“Some people believe football is a matter of life and death,” Bill Shankly, Liverpool FC’s manager between 1959 and 1974, once said. “I am very disappointed with that attitude. I can assure you it is much, much more important than that”. Now imagine the newspaper headlines if at the end of the football season three of the biggest English football clubs – Manchester City, Everton and Liverpool – were relegated from the league. If football were really a matter of life and death, this is exactly what would happen.
We put together a public health league table (PHLT) which ranks the areas local to the 2014-15 Premier League football clubs from best to worst using key health indicators with a corresponding code: the percentage of smokers (P, played); weight – percentage of obesity and overweight (W, won); deaths – all cause mortality rates per 100.000 (D, drawn); life expectancy for males in years (L, lost); female life expectancy in years (F, for); alcohol-related hospital admissions per 100,000 (A, against); and the gap or difference in life expectancy for men between the most and least deprived areas of the local authority in years (GD, goal difference).
The final league points represent the sum of ranks for each outcome. For example, Chelsea’s league-winning score of 114 points comes from ranking second for P, first for W, D, L, F, and A and last for GD.
While Chelsea would still be winners in the public health league table, Crystal Palace, Manchester United and Tottenham Hotspurs would join them in the top four, with West Ham in fifth place. As the bottom three in the table, Manchester City, Everton and Liverpool are all relegated.
The data we used came from PHE Outcomes Framework Data, the Office for National Statistics and the Public Health Observatory Wales. Premier League clubs were geo-referenced to the local area with which they are most associated, so Manchester United’s data, for example, is for Trafford Council, Chelsea FC is represented by data from the Royal Borough of Kensington and Chelsea, and Swansea is represented by data from the local health board (although the Wales average had to be used for the alcohol variable). Liverpool and Everton have the same data as their grounds, Anfield and Goodison,are located in the same local authority.
Apart from throwing up some unusual league places, the PHLT also further demonstrates the extent of the north-south divide in health in England: the top half of the table is dominated by southern clubs and the relegated trio are all from the north-west. To those working in public health, this will not be surprising as the cities of Liverpool and Manchester have some of the worst health outcomes in the country. The contrast between winners Chelsea and relegated Manchester City in terms of life expectancy is immense at seven years for men and six years for women.
The PHLT also demonstrates the local health inequalities that exist within our towns and cities. So while Manchester United place in the top four, their “noisy neighbours” Manchester City are relegated. Life expectancy for men and women on the red side of Greater Manchester is four years higher than for those on the blue side - only a couple of miles down the road. This is probably related to the stark differences on these two sides of the same city in terms of economic deprivation with, for example, child poverty rates of 34% for Manchester City Council compared to 14% in Trafford.
Even within local authorities there are high inequalities in life chances with, for example, a 14-year gap in male life expectancy between the most and least deprived areas of Chelsea.
The north-south health divide, local health inequalities, and inequalities within local authorities are a serious public health concern – to the extent that they were the subject of Due North, the first Public Health England commissioned independent review in 2014. This report recommended a number of ways in which central and local government and the voluntary sector and the NHS could help reduce these health divides. The PHLT is another way of showing these divisions and raising awareness of the inequalities in “life and death” that exist in our country today.