This tool has been developed to present evidence of health inequalities in England. Measures of inequality are provided for key indicators being used by Public Health England 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 PHE Public Health Outcomes Framework and are divided into the following domains:
The tool was last updated on 2nd September 2020.
The following indicators were updated to the latest available time period:
The latest update also includes the following changes:
The childhood excess weight indicator has been redefined from prevalence of overweight (including obesity) to prevalence of obesity (including severe obesity). This is to align with indicators presented in the National Childhood Measurement and Child Obesity Profile. The slope index of inequality and relative index of inequality are now available at national and regional level.
Additional inequality measures have been added to the smoking prevalence in adults indicator. This includes the mean difference by ethnic group, country of birth and religion.
The definitions tab has been moved to within the data 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 (date nearest to PHE inception) and a reporting period (the latest available data), with an indication of change between periods and direction of the trend.
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 at a 95% level.
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 PHE for the Health Inequalities Dashboard, using data from several PHE Fingertips profiles including the Public Health Outcomes Framework, the Local Tobacco Control Profiles and the National Child Measurement Programme & Child Obesity Profile.
The ‘Overview’ tab presents data for a baseline period and a reporting period. For each indicator, the baseline period is the period closest to the inception of PHE in 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.
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.
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.
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.
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 cancer premature mortality in 2016-18 was 2.2. This means that the cancer mortality rate 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 the there is a linear relationship between the indicator decile values and deprivation.
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 three indicators in the dashboard:
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 the standard PHE 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.
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 is group is stated on the ‘Definitions’ tab.
No relative measure is presented for these indicators.
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.
Further detail on some of these measures can be found in Appendix 2 of the PHOF Health Equity Report
Public Health Outcomes Framework data tool: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework
Health inequality tools (including the Health Inequality Dashboard): https://fingertips.phe.org.uk/profile/inequality-tools
Health Profile for England: https://www.gov.uk/government/publications/health-profile-for-england-2018
Health Equity collection: https://www.gov.uk/government/collections/health-equity
Health Equity Assessment Toolkit (WHO): https://www.who.int/gho/health_equity/heat_technical_notes.pdf
There is no set timetable for updating the dashboard but currently we aim to revise data twice a year.
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. Please contact us at firstname.lastname@example.org
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.
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.
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.
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.