Mind the Gap: Geographical Inequalities in Health during the Age of Austerity

Background Stockton-on-Tees has the highest geographical inequalities in health in England, with the life expectancy at birth gap between the most and deprived neighbourhoods standing at over 17 years for men and 11 years for women. It is well acknowledged that place can create inequalities in health but there is a debate within geographical research as to whether the health and wellbeing of an individual are determined by their own attributes (the compositional theory) or the political economy and environmental attributes of the area where they live (contextual approach). More recently, it has been argued that these determinants interact with each other, signifying that they are ‘mutually reinforcing’. Method This is one of the first studies that provides the detailed empirical examination of the geographical health divide by estimating the gap and trend in physical and general health (as measured by EQ5D, EQ5D-VAS and SF8PCS) between the most and least deprived areas. It uses a novel statistical technique to examine the causal role of compositional and contextual factors and their interaction during a time of economic recession and austerity. Using a longitudinal survey that recruited a stratified random sample, individual-level survey data was combined with secondary data sources and analysed using multi-level models with 95 percent confidence intervals obtained from nonparametric bootstrapping. In addition, trend analysis was performed to explore the role of austerity. Results The main findings indicate that there is a significant gap in health between the two areas, which remained constant throughout the study period, and that compositional level material factors, contextual factors and their interaction appear to explain this gap. Contrary to the dominant policy discourse in this area, individual behavioural and psychosocial factors did not make a significant contribution towards explaining health inequalities in the study area. Austerity measures are exacerbating inequalities in general and physical health by disproportionately impacting those in deprived areas. The findings are discussed in relation to geographical theories of health inequalities and the context of austerity. The study concludes by exploring the avenues for further research and key policy implications