1. Introduction
2. Material Deprivation
3. Social Deprivation
4. Deprivation in the South East
5. Conclusion

The man in the street knows that poverty is bad for health. In addition, the international evidence on inequalities in health between different sections of society is compelling. People who live in disadvantaged circumstances have more illness and disability and shorter lives than those with a better standard of living.¹ As far back as 1981, Nolan² showed that Irish men in higher professional positions had a mortality ratio in middle age which was one third that of men in unskilled occupations. The proportion of adults reporting chronic illness was twice as high for unskilled as for professional occupations. Lyons et al³ confirmed this finding in their study in Dublin. Johnson^4,5 showed higher death rates in electoral wards in disadvantaged areas in Dublin.

The size of the differences in health status varies between countries and between different time periods, and this would suggest that there is nothing fixed or inevitable about having such a health divide. Greater overall prosperity and improved living standards have led to significant health gains in this century. However inequalities in health remain and the gap between socio-economic groups is widening particularly for young men.⁶

Deprivation influences health from conception through childhood, into adulthood and old age. Davey Smith⁷ showed the cumulative effect of socio-economic factors over a lifetime. The socio-economic classification of occupations was divided into manual occupations, non manual occupations, managerial and professional occupations; class IV and V being manual and class I or II being professional and managerial. Men who were born to fathers with manual jobs and who were in manual jobs themselves, had age adjusted standardised mortality ratios 70% higher than those who themselves, and their fathers, had non manual jobs. For those who moved between the occupational classes over the course of their lifetime, their mortality experience lay somewhere in between. Several studies have been reported which link socio-economic conditions at birth and in childhood with a range of adult diseases. Davey Smith 1998,⁸ attempted to separate these effects from the effect of continuing deprivation in adult life. Social class in childhood had a specific effect on mortality from stroke and stomach cancer and had an additive effect on deaths from coronary heart disease and lung diseases. For other diseases and cancers it was the risk factors present in adult life that were more important.

In general, the lower the material standard of living (measured by indicators such as income, car ownership, etc.) the worse, the level of health. There is growing evidence that the relative distribution of income matters in its own right, for population health. The experience of relative poverty means that people go short of things considered essential or normal by others around them. It excludes people socially and materially from the normal life of society. This sense of being at a relative disadvantage may be an important indirect influence on health in developed countries by increasing the likelihood of behavioural risks e.g. smoking, drinking, "comfort" eating.⁹

A society with greater income equality improves social cohesion and reduces social divisions and marginalisation. Integration within a social network benefits health. Socially isolated people die at 2-3 times the rate of people with a network of social relationships. Kawachi¹⁰ puts forward the theory that this could equally apply to communities. He demonstrated an association between mortality and low levels of participation in community activities and measures of civic distrust in 39 states of the U.S. These were in turn highly correlated with the degree of income inequality in each state.

A number of indicators of material deprivation have been formulated internationally. The Directors of Public Health of the eight Health Boards requested the Small Area Health Research Unit to develop a suitable deprivation measure for Ireland. The index is statistically calculated from census data for small geographical areas on; unemployment, social class, proportion of rented accommodation, over crowding and car ownership.¹¹

References
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