What are health inequalities?
The Marmot Review Fair Society, Healthy Lives (2010) defined health inequalities as systematic, avoidable and unfair differences in health outcomes across the population, arising from the social gradient in which health improves at every step up the social and economic ladder. It demonstrated that these inequalities are driven primarily by the conditions of living, i.e. the conditions in which people are born, grow, live, work and age rather than healthcare or individual behaviour alone. The follow‑up report, Health Equity in England: The Marmot Review 10 Years On (2020), found that progress had stalled or reversed, with widening gaps in life expectancy and healthy life expectancy, particularly in more deprived areas, and increasing regional inequalities. In 2020, Marmot reaffirmed that health inequalities are not inevitable, but reflect policy and societal choices, concluding that reducing them requires sustained, proportionate action across the whole social gradient to improve living conditions, income security, employment, housing and place.
In the East Riding, evidence consistently shows that people living in more deprived communities experience poorer housing, lower incomes, insecure employment, limited transport and reduced access to services, which together increase the risk of ill‑health across the life course. These inequalities are not evenly distributed and are particularly pronounced in some coastal, urban and rural areas, contributing to earlier onset of illness, higher levels of disability and greater prevalence of multiple long‑term conditions.
Health inequalities not only impact on individuals and communities, they place sustained pressure on public services and widen long‑term demand. People exposed to multiple disadvantages are more likely to require support earlier, for longer, and with greater complexity, while children growing up in poor conditions of living face reduced educational, economic and health prospects into adulthood.
Health Inequalities on the East Riding JSNA website
One of the key purposes of the JSNA is to highlight any health and wellbeing inequalities that might exist within our local communities. The East Riding JSNA website contains a multitude of examples of such inequalities over many different pages, the table below attempts to bring most of them together in one place.
| Inequality subject area | Specifics about inequalities found | File location or URL |
|---|---|---|
| Age Friendly Communities | The Age Friendly JSNA document highlights a strong relationship between deprivation and: – Poorer health outcomes – Higher disability prevalence – Increased fuel poverty – Reduced access to transport and services Older people living in the most deprived wards are more likely to experience multiple disadvantages simultaneously (low income, poor housing, disability and social isolation), compounding inequalities accumulated across the life course. Access to transport is a major inequality driver, older people living alone are more likely to have no access to a car or van, especially in deprived urban and coastal wards. A lack of transport limits access to healthcare, social activities, employment, volunteering and essential services. Rural residents face additional barriers due to longer distances and less frequent public transport. These transport inequalities increase the risk of isolation and missed healthcare, particularly for older people living alone. The Age Friendly Communities programme aims to address inequalities and improve healthy aging in the East Riding. | East Riding State of Ageing Report (PDF document) Healthy Ageing (JSNA webpage) |
| Bridlington Place | Bridlington contains the most densely concentrated pocket of deprivation in the East Riding, with some of the area’s poorest health outcomes. The Bridlington place-based programme uses an adapted Asset‑Based Community Development model to build on community assets and strengthen local infrastructure. Four workstreams support this: – Health and Care, including digital health – Estate and infrastructure – Community and transport – Education, training and workforce | Crown Community Case Study (PDF document) Bridlington Place Based Programme (JSNA webpage) |
| Bridlington South focussed presentations | These presentations, about the Health & Wellbeing inequalities experienced in Bridlington South, demonstrated that in Bridlington South: – Length of life is shorter – Premature death is more common – Major Illnesses are more common – Limiting long term illness (a greater burden in the area) – Emergency admissions are highest in county – Travel times and access to health care (high dissatisfaction) – Health inequalities overall are highest in county | Link to February 2024 presentation (PDF document) Link to October 2025 presentation (PDF document) |
