# Health Inequalities Dashboard

## About this dashboard

This tool has been developed to present evidence of health inequalities in England. Measures of inequality are provided for key indicators to monitor progress on reducing inequalities within England. For some indicators, inequality measures are also provided within regions, upper tier local authorities and NHS clinical commissioning groups. More local level measures will be added to the dashboard over time.

The majority of indicators are drawn from the Public Health Outcomes Framework and are divided into the following domains:

- Overarching indicators (life expectancy and healthy life expectancy)
- Wider determinants of health
- Health improvement
- Health protection
- Healthcare and premature mortality

## Latest updates

The tool was last updated on 30th June 2022. A summary of latest results can be found in the statistical commentary

The following indicators were updated to the latest available time period:

- Life expectancy at birth
- Healthy life expectancy at birth (inequality measures have not been updated)
- Children in low income families
- 16-17 year olds not in education, employment or training (NEET) or whose activity is not known
- Self-reported wellbeing - people with a low satisfaction score
- Infant mortality rate
- Under 75 mortality rate from all cardiovascular diseases
- Under 75 mortality rate from cancer
- Suicide rate (inequality measures have not been updated)

The latest update also includes the following changes:

- Indicators of premature mortality from cardiovascular diseases and cancer have moved from being presented as three year rolling rates to annual rates so that the impact of the COVID-19 pandemic can be more clearly seen
- Three mortality indicators now use the log Slope Index of Inequality (SII) method to measure inequality. More information can be found in the Guidance & FAQs
- Under 75 mortality rate for all cardiovascular diseases
- Under 75 mortality rate for cancer
- Suicide rate

- Some changes have been made to the user interface of the tool to make the charts more accessible

## How to use the tool

### Overview tab

This provides a summary table for all the indicators in the dashboard and the associated inequality measures. Data are displayed for a baseline period and a reporting period (the latest available data), with an indication of change between periods and direction of the trend.

### Data tab

This provides visualisations of the trends over time for indicators and the summary inequality measures where available. It also shows the trend for indicators by inequality group. The table shows the underlying data and confidence intervals.

- Select the geography type from the ‘select geography’ drop down
- Select the area you would like displayed from the ‘select area’ drop down
- Select the indicator themes in the ‘select domain’ drop down
- Select the indicator to display in the ‘select indicator’ drop down. The dashboard will populate with the selected data
- Where several inequality measures are available to display, select the ‘inequality measure’

### Guidance and FAQs

Further information on the data and methods used to produce the dashboard indicators can be found in the Guidance & FAQs. More detailed information on the definitions and calculation of individual indicators can be found via the definitions tab in the data section of the dashboard.

## Other resources

- OHID Health inequality tools
- PHOF Technical Guidance
- OHID Home page

## Feedback

We are interested in your feedback on the tool. If you have any comments or suggested changes, please contact us.

*This dashboard was last updated 30th June 2022*

# Guidance and frequently asked questions

## Contents

### Data

### Inequality measures

### Frequently asked questions

## Data

### Data

The majority of indicator values are drawn from the Public Health Outcomes Framework. Data for these use a variety of data sources, and these are specified for each indicator in the ‘Definitions’ tab of the tool.

Inequality summary measures, for the most part, have been calculated by OHID for the Health Inequalities Dashboard, using data from several OHID Fingertips profiles including the Public Health Outcomes Framework, the Local Tobacco Control Profiles and the National Child Measurement Programme & Child Obesity Profile.

### Time periods

The ‘Overview’ tab presents data for a baseline period and a reporting period. For each indicator, the baseline period is around 2013. For some indicators, particularly where there has been a change in indicator definition, data for 2013 is not available, so the earliest possible time period is used.

The reporting period shows data for the latest time period.

Where available, the ‘Data’ tab shows longer term trend data for the indicator.

### Inequality dimensions

The tool provides breakdowns of data across a range of determinants referred to as dimensions of inequality eg personal characteristics, including age, sex, ethnic group, health status, religion and country of birth in addition to socio-economic deprivation.

For each dimension, a summary measure of inequality has been calculated using one of the measures described in the section below. Where possible, the same summary measure has been used for the same dimension of inequality across all indicators.

## Inequality measures

### Absolute and relative gap

The absolute and relative gap measures show inequality between two groups. The absolute range is calculated by subtracting the lower value from the higher value, and the relative range is calculated by dividing the higher value by the lower value.

The gap can be between a specific population group and the national average, or between two independent population groups. Where this measure has been used, the groups being compared are stated on the ‘Definitions’ tab of the tool.

Figure 1: Example of the absolute and relative gap, based on the school readiness indicator

### Slope index of inequality (SII) and relative index of inequality (RII)

The slope index of inequality (SII) and relative index of inequality (RII) are used to measure inequality by deprivation. These measures are used for indicators where data is available at lower super output area (LSOA) level to be grouped into deprivation deciles.

