Journal of Public Health Advance Access originally published online on October 22, 2008
Journal of Public Health 2009 31(1):147-153; doi:10.1093/pubmed/fdn089
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Deprivation and self-reported health: are there ‘Scottish effects’ in England and Wales?
David K. Whynes, Professor of Health Economics
School of Economics, University of Nottingham, Nottingham NG7 2RD, UK
Address correspondence to David K. Whynes, E-mail: david.whynes{at}nottingham.ac.uk
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Abstract |
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Background Although the association between poor health and deprivation is well-founded, a ‘Scottish effect’ has been observed, whereby the level of health appears even poorer than Scotland's higher level of deprivation should warrant. We consider whether ‘Scottish effects’ also occur within the regions of England and Wales.
Method Using ward-level data from the national census, we regress healthy life expectancies relative to total life expectancies on Carstairs deprivation scores, households' average disposable incomes, geo-spatial characteristics and regional dummy variables.
Results Higher incomes and lower Carstairs scores are each associated with longer proportions of lives expected to be spent in good health or without long-standing illness. Relative to the London region, the coefficients on the regional dummies are uniformly negative and mostly significant.
Conclusions There exist differences in relative health expectancies between the regions of England and Wales, which are not fully explained by the differences in socio-economic circumstances. Conventional deprivation measures tend to understate the poorer health performances of the more deprived regions (Wales and the north of England), and the understatement increases with deprivation. The exception to the rule is London, where health expectancies are superior to those which deprivation leads us to expect.
Keywords: carstairs score, deprivation, healthy life expectancy, self-reported health