Health inequalities

Health inequalities arise because of inequalities in society, in the conditions in which people are born, grow, live, work, and age. There is a ‘social gradient’ in health – the lower a person’s position in society, the worse their health [1]. In the UK, socioeconomic inequalities have increased since the 1960s and this has led to wider inequalities in both child and adult obesity, with rates increasing most among those from poorer backgrounds. This worsening of health inequalities in relation to obesity is more marked for women, and when socioeconomic position is measured by education, an indicator that captures the influence of childhood conditions as well as those in adulthood [2]. In children, socioeconomic inequalities in obesity are stronger in girls than boys.

Other dimensions of inequality, which intersect with socioeconomic status in complex ways, also have important influences on health. There are major health challenges relating to specific ’equality groups’ based on age, sex, ethnicity, sexuality, and disability [1]. Where information is available, these issues are discussed below.

Age and sex

There are differences in obesity prevalence by both age and sex. The prevalence of obesity and overweight changes with age. Prevalence of obesity is lowest in the 16-24 year age group, and generally higher in the older age groups among both men and women. There is a decline in prevalence in the oldest age group, which is particularly apparent in men. This pattern has remained consistent over time.

Adult obesity prevalence by age and sex

Health Survey for England 2008-2012

Adult obesity prevalence by age and sex

Deprivation

Adults

Overall, for women, obesity prevalence increases with greater levels of deprivation, regardless of the measure used. For men, only occupation-based and qualification-based measures show differences in obesity rates by levels of deprivation.

Highest level of educational attainment can be used as an indicator of socioeconomic status. For both men and women obesity prevalence decreases with increasing levels of educational attainment.

Adult obesity prevalence by highest level of education

Health Survey for England 2006-2011

Adult obesity prevalence by highest level of education

Adult (aged 16+) obesity: BMI ≥ 30kg/m2
Source: Health Survey for England

More information and analysis is available in the Adult Obesity and Socioeconomic Status Data factsheet.

Children

There is a strong relationship between deprivation and childhood obesity. Analysis of data from the National Child Measurement Programme (NCMP) shows that obesity prevalence among children in both Reception and Year 6 increases with increased socioeconomic deprivation (measured, for example, by the 2010 Index of Multiple Deprivation (IMD) score). Obesity prevalence of the most deprived 10% of the population is approximately twice that of the least deprived 10%.

Prevalence of obesity by deprivation decile

National Child Measurement Programme 2012/13

Prevalence of obesity by deprivation decile

Source: National Child Measurement Progrmme

Child obesity: BMI ≥95th centile of the UK90 growth reference
Deprivation deciles assigned using the Index of Multiple Deprivation 2010, and the LSOA of residence of children measured

  • Click here to view the childhood obesity and deprivation map at local authority level
  • Click here to view the Child Obesity and Socioeconomic Status factsheet

[1] Lower Layer Super Output Area (LSOA). Small area statistical geography, with a minimum population of 1,000 (average 1,500). Smaller than Ward.

Ethnicity

There is no straightforward relationship between obesity and ethnicity, with a complex interplay of factors affecting health in minority ethnic communities in the UK.

Apart from Health Survey for England (HSE) data from 2004 which included a ‘boost sample’ from minority ethnic groups, there is little nationally representative data on obesity prevalence in adults from minority ethnic groups in the UK. Data are scarce or non-existent for many smaller ethnic groups and only a few qualitative studies have focused on these communities.

There is continuing debate about the validity of using current definitions of obesity for non-white ethnic groups, for both adults and children. Different ethnic groups are associated with a range of different body shapes and different physiological responses to fat storage. Revised body mass index (BMI) thresholds and waist circumference measures have been recommended for South Asian populations who are at risk of chronic diseases and mortality at lower levels than European populations. In terms of public health action, it is particularly important for South Asian populations in the UK to be aware of the health risks associated with an increased BMI and waist circumference.

The prevalence of obesity-related conditions such as cardiovascular disease and type 2 diabetes varies by ethnic group. Health behaviours also differ according to different religious, cultural and socioeconomic factors, as well as by geography. Whilst many people from minority ethnic groups have healthier eating patterns than the White population, unhealthy diets and low levels of physical activity are known to be of concern in some minority ethnic groups, in particular those of South Asian origin. Members of minority ethnic groups in the UK often have lower socioeconomic status, which is in turn, associated with a greater risk of obesity in women and children. People from minority ethnic groups may also experience elevated levels of obesity-related stigma.

Click here to view a NOO briefing paper on obesity and ethnicity published January 2011

Adults

Women from Black African groups appear to have the highest prevalence of obesity and men from Chinese and Bangladeshi groups have the lowest. Women appear to have a higher prevalence in almost every minority ethnic group, with a significant difference between women and men among the Pakistani, Bangladeshi and Black African groups.

Prevalence of obesity in adults by ethnic group

Health Survey for England 2004

Prevalence of obesity in adults by ethnic group

Adult (aged 16+) obesity: BMI ≥ 30kg/m2
Source: Health Survey for England

Children

The NCMP reveals substantial variation in obesity prevalence by ethnic group for both Reception and Year 6 children.

Obesity prevalence among boys in Reception is highest in the Black African, Black Other, and Bangladeshi groups. For girls in Reception obesity prevalence is highest among those from Black African, and Black Other ethnic groups.

Boys in Year 6 from all minority groups are more likely to be obese than White British boys. For girls in Year 6, obesity prevalence is especially high for those from Black African and Black Other ethnic groups. Some of these differences may be due to the influence of factors such as deprivation and, possibly, physical differences such as height.

Prevalence of obesity among Year 6 children by ethnic group and sex

National Child Measurement Programme 2012/13

Source: National Child Measurement Progrmme Child obesity: BMI ≥ 95th centile of the UK90 growth reference

Click here to view the NCMP trends report

Disability

There is limited data on disability and obesity. It is known that people with disabilities are more likely to be obese and have lower rates of physical activity than the general population [3]. Children who have a limiting illness are more likely to be obese or overweight, particularly if they also have a learning disability [4]. Both underweight and obesity are an issue for people with learning disabilities. This relationship varies according to age and gender.

Click here to download the PHE briefing paper on Obesity and disability – adults published June 2013

References

[1] Strategic Review of Health Inequalities in England Post-2010 (The Marmot Review), 11 February 2010

[2] Department of Health Public Health Research Consortium, Law, C., Power, C., Graham, H. and Merrick, D. (2007), Obesity and health inequalities. Obesity Reviews, 8: 19–22

[3] Rimmer J, Wang E, Yamaki K, & Davis B. FOCUS Technical Brief No. 24. Documenting Disparities in Obesity and Disability, National Center for the Dissemination of Disability Research (NCDDR) 2010.

[4] Child and Maternal Health Observatory (CHIMAT). Disability and obesity: the prevalence of obesity in disabled children, 21 July 2011.