Impartial Reporter journalist, Colm Bradley, carried out a special investigation into the health inequalities facing people who live in deprived areas. In this, part one of the two part investigation, he explains how an area is classified as deprived, what inequalities you face if you live in one of those deprived areas and finally how long the Western Health and Social Care Trust have known about some of these inequalities and what they plan to do about them. 


What areas are classified as deprived in Fermanagh?

Northern Ireland is split into 890 Super Output Areas for the purposes of the gathering of statistics. Super Output Areas (SOAs) are geographical areas that were developed to help the Northern Ireland Statistics and Research Agency to improve the reporting of small area statistics. Across Northern Ireland there are 890 SOAs. For the purposes of analysing health inequality, the 20 per cent of most deprived SOAs are analysed against the average.

There are five SOAs in Fermanagh that fall into the 20 percent most deprived areas of Northern Ireland, with Devenish, which covers parts of Enniskillen in the top five per cent of most deprived areas in Northern Ireland. The other areas in Fermanagh that fall in the top 20 per cent of deprived areas are Belleek and Boa, Newtownbutler, Rosslea, and Irvinestown.


If you live in a deprived area what are the health inequalities that you face?

  • Life expectancy for women who live in deprived areas in Fermanagh and Omagh District (FOD) fell from 83 to 79 years between 2011-13 and 2015-17.
  • In 2011 women in deprived areas of FOD had equal life expectancy with the Northern Ireland average. Now this has moved to a position of relative disadvantage
  • There has been an increase in preventable causes of death between 2009 and 2017 in the most deprived areas of FOD from 250 to 278 deaths per 100,000. A reduction has been seen in other areas in FOD.
  • FOD has a slightly lower rate of hospital admission for alcohol-related causes than Northern Ireland average, but the most deprived areas of FOD have almost double the average rate.
  • Death rate due to alcohol is 70 per cent higher in the more deprived areas of FOD than Northern Ireland average
  • The death rate from smoking in FOD is similar to the NI average at 160 deaths per 100,000 but is much higher in deprived areas of FOD at 219
  • The death rate from smoking related causes has been falling in NI overall over last five years but has climbed in the deprived parts of F&O.
  •  The rate of new diagnoses of lung cancer has climbed sharply in FOD deprived areas from 70 per 100,000 population in 2006-12 to 111 per 100,000 population in 2010-16.
  •  The death rate due to lung cancer has been stable in NI at 66 deaths per 100,000 population between 2009 and 2017, but has increased from 53 to 88 per 100,000 in F&O deprived areas
  • Number of people diagnosed with cancer in deprived areas rose by over 20 per cent from 605 to 737 per 100,000. In the same six year period non deprived areas saw diagnoses rise from 561 to 584, a rise of 4 per cent
  • Above statistics are taken from two reports: 1) Health and Social care Needs in Fermanagh and West Tyrone; by Dr Declan Bradley. 2) Health and Inequalities Annual Report 2019; by the Department of Health.


Series of reports show the growing gap in health inequalities

Living in the most deprived areas of Fermanagh has a negative impact on your health, a series of reports have shown.

Considers these shocking statistics: life expectancy of women reduced by four years; 20 per cent rise in cancer diagnosis; 70 per cent more likely to be admitted to hospital with alcohol related illness; 59 per cent increase in diagnosis of lung cancer; 66 per cent increase in deaths by lung cancer and 36 per cent higher death rate from smoking than the Northern Ireland average.

Indeed, these are just some of the stark figures that portray the changing health landscape for people who live in the most deprived areas of Fermanagh.

It has also emerged that Northern Ireland has the worst health outcome of any of the four countries in the United Kingdom and that according to one health expert, people in Northern Ireland have “poorer health than most comparable countries”.

 The Health and Inequalities Annual Report 2019, commissioned by the Department of Health contain raw statistics showing the changing trends for health outcomes across each Health Trust and each District Council area.

Meanwhile another report, produced last November for the Pathfinder programme, spoke in stark terms about the inequalities that existed within the Fermanagh and West Tyrone area.

This latter report revealed that of the 54 areas in the Pathfinder catchment area, 46 are in the most deprived half of areas in Northern Ireland. In the report, written by Dr. Declan Bradley and entitled ‘Health and Social Care Needs in Fermanagh and West Tyrone’, Dr Bradley draws attention to these inequalities and pays particular reference to the falling life expectancy of women in deprived areas: “People in NI have, on average, poorer health than most comparable countries, and the people who live in the more deprived parts of Fermanagh and West Tyrone experience worse health outcomes more often than the average. The changing life expectancy of women from deprived areas is an important development that should be included in the work developing from the Pathfinder project.”

The Health Inequalities Report 2019 shows a downward trend in women’s life expectancy in the most deprived area over a number of years and the Impartial Reporter asked the Western Health and Social Care Trust  (WHSCT) specific questions in relation to when downward trends in health inequalities were identified and also how Pathfinder aims to redress the imbalance.

The Trust would not be drawn on when the downward trends were identified but did state that Pathfinder hopes to use the evidence to improve health outcomes: “Pathfinder, through the current series of independently facilitated ‘Moving to Action Workshops’, is currently working with key stakeholders to look at a number of areas, including health inequalities which are highlighted within Dr Bradley’s report.

“Through collaboration with the Community and Voluntary Sector, Statutory bodies and users of services from within communities, Pathfinder will thus develop a plan aimed at improving health outcomes of people in the area,” a spokeswoman for the Trust said.

Dr Bradley, for his part, believes that the evidence of inequality should be central to work that the WHSCT does during the next stage of their Pathfinder project.

“The issues identified in this report will be passed to multi-disciplinary teams of HSC staff, stakeholders and experts-by-experience who will be tasked with prioritising the issues in their remit and redesigning services to improve access, safety, flow and quality.”