Health Inequalities Action for All Prof Carol Tannahill Director - PowerPoint PPT Presentation

Health Inequalities Action for All Prof Carol Tannahill Director Glasgow Centre for Population Health

Picking up from 10 years ago • Scotland’s health – how it’s changing • Health inequalities – how our understanding has developed • The GCPH – working on how to make a difference • Fife – opportunities and challenges

Health in Scotland Three key messages

Proportionate Contribution by Cause - Males

Proportionate Contribution by Cause - Females

Multi-morbidity and deprivation

Premature mortality by social class Age-standardised all-cause mortality rates by Social Class, England and Scotland, males aged 20-64, 1991-93 (Source: Scottish Executive, 1993 (from data originally presented by Uren et al, 2001))

Life expectancy in Scotland Male life expectancy at birth by SIMD deprivation decile, Scotland 2008-2010 Source: National Records of Scotland 85.0 81.4 80.0 75.0 70.0 68.2 65.0 1 (most 2 3 4 5 6 7 8 9 10 (least deprived) deprived) AREA DEPRIVATION DECILE

Understanding Health Inequalities

Life expectancy trend by deprivation Estimates of male life expectancy, least and most deprived Carstairs quintiles, 1981/85 - 1998/2002 (areas fixed to their deprivation quintile in 1981) Greater Glasgow Source: calculated from GROS death registrations and Census data (1981, 1991, 2001) 85 Males -Dep Quin 1 (least deprived) Males - Dep Quin 5 (most deprived) Scotland Males 80 Estimated life expectancy at birth 76.2 75 73.9 73.3 72.2 71.2 69.4 70 65.3 64.8 64.4 65 60 1981-1985 1988-1992 1998-2002

Personal and household characteristics FUNDAMENTAL CAUSES INDIVIDUAL CIRCS WIDER ENV. INFLS Global Distribution forces Differences Differences of in provision of in power Political opportunities, capacity to and priorities environments, benefit from resources services etc opportunities (material & Societal non-material) values Inequalities in outcomes

Personal and household characteristics FUNDAMENTAL CAUSES INDIVIDUAL CIRCS WIDER ENV. INFLS Global Distribution forces Differences Differences of in provision of in power Political opportunities, capacity to and priorities environments, benefit from resources services etc opportunities (material & Societal non-material) values Inequalities in outcomes

Core principles 1. Level Up

Core principles 1. Level Up … recognising that achieving change among those with greater need may involve more intensive services/higher costs … and that sometimes the most advantaged will also need to experience change (for ethical, economic or sustainability reasons)

Core principles 1. Level Up 2. Focus on causes not consequences

Core principles 1. Level Up 2. Focus on causes not consequences … Act to reduce inequalities in life circumstances … remove (price and other) barriers to access … make positive outcomes and behaviours easier … remember the fundamental causes of inequality

Core principles 1. Level Up 2. Focus on causes not consequences 3. Start young

Healthy Start young child & adult populations • Inequalities are evident even in Good Education the earliest years of people’s parenting of & skills lives, not only in outcomes, but next attainment generation particularly in risk behaviours that we know have longer-term consequences for health and development ( Growing Up in Scotland ). Resilient individuals Economically • A good start in life doesn’t & social active adults guarantee good outcomes, but is networks associated with a range of Responsible citizens personal and social benefits & reduced crime

Core principles 1. Level Up 2. Focus on causes not consequences 3. Start young 4. Target, tailor and positively discriminate

Core principles 1. Level Up 2. Focus on causes not consequences 3. Start young 4. Target, tailor and positively discriminate … in favour of disadvantaged people and places … Universal doesn’t mean Uniform …consider proportional and additional approaches

Core principles 1. Level Up 2. Focus on causes not consequences 3. Start young 4. Target, tailor and positively discriminate 5. Build resilience …This will help reduce inequality with each new wave of challenge …Resilience requires networks, personal skills and a conducive environment

The GCPH The Centre’s mission is to generate insights and evidence, support new approaches, and inform and influence action to improve health and tackle inequality.

• Our ability to achieve desired ends is much stronger in relation to some kinds of needs than others • Why? Buzz Aldrin, the first moonwalk, 1969

The GCPH • Working with a wide range of stakeholders, the GCPH: – Stimulates, carries out and facilitates research – Provides a focus for the exchange of ideas, fresh thinking, analysis and debate – Supports processes of development and change

The contrasting experience of Scotland’s communities -70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70 -70 -60 -50 -40 -30 -20 -10 0 10 20 30 40 50 60 70 How should we respond?

How should we respond? • Direct and specific causes : action on individual features • Fundamental determinants : perpetuate systematic differences, operate consistently over time regardless of changes in causes • Complex systems of causation : need to understand relationships between components

Local service providers respond to the views of local people 100% Percentage 'agree' or 'strongly agree' 80% Regen area (TRA/LRA) 60% Non-regen area (WSA/HIA/PE) Overall 40% 20% 0% 2 3 Wave

Respondent feels part of the community 100% Percentage 'a great deal' or 'a fair amount' 80% Regen area (TRA/LRA) 60% Non-regen area (WSA/HIA/PE) 40% Overall 20% 0% 2 3 Wave

Neighbourliness: borrows and exchanges favours with neighbours 100% Percentage 'great deal' or 'fair amount' 80% Regen area (TRA/LRA) 60% Non-regen area (WSA/HIA/PE) 40% Overall 20% 0% 2 3 Wave

Challenges and opportunities for Fife

The oak and the reeds

The oak and the reeds Empower the Flexibility front-line. Invest in very Trust and local responses support their and be ‘know-how’. comfortable with variation.

The mountain in labour Be wary of speech acts which promise much but deliver little. This will take inspiration and ambition that’s followed-through and mainstreamed. The flow of public money is the most reliable indicator of system reform.

What might this mean for measures and approaches? Quality of experience; Capabilities; Opportunities; Relationships and Don’t forget to tell the story social capital; Share accountability System-based with those who’ll benefit from the investment … this demands method, process & governance Productivity, Efficiency, Cost-effectiveness; Outcome-focused; Condition-specific

Experiment, learn and change – Collaboration and networking – Adequate infrastructure – The innovation narrative – Distributed leadership & multi-directional influence – Fidelity and flexibility

Health Inequalities Action for All Flexibility Inspiration Fortitude Experimentation