Health Inequalities Intervention Toolkit
Life Expectancy Tool for Spearhead Areas, 2010
Instructions, notes on interpretation and frequently
asked questions
March 2010
What is the Life Expectancy Tool for Spearhead Areas?
How can the tool be accessed and displayed correctly?
What is the purpose of the tool?
What does the tool contain?
What other tools are in the intervention toolkit?
Guide to the tool:
Current Life Expectancy Status
View Life Expectancy Gaps
View your Gap: Tables and Charts
Commissioning Interventions
Frequently asked questions
What does life expectancy at birth mean?
Which areas are included in the Tool?
Further questions to help use and interpret the Commissioning
Interventions part of the tool.
What is the Life Expectancy Tool for Spearhead Areas?
The tool is an interactive resource which draws together key data and modelling.
It is part of the Health Inequalities Intervention Toolkit which has been developed
by the Association of Public Health Observatories (APHO) and Department of
Health. The tool allows users to find the latest data on local gaps in life
expectancy between each Spearhead area and England, and presents tables and
charts which show the causes of death, and age groups, which are driving low life
expectancy in each Spearhead area.
Users can also assess the impact that evidence-based interventions can have on
reducing the inequality in life expectancy between each Spearhead area and
England. This version of the tool was released in March 2010 and includes a new
intervention on blood sugar control. Work on the tool has been led by the London
Health Observatory – the lead Observatory for health inequalities.
How can the tool be accessed and displayed correctly?
The tool can be accessed from the LHO website:
http://www.lho.org.uk/NHII/spearhead/
Anyone can access the tool, there is no need to register or provide any personal
details.
To enter the tool, first select a Spearhead area from the dropdown menu on the
first page, before entering one of the three elements of the tool by clicking one of
the yellow buttons.
It may take a few seconds for your selected area to load. If you have the Address
bar displayed in your web browser, you can see that your selected Spearhead has
loaded when its area code appears at the end of the url.
If you click a yellow button before your area has loaded, the selection will be
cancelled and a pop-up message will appear asking you to select an area. In the
dropdown menu you should then click off your selection before returning to it,
and then waiting for it to fully load before proceeding.
The tool may not display correctly if your screen resolution is not set
appropriately. This can be changed by following these instructions:
Click on the start button
Click on control panel
Click on display
Click on settings
Click on screen resolution and reduce to 1024 by 768 pixels (see image
below)
Click on Apply
What is the purpose of the Tool?
The tool has been designed to assist Primary Care Trusts and local authorities in
evidence-based local service planning and commissioning, including Joint
Strategic Needs Assessments. The tool should also support planning to achieve
the national health inequalities Public Service Agreement (PSA) target:
“Starting with local authorities, by 2010 to reduce by at least 10 per cent the gap
in life expectancy at birth between the fifth of areas with the worst health and
deprivation (the Spearhead Group) and the population as a whole.”
Tackling health inequalities and achieving the PSA target remains a key priority
for the NHS as set out in the NHS Operating Framework 2010-11, and for local
authorities as part of Local Area Agreements, particularly the Vital Signs and LAA
National Indicator Set indicator for reducing All Age All Cause Mortality.
What does the tool contain?
There are three elements to the tool, accessible through buttons on the first
screen.
This screen contains:
The current life expectancy in Spearhead local authority, based on data for
2006-08.
The relative life expectancy gap between each Spearhead area and
England.
An indicator for each area to show whether it is on track or off track to
meet the national health inequality target.
This screen gives users options to access a set of tables and charts
which illustrate the causes of death, and age groups, which are
driving low life expectancy and making the greatest contribution to
local life expectancy gaps between each Spearhead area and
England.
This screen allows users to model the impact that systematically
implementing evidence-based interventions at scale can have on reducing
inequalities in life expectancy and All Age All Cause Mortality between each
Spearhead area and England. A new intervention illustrates the gains in
life expectancy which can be made by lowering levels of high blood sugar.
