Transcript Lancashire Public Health Report 2011

Lancashire Public Health
Report 2011
Addressing Health Inequalities
Background
• Independent report of the
three Directors of Public
Health for Lancashire
• Purpose of the report:
– To set out the main causes
of health inequalities in
Lancashire
– To make recommendations
to partners about the
action needed for health
equity
Health inequalities in Lancashire
• Lancashire Joint Strategic Needs Assessment analysis of health
inequalities (2009)
• People who live in the most deprived parts of Lancashire are:
– 7 times more likely to die early from chronic liver disease
– twice as likely to smoke
– 6 times more likely to say that anti social behaviour is a problem in
their neighbourhood
– 5 times more likely to have symptoms of extreme anxiety and
depression
• Than those that live in the least deprived neighbourhoods in
the county
Financial cost of health inequalities
in Lancashire
• If the death rates in the most deprived 40% of areas in
Lancashire were improved to the Lancashire average:
– 16,224 years of life would be saved with an economic value of £661
million
• Estimated lost production costs due to health inequalities are
£900 million per year
• Increased benefit payments and lost taxes due to health
inequalities cost the Lancashire economy £800 million per
year.
• Health inequalities are estimated to cost the NHS in
Lancashire around £300 million per year.
What do we mean by health
inequalities?
•
Health inequalities - differences in health status or in the
distribution of health determinants between different
population groups. Examples include differences in death
rates between people from different social classes.
•
Health equity - the distribution of disease, disability and
death in such a way as to not create a disproportionate
burden on one population. It is the absence of persistent
health differences over time, between different groups of the
population.
Why do health inequalities
matter?
• Poor health and wellbeing prevents too many citizens from:
–
–
–
–
working
learning
being involved in their community
enjoying their leisure time
• Reduced productivity due to poor health has a negative
impact on Lancashire's economy
• Health inequalities are fundamentally unfair
• It is possible to reduce health inequalities
• Health reforms provide new opportunities for health equity
Setting priorities for addressing
health inequalities
• Stakeholders keen to address the causes of the
causes of health inequalities
• Identified 6 priorities for health equity:
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–
–
–
Reduce unemployment and worklessness
Increase income and reduce poverty
Strengthen communities
Increase opportunities for life long learning and skills
development
– Reduce tobacco and alcohol consumption
– Increase social support
Focus on wellbeing
• New Economic Foundation
Five ways to wellbeing:
•
•
•
•
•
Connect
Be active
Take Notice
Keep learning
Give
Low WEMWBS score across the Lancashire social
gradient
Source: LCC Corporate Research and Intelligence team from NWPHO
Wellbeing survey 2009 and ID2007, Department of Communities and Local
Government (age standardised, 3966 particpants)
Least deprived
2nd least deprived
13.1%
13.4%
3rd most deprived
20.6%
2nd most deprived
23.6%
Most deprived
24.5%
Lancashire average
North west average
19.3%
17%
% of particpants recording a below average score
Reduce unemployment and
worklessness
Work protects mental and physical
health through :
• income
• psychological benefits
• social interaction
Poor working conditions, including:
• uncertainty and job insecurity
• high work demands and low
rewards,
• low control and autonomy in
relation to work
• low social support within the
workplace
contribute to increased risk of
heart disease, stroke, poor mental
health and unhealthy behaviours
Working age benefit claimants across the
Lancashire social gradient, August 2010
Source: Department for Work and Pensions and Department for
Communities and Local Government
least deprived
2nd least deprived
3rd most deprived
7.4%
8.9%
12.6%
2nd most deprived
18.9%
most deprived
Lancashire average
Great Britain average
30.1%
15.5%
14.7%
Unemployment and worklessness
– recommendations
1. Undertake analysis of health needs of unemployed and
workless people
2. Employers should:
–
–
Encourage those facing redundancy to develop alternative social
networks
adopt healthy recruitment and working practices and encourage
suppliers to do the same
3. GPs recognise role they play as potential gateway to
employment support services
4. Train front line health staff to provide support to
unemployed patients and those at risk of worklessness
5. Align health services to the ‘work programme’
Unemployment and worklessness
– recommendations
6. Mental health programmes reviewed to ensure they address
timely identification of mental health problems in workplace
and meet needs of those not in employment
7. Develop multi agency strategy to optimise healthy working
practices
8. Existing healthy workplace schemes should be retained during
the reform and should be targeted at employers within sectors
with the highest risk of redundancies and worklessness
9. Existing work and health initiatives should be reviewed and a
common approach to delivery should be agreed and
commissioned across the county
Increase income and reduce poverty
• Low income:
– Reduces access to goods and services that maintain/ improve health
– Prevents participation in social, cultural and leisure activities that
protect mental health and wellbeing
• Action needs to both reduce poverty and address its impacts
• Child poverty – perpetuates health inequalities across the
generations
• Poverty in the working age population – minimum income for
healthy living
• Poverty in later life – older people vulnerable to effects of fuel
poverty
What is already happening to
reduce poverty and its effects?
