children living with obesity in the most deprived areas of England was 2.4 times higher than those living in the least deprived areas for both age groups in 2021 to 2022. This inequality gap has widened over time: in 2007 to 2008, prevalence in the most deprived areas was 1.9 times higher than the least deprived, for both age groups.

There are inequalities in prevalence of children living with obesity between ethnic groups for both age groups. In 2021 to 2022, the highest levels for those aged 10 to 11 were in the black African ethnic group (33.2%), black Caribbean (32.8%) any other black background (32.3%), and Bangladeshi (32.0%) ethnic groups. The lowest prevalence was in the Chinese ethnic group (17.7%).

Risk Factors

Smoking prevalence in adults fell from 19.8% in 2011 to 13.0% in 2021. The odds of being a smoker were 2.2 times higher in the routine and manual occupation group compared with those with other occupations in 2020, the latest available data point. This was significantly narrower than the odds ratio of 2.5 in 2019. Smoking prevalence has fallen in all ethnic groups since 2011 but inequalities remain. The highest prevalence in 2021 were in the mixed (16.0%) and white ethnic groups (13.7%), both significantly higher than the black, Asian, Chinese, and other ethnic groups.

The percentage of adults classified as living with obesity increased from 22.7% in 2015 to 2016, to 25.3% in 2020 to 2021. The proportion of adults living with obesity in the most deprived areas of England was 1.7 times higher than in the least deprived areas in 2020 to 2021. This inequality gap has not changed significantly since the start of the time series in 2015 to 2016.

Wider Determinants of Health

The percentage of children (aged under 16) in relative low-income families increased from 15.3% in 2013 to 2014 to 18.5% in 2020 to 2021 (see the ‘Background’ section for the definition of this indicator). For children in the most deprived areas of England, 32.1% were living in a relative low-income family in 2020 to 2021, while in the least deprived areas the proportion was only 10.2%.

In 2021 to 2022, just over half (50.9%) of children who were eligible to receive free school meals, did not achieve a good level of development at age 5. For children who were not eligible to receive free school meals, this proportion was 31.2%. Data collection reforms for this indicator mean that no trend data are available.

The gap in the employment rate between those with a physical or mental long term health condition and the overall employment rate has steadily decreased from 13.1% in 2013 to 2014 to 9.9% in 2021 to 2022.

The percentage of the population reporting a low life satisfaction score increased significantly during the pandemic to 6.1% in 2020 to 2021 but has since reduced to 5.0% in 2021 to 2022. This increase and subsequent decrease was seen across all employment groups. In 2021 to 2022, 3.1% of working people reported a low life satisfaction score, while for the unemployed it was 10.8% and 7.8% among the economically inactive. This is an average difference of 6.2 percentage points between the employment groups, narrower than in 2020 to 2021 (6.5 percentage points).

Background

The Health Inequalities Dashboard provides information to monitor progress on reducing inequalities within England. It presents measures of inequality for 19 indicators, the majority drawn from the Public Health Outcomes Framework (PHOF).

The dashboard measures trends in each indicator. Inequalities are considered across a range of dimensions, including deprivation, ethnic group, country of birth, sexual orientation, employment status and socio-economic group.

The most and least deprived areas of England referred to in this commentary were defined using the English Index of Multiple Deprivation (IMD), which defines deprivation to encompass a wide range of an individual’s living conditions. They were defined as the most and least tenth of Lower Super Output Areas (LSOAs) and were created by ranking these areas in England from most to least deprived and dividing these into 10 categories with approximately equal numbers of LSOAs in each. The exception is for children in relative low-income families, for which the most and least deprived areas were defined using upper tier local authorities, rather than LSOAs.

The percentage of children aged under 16 living in relative low income families is defined as follows. A family is defined as a single adult; or a married or cohabitating couple; or a civil partnership; and any dependent children. Relative low income is defined as a family in low income Before Housing Costs (BHC) in the reference year. A family must have claimed one or more of Universal Credit, Tax Credits or Housing Benefit at any point in the year to be classed as low income in these statistics. Relative low income sets a threshold as 60% of the UK average (median) income and moves each year as average income changes. The percentage of individuals in relative low income will decrease if: average (median) income stays the same or rises, and individuals with lower incomes see their incomes rise more than the average; or average (median) incomes fall, and individuals with lower incomes see their incomes fall less than average incomes.

For every indicator in the dashboard, information on data sources is available (through the Data tab) which provides further details of the definition of each indicator, and the measures of inequality used.

New in this update

The following changes have been made since the previous update in June 2022:

The following indicators have been updated with the latest data:

• healthy life expectancy (inequality measure only)
• infant mortality rate
• low birth weight of term babies
• smoking prevalence in adults
• prevalence of obesity (including severe obesity) - reception and year 6
• gap in the employment rate between those with a physical or mental long-term health condition and the overall employment rate
• children in relative and absolute low-income families
• 16 to 17-year-olds not in education, employment or training (NEET) or whose activity is not known
• percentage of children not achieving a good level of development at age 5
• self-reported wellbeing - people with a low satisfaction score

The following additional changes have been made:

• a new indicator on prevalence of adult obesity has been added
• four indicators (prevalence of obesity in reception and year 6 children, low birth weight of term babies, and dental decay) have been updated to use the logit slope index of inequality as the summary measure of inequality. More information can be found in the guidance and FAQs section
• the indicator on tuberculosis incidence has been removed
• changes have been made to the layout of the tool to make it easier to use and more consistent with other OHID tools

View the Health Inequalities Dashboard.

Responsible statistician, product lead: Laura Powell

Any queries can be directed to pha-ohid@dhsc.gov.uk