| Community Wellbeing Teams | The Community Wellbeing Team JSNA document was created to help the ASC directorate understand their different locality areas. Although East Riding overall is relatively affluent, specific localities experience concentrated disadvantage, particularly: Bridlington, Withernsea and Central Goole. These areas consistently show worse outcomes across multiple indicators, including mortality, long‑term illness, disability, and service demand. In contrast, areas such as Beverley and Haltemprice frequently have better outcomes than the East Riding average on health and mortality indicators. | Community Wellbeing Teams (JSNA page) |
| Conditions of Living | Health inequalities in the East Riding are primarily driven by unequal conditions of living, including housing quality, income, employment, transport, education, social connection and the local environment, rather than individual behaviours alone. Evidence consistently shows that people living in more deprived areas are exposed to multiple poor conditions simultaneously, such as insecure or cold housing, financial strain and limited access to services, which predicts worse health outcomes and drives persistent gaps between the most and least deprived communities, particularly in coastal and urban areas. Addressing inequalities therefore requires upstream, place‑based action to improve living conditions and reduce cumulative disadvantage across the life course | East Riding Health and Wellbeing Strategy (PDF document) |
| Core20Plus5 (Children & Young People) | The CORE20PLUS5 analysis shows that health and wellbeing inequalities for children and young people in East Riding are strongly patterned by deprivation, place, and vulnerability, with evidence that some gaps are widening over time rather than narrowing. Around 9%* of children and young people live in the most deprived 20% of neighbourhoods nationally, concentrated in a small number of wards including Bridlington South, South East Holderness, Bridlington Central and Old Town, and Goole South. Children in these areas experience higher prevalence of long‑term conditions, poorer outcomes, and greater use of emergency care. * at the time of the documents production Several locally defined “Plus” groups face additional disadvantage. Children Looked After are increasingly concentrated in deprived wards, with almost half living in the two most deprived quintiles. Young carers, while often reporting good health, include a significant minority providing high levels of care and living with disability themselves. Across the five national priority conditions—asthma, diabetes, epilepsy, oral health and mental health children in more deprived communities experience higher prevalence, worse outcomes, or higher emergency admission rates. Childhood obesity shows one of the clearest inequalities, with rates in the most deprived areas almost double those in the least deprived, and the gap continuing to grow. | Core20Plus5 (Children & Young People) (JSNA webpage) |
| Inclusion Health | Inclusion health is concerned with any population group that is socially excluded (such as people experiencing homelessness, vulnerable migrants, Gypsy, Roma and Traveller communities, care leavers, prison leavers, veterans, and people with substance dependence). These groups experience multiple, overlapping disadvantages including social exclusion, stigma, poorer health and wellbeing outcomes than the general population (often dying younger) and often access services only at crisis point. The data gaps about these groups are themselves an inequality. The East Riding JSNA inclusion health needs assessment can be accessed from the link on the right. The Inclusion Groups programme reporting into the Health and Care Committee is working to address systemic health inequalities inclusion groups face, with the overarching aim of improving access to and experience of services within the East Riding for inclusion groups. Key activities: – Implementing the recommendations of the inclusion health needs assessment – Undertake phase two of the inclusion health needs assessment (voice of lived experience) – Inclusion Champions – a network of volunteers from across the system who are passionate about improving outcomes for people from inclusion health groups – Service developments – Bridlington Homeless Hub, Inclusion Health vehicle presence at Gypsey, Roma Traveller Sites – Awareness Raising – quarterly inclusion health newsletter – Influencing policy – commissioning for inclusion project Locally there is an Inclusion Health post hosted by the HEY Smile Foundation. The inclusion health role has helped to build relationships and gather intelligence to support inclusion health groups. | Inclusion Health (JSNA webpage) VCSE insights into Inclusion Health (JSNA webpage) East Riding Health and Care Committee – Humber and North Yorkshire Health and Care Partnership (external webpage) |