• Developing child poverty strategy
• Total Family
• Welfare rights in health settings (through GPs and
Macmillan nurses and for those with asbestos
related illness (Partnership between LCC and PCTs)
• Fuel poverty referral project (LCC, PCTs and 12
district councils)
• Fire and rescue service integrated identification of
fuel poverty into home safety checks)
Poverty and income –
recommendations
1.
2.
3.
4.
5.
6.
7.
8.
All partners identify how they will contribute to the Lancashire Child
Poverty Strategy
Partners identify families in poverty and work together to provide coordinated services
Focus resources towards pregnancy and early years
Expand Total Family Programme across Lancashire
Integrate Fuel Poverty Referral Project into the NHS QIPP programme and
promote it to GP commissioning consortia
Undertake equity audit of welfare rights provision to ensure services are
reaching and benefiting those that need them most
Investigate provision of welfare rights services in primary care settings
Integrate income maximisation into social prescribing programmes and
link to case management approaches
Strengthen communities
• Strong communities
increase resilience to
the affects of poverty
• Good health and
wellbeing is associated
with access to good
social and community
networks
• Characteristics of strong
communities not
equally distributed
Perceptions that people in the area do not treat one
another with respect and consideration across the
Lancashire social gradient
Source: Place Survey 2008 and Department for Communities and
Local Government
least deprived
2nd least deprived
3rd most deprived
16.6%
20.5%
25.9%
2nd most deprived
39.3%
most deprived
Lancashire average
England average
49.9%
29.5%
31.2%
What is already happening to
strengthen communities?
• The Voluntary, community and faith sector
contributes to strengthening communities by:
– Providing opportunities people to connect with others
through volunteering, social network, involvement in
community associations
– Providing 'wellness services’
– Contributing to assessment of health and wellbeing needs
– Providing a public and service user voice into
commissioning and provision of services
– Advocating for the needs and involvement of specific
communities and promoting equality and diversity
What is already happening to
strengthen communities?
• Asset based approaches to strengthening
communities (Preston, West Lancashire, Ribble
Valley)
• Advocate for the needs and involvement of specific
communities (e.g. Preston work with travellers)
• Voluntary, Community and Faith Sector
– Provide opportunities for people to connect with others
– Provide 'wellness services’
– Provide public / service user voice
Strengthening communities –
recommendations
1.
2.
3.
4.
5.
6.
Asset based approaches to community development should be used by
local authorities at both county and district levels
Extend the Central Lancashire framework for action for asset based
community development across the county
Develop capacity and capability for asset based approaches within the
voluntary, community and faith sector (VCFS)
As far as possible, protect public investment in the VCFS
Implement the Healthy Streets initiative (includes 20 mph speed limits,
improved quality of the public realm, promotion of street based physical
activity
Where possible provide public sector services at local venues and share
public sector assets across agencies
Increase Opportunities for Life Long
Learning and Skills Development
• Lifelong learning impacts on health inequalities:
– Indirectly, provides skills and qualifications for employment
and progression in work
– Directly,
participation in
learning impacts
on health
behaviours and
outcomes
– Learning for its
own sake is one
of the five ways
to wellbeing
Population with no qualifications across the Lancashire
social gradient
Source: LCC Corporate Research and Intelligence team from NWPHO
Wellbeing survey 2009 and ID2007, Communities and Local Government (age
standardised, 3966 participants)
Least deprived
2nd least deprived
3rd most deprived
22.2%
26.8%
29.8%
2nd most deprived
38.5%
Most deprived
Lancashire average
North west average
51.7%
33.8%
32.7%
% of particpants with no qualifications
What is already happening to
increase life long learning and
skills development?