The slope index of inequality is a measure of the social gradient in an indicator, i.e. how much an indicator varies with deprivation. It takes account of health inequalities across the whole range of deprivation within an area and summarises this in a single number. This represents the range in indicator values across the social gradient from most to least deprived.

The chart in Figure 2 based on life expectancy at birth shows how the SII is calculated. The population has been divided by level of deprivation, based on the Index of Multiple Deprivation. This has been done by ranking Lower Super Output Areas (LSOAs) from most to least deprived. These have then been divided into 10 groups, or deprivation deciles, with approximately equal numbers of LSOAs in each. Decile 1 contains people living in the most deprived areas and Decile 10 contains people in the least deprived areas. Life expectancy at birth has been calculated for each of these deciles, illustrated by the blue dots in Figure 2.

Figure 2: Life expectancy by deprivation decile and the slope index of inequality

The life expectancy figures have also been plotted to take account of their population size. While the deprivation deciles have roughly one-tenth of the population in each, they are not precisely equal because they are aggregated up from LSOAs. The horizontal x-axis along the bottom of the chart in Figure 1 represents the whole population of an area. Each blue dot in Figure 1 represents the life expectancy for each deprivation decile. If Decile 1 includes exactly 10% of the population, the first blue dot is positioned at 5%, the mid-point of the range of population covered by that decile. If the second decile includes 11% of the population, this would cover the range from 10% to 21%, so the midpoint is 15.5%, and that is where the point would be located on the x-axis.

The red line on the chart is a linear regression line of best fit for the data, calculated by the least squares method. The SII is simply the gradient of that line, or the difference between the top of the line (at 100% on the horizontal axis) and the bottom (0% on the horizontal axis). In the example in Figure 1, the regression line goes from 78.0 to 85.9 years. This gives an SII of 7.9 years (with a 95% confidence interval of 6.7 to 9.1 years). The range in life expectancy across the social gradient from most to least deprived in this area is therefore 7.9 years. An SII of zero indicates there is no inequality. When looking at health outcomes such as life expectancy and mortality, a positive SII indicates a higher concentration of the indicator among the most deprived populations whereas a negative value would indicate a higher concentration of the indicator among the least deprived populations.

For more technical guidance on how to interpret SII measures see the PHOF technical guidance

The relative index of inequality is a summary measure of inequality related to the SII. While the SII measures the absolute difference between the most and least deprived, the RII measures the relative difference and is presented as a ratio of the least deprived to the most deprived for an indicator. For example, the RII for low birth weight of term babies was 2.2 in 2018. This means that the percentage of low birth weight term babies is 2.2 times higher in the most deprived compared to the least deprived areas. A relative measure of 1 would indicator that there was no inequality by deprivation.

When calculating the SII and RII it is assumed that there is a linear relationship between the indicator decile values and deprivation.

### Log slope index of inequality (log SII) and log relative index of inequality (log RII)

The log slope index of inequality and log relative index of inequality are used to measure inequality by deprivation for indicators where there is not a linear relationship between the indicator decile values and deprivation.

This method has been used for five indicators in the dashboard:

- Premature cardiovascular disease mortality
- Premature cancer mortality
- Suicide
- Infant mortality
- Alcohol related hospital admissions

In this method, decile values for the indicator are logged before calculation of the SII and RII. This results in a regression line which better fits the data for each of the three indicators. The SII and RII based on the log scale are more difficult to interpret, so the figures in the dashboard are presented in the original units of indicator (converting back to original units by taking the anti-log of extreme values of the SII line and recalculating SII and RII).

The example below presents the data for one time period for premature cardiovascular disease mortality in England which was identified as being non-linear. The left hand chart shows the indicator values for each decile and the SII line using a standard SII method. The centre chart shows logged indicator values for each decile and the SII line. The right hand chart shows the indicator values for each decile and the transformed SII line. The SII and RII values below this chart are those that are/would be used in the dashboard.

Figure 3: CVD premature mortality (DSR per 100,000), 2014-16

### Mean difference

Where the dimension of inequality being considered contains a number of population groups which cannot be logically ordered, such as indicators by ethnic group, a summary measure called the mean difference has been presented.

The measure shows the average of the absolute differences between each of the groups and a reference group. The difference between each group and the reference is treated as a positive number regardless of whether it is higher or lower than the reference group. For each indicator, the largest group is selected as the reference group, and this group is stated on the ‘Definitions’ tab.

No relative measure is presented for these indicators.

Figure 4: Example of the mean difference, based on the smoking prevalence indicator

## Odds Ratio

For smoking prevalence, the odds ratio has been presented, representing the likelihood of those working in routine and manual occupations (exposure) being current smokers (outcome) compared with those working in professional or intermediate occupations (exposure).

An odds ratio of 1 represents no difference in the outcome in different exposure groups. If the confidence intervals overlap, we are able to say with 95% confidence that there is no significant difference in the outcome between groups.