| Life Expectancy | Life expectancy is a key indicator of health inequality. There is a stark difference in life expectancy between the East Riding’s most and least deprived wards (the least deprived generally recording higher life expectancy than the more deprived areas). For males there is over 10 years difference in life expectancy between the East Riding’s most deprived ward (Bridlington South with 72.9 years life expectancy at birth) and the least deprived ward (South Hunsley at 83.6 years). For females the gap is less but no less significant at 7.1 years difference between the same two wards. | Life Expectancy (JSNA webpage) |
| Multi-Morbidity | Current work is examining the inequalities in the development of multi-morbidity in more deprived areas of the East Riding. A comparison of Goole South (more deprived) against South Hunsley (less deprived) shows that Goole South residents are reporting a higher prevalence of multi-morbidity in most adult age groups. These conditions are presenting earlier in life in the East Riding’s most deprived communities. | Work is currently on-going, not yet published on JSNA site. |
| NCMP | Analysis is conducted annually on the National Child Measurement Programme (NCMP) dataset, which provides the prevalence of different BMI categories (e.g. healthy weight or overweight etc) for Reception Year and Year 6 children in the East Riding. More deprived areas (particularly in Year 6) report significantly higher rates of obesity than least deprived areas. Analysis has shown the gap widening between the obesity prevalence in the most deprived communities (which is higher) compared to least deprived communities. | NCMP (JSNA webpage) |
| Neighbourhood Health Partnerships | The East Riding has 7 Neighbourhood Health Partnerships (NHPs) made up of organisations from across health and social care, working together to improve population health and reduce inequalities in their local area. Each neighbourhood has had support from the Public Health Intelligence team to understand population health in their local area. Examples of areas of intelligence explored include: – Areas of high deprivation – Disease prevalence and multimorbidity – Migrant populations – Financial stability, including fuel poverty and children in absolute low-income families – Readiness for school in areas of high deprivation – Sexual health Examples of some of the projects/cohorts NHPs have worked with: – Working with local food banks to provide support to prevent people from reaching crisis – Proactive outreach in Bridlington – Supporting care leavers in Goole – Working with migrant communities in Goole – Working with traveller communities – Neurodiverse children – Support to care homes Neighbourhoods are currently in the process of drawing up strategic plans for their local area based on population health intelligence provided by the Public Health Intelligence team and local insight. Updated neighbourhood profiles are also currently in development. | Example of intelligence produced for neighbourhoods: Cygnet NHP Prevention Programme (PDF document) Driffield Neighbourhood Health Partnership Health Intelligence (PowerPoint file) Examples of case studies for neighbourhood projects: Olinda Road Case Study (PDF document) Driffield INT Care Home Case Study (PDF document) |
| Pharmaceutical Needs Assessment (PNA) | The East Riding Pharmaceutical Needs Assessment (PNA) reports on a number of inequalities within the East Riding, many of which are already reported from the sources within this table. | PNA (JSNA webpage) |
| Population Health Steering Group | The population health steering group embeds population health approaches across the health and care system. The group has three area of focus: 1. Intelligence – Develop an approach based on the ‘intelligence triangle’: – Quantitative data – Insights from local practitioners – Voices of local people – These resources feed into the Joint Strategic Needs Assessment (JSNA) for analysis and practical use. 2. Culture – Drive a cultural shift so population health becomes part of everyday practice. This involves: – Sharing best practice – Building knowledge – Applying ideas in real-world settings 3. Delivery – Move population health approaches towards ‘business as usual’. Practical application will make the change happen. – Population Health Community of Practice – Development of a population health training programme – Oversight of the East Riding Health Inequalities funding – JSNA PCN population health packs | Population Health Steering Group (JSNA webpage) |