• Programmes to widen participation from d deprived areas in
education for those 14-19
• Healthy schools
• Adult learning services
• Employment training for those not in work
• Library services
• Cultural and arts opportunities
• Voluntary, community and faith sector provision (e.g.
University of the Third Age co-operative approach to learning)
Life long learning and skills
development – recommendations
1. Increase access to lifelong learning across the social
gradient by:
• providing 16 – 25 year olds with life skills training and employment
opportunities
• providing work based learning and work experience for those not in
employment
2. Local authorities take account of the impact learning has
on wellbeing in spending decisions
3. Identify and develop opportunities to increase the
availability of non vocational learning across the life course
4. Support VCFS to provide learning opportunities using asset
approaches
Life long learning and skills
development – recommendations
5. Learning, culture and arts opportunities should be integrated
into social prescribing schemes and extended across the
county
6. Develop and implement a youth employment and
employability strategy for Lancashire
7. Social landlords should include training as part of resident
involvement in decision making
8. Community growing schemes should be extended across the
county to encourage the development of new skills
9. Schools should integrate the Five Ways to Wellbeing into the
curriculum
10. Employers should recognise skills gained by informal
opportunities
Reduce alcohol and tobacco
consumption
Alcohol
Tobacco
• Alcohol consumption has
an inverse social gradient
• Alcohol harm has a strong
social gradient
• Those in the most deprived
areas of Lancashire are 8.2
times more likely to die
prematurely from chronic
liver disease, than those in
the least deprived
• Strong social gradient in
tobacco use
• Smoking impacts across the
whole life course, with
children particularly
vulnerable to the effects of
tobacco
• Smoking contributes to
inequalities in many health
outcomes
Reduce alcohol and tobacco
consumption
Smoking prevalence across the
Lancashire social gradient
Perceptions of drunk or rowdy
behaviour as a problem across the
Lancashire social gradient
Source: LCC Corporate Research and Intelligence
team from NWPHO Wellbeing survey 2009 and
ID2007, Communities and Local Government (age
standardised, 3966 participants)
Source: Place Survey 2008 and Department for
Communities and Local Government
least deprived
15.7%
least deprived
2nd least
deprived
3rd most
deprived
17.9%
26.9%
26.2% 23.3%
3rd most
deprived
27.5%
42.2%
50.4%
29.1%
33.2%
28.8%
43.4%
38.0%
35.9%
most deprived
most deprived
Lancashire
average
36.5%
2nd least
deprived
2nd most
deprived
2nd most
deprived
21.3%
48.7%
28.0%
45.3%
Lancashire
average
30.9%
North west
average
29.8%
21.0%
27.7%
33.7%
41.4%
% of participants by smoking status (North West
data only published for current smokers)
England average
29.0%
Current smoker
Ex smoker
Non smoker
What is already happening to
reduce tobacco and alcohol
consumption?
• Community alcohol project (Hyndburn - Trading Standards,
Constabulary, School and Community Partnership Team,
Young Peoples Service)
• Youth tobacco prevention (Smoke and Mirrors)
• Lancashire Alcohol Network Strategic Framework
• Responsible alcohol retailing (Pendle and Rossendale)
• Chorley Alcohol Intervention (Chorley partnership)
• Tackling illicit tobacco (Smoke Free North West)
• Reducing exposure to second hand smoke (Take 7 steps out)
Tobacco and alcohol –
recommendations
1.
2.
3.
4.
5.
6.
7.
Resources should be allocated from the planned ring-fenced public
health budget for tobacco control and alcohol misuse
A strategic needs assessment on substance misuse (including tobacco
and alcohol) should be undertaken JSNA to inform the development of
strategies to address substance misuse
QIPP programme should include preventative action to reduce alcohol
and tobacco consumption
Use of regulatory powers in relation to alcohol and tobacco should be
maximised
Frontline staff and volunteers should be trained to deliver identification
and brief advice on alcohol and tobacco
Support should be given to employers to develop workplace alcohol and
tobacco policies
Partnership approach to alcohol and tobacco should continue and
develop within Public Health Lancashire
Tobacco and alcohol –
recommendations
1.
2.
3.
4.
5.
6.
7.
