Transcript Document 7531366

Health Impact Assessment:
Making the Difference
Plenary 1
Chair: Professor Gareth Williams
7th International Health Impact
Assessment Conference
Health Impact Assessment:
Making the Difference
Supported by:
Health Impact Assessment:
Making the Difference
Chris Tudor-Smith
Head of Public Health Improvement Division, Welsh
Assembly Government
Tackling inequalities in health in
Wales
Chris Tudor-Smith
Public Health Improvement Division
Office of the Chief Medical Officer
The presentation will cover...
•
•
•
•
The situation in Wales
The policy context
From policy to action
Sustainable Health Action
Research Programme
• Concluding remarks
‘So what do I need to know about health
inequalities then Humphrey?’
‘Well Minister…’
‘Headline’ indicator: all deaths by quintile of
deprivation, Wales, 1993-97
1000
900
800
700
600
500
400
300
200
100
0
734
quintile 1
(least
deprived)
770
quintile 2
825
quintile 3
European age-standardised mortality rate per 100,000 population
Source: NAfW (2001) Expert Group on Indicators of Health Inequality
865
quintile 4
926
quintile 5
(most
deprived)
Coronary heart disease mortality (age under
65) by quintile of deprivation, Wales, 1996
40
35
35
30
26
29
23
25
20
35
31
28
38 37
19
15
10
5
0
quintile 1 quintile 2 quintile 3 quintile 4 quintile 5
(least
(most
deprived)
deprived)
European age-standardised mortality rate per 100,000 population
Source: NAfW (2001) Expert Group on Indicators of Health Inequality
Males
Females
Adult mental health status by quintile of
deprivation, Wales, 1998
55
51
50
50
49
48
quintile 1 (least
deprived)
quintile 2
quintile 3
quintile 4
quintile 5 (most
deprived)
50
45
40
35
30
25
20
15
10
5
0
SF36 Mental Component Summary score
Source: NAfW (2001) Expert Group on Indicators of Health Inequality
Adults smoking by quintile of
deprivation, Wales, 1996
40
35
35
30
26
29
23
25
20
35
31
28
38 37
19
15
10
5
0
quintile 1 quintile 2 quintile 3 quintile 4 quintile 5
(least
(most
deprived)
deprived)
Source: NAfW (2001) Expert Group on Indicators of Health Inequality
Males
Females
Teenage conceptions by quintile of
deprivation, Wales, 1992-1997
80
75
70
60
53
50
45
40
30
30
22
20
10
0
quintile 1
(least
deprived)
quintile 2
quintile 3
Conceptions to girls under 18 per 1,000 girls aged 15-17
Source: NAfW (2001) Expert Group on Indicators of Health Inequality
quintile 4
quintile 5
(most
deprived)
The policy context in Wales
• ‘Better Health Better Wales’ - late 1990’s policy
document dealing with public health in Wales
– health inequalities acknowledged and described
• Townsend review ‘Targeting Poor Health’
– NHS resource allocation favouring those most in need
• ‘Review of Health and Social Care in Wales’ (Wanless
Report)
– notes inequalities and action being taken in other policy
areas
• Topic specific strategies with a focus on health
inequalities
– e.g. Food and Well Being identifies priority groups (low
income, ethnic minorities…)
• Health targets and inequality indicators
– e.g. to improve CHD mortality in all groups and at the same
time aim for a more rapid improvement in the most
deprived groups.
Tackling health inequalities in Wales –
working at different levels
• Government socio-economic policy e.g.
– responsibility with UK government e.g. fiscal policies
– Wales: A Vibrant Economy
• Collaboration and partnership between communities and
agencies e.g.
–
–
–
–
SHARP
Health Impact Assessment
Communities First
Development of food cooperatives
• Individual behaviour change e.g.
– Inequalities in Health Fund (focus on risk factors for CHD)
– Health Challenge Wales
– Programmes tackling smoking, nutrition, physical activity…
Sustainable Health Action Research
Programme (SHARP)
• Roots in Better Health Better Wales – attempt to develop
learning and add to evidence base on partnership-driven
and community-based action research approaches to
tackling broad social determinants of health
• Focused on communities with the highest incidence of
ill-health and premature death, social exclusion and poor
life chances
• Project level and overarching evaluation (Cropper S.,
Carlisle S., Beech R., Little R – Centre for Health Planning
& Management, Keele University)
• Seven projects funded for six year period, ending spring
2006
‘Barefoot’
Triangle
Pembs
Holway
BeWEHL
HYPP
R2R
SHARP funded projects (1)
• HYYP Project
An evaluation of community involvement in Powys to
meet the health needs of young people in rural areas
• ‘Right 2 Respect’ Project
A project to identify and begin to address issues of
particular concern to girls and young women (11 to 25
years) in Wrexham
• BeWEHL Project
An initiative in Newport to examine the contribution of
women’s learning to community health development
• Triangle Project
A programme to support local health alliances in Cardiff,
Merthyr and Powys in tackling health inequalities
SHARP funded projects (2)
• Healthy Living Approach Project
An evaluation of the Healthy Living approach to
improving the health and wellbeing of communities in
Pembrokeshire
• Holway Project House
Community development and regeneration in the Holway
community in Flintshire
• ‘Barefoot’ Health Workers Project
A project to support the health improvement of Somali,
Yemeni and Bangladeshi communities in the
Butetown/Grangetown area of Cardiff
Assets & Legacies
• ‘Barefoot’: Expertise in working with minority ethnic
groups; community researchers skilled in working with
agencies and local people.
• Triangle:
framework for establishing sustainable
community health partnerships; model of participatory
action research as tool for community health engagement
– ‘local health champions’; locally sustainable projects.
• Pembrokeshire SHARP: Community research training
programme and handbook - transferable inquiry into
local priorities; Community Action Plans.
• Holway House: community transformation - residents
working in partnership with external organisations.
Source: Cropper (2005)
Assets & Legacies
• BeWEHL: improvements in women’s mental and ‘social’
health
(increased
confidence/self-esteem,
wider
networks);
transferable
approach
to
developing
women’s capacity to engage in lifelong learning.
• HYPP: civic participation by young people,
relationships between different generations;
Council and OASIS roll-out.
better
Youth
• Right 2 Respect: impact on Wrexham CBC Youth
Services; ONC in a/r for single gender youth work;
outdoor worker; sustainable spin-off projects.
Source: Cropper (2005)
Policies tackling health inequalities – a
synthesis
• Successful policies will need to be broadly based including :
–
–
–
–
–
lifecourse approach
multisectoral interventions
health impact assessment
focus on the distribution of social determinants
tailoring where appropriate
• Policies on health inequalities and social justice/inclusion
should be inextricably linked
• Local capacity building is required to deliver policies
• Importance of (applied) research, particularly
monitoring
impact of policies and developing evidence base of effective
interventions
• Commitment
7th International Health Impact
Assessment Conference
Health Impact Assessment:
Making the Difference
Supported by: