Title: Health Equity Audit
1Health Equity Audit
- Habib Naqvi
- Public Health Analyst
- Bristol Directorate for Public Health
2Overview
- Tackling inequity of inputs to achieve equality
of outcomes - Important contribution to reducing health
inequalities - Matching need with distribution or resources or
services
3Why do health equity audit?
- Requirement for all NHS planning
- Provide commissioning information to meet needs
of groups currently underserved - Identify where new forms of integrated services
are needed across agencies - Provide robust performance evidence on extent to
which need is being met - Inform local inequality targets
- Inform LDP and support LSPs
- Provide a common framework for all agencies to
audit their contributions to reducing health
inequalities - Information for public and voluntary sectors
about gaps and inequities in service provision
4Remind me again, what is the difference between
health inequality and health equity?
- Both are concerned with distribution of health
and health care - Health inequality
- Differences in health experience or outcome
between population groups Dimensions ,
geography, age, sex, ethnicity, socioeconomic
status - Health equity
- Fair distribution of health or health care
resources or opportunities according to
population need - Equal share of resource for equal need
5Types of health inequality
6Remind me again, what is the difference between
an equity profile and a health equity audit?
- Equity profile
- Descriptive
- Technical
- Starting point for equity audit
- Equity audit
- Process
- Iterative
- Linked into planning cycles
7The health equity audit cycle
- Health equity audit stages
- Where to start agree priorities and partners
- Equity profile collect, collate and analyse
data - Use evidence to identify effective local action
- Set targets/decisions
- Influence changes in investment and service
delivery - Monitor and review
8Where do I start? Priorities and topics
1
- Possible examples
- national targets
- local health inequality assessments or use of
local health inequality indicators - local knowledge of service variations
- examples from elsewhere/literature/research (e.g.
in DPH annual report) - local priorities identified in the LDP
9Where do I start? Partners
1
- Will depend on choice of topic/local priorities
- Topics may emerge from existing partnerships
10Equity profiling
2
- Process of collating and analysing data and
evidence on need and health inequalities - Confirm inequity exists
- Usually wont require new data collection
often use existing sources or local data.
11Examples of data that can be used in equity
profiling
2
- Vital statistics births and deaths e.g. from
Compendium, Mortality files, ONS - To show variations in life expectancy, mortality,
IMR, birth weight by area, sex, cause, social
class - Proxy need measures
- Morbidity data e.g. from HES, registers, primary
care - To show variations in prevalence or utilisation
by area, sex, age, deprivationethnicity??? - Needs assessment
- Local authority and ward data e.g. neighbourhood
stats - Socioeconomic profiles/ broad determinants
- Service utilisation
- Activity data/access to services
- Coverage data e.g. screening, immunisation
- Resource allocation
12Evidence to identify effective local action
3
- Tackling health inequalities framework
- Strengthen individuals and vulnerable groups in
disadvantaged circumstances - Improve provision of and access to essential
services and facilities - Need to understand causal pathways how do we
think inequity has arisen - What local interventions might help?
- What evidence is there of effective action?
- What is feasible and affordable?
13Agree local targets
4
- Direction (e.g. narrow gap) and destination (e.g.
by how much and by when) - Equity targets focus on the gap between what is
provided and what is needed
14Targets - direction
4
- Improve life expectancy in areas with low life
expectancy compared to national average - Reduce infant mortality in deprived areas or
groups - Reduce smoking, esp. in disadvantaged groups
- Increase proportion of teenage mothers continuing
in education/ unemployment - Reduce higher incidence of childhood accidents in
deprived areas (wards) - Narrow the gap in educational attainment across
social groups, including attainment in schools
serving deprived areas
15Influence changes in investment and service
delivery
5
- PCT and Public Health performance (smoking
cessation) - New or redeveloping services e.g. South Asian
Diabetes Facilitators, Health Trainers - Partnership working e.g. with development
agencies/ neighbourhood renewal etc tackling
determinants
16Review progress and monitor
6
- Vital to close the loop
- Need indicators to support
17HEA database
- Examples of current/competed work that partially
or completely reflect a HEA - South Asian and access to CHD services
- Sexual health services and young BME people
- Drug related deaths in Avon
-
18Conclusions
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- A welcome must do
- Old wine in new bottles
- The data is there
- Linked into mainstream
- Part of everyday work