Resources should be allocated from the planned ring-fenced public
health budget for tobacco control and alcohol misuse
A strategic needs assessment on substance misuse (including tobacco
and alcohol) should be undertaken JSNA to inform the development of
strategies to address substance misuse
QIPP programme should include preventative action to reduce alcohol
and tobacco consumption
Use of regulatory powers in relation to alcohol and tobacco should be
maximised
Frontline staff and volunteers should be trained to deliver identification
and brief advice on alcohol and tobacco
Support should be given to employers to develop workplace alcohol and
tobacco policies
Partnership approach to alcohol and tobacco should continue and
develop within Public Health Lancashire
Tobacco and alcohol –
recommendations
8. Screening for tobacco and alcohol use should be integrated into health service
delivery and targets re completeness of data included in contracts
9. Service evaluation/ monitoring should include information to assess
acceptability and effectiveness
10. Intelligence-led social marketing approaches should be undertaken
11. Media campaigns re tobacco and alcohol should be evaluated for their
effectiveness and sustained or scaled up as appropriate
12. Partners should contribute to the delivery of alcohol and tobacco elements of
Children and Young People’s Plan (2011-2014)
13. Local partnerships should maintain and strengthen advocacy and lobbying in
relation to minimum unit pricing for alcohol and increasing taxation on
tobacco
14. North of England 'Tackling Illicit Tobacco for Better Health Programme' should
be sustained and supported locally.
Increase social support
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•
•
•
•
Social support provides emotional and practical resources
needed to live a fulfilled life and be resilient to challenges
Belonging to a social network makes people feel cared for,
loved and valued
Supportive relationships also encourage healthier behaviour
patterns
The influence of social relationships on risk of mortality is
comparable with well-established risk factors such as
smoking, alcohol consumption, obesity and lack of physical
activity
We estimate that there are more than 130,000 people in
Lancashire who experience a severe lack of social support
What is already happening to
increase social support?
VCFS in Lancashire offers wide range of social support for children
and young people:
– 153 voluntary youth organisations
– offer opportunities to over 94,000 young people
– E.g. West Lancashire young carers
Councils and VCFS provide social support for adults:
– Opportunities to volunteer time through Timebanks
– Befriending services to support people who are lonely
and at risk of becoming vulnerable
– luncheon clubs
– Handy person schemes
– Help Direct
Social support – recommendations
1. Undertake equity audits of supporting people and support
services for carers
2. Scale up social prescribing schemes
3. Undertake strategic needs assessment of older people to
inform commissioning of social support services
4. Monitor the impact of the recession on excluded groups
5. Screen budget reduction decisions for their health impact to
ensure vulnerable and isolated people are protected
6. Improve local data collection in relation to social support
7. Use asset approaches to enable assets of residents to be
realised and gaps to be filled by public services
8. Support the VCFS to engage in public sector procurement
and to develop the VCFS social support market
Setting health equity targets
• Liver disease – those in the most deprived areas are 8.2 times more likely
to die prematurely than those in the least deprived areas. This gap should
be narrowed to a ratio of 6.5.
• Mental health and wellbeing – those in the most deprived areas are 6.1
times more likely to experience extreme anxiety and depression as those
in the least deprived areas. This gap should be narrowed to a ratio of 4.9.
• Diabetes – those in the most deprived areas are 4.1 times more likely to
die prematurely than those in the least deprived areas. This gap should be
narrowed to a ratio of 3.2.
• Quality of life – those in the most deprived areas are 3.4 times more
likely to be experiencing extreme pain and discomfort than those in the
least deprived areas. This gap should be narrowed to a ratio of 2.72
• Infant mortality – babies in the most deprived areas are 2.9 times more
likely to die than those in the least deprived areas. This gap should be
narrowed to a ratio of 2.3.
•
Setting health equity targets
• Coronary heart disease – those in the most deprived areas are 2.8 times
more likely to die prematurely than those in the least deprived areas.
This gap should be narrowed to a ratio of 2.2
• Lung cancer – those in the most deprived areas are 2.7 times more likely
to die prematurely than those in the least deprived areas. This gap
should be narrowed to a ratio of 2.2.
• Stroke - those in the most deprived areas are 2.7 times more likely to die
prematurely than those in the least deprived areas. This gap should be
narrowed to a ratio of 2.2.
• Child health and wellbeing – those in the most deprived areas are 2.5
times more likely to die than those in the least deprived areas. This gap
should be narrowed to a ratio of 2.
• Accidents – those in the most deprived areas are 2.2 times as likely to
die as those in the least deprived areas. This gap should be narrowed to
a ratio of 1.8.