Inequality groups

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Health inequalities

An important part of public health work is to reduce unfair differences in health across our population. Health inequalities can be linked to different characteristics, and sometimes we do not have good enough data to assess or report on all of these. In this section we present the data that we do have on some of the most important aspects that are linked to health inequalities. Please note that inequalities in life expectancy linked to deprivation is covered elsewhere in this JSNA.

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Deprivation

Deprivation and health are often associated. Areas of higher deprivation levels tend to experience poorer health outcomes overall. The Index of Multiple Deprivation (IMD) is shown in page 2 of the dashboard. The Index of Multiple Deprivation is a commonly used indicator to describe overall deprivation of an area.  It is a combination of deprivation relating to income, employment, education, health, crime, living environment and barriers to housing and services.  It allows comparison between and across geographical areas. More information is available here.

Cambridgeshire is relatively less deprived than Peterborough. There is variation in the level of deprivation across the Cambridgeshire districts with Fenland being most deprived. Cambridgeshire has an IMD Score of 13.9 and Peterborough has an IMD Score of 27.8; out of 151 upper-tier local authorities Cambridgeshire is ranked 132 and Peterborough ranked 51 (1 being the most deprived). The IMD scores of the Cambridgeshire districts range between 8.5 in South Cambridgeshire and 25.4 in Fenland.

Compared to the nearest neighbours, most Cambridgeshire and Peterborough LTLAs are comparable to their nearest neighbours for their IMD rank. Fenland is more of an outlier, as it is ranked second most deprived when compared to its 15 nearest neighbours.

 

Children in relative low income households

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Poverty affects health in multiple and complex ways, and the impact of poverty in childhood can continue to affect people as they move into adulthood. The most recent data on children in low income households is from 2021/22 and as such does not fully reflect the impact of recent cost of living increases; the proportions and numbers presented here will have increased since these data were published. 

Page 4 of the dashboard shows the proportion of children in our areas living in relative low income households before housing costs, and this proportion was higher in Peterborough (25.1%) and Fenland (20.5%) than the England average (19.9%). It is important to note that a child in Peterborough was over three times more likely to be living in a low income household than a child in South Cambridgeshire. This data should also remind us that even in relatively less deprived areas such as South and East Cambridgeshire, in 2021/22 there were still significant numbers of children in low income households (2,435 in South Cambs and 1,563 in East Cambs).

Child poverty has worsened over time in England but in our areas up to 2021/22 it fluctuated rather than grew steadily. 

Ethnicity and general health

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The 2021 Census asked people about their ethnic background (see here) and their general self-rated health (see here) and self-rated health is also available by ethnic background. Please note that unlike the overall data presented elsewhere in this JSNA, the data on general health by ethnicity has not been adjusted for age, so if self-rated health tends to decline with age, we might expect ethnic groups with more older people to report poorer health. The unadjusted data presented here will also not match up perfectly with the age-standardised data presented elsewhere in the JSNA. 

Page 5 of the dashboard presents this data. Overall, 84% of Cambridgeshire residents and 82% of Peterborough residents say their health is good or very good. People from a White background are more likely than other groups to report that their general health is ‘not good’ (fair / bad / very bad); 17% in Cambridgeshire and 20% in Peterborough. People from an Asian background are more likely to report ‘not good’ health in Peterborough compared with Cambridgeshire (no statistical significance has been applied to these figures).  Asian people and people from a mixed ethnic background are the most likely to report good health (good / very good) in Cambridgeshire whereas in Peterborough it is Black people who are most likely to say their health is good. Across the district areas, Fenland is notable for having the poorest overall health in all ethnic groups.

People living with disability

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Page 6 of the dashboard presents data on the proportions and numbers of people living with disability, as self-reported in the 2021 Census. More than 145,000 people across Cambridgeshire and Peterborough are disabled under the Equality Act and living with a disability that either affects their day-to-day activity a little or a lot (16.2% of usual residents).  The data presented relate to age-standardised percentages, so take into account the age structure of the underlying population.

Disabled: Activity limited a lot

6.1% of people in Cambridgeshire (40,853 residents) and 7.9% of people in Peterborough (14,875 residents) are living with a disability where day-to-day activity is limited a lot, compared to 7.5% nationally. The proportion of disabled people in Fenland whose activity is limited a lot (8.4%) is notably higher than all other Cambridgeshire districts, as well as Peterborough.

Disabled: Activity limited a little

Around 1 in 10 people in Cambridgeshire and Peterborough are living with a disability where day to day activity is limited a little. This is similar to the England average (10.2%). At a district level, the proportion of people is highest in Fenland (11.2%).  

Data on statistical neighbours indicates all of the Cambridgeshire and Peterborough areas have similar levels of disability compared to their counterpart local authorities.

Children with a Special Educational Need (SEN)

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Page 6 of the dashboard shows the proportions of children with an identified special educational need (SEN) in Cambridgeshire and Peterborough. This is important information for planning educational and health services for these children.

2022/23 data show that in Cambridgeshire 16.8% of pupils have an identified SEN (this includes SEN support and EHC status) and in Peterborough this figure is 14.5% of pupils. This compares to 17.1% nationally (dashboard data shown: 83.2%, 85.5% and 82.9% with ‘no SEN’ respectively).

SEN with Education, Health and Care (EHC) plan status

In Cambridgeshire 5.3% of pupils have an identified SEN and an EHC plan in place. This compares to 3.8% of pupils in Peterborough and 4.2% nationally.

