In the 2011 Census, almost 80 per cent of residents in England and approximately 77 per cent of residents in Wales reported their general health as ‘Good’.
The 10 local authorities with the highest percentages of ‘Good’ health were clustered in an area to the south and west of London.
The lowest percentage of ‘Good’ health for males was reported in Merthyr Tydfil, which is in Wales (71.5 per cent), and for females in Tower Hamlets, which is in London (69.2 per cent).
Younger people (aged 35 and under) showed the least variation in their health status between the local authorities.
Self-assessed health differences were widest between authorities at ages 65-74.
Among males and females there was a strong relationship between self-assessed ‘Good’ general health and area deprivation, both in England and Wales.
This short story describes self-assessed general health by age, gender and administrative geographical areas in England and Wales, using the latest 2011 Census data.
Census data helps to describe the characteristics of people and households across areas in detail, giving government, private and voluntary sector organisations information to support planning and decision-making, and enabling public debate.
The 2011 Census asked two questions related to health. The first question asked about an individual’s general health. Respondents to Question 13 (Figure 1) can be categorised as assessing their health as ‘Good’ if they answered Very Good or Good, or as having ‘Not Good’ health if they assessed it as Fair, Bad or Very bad.
Age standardisation is a technique to produce comparable results across populations of different age structures. In England and Wales some local authority populations have markedly younger or older populations compared with the England and Wales average. Those populations with proportionately more residents at older ages are likely to have less favourable rates of self-assessed health simply on grounds of age, preventing other factors such as area deprivation being examined as a possible reason for health differences.
Age standardisation adjusts for these age differences, enabling populations to be compared on an equal footing. This short story gives a percentage of self-assessed health for each local authority’s resident population, enabling them to be ranked fairly.
The European Standard Population (ESP 2013) has been used to age standardise percentages of self-assessed health. Please see the background notes section for more detail.
This report uses English local authorities’ respective Index of Multiple Deprivation 2010 summary score to illustrate the pattern in health status with relative area deprivation in England. This index measures deprivation across seven domains: income, employment, health, education, living environment, crime and access to services. For Wales this report uses the Welsh Index of Multiple Deprivation (WIMD) 2011 to measure the relative deprivation of Welsh unitary authorities. The eight domains used in the WIMD are similar to those used in England: income, housing, employment, access to services, education, health, community, safety, physical environment.
The English index takes into account the characteristics of areas within each local authority such as employment and service access. This can be used to generate an average summary score across all neighbourhoods within the local authority, which enables local authorities to be ranked by the level of relative deprivation experienced.
Further details of how Welsh unitary authorities are ranked can be accessed on the StatsWales website.
The inclusion of these ranks in the tables shows how health status varies by level of deprivation that the authority’s population is exposed to.
Self assessment of health is an important indicator of an individual’s health-related well-being, indicating general physical and mental functioning, fitness for work and independent living. Figure 2 shows age-standardised rates of general health broken down into three categories for males and females in England and Wales. These national figures provide a benchmark for local authorities to compare themselves with.
In England and Wales 80.1 per cent (21.7 million) of males and 79.5 per cent (22.2 million) of females assessed their health as Very good or Good; a higher percentage of females assessed their health as Fair (14.5 per cent) than males (13.9 per cent). Only 6.0 per cent of males and 6.0 per cent of females assessed their general health as either Bad or Very bad. At the national level the self-assessed general health of males was slightly more favourable than females.
Figure 3 describes the overall age distribution of ‘Good’ general health for males and females across England and Wales. A familiar pattern of worsening health with increasing age is observed for each gender, with sharper declines occurring for those aged 50 and above. Children and young adults had the best self-assessed health, with only a modest difference apparent for those aged between 0 and 35. Among females, self-assessed health is less favourable than among males at ages 75 and above.
The remaining analysis in this report has been calculated separately for England and for Wales. One reason for this is because different indices of multiple deprivation are used by the countries and they are not comparable. In addition, as Health is a devolved policy area, administrations in England are interested in English rankings of local authorities for use in planning local services, while the Welsh government is primarily interested in Welsh unitary authority rankings for the same purposes.
ONS published data on general health prevalence based on the 2011 Census in January 2013, using crude rates for all persons to rank local authorities. This report presents data for the same time period, but for males and females using age standardised rates.
There are pronounced differences in local authority rankings on the two measures (crude versus age standardised); this illustrates the impact and benefits of age standardisation in enabling a fairer comparison between local authorities to be made. The top and bottom 10 local authorities in the earlier release were partly ranked on account of their relatively younger or older population structures. For example, Wandsworth, in London, with one of the youngest population structures was ranked 6th using crude rates, compared to 160th for males and 167th for females using age standardised rates. While East Lindsey, in Lincolnshire, with a much older age structure, ranked 326th using crude rates, compared to 277th for males and 260th for females using age standardised rates.
The earlier analysis showed only a weak relationship between crude rates of good health and area deprivation for local authorities, showing that age-structure differences can obscure other important local factors linked to health.
