NDCs and Health Overview of Phase 1

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NDCs and Health Overview of Phase 1

• Liddy Goyder, ScHARR University of Sheffield

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The health theme team

• University of Sheffield
• Liddy Goyder
• Jean Peters
• Lindsay Blank
• Libby Ellis
• Sheffield Hallam University
• NDC team, Mike Grimsley
• MORI and SDRC for health data

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Overview

• What are NDCs and what do they do?
• What are health issues for NDCs?
• Health-related activity in NDCs example of
  healthy eating initiatives
• So has health improved in NDCs?
• Do we expect NDCs to have an impact on population
  health in the future?

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The NDC Programme

• Launched in 1998
• Ten year, community led, holistic ABI in 39
  deprived English localities
• Five outcome areas housing and environment,jobs,
  education, crime, health
• 50 million per partnership
• Compares to about 600 million from mainstream
  service providers
• Plus funding and activity through other ABIs

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Complexity of ABI evaluation

• Dealing with attribution when so many
  previous/present initiatives
• Change in any ABI related to wider local/
  regional/national changes
• Area based interventions but aimed at individuals
• Spillover/displacement

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Delivery Plans 2004Top 7 outcomes for health

• Health promotion diet, exercise, health and
  well-being (31)
• Death rate/SMR and life expectancy (30)
• Mental health (16)
• Health services-access (15)
• Smoking (12)
• Teenage pregnancy (12)
• Self reported health (10)

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Interventions that are likely to improve health
and reduce inequalities

• ? income and employment
• ? educational attainment
• ? quality of housing/physical environment
• ? crime and fear of crime
• ? facilitating healthy lifestyles
• ? access to/quality of health services

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Wide variation in health indicators across
Partnerships

• Over 20 percentage point difference between
  Partnerships in residents with good health
• Health is worse over past year ranges from 28
  in Coventry to 10 in Lambeth
• General health is highly correlated with
  deterioration in health over past year (-0.88)
• NDC average SF36 mental health well being score
  ranges from 66 to 75 in 2004

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NDC population consuming 5 portions of fruit
and vegetables per day
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Spending by Theme 2001-4
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NDC Health Expenditure by Year
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NDC Health Reports- Main Topics

• Improving access to health services
• Complementary therapies
• Exercise Healthy eating
• Improving mental health
• Reducing Teenage Pregnancy
• Supporting Teenage Parents
• Drugs

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Health Theme Evaluation

• Analysis of NDC business plans
• Mapping of health areas and selection of topics/
  year
• Identification of case studies -
• to illustrate range of approaches
• variations in stages of development
• Multiple visits and face to face interviews with
  NDC programme manager, project leads etc

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Survey and routine data sources (MORI and SDRC)

• Health
• General health over past year and compared with a
  year ago
• Long standing illness, disability or infirmity
  and whether this limits activities
• SF36 mental wellbeing index derived from five
  questions on how respondent felt over past month
• Lifestyle
• 5 portions of fruit and vegetables
• Smoking
• Physical activity
• Services
• When last saw a doctor
• Ease of access
• Satisfaction with doctor
• When last used a local hospital
• Satisfaction with hospital

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Health Service Projects

• Buildings - health centres
• Staff - directly employed or seconded from NHS,
  esp PCTs
• Innovative delivery - the health bus
• Community involvement -first response
• Complementary therapies

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Healthy Eating

• Healthy food
• Limited Consumption
• Limited Access
• Limited Affordability
• Lack of confidence and skills in using fresh
  fruit and vegetables
• Lack of awareness / knowledge of impact on health

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NDC Approaches to Healthy Eating Interventions

• Food growing
• Mapping provision of food sources
• Cooking or provision of meals
• Education and support groups and sessions
• Art and Health

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Key Healthy Eating Projects

• Food Co-ops Delivery Schemes (12)
• Food Growing Allotments (10)
• Cook Eat / Cooking Skills (15)
• Breakfast Clubs (8)
• Lunch Clubs (6)
• Breastfeeding Support (7)
• School Meals (6)

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Has health improved in NDCs?
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Are NDCs closing the gap?
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Improving Health Indicators?

• Satisfaction with local hospitals and access to
  doctors have seen the most improvement from 2002
  to 2004
• However, ease of access to see a doctor in
  comparator areas improved by three times the rate
  in NDC areas.
• Mental health prescribing has increased, but not
  as much as national trends
• SMRs, SIRs and hospital admissions show no
  significant reductions and drug misuse admissions
  have increased

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Change in general health 2002-2004 by Partnership
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Do we expect health to improve in NDC residents?

• Evidence from longitudinal sample
• Change significantly different from comparator
  areas after adjustment for confounding variables
• Changes that we know are associated with better
  health
• - More likely to have stopped being unemployed
• - More likely to have started education/training
• - More likely to have increased social capital
  (people are friendly/neighbours look out)
• - But no positive change in health related
  behaviour

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Use of satisfaction with health services
Health models pathways
G
Social capital
Social networks
I
F
Trust
Self-reported health General health Health
change SF-36 MHI
Cohesion Reciprocity
Lifestyle smoking diet exercise
H
E
C
Engagement efficacy
Security, fear of crime
A
B
D
Partnership, tenure, education, age, gender,
ethnicity, household composition, household
worklessness ( years resident)
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Summary

• Unique source of longitudinal data on health and
  related factors in varied and deprived
  communities
• Need intermediate outcomes (health behaviour) to
  demonstrate impact
• Evidence that interventions associated with
  behaviour change but be cautious in attributing
  causality