Health Care Evaluation: Deprivation measures
Deprivation scores can be ascribed to an area or population to give a picture of its social and economic status.
When using deprivation scores, it is important to ensure that the area score being looked at does not confound the outcome being looked at eg living in a deprived area does not necessarily make you unhealthier, however being unhealthy is part of the deprivation score. Ascribing an area’s characteristics to the individual can lead to ecological fallacy.
Individual indicators used in the UK
National statistics socio-economic classification (NSSEC)
In 2001 the National Statistics Socio-economic Classification (NS-SEC) replaced Social Class based on Occupation (SC, formerly Registrar General's Social Class) and Socio-economic Groups (SEG). The NS-SEC classifies people based on their job and level within that job and this classification is now used in all official statistics and surveys.
There are 8 broad employment categories with many sub-categories beneath (not shown):
|
Categories |
|
|
1 |
Higher managerial and professional occupations |
|
1.1 Employers in large organisations and higher managerial occupations |
|
|
1.2 Higher professional occupations |
|
|
2 |
Lower professional and higher technical occupations, Lower managerial occupations, Higher supervisory occupations |
|
3 |
Intermediate occupations |
|
4 |
Employers in small organisations and own account workers |
|
5 |
Lower supervisory and lower technical occupations |
|
6 |
Semi-routine occupations |
|
7 |
Routine occupations |
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8 |
Never worked and long-term unemployed, including full-time students, and occupations not stated or inadequately described |
Source: www.ons.gov.uk/about-statistics/classifications/current/ns-sec/cats-and-...
Other individual markers of socio-economic status sometimes used in public health include: income, occupation, years of education, housing, ownership of various goods such as car, washing machine etc.
Summary of area indicators used in England
|
Deprivation score |
Issued by and latest version |
Domains |
Pros |
Cons |
|
Index of Multiple Deprivation |
Issued by Department of Communities and Local Government- latest version 2007 |
Includes the dimensions- employment, income, health and disability, education skills and training, barriers to housing and services, crime and disorder, living environment, plus overall score |
Issued at SOA level- can be aggregated by population-weighted averages. DCLG does this for LA but not PCTs because of boundary issues. Broad range of measures |
Cannot make direct comparisons between 2004 IMD and 2007 IMD Scores because scores are calculated differently by year. Can only comment on relative rank differences between years. |
|
Jarman score |
Initially developed as a measure of GP workload Used to determine deprivation payments to GPs by DH |
Includes: -% people in households aged >65 living alone, -% people in households aged <5, -1 person >16 plus 1 or more children <16, -those >16 seeking work, -persons in households with >1 person per room, -moved within last year, -households headed by new commonwealth /Pakistan. |
Can be used for small areas Diverse range of measures |
Differences between wards are masked Data is linked to last census (2001) so can be out of date Does not indicate the proportion of people in an area who are deprived Biased towards urban population |
|
DETR 2000 |
Uses ward level indices from former Department of the environment, transport and the regions (DETR) 2000 combined with IMD 2000 |
6 domains are: -income -employment -health deprivation and disability -education, skills and -training -housing -geographical access to services |
Data is updateable Can distinguish between different aspects of deprivation Gives the proportion of people that are deprived for the income and employment domains |
Some domains (housing) derived from only a few data sources Variables are weighted differently though justification is not clear Access score is more reflective of rural rather than urban need Data is not available below ward level District averages are applied to ward level in some instances |
|
Townsend Material Deprivation Score |
From last census |
4 domains are: -Unemployment: % economically active who are employed -car ownership -owner occupation -overcrowding (>1 person per room) |
Can be used to look at small areas Highly correlated with measures of ill-health Easy to calculate because sum of standardised scores |
Data can be out of date as linked to last census- particularly in terms of housing tenure Does not indicate the proportion of people in an area who are deprived Better indicator of deprivation in urban areas that rural areas |
|
Carstairs |
Office of National Statistics from last census |
4 domains are: -Unemployment: % economically inactive males aged >16 who are employed -% households without car ownership -overcrowding (>1 person per room) % residents in households with an economically active head of household in Social Class IV or V approximated from NS-SEC |
Based on census so allow objective results for whole population Can be used to look at small areas For an outcome such as low birthweight, Carstairs scores have been shown to perform better than individual social class in describing the extent of inequalities in the population[9] |
Data can be out of date as linked to last census- particularly in terms of housing tenure Better indicator of deprivation in urban areas that rural areas |
Adapted from: http://www.avon.nhs.uk/phnet/PHinfo/understanding.htm
Many other countries around the world use additional indices of deprivation.
Deprivation indices can be ascribed to different geographical areas such as PCT, locality, ward or super output area (SOA)*.
*Super Output Areas (SOAs) are a geographic hierarchy designed to improve the reporting of small area statistics. Unlike electoral wards, SOA layers (lower, middle and upper) are of consistent size across the country and are not subjected to regular boundary change. [10] In England there are:
- 32,482 Lower Layer SOAs with a minimum population of 1000
- 6,780 Middle Layer SOAs with a minimum population of 5000 and
- approximately 2,000 Upper Layer SOAs (the nature of upper layer SOAs has not yet been determined)
SOAs are defined by 9 characters: The first character is either E for England or W for Wales. The next two characters are either 01 for Lower Layer, or 02 for Middle Layer and the remaining six characters make up the unique 6-digit tag for each zone.[11]
References
•[9] http://www.statistics.gov.uk/articles/hsq/HSQ31deprivation_using_carstai...
•[10] http://www.statistics.gov.uk/geography/glossary/s.asp
•[11]http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=571&dirID=110769
© Rosalind Blackwood 2009