This supplements the original interventions (increasing numbers of
smoking quitters, lowering infant mortality, and prescribing
antihypertensives and statins) which have also been updated within this
latest version of the tool.
A technical document which describes in detail the sources of data and
calculations used within the tool is available from the LHO website:
http://www.lho.org.uk/LHO_Topics/Analytic_Tools/SpearheadTool2010.aspx
What other tools are in the intervention toolkit?
This tool provides trends in infant death rates and information on factors which
the evidence shows will influence infant mortality. It allows users to assess the
impact of modifying the factors which contribute to higher infant death rates in
the routine and manual group compared to all births within marriage/joint
registrations.
This tool provides information on within, as well as between, area inequalities.
Users can access data on gaps in life expectancy between the most deprived
quintile of each local authority in England, and a range of comparator areas. They
can also estimate the effect on life expectancy if certain evidence-based
interventions are increased. This tool has not been updated and results are based
on data for 2001-2005.
To access these tools, and for further details of both, see the Health Inequalities
Intervention Toolkit webpage on the LHO website:
http://www.lho.org.uk/LHO_Topics/Analytic_Tools/HealthInequalitiesInterventionToolkit.aspx
Earlier versions of the Intervention Tool for Spearhead Areas
Users can also access earlier versions of the Life Expectancy Spearhead Tool. The
2009 tool (based on data for 2005-07) and the 2007 tool (based on data for
2003-05) remain available so that comparisons over time can be considered.
http://www.lho.org.uk/LHO_Topics/Analytic_Tools/HealthInequalitiesSpearhead2007.aspx
Guide to the tool
Current Life Expectancy Status
At the top of each screen within the tool, the current progress of each Spearhead
area towards the Government‟s national health inequality target is displayed.
There is a status for each sex, showing whether male and female life expectancy
(based on figures for 2006-08) is on or off track to meet the target. The status
for each area was taken from the Dept of Heath publication Tackling Health
Inequalities: 2006-08 Policy and Data Update for the 2010 National Target:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109469
View Life Expectancy Gaps
To display this screen first select a Spearhead area from the dropdown menu on
the first page, before clicking the View Life Expectancy Gaps yellow button.
It may take a few seconds for your selected area to load. If you have the Address
bar displayed in your web browser, you can see that your selected Spearhead has
loaded when its area code appears at the end of the url.
If you click the yellow button before your area has loaded, the selection will be
cancelled and a pop-up message will appear asking you to select an area. In the
dropdown menu you should then click off your selection before returning to it,
and then waiting for it to fully load before proceeding.
The View Life Expectancy Gaps screen shows the current life expectancy in each
of the 70 Spearhead local authorities, based on mortality data and population
estimates for 2006-08.
Areas are presented alphabetically, but the Spearhead selected by the user
appears at the top of the screen, underneath life expectancy figures for England,
and the average for the Spearhead Group as a whole.
The relative life expectancy gap with England is also provided. This is the
absolute difference (England life expectancy minus Spearhead life expectancy)
reported as a percentage of England‟s life expectancy. These relative gaps were
used to rank the Spearhead areas from 1 to 70, with 1 representing the area with
the biggest gap, and 70 the area with the smallest.
For some areas, such as Hammersmith and Fulham, the relative gap figures are
negative. This is because life expectancy in Hammersmith and Fulham in 2006-08
is higher than the England average.
View your Gap: Tables and Charts
From this screen, tables and charts are available which illustrate the causes of
death, and age groups, which are making the greatest contribution to the life
expectancy gap between each Spearhead area and England. Targeting the causes
and age groups with the highest percentages should have the largest impact on
reducing the life expectancy gap with England. For comparison purposes, the
breakdown in the life expectancy gap between England and the Spearhead Group
as a whole, is also provided.
Tables
Breakdown by cause of death
This table lists 31 leading causes of death and illustrates the contribution each of
these makes to local life expectancy gaps between Spearhead areas and England.
