health Martin Gibbs Health Inequalities Unit Department of - - PowerPoint PPT Presentation

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Tackling Health Inequalities: Update and Inclusion Health programme

Martin Gibbs Health Inequalities Unit Department of Health Inclusive Health and Wellbeing Conference

29 November 2011

• health

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Policy context

Health inequalities:

Tackling health inequalities is a Government priority, part of a wider focus on fairness and social justice. Everyone should have the same

• pportunities to lead a healthy life, no matter where they live or who

they are. As well as helping people live longer, healthier and more fulfilling lives, we aim to improve the health of the poorest fastest.

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Policy context

Inclusion Health:

The health needs of the most vulnerable people are being addressed through the Inclusion Health programme, which will focus on improving access and outcomes for vulnerable groups.

• health

75.7 76.0 76.2 76.5 76.9 77.3 77.7 77.9 78.3 78.6 73.7 74.1 74.2 74.5 74.9 75.3 75.6 75.8 76.1 76.5 2.0 1.9 2.0 2.0 2.0 2.0 2.1 2.2 2.2 2.1

70 72 74 76 78 80

Three year average Life Expectancy at birth 1999-01 to 2008-10 for males, comparing England and the areas which had the worst health and deprivation*

• Change since 1999-01:

Absolute gap has risen by 0.1 years

1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 England Areas which had the worst health and deprivation Absolute gap between the areas which had the worst health and deprivation and England 2008-10

* Local authorities which had the worst health and deprivation, based on life expectancy and mortality data for 1995-97 and the 2004 Index of Multiple

• Deprivation. Change since 1999-01 and gap figures are calculated based on life expectancy figures rounded to 2 decimal places. Source: ONS

80.4 80.7 80.7 80.9 81.1 81.6 81.8 82.0 82.3 82.6 78.9 79.2 79.2 79.4 79.6 79.9 80.2 80.4 80.7 80.9 1.5 1.5 1.5 1.5 1.6 1.6 1.6 1.7 1.6 1.7

75 77 79 81 83 85

! Three year average Life Expectancy at birth 1999-01 to 2008-10 for females, comparing England and the areas which had the worst health and deprivation*

• Change since 1999-01:

Absolute gap has risen by 0.2 years

1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 England Areas which had the worst health and deprivation Absolute gap between the areas which had the worst health and deprivation and England

* Local authorities which had the worst health and deprivation, based on life expectancy and mortality data for 1995-97 and the 2004 Index of Multiple

• Deprivation. Change since 1999-01 and gap figures are calculated based on life expectancy figures rounded to 2 decimal places. Source: ONS

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What is the health inequalities challenge? By socio-economic classes

Condition by socio-economic group (rate per 1,000 reporting long-standing condition by socio-economic group of household reference person General Household Survey 2006)

I - Professional & technical II - Managerial IIIN - skilled (non-manual) IIIM - skilled (manual) IV - partly skilled V - unskilled Socio-economic class CHD (Lung) Cancer Cancers Diabetes Neurotic disorders Psychotic disorders Asthma Epilepsy Stroke COPD Renal Drug dependence Alcohol dependence Higher than expected need Lower than expected need

Expected level

• f need given

population size

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What is the health inequalities challenge? How do we compare - males

Life expectancy (LE) at birth, males: by deprivation twentieth in England & Wales, 1999-2003 vs Japan

79.1 78.7 78.5 78.0 77.8 77.7 77.4 76.9 76.7 76.3 76.0 75.6 75.1 74.6 74.4 73.9 73.5 73.1 72.2 71.5 Japan (2001) Japan (2007) E&W (1999-03) E&W (2006-08)

60 65 70 75 80 85 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Deprivation twentieth (1 = least deprived; 20 = most deprived) Life expectancy (years)

Potential months of life gained in deprivation twentieth (by increasing LE to 2001 Japan average):

• 4

1

• 5

22 17 14 8 25 44 42 36 30 50 79 71 60 55

Source: ONS (LE for E&W and deprivation tw entieths, based on w ards); OECD (LE for Japan). Note that methodology used to calculate LE may differ slightly betw een ONS and OECD.

Total gain in months of life across deprivation twentieths required to increase E&W LE to Japan average = 528 mths (based on 2001 position)

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What is the health inequalities challenge? How do we compare - females

Life expectancy (LE) at birth, females: by deprivation twentieth in England & Wales, 1999-2003 vs Japan

82.4 82.4 82.2 81.9 81.8 81.9 81.6 81.2 81.1 80.7 80.5 80.2 79.9 79.7 79.4 79.2 78.9 78.8 78.0 77.5 Japan (2001) Japan (2007) E&W (1999-03) E&W (2006-08)

65 70 75 80 85 90 95 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Deprivation twentieth (1 = least deprived; 20 = most deprived) Life expectancy (years)

Potential months of life gained in deprivation twentieth (by increasing LE to 2001 Japan average): 30 37 36 32 30 36 50 46 44 40 53 66 62 60 56 68 89 83 73 72

Source: ONS (LE for E&W and deprivation tw entieths, based on w ards); OECD (LE for Japan). Note that methodology used to calculate LE may differ slightly betw een ONS and OECD.

