Transcript Tools For Measuring Health Inequalities: The Local Basket Of Health Inequalities Indicators (LBOI) Developed by the LHO for the Association of Public Health Observatories Dr.

Tools For Measuring Health
Inequalities: The Local Basket Of
Health Inequalities Indicators (LBOI)
Developed by the LHO for the Association of Public
Health Observatories
Dr Bobbie Jacobson
Director
Recent policy background
to national inequalities work
 1998 - Independent Acheson Inquiry into Inequalities in
Health
 The NHS Plan & National Health Inequalities Targets
 Single PSA target reflected as priority in DH’s Priorities
& Planning Framework
 Tackling health inequalities: Programme for Action – 12
Headline targets July 2003
 Health Equity Audit – national requirement
 NHS Priorities & Planning Frameworks 2003-06; 200407
 New National PSAs, July 2004
 Forthcoming White Paper
What Kinds of Health Inequality?
Spectrum of inequality
GENDER
SOCIO-ECONOMIC
GROUP
GEOGRAPHY SEXUALITY
DISABILITY
AGE
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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How can the basket be used
locally?
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Quantifying current health inequalities to help
local partnerships identify priorities for action.
Supporting the setting of specific local
inequalities targets
Provides indicators for incorporation into
service planning, performance management
and appraisal monitoring.
Supporting local health equity audit and
Annual Report writing
The local basket of indicators
(Oct 2003)
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70 indicators
Whole range of inequalities covered
All can be measured at LA or PCT level
Many measurable within LA and PCTs by
ward, age, socio-economic group,
disability, ethnicity
• A tool under development
13 Indicator Domains
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Employment, poverty and deprivation
Housing and homelessness
Education
Crime
Pollution and the physical environment
Community development
Lifestyle
Access to health and other services
Accidents and injury
Mental health
Maternal, infant and child health
Older people
Tackling the major killers
Developing The Basket – The
Technical Criteria
• Is the indicator routinely published at LA or PCT
level?
• Is the indicator updateable at at least 3-yearly
intervals?
• Is the indicator robust enough to detect changes
over time?
• Can the indicator be interpreted?
• If not routinely published, is the data to calculate
this indicator routinely collected at LA or PCT
level?
Developing The Basket - Other
Criteria
• Include indicators of health, health care,
process, intervention and the health
determinants
• Cover the themes of the Programme for Action
• Include the national health inequalities targets
and 12 headline indicators
• Include indicators relevant to all localities and
those that will reflect individual priorities
• Track short, medium and long term change
• Address the measurable dimensions of
inequality
• Avoid too many similar indicators
Ways of Profiling Health Inequalities:
The Example of Southwark
Infant mortality rates by local authority and deprivation 1999-2001
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Southwark
R2 = 0.4391
Infant mortality rate
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A
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B
C
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1
0
0
10
20
30
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50
60
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Index of deprivation - index of ward scores
A: 45.3 Islington
B: 56.2 Newham
C: 61.3 Tower Hamlets
Further Work Underway
• Producing Data / Metadata for the LBOI
• 15 indicators now available on LHO site
• Analysis and interpretation for local and
national use
• Eventual integration with Neighbourhood
Statistics (NeSS)
Lessons Learned
• Time / Effort needed to agree metadata /
data release
• Disclosure policy holdings
• SHAs / PCTs want intelligent help in use of
data
• Integration with NeSS: a challenge
Next Steps?
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Analysis and interpretation
Small area focus
Updating existing set
Developing new indicators
Focussing on non-geographical
dimensions of inequality
• Developing web tools for local use
The Local Basket Of
Inequalities Indicators
http://www.lho.org.uk/Health_In
equalities/Basket.htm