By using age standardised rates a more valid ranking of local authorities can be made, and the relationship between self-assessed ‘Good’ general health and local area deprivation can be re-examined.
This report includes the data of self-assessed ‘Good’ health for all 326 local authorities in England; however, because of small population counts the City of London has been merged with the neighbouring London Borough of Hackney, and data for the Isles of Scilly has been merged with Cornwall UA. Therefore the analyses presented here are based on 324 local or unitary authorities.
Authorities are ranked for males and females separately using their respective age-standardised percentage of self-assessed ‘Good’ general health which combines the Very Good and Good responses. Tables 1 and 2 show the 10 local authorities with the highest and lowest age-standardised percentages of self-assessed ‘Good’ general health for males and females respectively.
|Local Authority||'Good' health Rank5||Age standardised percentages 'Good' health||IMD Ranks 2010|
|Local Authority||'Good' health Rank5||Age standardised percentages 'Good' health||IMD Ranks 2010|
|Barking and Dagenham||319||72.9||22|
|Hackney and City of London||320||72.4||2|
The composition of the top 10 local authorities is similar for males and females. These local authorities are clustered in an area to the South and West of London, known for being among the least deprived areas of England: the counties of Surrey, Buckinghamshire, Oxfordshire and Hampshire, with predominantly semi-rural populations. In these local authorities the male age-standardised rate of ‘Good’ health ranged from 86.2 per cent in South Bucks to 87.6 per cent in Hart; for females the equivalent range was 85.9 per cent in Horsham to 86.9 per cent in Chiltern.
In contrast, the bottom 10 is composed of predominantly urban centres in the North, Midlands and London, where levels of deprivation were high. For males the age-standardised rate of ‘Good’ health ranged from 72.4 per cent in Manchester to 74.2 per cent in Barnsley, showing that more than 1 in 4 of the male population in these local authorities assessed their general health as ‘Not Good’. For females the equivalent range was 69.2 per cent in Tower Hamlets to 73.5 per cent in Leicester, with females in the London boroughs of Newham and Tower Hamlets assessing their general health least favourably across England.
The local authorities of City of London, Richmond-upon-Thames, Wandsworth, Oxford and St. Albans appeared in the top 10 based on having the highest percentages of crude rates of self-assessed ‘Good’ health in the January 2013 report but dropped out of the top 10 when their age standardised rates were calculated for this report. Conversely East Lindsey, Tendring, Sunderland, South Tyneside, County Durham, Mansfield and Thanet had appeared in the bottom 10 in the January 2013 story based on having the lowest percentages of crude rates of self-assessed ‘Good’ health but are not in the bottom 10 for this analysis. This is mainly because of the different age structures: those which dropped out of the top 10 had younger population structures, and those which dropped out of the bottom 10 had older population structures.
Comparisons of ‘Good’ general health for males and females across all authorities in England in 2011 are shown in Maps 1 and 2 respectively. The darker colours indicate the authorities with higher percentages of ‘Good’ health and the lighter colours show the lower percentages.
Once differences in age structure are accounted for, there is a strong relationship between general health and area deprivation. Among males, the correlation coefficient is 0.94 and among females 0.93, a close to linear association. The closer to 1 the coefficient is the stronger the relationship between general health and deprivation. This means that even at the local authority level, area deprivation has a significant influence on self-assessed health.
The diverse ethnic composition of the London boroughs of Newham and Tower Hamlets may contribute to their population’s less favourable self-assessed health rates; assessment of general health is known to vary for cultural reasons as well as individual expectations of health status. However, both Newham and Tower Hamlets have poorer health outcomes on a number of measures such as lower health and life expectancy, higher rates of premature death from heart disease and strokes, and higher rates of people diagnosed with diabetes than for England as a whole. For females, Healthy Life Expectancy at birth in 2009-11 was lowest in Tower Hamlets and third lowest in Newham.
For those local authorities not included among the highest and lowest 10, their respective age-standardised percentages of self-assessed ‘Good’ general health and their IMD 2010 summary score rank can be downloaded using the link to the reference table accompanying this publication.
There were also some differences in the ranking of the unitary authorities in Wales following age-standardisation, compared with the results published in January 2013, but less markedly than those for England.
There are 22 unitary authorities in Wales; Cardiff had the largest population with the youngest population structure.