Total gain in months of life across deprivation twentieths required to increase E&W LE to Japan average = 1056 mths (based on 2001 position)

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The deprivation gradient in life expectancy and DFLE means people in the poorest areas die 7 years earlier

• n average than in affluent areas, and the difference

in DFLE is 17 years Life expectancy and disability free life expectancy at birth, persons by neighbourhood income level, England, 1999-2003

45 50 55 60 65 70 75 80 85 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Neighbourhood Income Deprivation - Population Percentile

Source: ONS …………………………………………………………………………..

Age

Life expectancy DFLE Pension age in 2024

• Poly. (DFLE)

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Inclusion Health challenges

• Homeless people have significantly higher levels of premature mortality

and mental and physical ill health than the general population.

• As many as 40% of rough sleepers have multiple concurrent health

needs relating to mental, physical health and substance misuse

• Of those registered at Cambridge Access Surgery, a homeless specialist

GP practice, 2-3% died each year between 2003-2008 and the average age of those who died was 44.

• Rough sleepers are 35 times more likely to commit suicide than the

general population

• Homeless people have higher rates of tuberculosis (TB), bronchitis, foot

problems and infections than the general population

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Inclusion Health challenges

• Studies show that Gypsy and Traveller women live 12 years less than

women in the general population and men 10 years less, although recent research suggests the life expectancy gap could be much higher

• There is an excess prevalence of miscarriages, stillbirths and neonatal

deaths in Gypsy and Traveller communities and high rates of maternal death during pregnancy and shortly after childbirth

• A high prevalence of diabetes has been reported in Gypsy and Traveller

communities, and a lack of community knowledge of the risk factors

• 38% of Gypsies and Travellers have a long-term illness compared with 26%
• f age and sex matched comparators, even after controlling for

socioeconomic status and other marginalised groups

• Travellers are 3 times more likely to have chronic cough or bronchitis, even

after smoking is taken into account

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Inclusion Health challenges

• Up to 95% of women in prostitution are problematic drug users
• More than half of UK women in prostitution have been raped and/or

seriously sexually assaulted. At least three-quarters have been physically assaulted

• 23% of parlour workers and 27%of street workers report having received

treatment for Chlamydia (compared to 3% of the general population)

• Among offenders convicted for prostitution related offences, over 48%

experienced psychological problems or depression compared to 33% of

• ther offenders
• 68% of women in prostitution meet the criteria for Post Traumatic Stress

Disorder in the same range as victims of torture and combat veterans undergoing treatment

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How are we moving ahead?

• Health reforms – building into the new system
• Inclusion Health
• Ministerial Working Groups
• Specific commitments for the most vulnerable - “Vision to

end Rough Sleeping”

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Reform agenda - headlines

• NHS Commissioning Board
• Clinical commissioning groups
• Public Health England
• Public health role for local authorities
• New core role for Dept. Health
• Strengthened roles for Monitor, CQC and NICE

And underpinning this:

• Greater democratic legitimacy and patient involvement

And crucially:

• Reducing health inequalities will be a priority for the NHS,

Public Health England and local authorities

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NHS reform – health inequalities

• Duty on Secretary of State
• Duties on the NHSCB and CCGs to have regard to the need to

reduce health inequalities

• Outcomes Frameworks for the NHS and Public Health with

inequalities and equalities at their heart

• Allocations for CCGs: ACRA to address the issue of unmet need.

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Public health reform – health inequalities

• Health and Wellbeing Boards
• Joint health and wellbeing strategies, drawing on Joint Strategic

Needs Assessments

• Directors of Public Health in local authorities
• Ring-fenced public health grant - based on relative population health

need and weighted for inequalities

• Health premium - to incentivise action to reduce health inequalities

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Wider determinants of health

• Public Health Cabinet Committee
• Enhanced role for local government
• Focus on social justice
• Big Society – giving voice to communities
• Implementation of Equality Act 2010

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Inclusion Health

• National Board
• Four working groups:

Leadership and Workforce Data, research and commissioning Provision, promotion and prevention Assurance and accountability

• Workplan

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Rough sleeping - commitments

Access healthcare

• Support health and wellbeing boards to ensure that the needs of

vulnerable groups are better reflected in Joint Strategic Needs Assessments

• The National Inclusion Health Board will work with the NHS, local

government and others to identify what more must be done to include the needs of homeless people in the commissioning of health services

• Highlight the role of specialist services in treating homeless people,

including those with a dual diagnosis of co-existing mental health and drug and alcohol problems

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Rough sleeping - commitments

Help prevent homelessness

• The National Inclusion Health Board will work with the NHS, local

government and others to identify what more must to be done to prevent people at risk of rough sleeping being discharged from hospital without accommodation.

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Challenges

But all this in a difficult environment:

• Reorganisation
• Transition timeline
• Loss of expertise and capacity
• Impact of financial pressures