# Health Inequalities Dashboard

## What’s new

The tool was last updated on 14 March 2023. A summary of main messages can be found here: https://www.gov.uk/government/statistics/health-inequalities-dashboard-march-2023-data-update

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

- 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 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 were 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 on this can be found in the guidance and FAQs section
- The indicator of 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

Note: Several indicators in this dashboard use ONS mid-year population estimates as their denominator. These are currently based on the 2011 Census. These indicators are not comparable with 2021 single year data displayed in the Public Health Outcomes Framework which are based on 2021 Census based mid year population estimates. These indicators will be updated to 2021 Census based population estimates when data becomes available. Please refer to the definitions tab for more detail on the data used for each indicator.

## 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, and upper tier local authorities. More local level measures will be added to the dashboard over time.

## Main messages

A summary of main messages for the Dashboard can be found in the statistical commentaries at the links below.

**March 2023 update**

https://www.gov.uk/government/statistics/health-inequalities-dashboard-march-2023-data-update

**June 2022 update**

https://www.gov.uk/government/statistics/health-inequalities-dashboard-june-2022-data-update

## How to use the tool

Use the tabs at the top of the screen to move between pages of the tool.

### Data page

The data page contains four tabs.

Overview: 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.

Charts: 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.

Data tables: This provides the underlying data for the charts and confidence intervals. Data can also be downloaded using the buttons on the left of the screen.

Definitions: This provides detailed information on the definitions and calculation of each indicator.

### Guidance and FAQs

Further information on the data and methods used to produce the dashboard indicators can be found in the guidance tab. A set of frequently asked questions is also available.

## Feedback

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

# 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.

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 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 in the ‘Interpretation notes’ section beneath the chart and 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 and logit slope index of inequality and relative index of inequality

The log and logit slope index of inequality and 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 applied to all SII indicators in the dashboard except for healthy life expectancy and life expectancy.

In this method, decile values for the indicator are transformed before calculation of the SII and RII. If the indicator is a rate, then a log transformation is applied, and if the indicator is a proportion, then a logit transformation is applied. This results in a regression line which better fits the data for each of the indicators. The SII and RII based on the log/logit 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/anti-logit 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.. 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 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 in the ‘Interpretation notes’ section beneath the chart and 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?

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. Each measure has advantages and disadvantages, but used together they can provide a more complete picture of inequality. More information about absolute and relative inequality can be found in an explainer document here: https://fingertips.phe.org.uk/documents/Absolute%20and%20relative%20inequality%20explainer_OHID.pdf

### 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: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework
Health Inequality Tools page: https://fingertips.phe.org.uk/profile/inequality-tools
Health Profile for England: https://www.gov.uk/government/publications/health-profile-for-england-2021
COVID 19 Health inequalities monitoring for England (CHIME) tool: https://analytics.phe.gov.uk/apps/chime

# 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
- navigate most of the website using just a keyboard
- navigate most of the website using speech recognition software
- listen to most of the website using a screen reader (including the most recent versions of JAWS, NVDA and VoiceOver)

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.
- You cannot skip to the main content when using a screen reader, and most pages missing landmarks.
- Some page updates (when searching or filtering) do not announce the updates to screenreaders.

### Feedback and contact information

If you need information on this website in a different format like accessible PDF, large print, easy read, audio recording or braille, please email us. We’ll consider your request and get back to you in 5 working days.

### Reporting accessibility problems with this website

We’re always looking to improve the accessibility of this website. If you find any problems not listed on this page or think we’re not meeting accessibility requirements, please email us.

### Enforcement procedure

The Equality and Human Rights Commission (EHRC) is responsible for enforcing the Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018 (the ‘accessibility regulations’). If you’re not happy with how we respond to your complaint, contact the Equality Advisory and Support Service (EASS).

### Technical information about this website’s accessibility

Office for Health Improvement and Disparities is committed to making its website accessible, in accordance with the Public Sector Bodies (Websites and Mobile Applications) (No. 2) Accessibility Regulations 2018.

### 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**

- Graph controls could not be accessed with a keyboard alone
- A feature to skip over the navigation and filters to go directly to the main content was not provided
- It is not possible to dismiss content on the navigation bar that appears on-hover with keyboard only

**Images**

- A number of icons and images were missing alternative text

**Colours**

- The colour contrast of text and the graph controls was insufficient

**Structure**

- ARIA landmarks such as main & banner were missing
- The language of the page had not been set
- The current page state is visually communicated but not programmatically communicated
- Important changes in content that occur dynamically are not announced to screen reader users
- Lists were not used to group contents in some areas
- HTML was not nested according to the specification

**Graphs**

- The graphs require colour vision to interpret, failing Use of Color
- Icons used in the graphs, and some colour combinations fail Non-Text Contrast
- 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.