Health Inequalities

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Health Inequalities

• Dr John Hayward
• Director of Public Health
• Health Partnership Board 16 Jan 2003

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The distribution of health and ill-health among
and between populations has for many years been
expressed most forcefully in terms of ideas of
inequality. These inequalities are not just
differences.The focus of interest is not so
much natural physiological constitution or
process as outcomes which have been socially or
economically determined.The Black Report 1980
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Health Inequalitiesa working definition

• Variations in health between different groups in
  our population, due to socio-economic factors,
  gender, ethnicity or geography
• Variations which are unacceptable on grounds of
  social justice and equity

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Policy Context

• Acheson Report Independent Inquiry into
  Inequalities in Health (1998)
• Saving Lives Our Healthier Nation (1999)
• The NHS Plan commitments (July 2000)
• Announcement of two national health inequalities
  targets (February 2001)
• Consultation (Aug Nov 2001)
• Cross cutting spending review (Nov 2002)

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Acheson Report

• Poverty, income, tax and benefits
• Education
• Employment
• Housing and environment
• Mobility, transport and pollution
• Nutrition and C.A.P
• Mothers, children and families
• Young people and adults of working age
• Older people
• Ethnicity
• Gender
• NHS Access to services

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National Health Inequalities Targets

• Starting with children under one year, by 2010
  to reduce by at least 10 per cent the gap in
  mortality between manual groups and the
  population as a whole
• Starting with Health Authorities, by 2010 to
  reduce by at least 10 per cent the gap between
  the fifth of areas with the lowest life
  expectancy at birth and the population as a
  whole
• February 2001

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National inequalities targets

• We need to focus attention on
• the health of children (infant mortality)
• the major killers CHD and cancer
• variation by social class and group
• variation by area

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Life Expectancy in deprived areas in NE London
Deprivation Quintiles
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Relationship between deprivation and death rates
across London 1995
Each square represents one London Borough.
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Cross cutting Reviewkey areas for intervention

• Infant Mortality
• Life Expectancy
• Breaking the cycle
• Major Killers
• Improving Access
• Strengthening disadvantaged communities
• Specific groups with poor health outcomes

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Milburns five steps

• Putting public health and addressing health
  inequalities at the heart of the NHS
• Securing a better balance between prevention and
  treatment
• Tackling inequalities in access to health
  services
• Tackling the biggest killers - coronary heart
  disease and cancer
• Tackling smoking

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What is our situation in Newham?
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NE London context - infant mortality rates

• Infant mortality rates (per 1000 live births,
  ONS, 2000)
• BD 5.7
• City of London 3.7
• Hackney 8.9
• Havering 5.6
• Newham 7.3
• Redbridge 4.8
• Tower Hamlets 6.7
• Waltham Forest 7.1
• England and Wales 6.0

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1 - Infant mortality

• Building on Sure Start mainstreaming?
• Smoking in pregnancy
• Reducing teenage pregnancy/causes/effects
• Better housing
• Other NHS interventions

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NE London context - housing

• Unfit dwellings ( of total dwellings, 2001)
• BD 8.1
• Hackney 8.3
• Havering 3.7
• Newham 18.3
• Redbridge 9.2
• Tower Hamlets 8.6
• Waltham Forest 9.0
• England and Wales 6.4

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2 - Life Expectancy

• Reducing smoking
• Prevention services in primary care
• Environmental improvements (inc housing)
• Targeting the over 50s

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3 - Breaking the cycle

• Promoting healthy pregnancy
• Early years development
• Narrowing educational attainment gap
• Reducing teenage pregnancy

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NE London context - education

• Pupils with no GCSE pass grades in maintained
  secondary schools (DfES, 2001)
• Newham 2.4
• Inner London 5.3
• Outer London 4.2
• England 5.5

• Pupils permanently excluded from maintained
  secondary schools (DfES, 2000)
• Newham 0.15
• Inner London 0.33
• Outer London 0.24
• England 0.21

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NE London context - employment

• Employment rate, working age (ONS, Labour Force
  Survey, 2000/2001)
• Newham 51.1
• Inner London 64.5
• Outer London 73.9
• England 74.8

• Income Support/Job Seekers Allowance claimants
  (Dept of Work and Pensions, 1999)
• Newham 18.4
• Inner London 13.2
• Outer London 8.2
• England 8.2

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4 - Tackling major killers

• Reducing smoking esp.groups with highest
  incidence
• Prevention and treatment NSFs
• Nutrition in children, less obesity
• More physical activity esp. deprived groups
• Reducing accidental injuries amongst children

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5 - Access to public services

• Improving mainstream services
• Primary care in disadvantaged areas
• Public transport
• Improved access through technology and
  information

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6 - Strengthening disadvantaged communities

• Improving mainstream services
• Improved access / quality of primary care
• Improved public transport
• Technology and information

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7 - Specific Groups

• Housing for older people and families with
  children on low incomes
• Reducing accidents
• Ending fuel poverty among older people etc
• Enabling disabled people to return to work
• Addressing needs of homeless people and prisoners

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An omission again!

• Health of children and young people who are
  looked after by the local authority
• Large piece of local work coming, aided by 600K
  from NRF

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Teenage Pregnancy - An Example
Next Generation Continues.
Older Person 65yrs gt
Child 4 - 10yrs
Mature Adult 45 - 65yrs
Adult 25 - 45yrs
Toddler 0 - 4yrs
Adolescent 11 - 17yrs
Young Adult 18 - 25yrs
Pre-Conception
Antenatal
Poor nutrition Smoking Low educational attainment
Low birthweight Low income Unemployment
Early sexual debut Poor access to contraception
SHiNe SRE Connexions
Sure Start plus
Re-integration officer
EAZ
Food co-op

Cancer CHD Diabetes
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Overview

• Broad determinants poverty, transport,
  environment, regeneration, education
• No mention of employment
• Work targeted at
• Families, children and young people
• Teenage pregnancy and breaking the cycle
• Older people
• Big killers Need to reduce smoking

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Impact of the Review

• Action on health inequalities to be part of
  mainstream work of public services, including the
  NHS, over the next three years (linking to CSR)
• An Implementation Plan to follow shortly,
  including performance management arrangements and
  a basket of indicators to track progress

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Implementation

• We do know that successful interventions
• Include local assessment of need
• Involve local people in design and management
• Have organisations working together
• Train local people and support community based
  initiatives
• Have visible political commitment
• Systematically invest in successful
  community-based programmes
• Enable these programmes to drive organisational
  priorities and policies
• Create flexible and responsive organisations

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Newham HPB

• Health inequalities to be at the centre of its
  work
• Oversee implementation phase
• Ensure LSP picks up broader determinants
• Education, environment, housing, transport,
  employment, community development
• Local public health policy (e.g. smoking?)
• Teenage pregnancy
• Improved health of families with young children

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Own view

• Implementation needs strengthening
• LSP distracted by NRF
• Time for HPB to lead!