Analysis of pupils with EHC plan status shows that ‘autistic spectrum disorder’ is the primary need locally and nationally (24.4% of EHC pupils in Cambridgeshire, 41.9% Peterborough and 32.2% England).

In Cambridgeshire, this is followed by ‘social, emotional and mental health’ needs (17.9% of EHC pupils) and ‘speech, language and communication’ (14.4%). England also has these two categories, along with autism, as its most cited primary need for EHC pupils. In Peterborough, however, ‘speech, language and communication’ (11.3%) and ‘moderate learning difficulty’ (10.3%) are the second and third most common primary need for pupils with EHC plan status.

SEN support (no EHC plan status)

In addition to pupils with Education, Health and Care (EHC) plan status, there are many other pupils who require SEN support. In Cambridgeshire 11.5% of pupils have SEN support (no EHC plan). In Peterborough 10.7% of pupils have SEN support (no EHC plan). This compares to 12.9% of pupils nationally.

In Cambridgeshire, the most common category of primary need for SEN support is ‘social, emotional, and mental health’ needs, 21.7% of all SEN support pupils (compared to 19.8% in Peterborough and 21.0% in England).

In Peterborough, the most common category of primary need for SEN support is ‘speech, language and communication’, 28.4% of SEN support pupils (compared to 18.3% in Cambridgeshire and 25.5% in England).

All SEN

When considering all SEN support provided (for pupils with and without EHC status) data shows that the most common category of primary need for Cambridgeshire pupils is ‘social, emotional and mental health’ (3,154 pupils or 3.4% of all pupils), ‘moderate learning difficulty’ (2,667 pupils, or 2.9%) and ‘speech, language and communication’ needs (2,633 pupils, or 2.9%).  In Peterborough the most common categories of primary need are ‘speech, language and communication’ (1,423 pupils or 3.5% of all pupils), ‘Autism spectrum disorder’ (1,064 pupils, or 2.6% of all pupils) and ‘social, emotional and mental health’ (1,026 pupils or 2.5% of all pupils).

Children in need (CIN)

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Children in Need are a legally defined group of children 0-17 (under the Children Act 1989), assessed as needing support because of risks to their development or health. This group includes children on child in need plans, children on child protection plans, children looked after by local authorities, care leavers and disabled children. Identifying the number of Children in Need (CIN) helps support evidence-based decision making to ensure vulnerable children receive adequate support. Page 8 of the dashboard presents this information.

 

Children in need – by primary need

Cambridgeshire has 2,755 Children in Need (CIN), whilst Peterborough has 1,477.  Although numbers are higher in Cambridgeshire, the proportion of CIN is higher in Peterborough – 2.0% of Cambridgeshire children are CIN compared to 2.8% of Peterborough children.  The proportions of CIN in both areas are lower than the England average and have remained mostly unchanged in Cambridgeshire though Peterborough has seen a fall over time.

Most CIN are in need as a result of abuse or neglect – 1.3% of all Cambridgeshire children and 2.8% of all Peterborough children are CIN with a primary need of abuse or neglect. Put another way, 66% of Cambridgeshire CIN (1,830 out of 2,755 CIN) and 77% of Peterborough CIN (1,132 out of 1,477 CIN) are Children in Need primarily due to abuse or neglect. This compares to 59% for England.

Overall, the proportion of children who are CIN in Cambridgeshire is lower than in previous years, although 2022 has had a slight increase (+0.1%) compared to 2021. A similar increase in CIN between 2021 and 2022 is also found in the East of England and England. In Peterborough the trend is an overall decline of CIN, including in the most recent year.  

The second most common primary need in Peterborough CIN is due to a child’s disability or illness (for 106 out of 1,477 (7.2%) CIN, a child’s disability or illness is the primary need). In Cambridgeshire the second most common primary need for CIN is family stress (for 280 out of 2,755 (10.2%) CIN, family stress is the primary need); family stress has had an increasing trend as primary need since 2018. 

Cambridgeshire’s nearest neighbours have between 1.9% – 3.6% of all resident children as CIN. Cambridgeshire is second lowest, at 2.0%.  Peterborough’s nearest neighbours have between 2.7% – 5.4% of all resident children as CIN. Peterborough is second lowest, at 2.8%.  

 

Children in need by recorded disability

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Page 9 of the dashboard contains data on disabilities among children in need. 11.3% of all CIN in Cambridgeshire and 13.4% of all CIN in Peterborough have a recorded disability. This compares to 15.7% in the region and 12.3% in England.

The most common recorded disability among CIN in Cambridgeshire is autism (37.6% of CIN with a recorded disability) followed by learning difficulties (37.0%). In Peterborough the most common recorded disability among CIN is learning difficulties (41.9% of CIN with a recorded disability) followed by autism (36.4%). Learning disabilities and autism are also the most recorded disability for CIN in the East of England and England.

Other groups at heightened risk of poor health outcomes

It has not been possible to present thorough data on these groups for this JSNA but it is important to note that health outcomes tend to be considerably poorer in the following groups.

  • Gypsy, Roma and Traveller communities
  • People with no recourse to public funds
  • Drug and alcohol users
  • People in prison or in the criminal justice system
  • Households where no-one is in paid employment 
  • Rough sleepers
  •  People with serious mental illness
  • People with a learning disability

 

 

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