An odds ratio higher than 1 signifies that one population is more likely to have the outcome than their counterparts, for example if the odds ratio is 2, they have twice the odds of the outcome. On the other hand, an odds ratio between 0 and 1 signifies that they are less likely to have the outcome, for example if the odds ratio is 0.5 they have half the odds of the outcome.

## Frequently asked questions

### How often is the Dashboard updated?

There is no set timetable for updating the dashboard but currently we aim to revise data twice a year.

### Will the tool be developed further?

There is potential to further develop the tool. We would welcome feedback on what development would be most useful in order to inform future work. If you have any comments or suggested changes, please contact us.

### Can the data and charts be downloaded from the dashboard?

You can download any of the charts in the data tab by clicking on the camera icon that will appear in the top right corner of charts when hovered over. Data tables can be downloaded to a number of formats by clicking the options at the top of the Data tables tab.

### Are inequality measures available for local authorities?

Inequality measures are available for some indicators at local authority level. These are:

- Life expectancy at birth
- School readiness:percentage of children not achieving a good level of development
- Gap in the employment rate between those with a long-term health condition and the overall employment rate
- Smoking Prevalence in adults (18+) - current smokers (APS)
We plan to add more local authority level data to the dashboard over time.

### Will other geography types be added to the dashboard?

CCG level data for smoking prevalence was added to the dashboard in March 2020. We plan to add further data over time, and there is potential to add additional geography types. Work is underway to establish what additional data could be added.

### Why are both absolute and relative measures of inequality included?

Absolute inequality shows the magnitude of difference between subgroups of the population (most simply calculated by subtracting the value for one group from another), whereas relative inequality shows the proportional difference between subgroups (most simply calculated by dividing the value for one group by another). Eg If 30% of people smoke in Group A and 20% smoke in Group B then the absolute inequality between them is 10 percentage points and the relative inequality is 1.5, ie there are 1.5 times as many smokers in Group A as Group B.

Both absolute and relative measures are important indicators of inequality. However, they can lead to differing conclusions about the direction of change in inequality over time, depending on the trajectory of the indicator overall. Eg Using the example above, if smoking prevalence in Group A reduces to 24% and in Group B it reduces to 15% then the absolute inequality between them has narrowed to nine percentage points. However, the relative inequality between them has increased to 1.6. Each measure has advantages and disadvantages, but used together they can provide a more complete picture of inequality.

### Why isn’t the slope index of inequality used for all deprivation based inequality measures?

Wherever possible, the slope index of inequality has been used as the summary measure of inequality by deprivation . However, for a small number of indicators, inequality by deprivation has been measured using a simple range measure rather than using the slope index of inequality and relative index of inequality measures. In these cases, data were not available at a small enough geographical level to define deprivation groups in a consistent way. So deprivation groups were defined by grouping upper tier local authorities into ten groups based on their level of deprivation, then calculating the absolute and relative inequality between the most and least deprived groups.

### Where can I access other sources of data and information on health inequalities?

Public Health Outcomes Framework data

OHID Health inequality tools

Health Profile for England

COVID 19 Health inequalities monitoring for England (CHIME) tool

# Accessibility statement for Health Inequalities Dashboard

This accessibility statement applies to https://analytics.phe.gov.uk/apps/health-inequalities-dashboard/

This website is run by the Office for Health Improvement and Disparities. We want as many people as possible to be able to use this website. For example, that means you should be able to:

- change colours, contrast levels and fonts
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We’ve also made the website text as simple as possible to understand.
AbilityNet has advice on making your device easier to use if you have a disability.

### How accessible this website is

We know some parts of this website are not fully accessible:

- The graphs and charts may not be usable if you rely on the keyboard, struggle with colors, or use a screenreader. The data tables associated with each should be more usable.
- Not all the text will be available when you zoom in.
- Some text and graphics do not have sufficient contrast.
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### Technical information about this website’s accessibility

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### Compliance status

This website is partially compliant with the Web Content Accessibility Guidelines version 2.1 AA standard, due to the non-compliances listed below.

### Non-accessible content

The content listed below is non-accessible for the following reasons.

**Navigation**

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**Images**

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**Colours**

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**Graphs**

- The graphs require colour vision to interpret, failing Use of Color
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- The keyboard controls are not Keyboard accessible
- The graphs do not have alt-text, failing Non-Text Content
- The text within the graphs are not structured, failing Info and Relationships

### What we’re doing to improve accessibility

Most of the issues above will be reviewed with the development team and be resolved within 6 months.
The graphs are created using a library, and it has not been possible to find an accessible alternative. The data tables associated with each graph will be updated to ensure they include the same information as the graph.

### Preparation of this accessibility statement

This statement was prepared on 23rd September 2021. It was last reviewed on 23rd September
This website was last tested on 22nd September 2021. The test was carried out by Nomensa. A selection of 10 pages across the site were selected for testing, covering the main templates and types of content (graphs) that are available.