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Health Inequalities

Levers

The “social determinants” of health (such as poverty) are translated into health inequalities in a number of ways including, for example, by creating barriers in access to services. We’ve called these factors “levers” for change. 

There are twice as many youth services in England’s richest areas than in the poorest

Public health screening and interventions

Public health screening such as for common sexually transmitted infections, and interventions such as vaccines, are important for maintaining health. The patterns by area deprivation are not entirely straightforward.

As Charts L11 and L12 show, young people in deprived areas are more likely than their peers in other areas to receive screening for Chlamydia, and more likely to receive emergency contraception. It is not clear why they have higher level of Chlamydia screening, but the higher rates of emergency contraception presumably reflects the fact that rates of under-18 conceptions are higher in areas of high deprivation, as shown in the health outcomes section of this website. Again it is interesting to note the impact of Covid-19 on these figures, reducing the rates of both Chlamydia screening and emergency contraception to all in the age group, regardless of area deprivation.

Research has found that sex education in schools can play an important role in adopting safe and consenting relationships. 1 in 10 pupils eligible for free school meals have reported not learning about STIs, consent, LGBT relationships or relationships in general during their RSE lessons (Stewart, H. et al. 2021).

Chart L11: Young people from the most deprived backgrounds are more likely to be screened for chlamydia
Chart L12: Young women in deprived areas are more likely to receive emergency contraception

Receipt of routine vaccinations during adolescence also have a complex relationship with area deprivation. As Chart L13 shows, in Scotland the rates of receipt of two doses of the HPV vaccination in secondary school are lower in areas of high deprivation. This is also reflected in Scotland in terms of rates of MenACWY in Scotland, as Chart L14 shows. The MenACWY is a single booster vaccination to protect young people from meningitis and septicaemia and it was introduced into the vaccine programme in 2015 in the UK.

Chart L13: Young people from the least deprived areas are slightly more likely to complete their HPV vaccine course in Scotland
Chart L14: Young people from deprived areas are less likely to receive their MenACWY vaccination in Scotland

However the same patterns do not hold for HPV vaccination in England, as Chart L15 shows. It may be that this somehow reflects data quality. Again, we also know this has been significantly affected by the Covid-19 pandemic, when overall rates of HPV vaccination fell from 64.7% of Year 9 females with the completed 2-dose course in 2019/20, compared to 83.9% in 2018/19 (Public Health England, 2020). Although overall rates begun to rise again in 2020/21, they have not yet reached pre-pandemic levels.

Read more about our method for analysing these data here.

Chart L15: Young people from more deprived areas are slightly more likely to receive the HPV vaccine in England, though this may have been disrupted due to Covid-19

However rates of MenACWY in England do show the same relationship with deprivation and vaccine uptake (Chart L16) as is also seen in Scotland (Chart L14).

Chart L16: Young people from the most deprived areas are less likely to receive their MenACWY vaccination in England

All data correct as of 1st May 2022

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