Transcript Saving Londoners Lives Emergency Life Skills programme

Health Equity Audit
Made Simple
A briefing for Primary Care Trusts and
Local Strategic Partnerships
Fiona Johnstone
St Helens PCT/MBC
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Health Equity Audit: Definition

“Systematically review inequities in the causes of ill
health, and in access to effective services, and their
outcomes, for a defined population”

“Ensure that action required is agreed and
incorporated into local plans, services and practice”

“Evaluate the impact of actions on reducing inequity”
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Health inequality v 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
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Partner requirements

In NHS performance management framework

National PSAs for local government (inc Best
Value Reviews)

Coordinated through local strategic
partnerships (ie promotes community
involvement)
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Value of health equity audit

Inform the commissioning of services

Contribute to local performance management
of public services

Support partnership working and allocation of
resources

Encourage community involvement in the
NHS and across LSP Planning
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What are the questions HEA
can answer?

What are the known health inequalities for a particular population group
or area?

What are the significant equity issues in relation to provision/access,
use and quality?

What are the priorities for action?

What could help us deliver on this target?

National/local targets?

What targeted action can we take?

Have resources been reallocated to take the most effective action?

Has there been any impact on the inequities targeted?
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Types of health inequality
GENDER
GEOGRAPHY
DISABILITY
AGE
ETHNICITY
Social-economic environment
e.g. jobs, housing, education, transport
Lifestyles/health behaviour
e.g. diets, smoking, social networks
Access to effective health/social care
e.g. services that result in health benefits
Health outcomes
e.g. increase/reduce mortality, morbidity, ill health, disability
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Equity in Service Provision
Equal Access
for Equal Need
Equal
Equal Quality of
Utilisation for Care for Equal
Equal Need
Need
Age
Gender
Ethnicity
Impairment
Socio-economic
deprivation
Geography
“Gateway”
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Cycle of health equity audit
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Review progress
and impacts
against targets
5
Secure changes in
investment and
service delivery
1
Agree priorities
and partners
4
Agree local
targets with
partners
2
Equity
profile
3
Identify local
action to tackle
inequalities
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Establishing a process

Requires:
– technical skills
– negotiating and influencing skills

Timescale dependent on:
– available data
– partnership decisions
– delivery of interventions and time to follow up
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Stage 1: Agree Priorities and
Partners

LSP and Local Delivery Plans and NSFs are most
likely starting points for agreeing priorities

Community consultation process will need to be
factored in

Team should reflect health issues chosen for audit will include NHS, local government and other key
partners
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Stage 2: Do an equity profile

Process of mapping health status, service
provision and use against need

Need to identify:
– resources to undertake the audit
– links with other planning processes
– how inequalities will be measured
– who are your comparators (important in setting targets)
– information sources
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Local and National Comparison of
Audit Data (Index of Multiple Deprivation1)
Local Ranked Score
National Ranked Score
Income
Child Poverty
Income
35
8500
30
7500
25
20
6500
Employment
Child Poverty
5500
Employment
4500
15
3500
10
2500
1500
5
500
0
Access
-500
Health
Housing
Education
Access
Health
Housing
Deprived Ward
Deprived Ward
Education
Affluent Ward
Affluent Ward
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Source: Department of Environment, Transport & Regions, UK, 2000
Socio-Economic Equity Audit in an Affluent
and Deprived part of Liverpool (1)
Deprived
Ward
Affluent
Ward
11.1%
3.8%
Long-term unemployment
29.7%
29.4%
Youth unemployment
28.3%
29.1%
 Housing benefit
49.6%
11.3%
 Free school meals
 Public spending per head
(1995/96)
49.0%
£4,532
13.3%
£3,328
Economic Capital
 Unemployment
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Geographical Equity Audit in an Affluent and
Deprived part of Liverpool (2)
Deprived
Affluent
Ward
Ward
16.0%
4.0%
Physical/Environmental Capital
Street cleanliness (% unsatisfactory)
Bus stop within 250m
100.0%
89.3%
Human Capital
Educational attainment (age 14)
English
54.5%
85.8%
Maths
58.2%
80.7%
Science
68.3%
85.4%
1.4%
0.8%
Social Capital
Domestic Burglary (per 1000 pop)
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Health Outcome Indicators
Deprived
Affluent
Ward
Ward
1,182
706
Standardised mortality ratio
< 75 years
160
101
5 year olds with dental decay
56%
39%
Emergency admissions
per 10,000
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Example

Analysis of domestic burglary rates showed a
wide range across Liverpool (1.46 to 11.32
per 1000 properties in 1995/96). Burglary
rates were highest in more deprived areas of
the City, which were also areas where there
are high numbers of terraced housing stock
with vulnerable back alleys.
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Stage 3: Identify effective local
action to tackle inequities

Tackling health inequalities framework

Look at causal pathways

Models of good practice

Formal evidence base

Feasibility and affordabiity

Link to targets
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Example

The use of “Alley Gates” was identified as a
suitable intervention, despite worries from
partners as to the legality of closing access
routes. It was agreed that the perceived
benefits outweighed right of way issues, and
the Council decided to go ahead. Alley gates
were installed at the rear of entries covering
210 properties.
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Stage 4: Agree local targets
with partners

Must achieve partnership sign-up

Should be clear and not solely aspirational

Should identify what should happen to who
and by how much

Which dimensions of equity will be targeted
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Key established targets for delivery

Improving life expectancy in areas with low life expectancy compared to
the average

Reducing infant mortality in deprived areas or groups

Reducing teenage pregnancy

Increasing the proportion of teenage mothers continuing their education
and employment

Reduce smoking, particularly amongst disadvantaged groups

Reducing the higher incidence of childhood accidents in deprived
wards

Increasing the number of vulnerable households helped out of fuel
poverty

Narrowing the gap in educational attainment across social groups
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Stage 5: Secure changes in
investment and service delivery

Accountability for investment to reduce
inequalities is built into the performance
management framework

Equity audit can help bend mainstream
funding or to access other streams such as
Neighbourhood Renewal Funding

Further investment will rely on a dynamic
audit process
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Example

The target was to reduce the number of
domestic burglaries in those properties which
were covered by the scheme.

The cost of this intervention was £10k (less
than £50 per property).
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Stage 6: Review progress and
impacts against targets

Critical to ‘close the loop’

Make the case for mainstream funding

Need for appropriate indicators

Move beyond measurement
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Example

Number of burglaries in those properties
covered by the Alley Gating scheme fell from
23 burglaries in 1995/6 to 5 burglaries in
1999/2000.

Additional gains included residents reporting
measures of greater social capital, improved
cleanliness, and reduced fear of crime.
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Emerging issues: 1

Wish to clarify what HEA is and where it will
most effectively fit with other policy work

Many HEAs not badged as HEAs

Much focus on equitable access to health
services

Equity profiling a common first step
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Emerging issues: 2

Enthusiasm for sharing best practice

HAZ

Regeneration

Equity profiles for CHD

Neighbourhood renewal strategies

Concerns over capacity available v capacity needed

Lack of appropriate local health inequalities data
presents difficulties
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Consultation to explore

Planned activity and resources needed

Practical problems

Fit with local planning

Performance monitoring

Further work/gaps

Future possibilities for HEA
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Consultation questions

Definitions

Short listing criteria

Selection criteria and local flexibility

Performance management

Decisions

Further work/gaps
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