Men and women in the lowest income bracket are three times more likely than those in the highest income bracket to have kidney disease and to smoke. the disparity in health between England’s richest and poorest is particularly marked amongst women, with those in the lowest income bracket four times more likely to be diagnosed with diabetes and twice as likely to be obese than women in the highest income bracket.

Vasant Hirani, Senior Research Fellow in UCL’s Department of Epidemiology and Public Health, and co-editor of the study, said: “This important survey provides an annual health check for the nation, and shows that there are still marked inequalities in health between different socio-economic groups. there is a clear social gradient, with people with lower incomes much more likely to experience poor health than those that are more affluent. We need to reduce inequalities and improve health outcomes for some of the most vulnerable groups in our society – a real challenge in the current economic climate.”

Rachel Craig, Research Director at the National Centre for Social Research, and co-editor of the study added: “The Health Survey for England gives us an excellent picture of how health changes over time, allowing us to accurately monitor the problem areas of health inequality in Britain today. As the coalition takes a new approach to public health during a time of high satisfaction levels in the NHS it will be vital to monitor how outcomes develop. in particular, it will be interesting to see how successful the government plans are to ‘nudge’ people towards making healthy lifestyle choices.”

Key measures of health covered by the latest report include:

Kidney disease

The Health Survey this year provides the first national picture of chronic kidney disease. Results show that between 5% and 10% of adults have symptoms of kidney damage, although only around 2% report a doctor’s diagnosis of kidney disease.

Three times as many men in the lowest income bracket have kidney disease than men in the highest income bracket (2.4% compared with 0.8%) and nearly three times as many women in the lowest income bracket (1.4%) than women in the highest income bracket (0.5%).

Diabetes

Overall, 9% of men and 6% of women aged 35 and over reported doctor-diagnosed diabetes. the biggest disparity in prevalence is between women in the highest and lowest income brackets. Women in the lowest income bracket are much more likely to suffer from diabetes (8%) in comparison with women in the highest income bracket (2%). Amongst men the prevalence rate is lowest for those in the highest income bracket (7%) and highest for men in the middle income bracket (11%).

Adult obesity

Obesity has been on the rise for 20 years but we are beginning to see the trend is slowing down. however nearly 2 in 3 men and women in Britain are overweight, with 22% of men obese and 44% overweight . 24% of women are obese and 33% overweight.

Women in the lowest income bracket are twice as likely to be obese, with a 33% prevalence rate for this group in comparison with 17% of women in the highest income bracket. this is important because being overweight increases a person’s risk of developing health problems such as heart attack, stroke, type 2 diabetes, high blood pressure and some types of cancer.

Smoking

For both men and women, smoking prevalence was around three times higher among those from the lowest income households (40% for men and 34% for women) than among those living in the highest income households (14% for men and 11% for women).

Alcohol consumption

In contrast to other health measures, alcohol consumption is one area where lifestyles are less healthy among the better off. Men and women in the highest income bracket were most likely to have drunk alcohol in the last week (86% and 72% respectively); the proportion that had drunk in the last week declined in line with income, so that just 54% of men and 47% of women in the lowest income bracket had drunk alcohol in the last week. Men and women in the highest two income brackets were also more likely than others to have drunk alcohol on five or more days in the week.

Fruit and vegetable consumption

Adults in the higher income brackets were more likely than those in the lower income brackets to eat the recommended five or more portions per day: 32% of men and 37% of women in the highest bracket did so, compared with 18% and 19% respectively in the lowest bracket.

Longstanding illness

Both men and women in the highest income bracket were less likely to report a longstanding illness than those in the lowest income bracket (38% of men and 37% of women in the highest income group compared with 49% of men and 52% of women in the lowest income group). Examples of longstanding illness include asthma, diabetes, arthritis and stroke.

Self-reported general health and acute sickness

Both men and women in the lowest income bracket were most likely to consider their health as bad or very bad (18% of men and 15% of women compared with 3% of men and 2% of women in the highest income bracket). Men and women in the lowest income bracket were most likely to have cut down on the things they usually did in the last two weeks because of illness or injury (17% of men and 23% of women compared, with 10% of men and 12% of women in the highest income bracket).

In a report in the December American Journal of Public Health (AJPH), a Massachusetts General Hospital (MGH) research team describes how their model for screening and assessing patients for depression in a primary care setting increased the percentage of depressed patients entering treatment nearly sevenfold.

“Ours is the first study to incorporate a culturally sensitive interview into a collaborative care model in order to address disparities in mental illness treatment among ethnic minorities in primary care,” says the report’s lead author Albert Yeung of the MGH Department of Psychiatry and an assistant professor of psychiatry at Harvard Medical School. ”the model appears to be a promising way to treat this population, which highly underutilizes mental health services.”

Yeung and his co-authors note that, while major depression is just as common among Asian Americans as in the overall U.S. population, a lack of familiarity with mental illness and a cultural stigma against psychiatric disorders lead to most cases of depression among Asian Americans going unrecognized and untreated. Language barriers, a tendency to seek medical care for physical symptoms only, and lack of cultural sensitivity among health care providers can further exacerbate the disparity.

To overcome these barriers, the MGH team devised a culturally sensitive collaborative treatment model that incorporates systematic depression screening at all primary care visits, contacting those who screened positive for depression to recommend assessment, and designed an assessment protocol designed to explore patients’ cultural beliefs. Patients who chose to enter treatment received either usual care or care management, which included regular telephone contact with a care manager along with depression treatment by a primary care physician, psychologist, or psychiatrist.

The study tested this model among patients of the South Cove Community Health Center in Boston’s Chinatown, where Yeung is on staff. Completion of a bilingual health questionnaire has been part of routine primary care at the health center for more than a decade, and the research team reviewed screening results for 4,228 adult Chinese immigrants who came to South Cove for primary care visits between late 2004 and early 2007. the almost 300 patients who screened positive for depression were contacted within two weeks of their screening by investigators, who informed patients of their results, told them about the study and recommended more focused psychiatric assessment.

While more than half the contacted patients declined further treatment, 122 came in for the assessment. in addition to a standard survey of depression symptoms, the assessment asked participants how they would describe their symptoms, what they believed caused them, how symptoms affected their daily lives, and what they hoped that treatment would accomplish. Based on participants’ answers, the assessing clinicians were able to communicate information about depression in more comprehensible ways, using the participants’ language and illness beliefs. Of the 104 participants whose depression diagnosis was confirmed in the assessment, 100 agreed to enter treatment — 96 percent of those with a confirmed diagnosis and 43 percent of those who had screened positive on the original questionnaire. Prior to this study, only 6.5 percent of South Cove patients with a positive depression screening result entered treatment.

Participants — who could choose to receive treatment from their primary care physician or from a psychiatrist or other therapist at the health center — were randomized to receive either usual depression care or care management. at the end of the 24-week study period, more than half the participants in both treatment groups had symptom improvement rates as good as or better than those reported by several large-scale depression treatment studies. While there were no significant differences in response between the usual and managed care groups, the authors believe that could be explained by the high percentages of both groups who chose to receive care from South Cove-based psychiatrists.

“Our model appears to be very promising, but it needs to be tested at other centers,” says Yeung. ”Similar models could be designed and tested to help other minority populations who have cultural barriers that prevent receiving mental health services.” Additional co-authors of the AJPH report are Irene Shyu, Lauren Fisher, Shirley Wu, Huaiyu Yang, and senior author Maurizio Fava all of MGH Psychiatry. the study was supported by a grant from the National Institute for Mental Health.