Health care consumption and health inequalities - the case of Tower Hamlets

The east London borough has one of the lowest healthy life expectancies of any district in England for both men and women, and ranks highest for child and older person poverty.

It is also a borough of contrasting fortunes. Although there is widespread poverty, the wealthy Docklands area falls within its boundaries and the influx of affluent people it has attracted has improved the average rankings of some factors, such as health and income.

The report The London Borough of Tower Hamlets - Case studies in health inequalities and health care consumption asks whether the amount the borough spends each year on health and social care (roughly £640 million at the time of writing) is too much or too little, and whether savings from improvements in health could be used to better effect. To understand whether this is feasible or not, we need to understand what causes health costs to be higher in some people than others.

The presence of the wealthier demographic attracted to the borough by the Docklands financial district enables a more detailed examination of health differences between those richer and poorer people resident in the borough.

By disentangling the differences and calculating the associated costs, it ought to be possible to devise and target policies which promote healthier living and reduce the burden on public services such as the NHS.

The report's aim is to establish a more complete picture of cost and need, in order to inform strategy, commissioning, and resource allocation.

The report was structured on the lines of a series of case studies that link together information on the wider determinants of health, such as low income, household composition, and housing on health outcomes and health care usage.

Some key findings:

• There are 320,000 registered patients in the borough. 75% are aged 20-64. 22% are aged 0-19. 5.4% are 65 and over.
• Reported spending on the borough’s health economy is £647m, of which £441m is spent on health care services. The rest is spent on social services and public health.
• Overall cost of health care increases with the level of deprivation. Costs per capita vary less in the youngest and the oldest age groups.
• The case studies find a high correlation between deprivation and health cost in the 20-64 age group, even after maternity costs are removed.
• Average household sizes are larger in the more deprived areas, where relatively more are on benefits and/or live in social housing. Yet there is evidence that health care costs in the 0-19 age groups are less affected by deprivation than the 20-64 group.
• There is evidence that the take up of MMR jabs is higher in more deprived groups.
• The 65+ age group has the highest per capita health care costs. Smoking status, being aged 75+, living alone, and being male are among the main risk factors, more so than deprivation.
• Secondary care (hospital and specialist care) costs average about £410 p.a. Costs are significantly higher for those in social housing, and more again for people living in a benefits household (although this varies with gender).
• In the 20-64 age group, average male annual secondary care costs varies eight-fold depending on their exposure to different risk factors, such as smoking or living in a benefits household.
• For women in the 20-64 age group the risk factors are similar but additional costs are slightly less.
• Secondary care costs rise steeply from age 65+.
• Secondary care costs are higher for people with long-term lifestyle related conditions such as hypertension or diabetes.
• Based on 23 long term conditions and risk factors and using the absence of any QoF conditions as a measure of health, the study finds that two thirds of the population aged 20-64 in the least deprived decile are in good health, compared to half of those in the most deprived decile.
• On the other hand, there is a 90% correlation between the number of long-term conditions per person and deprivation. Although women are generally healthier, they are more likely to be affected by multiple health conditions. This may partly explain their lower health life expectancy.
• Face to face contact with GPs varies little with deprivation and appear to be lower overall as compared with attendance nationally. Contact with hospital services by contrast increases with levels of deprivation. There is, for example, an almost two-fold difference in male A&E attendance between the most and least deprived areas.
• The ratio of GP visit to A&E attendance is a barometer of how people use the NHS. Up to the age of 20, GP visits are two times more frequent than A&E visits and higher for women than men. Between ages 40 and 50 they are six times more frequent and thereafter decline to two or less by age 80.
• Clinically diagnosed depression affects 11% of the 20-64% population and is more common in women, although the prevalence varies widely from those with no risk factors to those with various.

The full report can be downloaded at the link below. It is part of the Whole Systems Dataset Project (WSDP), which is led by the Public Health Division at the London Borough of Tower Hamlets (LBTH).  Partnering organisations include the UCL Institute of Health Equity, and the Tower Hamlets Together (THT) partnership whose members include: London Borough of Tower Hamlets (LBTH), Bart’s Health NHS Trust, East London Mental Health Foundation Trust, Tower Hamlets Clinical Commissioning Group, Tower Hamlets Council for Voluntary Service, and Tower Hamlets GP Care Group.