Table 3 shows the age-standardised percentages of self-assessed ‘Good’ health for the five Welsh unitary authorities with the highest and lowest percentages, for males and females respectively, along with the unitary authority rank on the Welsh Index of Multiple Deprivation(WIMD), 2011.
|Unitary Authority||'Good' health Rank4||Age standardised percentages 'Good' health||WIMD rank 2011|
|The Vale of Glamorgan||5||80.2||12|
|Neath Port Talbot||18||74.0||6|
|Rhondda Cynon Taf||19||73.3||3|
|Isle of Anglesey||4||80.4||19|
|Rhondda Cynon Taf||18||72.5||3|
|Neath Port Talbot||20||72.4||6|
Overall, males in Wales assessed their general health more favourably than females, but both genders had less favourable self-assessed health than their counterparts in England. Monmouthshire had the highest percentage of males assessing their health as ‘Good’ (81.9 per cent), although this would have placed Monmouthshire only in the middle of the English local authority rankings. The lowest percentage of self-assessed ‘Good’ health by males was in Merthyr Tydfil at 71.5 per cent, which was lower than the lowest ranking English local authority of Manchester. The inequality in health between administrative areas was lower in Wales than in England, but a similar pattern of health worsening with rising levels of deprivation exposure was observed, as in England.
Merthyr Tydfil also had less favourable health outcomes on other measures such as life expectancy where it was lower than the Welsh average in 2009-11, while its mortality rates from circulatory diseases, respiratory diseases and cancer was higher. Merthyr Tydfil was also ranked the most deprived unitary authority in Wales, having the highest proportion of Welsh LSOAs in the most deprived national decile using the WIMD 2011. Conversely, those in the top five were among the least deprived.
Welsh females assessed their general health most favourably in Gwynedd at 81.6 per cent, with Monmouthshire and Powys also in the top five unitary authorities. Again, the female rates in the top five authorities in Wales would have positioned these authorities only in the middle of the English local authority rankings.
The only effect age-standardisation had on the top and bottom five unitary authorities in Wales was to displace Cardiff as the authority with the highest percentage of self-assessed ‘Good’ general health; before age-standardisation Cardiff was ranked 1st, but following age-standardisation it was ranked 12th for both males and females because of the relatively young age profile of Cardiff.
The relationship between self-assessed health and area deprivation is also strong in Wales, following age-standardisation. Among males, the correlation coefficient is 0.84 and among females 0.86. This is not as strong as for England, possibly because of different method of ranking authorities using the WIMD 2011 (which is based on the proportion of neighbourhoods placed in the 10th most deprived neighbourhoods the authority has within its boundary). At the unitary authority level, area deprivation has a significant influence on self-assessed ‘Good’ health in Wales.
Overall general health was more favourably assessed in North and Mid Wales than South Wales. For those authorities not included among the highest and lowest five, their respective age-standardised percentages of self-assessed ‘Good’ general health and their WIMD 2011 rank can be found in the reference table.
While health inequalities between authorities can be measured using age-standardised percentages, it is also interesting to assess at which ages health inequalities are wider or narrower. In England, the London borough of Tower Hamlets had the lowest age-standardised percentage of self-assessed ‘Good’ general health for females and the second lowest for males; while Hart in Hampshire had the highest percentage for males and the second highest for females.
Figure 4 shows self-assessed health at different ages throughout the life course between all residents of Tower Hamlets, the seventh most deprived authority in England, and all residents in Hart, the least deprived authority, with the all England figures also included.
This chart shows that the absolute difference in self-assessed health between these local authorities is small at the younger ages (under 35). However, although health deteriorates from the age of 35 in both local authorities, the decline is more pronounced in Tower Hamlets. The difference in age-specific percentages of ‘Good’ health between Tower Hamlets and Hart widens from a difference of 2.2 percentage points higher in Tower Hamlets at ages 25-34, to 35.7 percentage points higher at ages 65-74, before starting to narrow beyond age 74.
Residents of Hart aged 50-64 assessed their general health more favourably than residents in Tower Hamlets aged 35-49. Similarly, Hart residents aged 75-84 assessed their health more favourably than Tower Hamlets residents aged 50-64. These results show stark contrasts in premature health declines in different parts of England. This provides the opportunity for general population health improvement, by improving the health of those aged 35-74 in authorities such as Tower Hamlets and other authorities which have ‘Good’ health ratings below the England average.
Among residents in Wales, the unitary authority of Gwynedd had the most favourable self-assessed health for females and second most favourable for males, while Merthyr Tydfil had the least favourable. Figure 5 shows that a similar age-specific pattern to that in England was observed. The difference between the Welsh authorities which assessed their health most and least favourably was slightly wider at ages 25-34 at 3.8 percentage points than the top and bottom England authorities, but at older ages the divergence was less marked than between Hart and Tower Hamlets. Age-specific variations in self-assessed health between Gwynedd and Merthyr Tydfil were widest at ages 65-74, with a 25.2 percentage point gap, smaller than at the equivalent age in England (see above). At ages 75 and above there was a greater convergence in percentages of ‘Good’ health between these authorities than in the England authority comparison.
Additional age-specific data is available for all local and unitary authorities; an interactive map shows the percentage of those with ‘Good’ health in each age group together with their individual trend compared to the England and Wales average in an interactive chart.
Details of the policy governing the release of new data are available by visiting www.statisticsauthority.gov.uk/assessment/code-of-practice/index.html or from the Media Relations Office email: firstname.lastname@example.org