An analysis of data from the annual Health Survey for England shows that among people who report their health as ‘poor’, those living in areas of high deprivation are likely to have worse health than those living in the least deprived areas. The study results suggest that using self-reported health as a proxy for health status could underestimate health inequalities, and could have implications for public health practice and policy informed by self-reported health data.
Researchers from WIPH and the University of Warwick analysed data collected from over 14,000 participants in the 2017 and 2018 waves of the Health Survey for England. They compared participants’ simple self-reported health (SRH) statements with a more detailed health-related quality of life measure (EQ-5D), collected at the same time. The analysis assessed differences in the relationship between SRH and EQ-5D by Index of Multiple Deprivation (IMD) quintile, a widely-used measure of deprivation.
The study examined how socio-economic status affected the answer to the commonly used survey question: ‘In general, would you say your health is very good, good, fair, bad or very bad?’. Analysis showed that self-reported good health declined with increasing deprivation, from 82.9% in the least deprived quintile to 63.9% in the most deprived quintile. Researchers also found that participants living in the most deprived two quintiles of areas in England who reported poor health had lower EQ-5D scores, and therefore worse health, than would be expected based on their deprivation quintile and SRH status.
Authors conclude that socioeconomic status modifies how individuals perceive or describe their own health, and say that this may be because people judge their health status somewhat through social comparison. They suggest that if someone has one health condition and so do all their friends, they think their health is good or fair, but if they are the only person in their social circle with a health condition, they consider themself to be in poor health, even with just one health condition.
Self-reported health is used to calculate healthy life expectancy, which is used to calculate resource allocation, for example, in funding to local authorities, where areas with lower healthy life expectancy receive a greater proportion of funding. While additional research is needed to quantify any impact on measures such as healthy life expectancy that incorporate SRH data, this study suggests that basing public health funding and interventions on SRH alone could result in an underestimation of health inequalities based on deprivation.
WIPH Author, Professor Oyinlola Oyebode, said:
‘Self-reported health is a widely used measure of health. In England we use it to calculate healthy life expectancy. Our analysis suggests that using self-reported health might under-estimate socio-economic health inequalities, which may mean that resources and interventions are not appropriately targeted to the most vulnerable neighbourhoods or people.’
Rosanna Fforde, Honorary Research Fellow at the University of Warwick and Consultant in Public Health at Sandwell Metropolitan Borough Council, said: ‘Understanding any systematic variation in how people self-report their health is important because this single question measure of health is so widely used, including in large surveys and the Census. The resultant large number of responses provides us with valuable granular insights into patterns of health, but this also means that it is important to explore whether good health means the same thing to everyone.’
Fforde R, Parsons N, Oyebode O. Does socio-economic status modify how individuals perceive or describe their own health? An assessment of reporting heterogeneity in the Health Survey for England., BMJ Public Health (2024). DOI: 10.1136/bmjph-2023-000813