Transcript FHWA Health and Health Inequalities Dr Gina Radford DPH

FHWA
Health and Health Inequalities
Dr Gina Radford
DPH
SMRs, Fife, 1995 - 2004
300
Heart Disease
Cerebrovascular Disease
All Malignant Neoplasms
250
Standardised Mortality Rate
Respiratory Disease
200
150
100
50
0
1995
1996
1997
1998
1999
2000
Year
2001
2002
2003
2004
All cause mortality rate per 100000
population aged under 65, by
interzone, Fife and Scotland, 2006
800
700
rate per 100000 population aged under 65
600
500
400
Fife
300
200
100
0
Interzone
Scotland
Determinants of health
ROA
areas
20% most
deprived
population
20% least
deprived
population
Fife
All cause mortality rate per
10000 population under 65
(2005)
44.7
42.4
16.7
31
Hospital admissions for
alcohol misuse rate per 10000
population (2002-2004)
95.9
89.7
19.2
48.5
Percentage of women
smoking in pregnancy (20022004)
47.2
46.8
7.8
28.5
Percentage of working age
population claiming Job
Seekers Allowance (2005)
7.5
6.9
1.1
3.4
Percentage of working age
population in receipt of
Incapacity Benefit, Severe
Disablement Allowance or
Compulsory New Deal (2005)
18.2
17.1
2.9
9.1
Reducing Health Inequalities
Health varies in Fife in relation to
• Socio-economic status
• Gender
• Ethnicity
• Place of residence
• Other inequalities
Percentage of S4 children
attaining English and Maths
at SCQF level 3 and above,
2006
Looked after children
40%
Fife
89%
Scotland
91.3%
Risk factors for teenage pregnancy
• Poor attendance rates and dislike of school
• Poor educational attainment
Feeling like they belong somewhere, like they’re living their life.
More likely to reduce
inequalities
• Improving accessibility of
services
• Prioritising disadvantaged
groups
• Offering intensive support
• Starting young
Disadvantaged groups
tend :
•
•
•
to be harder to reach
to find it harder to change behaviour
to receive less benefit from lifestyle change or access to services
interventions with more disadvantaged groups may need
to be much more intensive and targeted than might be
appropriate for more advantaged groups: information
based approaches such as food labelling, pamphlets in
doctors’ surgeries, and mass media campaigns, or those
which require people to take the initiative to sign up for,
may be less effective among more disadvantaged groups
An intervention which, in general, works (e.g.
dental health education) might have
– no effect on health inequalities if all SES
groups benefit equally
– increase health inequalities if the rich benefit
more
– reduce health inequalities if the poor benefit
more
Less likely to reduce inequalities
• Information based campaigns
• Written materials
• Campaigns reliant on people taking the
initiative to opt in
• Campaigns/messages designed for the
whole population
• Whole school health education approaches
Young people are the future
generation so we need to help them
before they become useless to society.
What use is a twenty-five year old
man with no qualifications, no job and
messes around with alcohol and
drugs?
Priority areas for Fairer Scotland Fund
Health Inequalities funding – the context
•
•
•
•
•
•
SOA
Community Plan
Fairer Fife Framework
FSF principles
JHIP
Equally Well
What people told us
Priority 1
Priority 2
Targeting resources to people living in the
most disadvantaged life circumstances
17
8
Improving mental health and emotional
well-being
4
10
Increasing opportunities for people to have
a healthier lifestyle in relation to where
they live, work and spend their time
3
2
Increasing community involvement in the
planning and delivery of health
improvement work –
3
3
Improving access to services and support
that impact on peoples health and wellbeing –
3
8
Fairer Fife Framework Action Areas
What people told us
Equally well priority areas
Priority 1
Priority 2
Children, particularly in the early
years
11
3
“Killer diseases” such as heart
disease, cancer, diabetes (and
associated risk factors such as
smoking, obesity etc)
12
2
Mental health and wellbeing
4
12
The harm caused by drugs,
alcohol and violence
5
12
What people told us
• People living in most disadvantaged areas in Fife
19
• People represented by one of the six equality strands
2
• Race
4
• Gender
2
• Disability
6
• Age
6
• Religion/belief
3
• Sexuality
4
• Other e.g. people addicted to drugs/alcohol; long-term unemployed
16
Early Years and vulnerable young people
Homelessness and housing issues
People with mental health issues
Others
What people told us
Other issues
•
•
•
•
Integrated approaches
Improving access to services
Early intervention across lifestages
Clusters of disadvantage/identified families
not geographical areas
5 areas emerged
•
•
•
•
•
Vulnerable families
Mental health & wellbeing
Homelessness & housing issues
Alcohol
Disadvantaged life circumstances
Seasons Greetings
Consensus Voting
You have three votes
• Vote once for each of
your top three
priorities from the list
• Your votes are worth
3 points, 2 points and
1 point
• Use more points for
your higher priority
List
• Disadvantage (Areas
and/or Individual
Circumstances)
• Mental health and
wellbeing
• Alcohol
• Vulnerable families
• Homelessness and
housing issues