Transcript Document
Creating positive life chances for all.
31st May 2012
Illaria Geddes and Mike Grady Principal Advisor.
Marmot Review Team Institute of Health Equity UCL
Fair Society: Healthy Lives: 6 Policy Objectives
A. Give every child the best start in life B. Enable all children, young people and adults to maximise their capabilities and have control over their lives C. Create fair employment and good work for all D. Ensure healthy standard of living for all E. Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill health prevention
Local Government
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Complex, disparate and diverse systems of Local Government across Europe.
Focus on needs of local population.
Differing capacities to orchestrate action to address the social determinants of health.
Whole System Leadership Increasing participation and empowering communities.
Within the context of HWBs the aim for JSNA / JHWS is to be: What services do we need to commission (or de-commission), both separately and jointly? – Commissioning plans EXPLICIT LINK So what are our priorities for collective action, and how will we achieve them together? – JHWS So what does that mean they need, now and in the future and what assets do we have? – a narrative on the data – JSNA What does our population & place look like? – data HEALTH & WELLBEING BOARD
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No shared vision Dominant partner Top down Project focussed Quick wins Funding constraints Grant giving Internal focus Individual ownership Health an NHS issue Medical Model
A Theory of Maturing Partnerships for Health Improvement
Process factors
Immature Partnership Little added value Gaining collaborative advantage for health improvement Maturing partnership Increasingly acting on social determinants of health
External contextual factors
Mature Partnership Showing Added value
Confidence in partners Shared identity Shared vision Joint ownership Alignment Joint posts Citizen engagement Accountability Holistic Health everyone's business.
Addressing SDH
Adapted from Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement.
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Reorient (health) services Population Level Interventions Build healthy public policy Create supportive environments Strengthen community action Intervention Through Services Develop personal skills Ottawa Charter Intervention Through Communities
Producing Percentage Change at Population Level C. Bentley 2007
Allen G. (2011) Early Interventions: Next Steps.
Social Determinants Approach to PPHCs
SDH
Early Years
PPHC Alcohol Misuse Obesity
E.g. Universal free school meals.
Smoking
E.g. improved access to early years education.
Education and Skill Development Employment and Work Communities and Places Standard of living E.g. Reducing the number of NEETs.
E.g. Managing stress at work.
E.g. Reducing environmental inequalities.
E.g. Develop pathways to work.
E.g. Planning walkable neighbourhoods.
E.g. Increase exposure to green space.
E.g. Minimum income for healthy diet.
E.g. Tackle debt issues.
Prevention and Regulation Equality and Health equity E.g. Reducing crime and fear of crime.
E.g. Reducing salt and fat content in processed foods.
E.g. Fire fighters in the community.
Tool 1
Percentage of 5-year-olds achieving good development score* in Birmingham Local Authority, the West Midlands region and England.
* in personal, social and emotional development and communication, language and literacy. Source: Department of Education.
Early Years
Education and Skills
• Educational attainment is a predictor of health outcomes.
• Higher educational attainment is associated with healthier behaviour.
• There is a gradient in limiting illness by level of educational attainment.
• There is a gradient in mortality by educational attainment.
Swansea and Wrexham NEETs
NEETs reduced by 68% over 5 years, in Swansea from 12.2% in 2004 to 4.2% in 2010 – well below the Welsh average.
• • • • • Strategic focus (priority at strategic level; clear targets set; resources shifted; work intensified; earlier intervention) Identifying target groups within the population of young people (Careers Wales advisers and school staff working together to identify pupils in Year 11 at risk of becoming NEETs) Partnership working and information sharing (Local Authority, Careers Wales, JobCentre Plus, head teachers, teachers, Learning Coaches, Youth Workers, and Education Welfare Officers) Provision & support (change in core service provision, greater emphasis on summer months, skills building provision, flexible start dates for training, work placement through project partners) People (enthusiastic and committed staff)
Education and Skills
Proportion of Year 11 school leavers known to be NEET in 2004 - 2010
Education and Skills
Young people offending in Swansea
Education and Skills
Education and Skills
• Being in good employment is protective of health.
• Unemployment contributes to poor health and higher mortality rates.
• Insecure and poor quality employment associated with increased risks of poor physical and mental health.
• There is a graded relationship between a person’s status at work and the risk of developing ill-health.
Feeling good about where you live
• Run by Greenwich Council and NHS Greenwich.
• Aims to understand the causality between built environment, social networks and mental well-being through providing a number of interventions in the environment.
• 3-years study which include a case control group.
• Based on postal survey to 1,600 households in 9 areas in Greenwich; response rate 38% (n=608).
• Focused on two estates - Baseline survey has been completed on two estates - 810 responses (from 1500 households); the ‘control’ estate will receive improvements at the end of the project.
• Delivery partnerships with NHS Greenwich, Metropolitan Police, Greenwich Council, local schools established.
Communities and Places
Communities and Places
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EWDs are almost three times higher in the coldest
quarter of housing than in the warmest quarter (21.5% of all EWDs are attributable to the coldest quarter of housing, because of it being colder than other housing).
• Children living in cold homes are more than twice as likely to suffer from a variety of respiratory problems than children living in warm homes.
• Mental health is negatively affected by fuel poverty and cold housing for any age group.
• More than 1 in 4 adolescents living in cold housing are at risk of multiple mental health problems compared to 1 in 20 adolescents who have always lived in warm housing.
• Cold housing increases the level of minor illnesses such as colds and flu and exacerbates existing conditions such as arthritis and rheumatism.
Income group 4 is most deprived • The is a gradient in environmental disadvantage.
• Strong link between environmental factors and health (e.g. Pollution).
• Strong evidence that access to good quality green spaces improves mental health.
• Traffic accidents concentrated at the bottom of the gradient.
Communities and Places