Transcript The National Service Framework for Diabetes

NDCs and Health
Overview of Phase 1
Liddy Goyder, ScHARR
University of Sheffield
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
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?
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
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
Delivery Plans 2004
Top 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)
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
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
0
NDC Area
Hull
Derby
Plymouth
Middlesbrough
Oldham
Bristol
Knowsley
Hartlepool
Sheffield
Salford
Sunderland
Manchester
Luton
Doncaster
Coventry
Bradford
Sandwell
Nottingham
Liverpool
Rochdale
Southampton
Newcastle
Fulham
Leic
ester
Walsall
Newham
Birmingham
Wolverhampton
Lewisham
Brighton
Kings Norton
Norwich
Lambeth
Tower Haringey
Hamlets
Islington
Brent
Hackney
Southwark
% NDC population consuming 5
portions of fruit and vegetables
per day
40
35
30
25
20
15
10
5
Spending by Theme 2001-4
Housing & PE
104
Community
Development
87
Education
68
47
Worklessness
Health
45
Community Safety
45
66
Average
0
20
40
60
80
Total NDC Expenditure (£000,000)
100
120
NDC Health Expenditure by Year
Average Theme Expenditure
8
Health Expenditure
2001/02
3
21
2002/03
12
33
2003/04
30
0
10
20
30
40
Total NDC Health Expenditure (£ 000,000)
50
60
NDC Health ReportsMain Topics
•
•
•
•
•
•
•
Improving access to health services
Complementary therapies
Exercise & Healthy eating
Improving mental health
Reducing Teenage Pregnancy
Supporting Teenage Parents
Drugs
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
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
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
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
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
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)
Has health improved in NDCs?
19
Health worse than 12 months
ago (Comparator)
19
22
Health worse than 12 months
ago (NDC)
21
2002
2004
30
Long standing illness
(Comparator)
32
33
Long standing illness (NDC)
32
0
5
10
15
20
25
30
35
Are NDCs “closing the gap”?
100
80
90
86
90
84 84
77 78
79
84 81
70
60
50
40 38
40
26
30
15 15 15
20
10
0
Health good/fairly
good
Health better
Satisfied with doctor
2002
2004
National
Satisfied with local
hospital
Residents who
smoke
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
Lambeth
Walsall
Brent
Knowsley
Liverpool
Plymouth
Newham
Coventry
Fulham
Birmingha
Brighton
Wolverham
Doncaster
Newcastle
Nottingham
Middlesbro
Leicester
Hartlepool
Oldham
Hull
Derby
Bristol
Bradford
Rochdale
Norwich
Hackney
Sandwell
Birmingha
Luton
Southampt
Manchester
Tower
Sheffield
Southwark
Islington
Haringey
Lewisham
Salford
Sunderland
Change in general health
2002-2004 by Partnership
10
8
6
4
2
0
-2
-4
-6
-8
NDC
NDC average
Comparator
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
Health models: pathways
G
Social capital:
Social
I
networks
Use of &
satisfaction with
health
services
F
Trust
Cohesion &
Reciprocity
E
Lifestyle:
smoking
diet
exercise
Engagement &
efficacy
H
Self-reported
health:
General health
Health change
SF-36 MHI
C
Security,
fear of crime
B
A
D
Partnership, tenure, education, age, gender, ethnicity,
household composition, household worklessness (& years resident)
2.3
2.2
2.1
2002 General H
2.0
2004 General H
N = 1969 1969
1419 1419
Large decrease
3345 3345
1482 1482
No change
Small decrease
2061 2061
Large increase
Small increase
Change wave 1 to 2: Diet quality
72
71
70
69
68
2002 Mental H
67
66
2004 Mental H
N=
1930 1930
1393 1393
Large decrease
3283 3283
1453 1453
No change
Small decrease
2027 2027
Large increase
Small increase
Change wave 1 to 2: Diet quality
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