| Respiratory Mortality work for ICB Big Harms Matrix | Analysis of all age mortality for 2 respiratory conditions* have shown significantly higher rates of death in more deprived communities (* for deaths registered during 2022-24) – COPD: Goole South & Bridlington South, significantly higher than ERY average & less deprived areas. Bridlington South 2.5 times higher rate than Willerby & Kirk Ella. Goole South almost 3 times higher rate than Willerby & Kirk Ella. – Lung Cancer: Bridlington South & SE Holderness, significantly higher than ERY average & less deprived areas. Bridlington South 2.5 times higher rate than Willerby & Kirk Ella. | Not yet published on JSNA site – work in progress. |
| Rural and Coastal Communities | The Rural & Coastal JSNA work demonstrated: A strong coastal inequality gradient: people living in coastal communities (notably Bridlington, Hornsea and Withernsea) experience worse health and wellbeing outcomes than those living inland or in non-coastal areas. Inequalities include: lower life expectancy and healthy life expectancy, higher levels of poor self-reported health, higher disability prevalence, higher premature mortality and higher emergency hospital admissions. Rural inequalities driven by access and isolation: Rural areas generally show better overall health outcomes than coastal and urban areas, but experience a different form of inequality, including poor access to services and transport and also digital connectivity barriers. | Rural and Coastal Communities (JSNA webpage) |
| Special Educational Needs and Disabilities (SEND) | Children and young people with Special Educational Needs and Disabilities (SEND) in the East Riding experience systematic inequalities across education, health, social care and adulthood, which begin early in life and persist over time. – SEND being more likely to be eligible for Free School Meals and more likely to live in areas of higher deprivation. – SEND prevalence and complexity are not evenly distributed geographically, contributing to variation in need and service demand across the local area. Educational inequalities are evident throughout the system. – Pupils with SEND experience higher levels of absence, suspensions and permanent exclusions compared with pupils without SEND. – Children and young people with SEND consistently achieve lower educational outcomes than their peers at Early Years, Key Stage 2, Key Stage 4 and post‑16 stages – Children with SEND are over‑represented among Children in Need, those subject to Child Protection Plans, and Children Looked After, indicating compounding disadvantage where SEND intersects with safeguarding and family stress. – Inequalities continue into early adulthood. Young people with SEND are less likely to be in education, employment or training, and experience poorer outcomes in relation to employment, accommodation and independence at ages 19–25. | SEND (JSNA webpage) East Riding SEND JSNA document (PDF document) |
| Teenage Conceptions | Teenage conceptions (i.e. females conceiving under the age of 18 years), at a population level, are strongly associated with poorer outcomes for young parents, their children, and wider services, particularly where pregnancies are unplanned and occur alongside socio‑economic disadvantage. Teenage conception rates have been falling in the East Riding since 2009. However, within some East Riding communities, rates are significantly higher than other areas. There were 2 MSOAs with significantly higher rates of under 18 conceptions than the East Riding average rate in 2020-22, these were Bridlington Hilderthorpe (a rate of 69.0/1,000 population based on 18 conceptions) and Bridlington West (33.4/1,000 population based on 13 conceptions). Bridlington Hilderthorpe’s rate of 69/1000 population was 5.5 times higher than the East Riding average and placed it as the 5th highest MSOA rate within the 7,264 MSOAs of England and Wales. This MSOA rate has increased in rate year on year between 2018-20 and 2020-22, overtaking Bridlington West to become the MSOA with the highest rate. | Teenage Conceptions (JSNA webpage) |
Local Inequalities Interactive Explorer Tool (OHID)
The purpose of the interactive tool below is to provide a resource to support decision making by demonstrating some local, within-area inequalities. It allows users to explore and demonstrate inequalities within areas at a ward level using indicators from Local Health, an existing OHID profile on Fingertips. The tool also includes information on trends in life expectancy and disease burden at an area level. The local inequalities explorer tool seeks to:
- show the strength of association between some important high-burden diseases and deprivation
- emphasise the strength of association with deprivation, more than the magnitude of the local inequality
- provide a resource to stimulate and support local inequalities discussions (for example by Health and Wellbeing Boards and ICS Boards)
- illustrate examples of within-area inequalities