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

(Source: Scottish Executive, 1993 (from data originally presented by Uren et al, 2001))

Age-standardised all-cause mortality rates by Social Class, England and Scotland, males aged 20-64, 1991-93

Life expectancy in Scotland

Male life expectancy at birth by SIMD deprivation decile, Scotland 2008-2010

Source: National Records of Scotland 81.4 68.2 65.0 70.0 75.0 80.0 85.0 1 (most deprived) 2 3 4 5 6 7 8 9 10 (least 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)

72.2 76.2 65.3 64.8 64.4 69.4 71.2 73.3 73.9 60 65 70 75 80 85 1981-1985 1988-1992 1998-2002 Estimated life expectancy at birth

Males -Dep Quin 1 (least deprived) Males - Dep Quin 5 (most deprived) Scotland Males

Global forces Political priorities Societal values Distribution

• f

power and resources (material & non-material) Differences in provision of

• pportunities,

environments, services etc Differences in capacity to benefit from

• pportunities

Personal and household characteristics Inequalities in outcomes FUNDAMENTAL CAUSES WIDER

• ENV. INFLS

INDIVIDUAL CIRCS

Global forces Political priorities Societal values Distribution

• f

power and resources (material & non-material) Differences in provision of

• pportunities,

environments, services etc Differences in capacity to benefit from

• pportunities

Personal and household characteristics Inequalities in outcomes FUNDAMENTAL CAUSES WIDER

• ENV. INFLS

INDIVIDUAL CIRCS

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

• ther) 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

Start young

• Inequalities are evident even in

the earliest years of people’s lives, not only in outcomes, but particularly in risk behaviours that we know have longer-term consequences for health and development (Growing Up in Scotland).

• A good start in life doesn’t

guarantee good outcomes, but is associated with a range of personal and social benefits

Good parenting of next generation Resilient individuals & social networks Responsible citizens & reduced crime Economically active adults Education & skills attainment Healthy child & adult populations

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

• thers
• 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

• 70
• 60
• 50
• 40
• 30
• 20
• 10

How should we respond?

How should we respond?

• Direct and specific causes: action on

individual features

• Fundamental determinants: perpetuate

systematic differences, operate consistently

• ver 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

0% 20% 40% 60% 80% 100% 2 3

Wave Percentage 'agree' or 'strongly agree'

Regen area (TRA/LRA) Non-regen area (WSA/HIA/PE) Overall

Respondent feels part of the community

0% 20% 40% 60% 80% 100%

2 3 Wave Percentage 'a great deal' or 'a fair amount'

Regen area (TRA/LRA) Non-regen area (WSA/HIA/PE) Overall

Neighbourliness: borrows and exchanges favours with neighbours

0% 20% 40% 60% 80% 100% 2 3 Wave Percentage 'great deal' or 'fair amount'

Regen area (TRA/LRA) Non-regen area (WSA/HIA/PE) Overall

Challenges and

• pportunities for Fife

The oak and the reeds

The oak and the reeds

Empower the front-line. Trust and support their ‘know-how’. Flexibility Invest in very local responses and be 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

• f system reform.

What might this mean for measures and approaches?

Quality of experience; Capabilities; Opportunities; Relationships and social capital; System-based Productivity, Efficiency, Cost-effectiveness; Outcome-focused; Condition-specific

Share accountability with those who’ll benefit from the investment … this demands method, process & governance

Don’t forget to tell the story

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