Health Inequalities in BelfastHealth Inequalities in Belfast

Belfast Trust StrategyWhy?

Why now?

PurposeImprove Health and Wellbeing and reduce health inequalities

BusinessIn partnership with others, and by engaging with staff, deliver safe, improving, modernising, cost effective health and social care

SafetyProvide safe high quality effective care

StandardsOutcomesHCAIContinuous improvementAssurance

ModernisationModernise and reform our health and social servicesAccessLocalise where possible, centralise where necessaryService ReviewsAligned Capital Plans

PartnershipsImprove health and wellbeing through partnership with users, communities and partnersCitizen CentredJoint WorkingCivic Leadership

StaffShow leadership and excellence through organisational and workforce developmentStaff engagementLeadershipLearning & DevelopmentTeam effectiveness

ResourcesMake best use of Resources by improving performance and productivity

Belfast Health and Social Care Trust

Values and behaviours: Public sector values Confidentiality Personal accountabilityRespect and dignity Access according to need

Fair Society, Healthy LivesMarmot Review

Fair Society, Healthy LivesMarmot Review

‘The key drivers of health and health inequalities lie outside the healthcare system. What is important is where people are born, where they grow up, their work and how they live and age.’

Fair Society, Healthy LivesMarmot Review

Fair Society, Healthy LivesMarmot Review

For those in the health sector, reducing health inequalities takes work on three fronts:Making universal access to good quality care a realityCollaboration with other sectorsUnderstanding and measuring outcomes

Fair Society, Healthy LivesMarmot Review: recommendationsFair Society, Healthy LivesMarmot Review: recommendations

Give every child the best start in lifeFair employment and good work for allStrengthen ill-health preventionEnable all to maximise capabilities and have control over their livesHealthy and sustainable places and communitiesA healthy standard of living for all

Dahgren and WhiteheadSocial Model of Health

Dahgren and WhiteheadSocial Model of Health

Divided by HealthA City Profile

Source: Office for National Statistics

Life Expectancy at Birth, 1993-95 and 2004-2006

Life expectancy at birth by Parliamentary Constituency, 2001/03-2004/06 (years)Life expectancy at birth by Parliamentary Constituency, 2001/03-2004/06 (years)

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

Belfast East Belfast North Belfast South Belfast West

Year

s

Males 2001-03Males 2004-06Females 2001-2003Females 2004-06

Source: Department of Health, Social Services and Public Safety

Crude casualty rate per 100 000 population, selected UK cities, 2006Crude casualty rate per 100 000 population, selected UK cities, 2006

0

50

100

150

200

250

300

350

400

450

500

550

600

650

700

750

800

Sunde

rland

Edinbu

rgh

Glasgo

w

Stirling

Cardiff

Castle

reagh

Sheffie

ldBrig

hton &

Hov

eNew

castl

e upo

n Tyn

eStok

e on T

rent

Liverp

ool

Manch

ester

Belfas

t

Crude casualty rate per 100 000 population

Rat

e pe

r 100

000

Source: Central Statistics Unit, PSNI; Department for Transport, England; Welsh

Assembly Government, Scottish Government

5 or more GCSE grade Cs in 2007Blackstaff.................8.3%Bloomfield..............53.7%Stranmillis..............95.4 %

Belfast....................57.6%NI............................64.7%

Education

Achieving health equity within a generation is achievable, it is the right thing to do, and now it the time to do it

WHO Commission Social Determinants of Health (2009)

Improve daily living conditions. In particular emphasising early childhood development, education for boys and girls, living and working conditions and social protection for all.

Tackle the inequitable distribution of power, money and resources through strengthened governance; support for civic society and an accountable private sector.

Measure and understand the problem and assess the impact of action

Recommended ActionsRecommended Actions

1. Focus on making early childhood experience as good as possible

2. Provide leadership through partnerships and advocacy

3. Encourage all health and social care professionals to use available opportunities to promote health and wellbeing

4. Provide a healthy work environment and maximise the health and wellbeing of our staff, especially the less well off

6. Measure inequalities in our own services

5. Build on Involving You,our Framework foruser involvement and

community development

7. Reduce our carbon footprint and prepare to deal with the impacts of climate change which affect the worst off most

What does that mean for the Belfast Trust?What does that mean for the Belfast Trust?

