I am often asked why I dedicate so much time to blogging. One of the reasons is to help disseminate knowledge and to help curate knowledge, i.e. to highlight what is important to pwMS. By doing this I am participating in a ‘healthcare revolution’ that is leading rapidly to an era when people with a chronic disease will be able to self-manage their disease. Another important reason for blogging is to counteract ‘fake knowledge’, ‘pseudoscience’ and ‘fake news’. Unfortunately, the latter often brings out the worst in some of our followers (aka trolls).
|Trends in life expectancy in the most deprived local authorities and the rest of England,
and the relative and absolute differences 1983-2015. (Source BMJ)
Barr et al. Investigating the impact of the English health inequalities strategy: time trend analysis. BMJ 2017;358:j3310.
Objective: To investigate whether the English health inequalities strategy was associated with a decline in geographical health inequalities, compared with trends before and after the strategy.
Design: Time trend analysis.
Setting: Two groups of lower tier local authorities in England. The most deprived, bottom fifth and the rest of England.
Intervention: The English health inequalities strategy—a cross government strategy implemented between 1997 and 2010 to reduce health inequalities in England. Trends in geographical health inequalities were assessed before (1983-2003), during (2004-12), and after (2013-15) the strategy using segmented linear regression.
Main outcome measure: Geographical health inequalities measured as the relative and absolute differences in male and female life expectancy at birth between the most deprived local authorities in England and the rest of the country.
Results: Before the strategy the gap in male and female life expectancy between the most deprived local authorities in England and the rest of the country increased at a rate of 0.57 months each year (95% confidence interval 0.40 to 0.74 months) and 0.30 months each year (0.12 to 0.48 months). During the strategy period this trend reversed and the gap in life expectancy for men reduced by 0.91 months each year (0.54 to 1.27 months) and for women by 0.50 months each year (0.15 to 0.86 months). Since the end of the strategy period the inequality gap has increased again at a rate of 0.68 months each year (−0.20 to 1.56 months) for men and 0.31 months each year (−0.26 to 0.88) for women. By 2012 the gap in male life expectancy was 1.2 years smaller (95% confidence interval 0.8 to 1.5 years smaller) and the gap in female life expectancy was 0.6 years smaller (0.3 to 1.0 years smaller) than it would have been if the trends in inequalities before the strategy had continued.
Conclusion: The English health inequalities strategy was associated with a decline in geographical inequalities in life expectancy, reversing a previously increasing trend. Since the strategy ended, inequalities have started to increase again. The strategy may have reduced geographical health inequalities in life expectancy, and future approaches should learn from this experience. The concerns are that current policies are reversing the achievements of the strategy.