For each cause of death, a local authority is assumed to have the same mortality
rate as in England as a whole. For causes where the mortality rate is actually
higher in the Spearhead area than in England, making this assumption increases
the potential life expectancy for a local authority. When added together for each
cause of death, these extra years of life provide the total life expectancy gap
between the local authority and England. The percentages in the table show how
much each cause of death contributes to this gap.
Negative values, where mortality in a local authority is actually lower for a
specific cause than the England average, are excluded from the table, and do not
contribute towards the calculation of the life expectancy gap. These results are
shown as „..‟ in the table.
Interpreting the results
The gap in life expectancy is broken down so that the percentage contribution of
causes will sum to 100 per cent. For some Spearhead areas, particularly where
the gap in life expectancy between the local authority and England is quite narrow
or where only a few causes have excess mortality, care should be taken in
interpreting the results. Some causes of death may be highlighted as contributing
to a large percentage of the life expectancy gap, even though the gap itself may
be narrow.
To aid interpretation, numbers of deaths are included in the table. The first
column shows the total number of deaths for each cause in the period 2006-08.
The second column shows the number of excess deaths for each cause, compared
to the England average. These are calculated by working out how many deaths
from each cause would be expected in the local area if the population had the
same cause-specific mortality rate as the England average. The number of deaths
which actually occur above this expected figure are the excess or „extra‟ deaths
for each cause. If the mortality rate for a particular cause is lower than the
England average then the number of excess deaths will be negative. These
results are reported as 0s in the table. The excess deaths were calculated for
each cause of death separately and do not sum to a total excess deaths figure for
the Spearhead area. There is therefore no total for this column.
Causes of death
The causes are the underlying cause of death and were extracted using
International Classification of Disease Codes, Tenth Revision (ICD-10). The ICD-
10 codes can be found in the technical document which accompanies the tool,
available from here:
http://www.lho.org.uk/LHO_Topics/Analytic_Tools/SpearheadTool2010.aspx
Some of the cause of death categories include a range of different diseases:
Infectious and parasitic diseases - includes tuberculosis and HIV-related deaths.
Endocrine, nutritional, metabolic diseases - includes deaths with an underlying
cause of diabetes. Diabetes however is often mentioned on death certificates
where the underlying cause of death is from another disease.
Mental and behavioural disorders - includes deaths from dementia and from
mental and behavioural disorders due to alcohol and drug misuse.
Diseases of nervous system - includes Alzheimer‟s, Parkinson‟s disease and
epilepsy.
Coronary Heart Disease - also referred to as Ischaemic Heart Disease – includes
deaths from acute myocardial infarction (heart attack).
Chronic liver disease including cirrhosis – includes deaths related to chronic
alcohol misuse.
Genitourinary diseases - includes kidney disease.
Perinatal conditions - includes conditions that have their origins in the perinatal
period even though death occurs later.
Deaths under 28 days – these deaths do not have an underlying cause of death
assigned.
Breakdown by age group
This table shows the age groups which are making the biggest contribution to
local life expectancy gaps between Spearhead areas and England. The figures are
calculated in the same way as for causes of death (see above) and show the age
groups where mortality was higher in the local authority than in England as a
whole.
Charts
Six „scarf‟ charts are available for each area within the tool:
By cause of death – Selected Spearhead – Males and Females
This chart shows the life expectancy gap between the selected Spearhead local
authority and England, broken down by cause of death, with causes grouped into
eight broader categories, such as for all cancers. Only positive values, (e.g. where
there was excess mortality in the local authority) are used in the calculation of
the charts. Charts are presented next to each for both males and females for the
same local authority.
By cause of death – Selected Spearhead and Spearhead Group Average – Males
This chart shows the life expectancy gap broken down by cause of death for
males from the selected Spearhead area, as above. The equivalent breakdown for
the Spearhead Group as a whole is also shown for comparison, but the life
expectancy gap being shown is with England in both cases.
By cause of death – Selected Spearhead and Spearhead Group Average –
Females
As with males, the life expectancy gap for females in the selected area is
presented next to the life expectancy gap for females for the Spearhead Group as
a whole. The gap for both however is with England as a whole.