1. MAKING EARLY CHILDHOOD EXPERIENCE AS GOOD AS POSSIBLE

Keys: Attunement and EmpathyKeys: Attunement and Empathy

Lack of attunement means empathy does not develop

Low maternal responsiveness at 10-12 months predicted:• at 1.5 years: aggression and temper

tantrums• at 2 years : attention-seeking and hitting• at 3 years : problems with other children• at 6 years : fighting and stealing

NURSE-FAMILY PARTNERSHIPNURSE-FAMILY PARTNERSHIPSupport for “at risk” families@ 33 visits per family from onset of pregnancy to age 2Case load 25 families per nurse

Outcomes50% reduction in child abuse and neglect75% fewer hospitalisations due to non-accidental injuries 50% lower arrests for nurse-visited children

ROOTS OF EMPATHYROOTS OF EMPATHYMethod:

Baby visits classroom with parents once a monthSpecialist trainers work in parallel with teachers, interact with academic subjectsChildren become “attached” to their baby

Results:Decreased aggression, bullyingIncreased empathy, emotional understanding, pro-social behaviour, sharing, kindness, co-operation

Implication for optimum investmentImplication for optimum investment

Source: J Heckman & D Masterov (2005) Ch 6, Source: J Heckman & D Masterov (2005) Ch 6, New Wealth for Old Nations: ScotlandNew Wealth for Old Nations: Scotland’’s Economic Prospectss Economic Prospects

Californian ACE StudyCalifornian ACE StudyHealth risks which increase with 4 ACEs (17% of

population):depression (x 3)teenage pregnancy (x 2) intravenous drug use (x 11)liver disease (x 2)chronic obstructive pulmonary disease (COPD) (x 3)adult smoking (x 3)absenteeism from work (x 4)alcoholism and alcohol abuse (x 6)suicide attempts (x 14)

180.6

160.1

144.0137.5

124.2116.6

104.6 100.1

172.9

150.6

110.0

131.5

80

100

120

140

160

180

200

97-01 98-02 99-03 00-04 01-05 02-06

DepNI

Cardiovascular DiseaseD

eath

s pe

r 100

,000

pop

ulat

ion

Source DHSSPS

Adult Smokers by Area- 2008/9Adult Smokers by Area- 2008/9

0 5 10 15 20 25 30 35 40

Belfast EastBelfast NorthBelfast SouthBelfast WestEast Antrim

East LondonderryFermanagh & South Tyrone

FoyleLagan ValleyMid‐Ulster

Newry & ArmaghNorth AntrimNorth DownSouth AntrimSouth DownStrangford

Upper BannWest Tyrone

% Smokers 

Cardiovascular Service Health and Wellbeing FrameworkCardiovascular Service Health and Wellbeing Framework

2.Encourage all health and social care professionals to promote health , focusing on smoking

3.Establish Belfast Cardiac Users Forum and link with Eastern Area Stroke Services Users Group

4.Measure inequalities in access to cardiovascular services

Improving workforce HealthImproving workforce Health

6. A healthy weight programme for staff

7. A peer health programme for staff in bands 1 and 2

Reducing our carbon footprintReducing our carbon footprint8. Implement Trust Environmental and Sustainability Policy: increase energy efficiency, increase sustainable transport and procurement, minimise waste and increase recycling BECAUSEthose actions which promote sustainability will impact positively on health as well as carbon emissions AND those most vulnerable to impacts of climate change are those already deprived by low income, poor housing and poor health.

Questions for groupQuestions for groupDo you agree that, as a health and social care organisation, developing a strategy for health inequalities is the right thing to do?If so, does this strategy go far enough?Do you agree with the priorities?What is missing?What should we do next?