Skip to content

The largest health gaps between socio-economic classes are found in big cities

Islington in London had the largest health gaps for both men and women

A health gap is the difference in the health experienced between different groups. Health gaps can be measured between men and women, localities, social groups, economic factors or environmental characteristics. Tackling health inequalities or closing the health gap is an important policy issue. 

The health gaps discussed in this summary are the differences in self-assessed health experienced between socio-economic groupings of occupations. They are measured as the percentage point difference in the rates of "Not Good" health, reported in the 2011 Census, between the most and least advantaged socio-economic occupations. Current legislation places a duty on health organisations to have regard to reducing health inequalities in decision-making.

The analysis uses seven occupational groupings in the National Statistics Socio-economic Classification (NS-SEC) derived from questions asked in the 2011 Census.


‘Not Good’ health rates are highest for those from the most socially disadvantaged  socio-economic classes

An examination of the rates of ‘Not Good’ health from the 2011 Census show there was a pattern of deteriorating health with increasing disadvantage associated with the socio-economic position of the occupation. Routine workers in Class 7 had the highest rates of ‘Not Good’ health nationally, regionally and at local authority level for both men and women. Conversely, the most advantaged higher managerial and professional class (Class 1) had the lowest rates of ‘Not Good’ health.

It is estimated that an additional 1.6 million men and 1.8 million women would be assessing their health as ‘Good’ if they had the same self-assessed health rates as those in the most advantaged occupations such as lawyers and medical doctors in England and Wales.

Health gaps between all classes at regional and local authority level  

There is a North-South divide with the northern regions and Wales having larger health gaps than those in the South. London is not included in the South due to its differing characteristics which, include its transient population, access to services and limited rural population.

The East of England had the smallest health gap, measured by the Slope Index of Inequality (SII), for both men and women at regional level, at 16.7 and 17.2 percentage points respectively. The North East had the largest health gap for men at 21.6 percentage points, but for women Wales had the largest health gap at 23.4 percentage points.

Regionally, the health gaps are generally bigger for women than men and this is mirrored at the England and Wales level. The picture at local authority level is more varied but the health gaps still tend to be larger for women.

At the local authority level the health gaps are narrower for some local authorities and wider for others than at regional level; the largest health gaps for both men and women are concentrated in large population centres. Conversely, those with the smallest health gaps are in local authorities with no large towns or cities. Islington in London had the largest health gap in England and Wales for men and women at 33.3 and 31.4 percentage points. South Holland in Lincolnshire and Rochford in Essex had the smallest health gaps for men and women at 9.8 and 11.1 percentage points.

Across all regions and local authorities it appears that it is the health rates of the most socio-economically disadvantaged classes, rather than the most socio-economically advantaged classes, that determined the size of the health gap. In the local authorities with small health gaps the ‘Not Good’ health rates of routine workers were lower than the England and Wales average. Stronger correlations were found between the size of ‘Not Good’ health rates of routine workers and the size of the health gaps than any other class.


Background Notes

1. ‘Not Good’ general health was derived from those assessing their general health as either ‘Fair’, ‘Bad’ or ‘Very Bad’ to the general health question in the 2011 Census. The ‘Not Good’ health rates in this summary are age standardised to the European standard population 2013. Age standardisation allows geographies, sexes or occupational classes with differing age structures to be compared.

2. In this summary the age standardised rates of ‘Not Good’ health are reported. Therefore the health gaps are measured as the difference in the rates of Not Good health.  As an example a health gap of 15% ‘Not Good’ health would mean that there is a difference of 15% between the least and most socio-economically advantaged people  in their self-reporting of ‘Not Good’ health.

3. The range between the health rates of the most advantaged higher managerial and professional occupations and the most disadvantaged routine occupations is a simple measure of the health gap. To get a more complete measure of the health gap a statistic called the Slope Index of Inequality (SII) is used.

4. The SII represents the absolute inequality in health rates between the least and most disadvantaged socio-economic classes, taking account of the health rates in all classes and also accounting for the varying distribution and numbers working in each of the classes.

5. Data is for all usual residents aged 16 and over, who work (or did work) and are classifiable into the reduced NS-SEC, in households.

6. Local Authorities have been ranked on the age standardised rates of 'Not Good' health to more than one decimal place.

7. Due to small population counts, data for City of London has been merged with Westminster and data for Isles of Scilly has been merged with Cornwall. Therefore, in this analysis, there are 346 local authorities in England and Wales.


These statistics were compiled and analysed by the Health Analysis team in the Public Policy Analysis division. For further details on health gaps by socio-economic position of occupations at national, regional and local authority level, see this infographic and short story. If you have any comments or suggestions, we’d like to hear them! Please email us at  

Categories: Health and Social Care, Health of the Population, Health Inequalities
Content from the Office for National Statistics.
© Crown Copyright applies unless otherwise stated.