By age group – Selected Spearhead – Males and Females
This chart shows the life expectancy gap between the selected Spearhead local
authority and England, broken down by age at death, with ages grouped into ten-
year age bands. Only positive values, (e.g. where there was excess mortality in
the local authority) are used in the calculation of the charts. Charts are presented
next to each for both males and females for the same local authority.
By age group – Selected Spearhead and Spearhead Group Average – Males
This chart shows the life expectancy gap broken down by age group for males
from the selected Spearhead area, as above. The equivalent breakdown for the
Spearhead Group as a whole is also shown for comparison, but the life
expectancy gap being shown is with England in both cases.
By age group – Selected Spearhead and Spearhead Group Average – Females
As with males, the life expectancy gap for females in the selected area is
presented next to the life expectancy gap for females for the Spearhead Group as
a whole. The gap for both however is with England as a whole.
Charts are not shown for areas where life expectancy in 2006-08 is higher than
the England average.
Commissioning Interventions
This screen allows users to model five cost effective interventions which evidence
shows can increase life expectancy rapidly in Spearheads.
Step 1 - click the interventions for which you wish to see the impact on life
expectancy in your selected area. Interventions can be modelled individually or in
combination. Use the (?) buttons for guidance.
Step 2 – review current information provided for your local authority.
Step 3 – enter planned changes, using the (?) button for guidance.
Step 4 – press the Calculate button at the bottom of the screen.
The results screen shows a summary of the changes made at the top. It then
shows four sets of results - use the (?) buttons for guidance on screen:
Life expectancy (years) – the first two boxes show current life expectancy in
the selected areas based on data for 2006-08. The two boxes on the right then
show the increase in life expectancy if the selected interventions are achieved.
Life expectancy gap – the first two boxes show the current relative gap in life
expectancy between the selected area and England, based on data for 2006-08.
The two boxes on the right then show what the gap would be if planned
interventions are achieved. If these latter numbers are negative, it indicates that
life expectancy in the selected area has been raised to a higher level than the
England average.
Percentage narrowing of life expectancy gap with England – this shows the
percentage change between the two sets of results presented above, i.e. the
percentage decrease in the life expectancy gap between the selected area and
England if the planned level of intervention is achieved.
Spearheads should aim to narrow their life expectancy gap with England by at
least 10% for males and females. If the modelled interventions show a decrease
in the gap of at least 10% for both sexes, this will be shown as Achieved on
screen. A decrease of under 10% is shown as Not Achieved.
The percentage change is not shown for areas where life expectancy is higher
than for England in 2006-08. If life expectancy is higher for only one sex, a result
for the other sex will however be shown.
Absolute decrease in all cause mortality (deaths per 100,000 population)
– the life expectancy figures before and after interventions have been made have
been modelled to convert them to the number of deaths per 100,000 population.
The difference between these two figures is presented here as the absolute
decrease in the All Age All Cause Mortality Rate that would be expected with the
interventions specified.
Frequently Asked Questions
What does life expectancy at birth mean?
Life expectancy at birth is an estimate of the average number of years a new-
born baby would survive if he or she experienced the particular area‟s age-
specific mortality rates for that time period throughout his or her life. The figures
in the intervention tool therefore reflect mortality among those living in each
Spearhead area in 2006-08, rather than mortality among those born in each
area. It is not therefore the number of years a baby born in the area in 2006-08
could actually expect to live, both because the death rates of the area are likely
to change in the future and because many of those born in the area will live
elsewhere for at least some part of their lives.
Which areas are included in the Tool?
The tool includes information for the 70 Spearhead local authorities in England.
Some of these ceased to exist as administrative areas in the reorganisation of
local authorities in England in April 2009. Their performance towards meeting the
national health inequality target is however still being monitored.
Questions related to the Commissioning Interventions part of the
tool:
Which interventions are included in the Tool?
