The most important charts in health and social care

A few days ago I posted a pic from some analysis done in Sheffield with the bold strap line of “second most important chart in contemporary health care”

Whether it IS indeed the second, third or most is probably immaterial

I was then asked for my view on the most. Others then suggested others. It’s probably impossible to suggest a “single”

Here are a few

Let me have others and I will add them to this top of the pops

Here is my take. With a line or two on each

1) the jaws of doom

This is from the Scottish Deep End crew.

Demonstrates the relatively flat shape of the curve of funding per capita in primary care with steep slope of need. Important if you are making a case for equitable (not equal) distribution of resources.

2). The fall off in historic improvements in life expectancy

This is a HUGE deal. I and many others have blogged on this. The same is happening re healthy life expectancy.

This was updated in the 2018 Health Profile

3). Life expectancy and heathy life expectancy by deprivation decile

Note the differences of years not in good health comparing best and worst. This drives demand for services.

3a). Healthy life expectancy split by deprivation

4). Multi morbidity prevalence by age and deprivation

Note the relatively big differences between best and worst in terms of % prevalence at a certain age. This chart at a stroke blows a significant hole in the “ageing population spells certain doom” hypothesis

5). The law of diminishing marginal returns is simple, yet mostly overlooked. Meanwhile harm goes up linearly.

Accept that my value judgement

6). The graph of doom. All consuming if you are working in social care. Money in vs demand.

7) Healthcare costs across lifecourse (CHE)

Note the gradient in cost across social divides. Reference here

8). Chris Bentley’s inverse care map

8a)

Equity is key to reducing inequality. This useful illustration may mirror what dietetic depts see. Given greater levels of need in the most deprived areas, u would expect to see higher elective surgery in deprived areas instead these ppl often arrive as emergency

C/o @davidjohnsrd

9)

10)

Underscoring the importance of mental health. Writ large.

And taking a longer term (though it is a very immediate and here and now issue) and global AND local issue

Policy thresholds in mitigation

https://www.nature.com/articles/ngeo2607

11). This is what #northernpowerhouse should be there to fix! There was no North/South divide in mortality until 1995 and look at it now @michaelmarmot

12). Y6 boys obesity trend across 10 years of the NCMP by deprivation quintile.

From @PHE_uk @PHE_obesity. Frightening – #inequality widening all the time.

All the more reason for way upstream interventions

Unlikely to be a problem solved by service offer one person at a time, depth of coverage, effectiveness of intervention in toxic environment

13)

Another @MichaelMarmot one – highlighting just how early in a child’s life inequalities in outcomes are seen

nick Hassey suggested an important caveat

“While disadvantage certainly emerges early, this discussion highlights concerns Feinstein (the original author) does not account for regression to the mean or measurement error properly.

See here

So there’s certainly divergence between rich and poor but the “cross-over” in that graph is contested at *best* – and leads us to focus too much on early years as a silver bullet. When actually it’s sustained effort over several key stages that is key

And it’s worth stressing, that there’s a gap that emerges early b/w well off and more disadvantaged kids is well evidenced. It’s probably just smaller & the “cross-over” bit probably doesn’t exist”

14). The slowing of historic falls in infant mortality over recent years

15) climate

Harry Rutter, says this one from the IPPC report is – by far – the most important chart in the whole word, ever, for anything

Who am I to disagree

He is a global professor and everything

16) complex lives vs social deprivation

Via @pathwayuk

Self explanatory

What are your favourites.

I’ll add to this as they come

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8 comments

  1. Hello Greg-fantastic slide set! John Middleton has suggested you might be interested in an old Liam Donaldson one from his 2001 Annual report which I still use in my inequality lectures. Shows that region of residence makes no difference in male mortality (1991-93) for the affluent but a huge difference for the deprived with a marked North-South gradient that simply can’t be explained by ‘behaviours’. Liam explicitly recognised environmental quality as a plausible factor as has Marmot in his subsequent analyses which show these differences have persisted. The harms of employment in the old ‘dirty’ industries have long been accepted but it is so disappointing that the subsequent impact of long term unemployment in many areas following their closure in the 80s/90s as well as the continuing impact of their contaminative legacy on subsequent generations hasn’t had a higher profile nationally. Might be interesting in relation to slide 11

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  2. […] it is a driver of demand for public services. I’d encourage readers to consider my take on the  the most important charts in health care, particularly chart 2, 3 & 4. This is where the demand in your health and social care system is […]

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