Transcript Document

HINST
Associates
Addressing inequalities
in
Health and Wellbeing Outcomes
Bradford
Professor Chris Bentley
Well being
and Health
Health Seeking
Behaviour
Risk conditions – e.g.:
Poverty
Low social status
Poor educational
attainment
Unemployment
Dangerous environments
Discrimination
Steep power hierarchy
Gaps/weaknesses in
services and support
After Ronald Labonte
Physiological risks
High blood pressure
High cholesterol
Stress hormones
Anxiety/depression
Behavioural risks
Smoking
Poor diet
Lack of activity
Substance abuse
Psycho-social risks:
Isolation
Lack of social support
Poor social networks
Low self-esteem
High self-blame
Low perceived power
Loss of meaning/purpose of life
Marmot ‘Plus’ policy Objectives
Healthcare
Public Health
Give
every
child
the
best
start in
life.
Enable all
children,
young
people &
adults to
maximise
their
capabilities
& control
their lives.
Create
fair
employm
ent &
decent
work for
all.
Ensure
healthy
standard
of living
for all.
Create and
develop
healthy and
environmentally
sustainable
places &
communities.
Strengthen
the role and
impact of illhealth
prevention.
Health Inequalities
Different Gestation Times for Interventions
For example intervening to reduce risk of mortality in people
with established disease such as CVD, cancer, diabetes
A
For example intervening through lifestyle and behavioural
change such as stopping smoking, reducing alcohol related
harm and weight management to reduce mortality in the
medium term
B
For example intervening to modify the social determinants of
health such as worklessness, poor housing, poverty and
poor education attainment to impact on mortality in the
long term
C
2005
2010
2015
2020
Population Level
Interventions
Systematic community
engagement
Systematic and scaled
interventions through
services
Partnership,
Vision and Strategy,
Leadership and
Engagement
Intervention
Through
Services
Service engagement
with the community
Intervention
Through
Communities
Producing Percentage Change at Population Level
C. Bentley
2007
Life expectancy and disability free life expectancy at birth, persons
by neighbourhood income level, England, 1999-2003
Age
85
80
75
70
65
60
Life expectancy
55
DFLE
50
Pension age in 2024
Poly. (DFLE)
45
0
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75
Poly. (Life
80 85 90
expectancy)
95 100
Neighbourhood Income Deprivation - Population Percentile
Source: ONS …………………………………………………………………………..
Haringey: Slope Index of Inequality (Males)
Haringey
Index of Multiple
Deprivation (IMD)
% of residents from
each English quintile
Bradford and Airedale – national deprivation quintiles
Bradford and Airedale: Slope Index of Inequality
(Males)
Bradford and Airedale: Slope Index of Inequality
(Females)
Bradford and Airedale – national deprivation quintiles
Bradford Cause of Excess Death (not infants)
most deprived 20% versus the rest
Improving Male Life Expectancy in Birmingham
Coronary Heart Disease
Cold Damp Housing
Benefit from evidence based interventions across populations
(not to scale)
Have the
problem
Eligible for
treatment
Aware of
problem
A
B
Compliance
with therapy
Optimal
therapy
C
D
Have the
problem
Eligible for
Optimal
intervention intervention
Aware of
problem
A
B
C
Compliance
with plan
D
Components of Population Level Strategy
A.
B.
C.
D.
Awareness and understanding
Presentation and Assessment
Quality of Service
Support for Self Management
Health and Wellbeing Boards should
provide an excellent platform for more
systematic engagement with
communities, families and individuals
currently not connecting appropriately
with health services
F840
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5
F840 0
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5
F840 3
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7
F840 4
7
F840 7
F84086
8
F840 8
F84089
9
F840 0
F84091
9
F840 2
9
F840 3
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2
F841 1
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3
F846 1
4
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5
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5
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6
F846 0
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6
F846 2
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6
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7
F846 1
7
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7
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8
F846 1
9
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0
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0
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1
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2
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2
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2
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3
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3
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3
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4
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Y00 2 49
25
C + D. Quality of Care
CHD 6 - % patients whose last BP reading <= 150/90 (measured in last 15 months)
100%
80%
60%
40%
20%
0%
Practice code
Target Met
Target Missed
Exception Coded
C860
01
C860
02
C860
03
C860
05
C860
06
C860
07
C860
09
C860
11
C860
12
C860
13
C860
14
C860
15
C860
16
C860
17
C860
18
C860
19
C860
20
C860
21
C860
22
C860
23
C860
24
C860
25
C860
26
C860
29
C860
30
C860
32
C860
33
C860
34
C860
37
C860
38
C860
39
C866
03
C866
04
C866
05
C866
06
C866
09
C866
11
C866
12
C866
13
C866
14
C866
16
C866
21
C866
23
C866
25
C866
26
C866
29
A High Performance PCT
CHD 6 - % patients whose last BP reading <= 150/90 (measured in last 15 months)
100%
80%
60%
40%
20%
0%
Practice code
Target Met
Target Missed
Exception Coded
P85 0
01
P85 0
02
P85 0
03
P85 0
04
P85 0
05
P85 0
06
P85 0
07
P85 0
08
P85 0
09
P85 0
10
P85 0
11
P85 0
12
P85 0
13
P85 0
14
P85 0
15
P85 0
16
P85 0
17
P85 0
18
P85 0
19
P85 0
20
P85 0
21
P85 0
22
P85 0
24
P85 0
25
P85 0
26
P85 0
28
P85 0
29
P85 6
01
P85 6
02
P85 6
03
P85 6
05
P85 6
06
P85 6
07
P85 6
08
P85 6
10
P85 6
12
P85 6
13
P85 6
14
P85 6
15
P85 6
19
P85 6
20
P85 6
21
P85 6
22
P89 0
06
O ldh
am P
CT
A +B. ‘Missing thousands’
CHD 8 - % patients whose last measured cholesterol <= 5mmol/l (measured in last 15
months)
100%
80%
60%
40%
20%
0%
Practice code
Target Met
Target Missed
Exception Coded
Undiagnosed based on Expected Prevalence
Benefit from evidence based interventions across populations
(not to scale)
Have the
problem
Eligible for
intervention
Aware of
problem
A
B
Compliance
with plan
Optimal
intervention
C
D
Chris Bentley 2012