Health status is not evenly distributed and with each step up the socio-economic ladder, people become less vulnerable to disease, disability and premature death. Whilst the relationship between socio-economic status and health is clearly established, measurements of socio-economic status are fraught with inconsistencies. Assessment of socio-economic status based on employment, for example, may fail to distinguish between housewives, the retired and jobseekers, whilst assessment based on car ownership is flawed because cars are an unavoidable expense for poor families in rural communities.
Finding a better measure of socio-economic status could help the NHS allocate its resources more effectively and ultimately reduce the differences in health between rich and poor. With this in mind, Norman Beale and his colleagues used the patient list and death register of general practice in Calne, Wiltshire between 1992-2000 to determine whether council tax valuation band could be used as a predictor of mortality. Mortality was investigated as it is the most reliable measure of health in any given geographic area.
The amount of council tax an individual pays is related to the value of their home. Each house is placed into one of eight council tax evaluation bands A-H, which dictate the amount of tax paid. Classification is done locally to prevent regional differences in house prices affecting the classification.
Their analysis showed that, in this area of Wiltshire, death rates were significantly higher for people living in houses charged the lowest levels of tax, (bands A and B) compared with people living in houses taxed at the higher rates (C-H). Out of the 856 measurable deaths, 461 were from the bands A and B, and only 39 were from the three most expensive council tax bands (F, G and H). They also found higher occurrences of premature deaths in bands A and B.
The authors recognize that a larger national study would be needed before council tax valuation bands are adopted as an indicator of socio-economic status. However, if these results are repeated across the UK, it may help policy makers decide on the best distribution of resources in the NHS to break the link between poverty and ill health.
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