The following interventions are included in the tool:
Increasing the number of smoking quitters
Controlling high blood sugar – this is a new intervention
Reducing infant mortality
Antihypertensive prescribing in people with previously
undiagnosed\uncontrolled hypertension, but who do not have existing
coronary heart disease or history of stroke
Statin prescribing in those people that are newly identified and have been
treated with antihypertensive medication, but who do not have existing
coronary heart disease or history of stroke
Why were these interventions chosen?
These key interventions have been chosen as they can be directly influenced by
Primary Care Trust and Local Authority commissioning. The inclusion of infant
mortality also links with the national target to reduce inequalities in infant
mortality.
All of these interventions must be considered within the context of the wider
determinants of health and the potential for partnership working. For example,
smoking cessation should be part of a comprehensive, multi-sectoral tobacco
control strategy.
What time period does the data refer to?
The life expectancy figures within the tool are based on mortality data and
population estimates for the three-year period 2006-08. Data for the intervention
calculations are the most recent available. The technical document which
accompanies the tool gives further details of these. It can be accessed from here:
http://www.lho.org.uk/LHO_Topics/Analytic_Tools/SpearheadTool2010.aspx
Does the model assume that all smoking quitters remain quit in the long
term?
No, the model assumes that 29% of people who quit at 4 weeks will remain quit
at 52 weeks. For further information please see the technical document.
Why is there no smoking data in the ‘Current Local Authority
Information’ panel for my area?
Data are only available when the local authority is coterminous with a PCT.
Otherwise a „0‟ is displayed. This does not affect the results of the modelling, as
the default for the smoking intervention is that 0 smoking quitters are achieved in
the coming year, rather than looking at the increase/decrease from the previous
(2008/09) figures.
Why can’t the statin modelling be used independently of anti-
hypertensives?
Currently the model looks at the benefits of giving statins and anti-hypertensives
simultaneously to people with hypertension who are free of cardiovascular
disease. This group has been chosen as the initial focus as they are at particular
risk of developing cardiovascular disease.
The ‘Life expectancy gap’ figure for my area negative. What does this
mean?
A negative life expectancy gap means that the modelled life expectancy is higher
than life expectancy for England in 2006-08.
The ‘Percentage narrowing of life expectancy gap’ figure is greater than
100%. What does this mean?
A figure greater than 100% in this box means that the modelled life expectancy is
estimated to be higher than life expectancy for England in 2006-08.
Why has the change in All Age All Cause Mortality (AAACM) been
included in the model?
While life expectancy is a very good measure for monitoring health inequalities at
the national level there can be difficulties in its use locally. All Age All Cause
Mortality (AAACM) rates may be easier to interpret for local performance
management purposes, and they correlate well with life expectancy. AAACM will
directly support achievement of the health inequalities target. If AAACM reduces,
life expectancy is likely to rise.
The tool can therefore be used to help meet targets set within Local Area
Agreements, or as national priorities within the 2010 Operating Framework,
particularly the Vital Signs and LAA National Indicator Set indicator for reducing
All Age All Cause Mortality.
How should I interpret the results of the intervention modelling?
The tool is a static model, and looks at the effect that the interventions selected
would have on life expectancy if everything else remains constant - meaning that
there is no change in the local area due to any other effect and no change in
England when comparing with Spearhead areas. Therefore the results given after
the effect of the interventions selected do not refer to any specific time period in
the future. In practice, the effect of smoking cessation, for example, on life
expectancy will not be instantaneous and will take at least 5 years, the effect of
the other interventions will be more immediate, particularly reductions in infant
mortality.
Why does entering a large number of people in the smoking cessation
box result in a small change in life expectancy whereas a small change in
infant mortality numbers results in a large change in life expectancy?
Because infant deaths occur at a young age, reducing the number of deaths by
one will result in a higher number of life years saved than reducing the number of
smoking quitters by one, as a death from smoking will occur at an older age.
When will the interventions selected bring about a change in life
expectancy?
Any change in infant mortality will impact on life expectancy immediately. Any
change in anti-hypertensive and statin prescribing is likely to impact on life
expectancy in a very short time period. It is estimated that stopping smoking will
impact on life expectancy in five or more years time.