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Health Inequalities Intervention Tool for Scotland (HITS). Faculty of Public Health in Scotland, Annual Conference 2011 Rory Mitchell Public Health Observatory Division NHS Health Scotland. What do we do about health inequalities in Scotland?. Overview. Background & aims - PowerPoint PPT Presentation
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Health Inequalities Intervention Tool for Scotland (HITS)
Faculty of Public Health in Scotland, Annual Conference 2011
Rory Mitchell
Public Health Observatory DivisionNHS Health Scotland
What do we do about health inequalities in Scotland?
Overview
• Background & aims• What are the health inequalities intervention tools?• Data issues
• Demonstration
• Preliminary findings• Discussion (wider context of tackling health inequalities)• Conclusions
Health Inequalities Intervention Tools• Spreadsheet based models, underpinned by current data
and effectiveness evidence
• Tools available at local and national level, for use by policy makers and local planners to inform decision making
• Modelling of the impact of selected interventions on population health and health inequalities
• Modelling of costs required to achieve particular outcomes
Health Inequalities Intervention ToolsInterventions:
Alcohol brief interventions (ABIs)Counterweight (BMI reduction intervention)NHS smoking cessation services
Outcomes:Deaths (number prevented, life expectancy)Hospital admissions (number prevented, rate)Risk factor (prevalence, population mean)
[population & most deprived quintile (MDQ)]
Data
Demo
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Draft!
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Baseline throughput
Cost per intervention (£) £25
User input 1: population
88,138User input 2: current activity
Scotland
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population size
Number eligible for interventionTotal costThroughput numberRecruitment rate requiredNo. of 'successful' interventionsCost per successful intervention
Males Females
Harmful / hazardous drinking (%) 28.7% 19.4%
Males Females
Life expectancy (years) 75.32 80.04
No of alcohol-related admissions 27,907 11,370
Males Females
No of alcohol admissions in MDQ 11,821 4,816
Life expectancy in MDQ (years) 69.40 76.39Life expectancy gap (years) 11.00 7.19
5,143,680
Baseline data
1,005,198£2,203,45088,1388.8%57,290£38
Alcohol Brief Interventions Tool Demo
1. Investment of an additional £1 million at Scotland level
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Parameter to model Investment
Cost per intervention (£) £25
Outcome gap comparator Least deprived quintile (Scot)
SIMD Distribution Baseline distribution
Budget (£) 3,203,450
User input 3: model data
= Modelling £1M investment above estimated 2010/11
baseline
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Total Cost £3,203,450Throughput 128,138Recruitment rate required 14.0%No. of 'successful' interventions 83,290Cost per successful intervention £38
Intervention Impact
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Females
40.00332
0.007Deaths preventedGain in life expectancy (years)
10
Alcohol-related hospital admissions prevented 117
Population Health Outcomes Males
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Females
12-0.28%
Deaths prevented in MDQ 176.397.19-0.05%
3
Alcohol-related hospital admissions prevented in MDQ 51% change in alcohol-related admission rate gap -0.42%
Health Inequalities Outcomes Males
69.41
% change in life expectancy gap10.99-0.09%
New life expectancy in MDQ (years)New life expectancy gap (years)
Alcohol Brief Interventions Tool Demo
1. Investment of an additional £1 million at Scotland level
2. Investment of an additional £1 million at Scotland level, and targeting of all interventions to the most deprived two quintiles
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Same budget, but perfectly targeted to more deprived
groups
Parameter to model Investment
Cost per intervention (£) £25
Outcome gap comparator Least deprived quintile (Scot)
SIMD Distribution Perfect targeting to Q1&2
Budget (£) 3,203,450
User input 3: model data
Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)
Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model
Population size
Number eligible for intervention Females
Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention
Males FemalesHarmful / hazardous drinking
Males Females Females
Life expectancy (years)
No of alcohol-related
Males Females Females
No of alcohol admissions in
Life expectancy in MDQ (years)Life expectancy gap (years)
Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap
New prevalence of harmful / hazardous drinking (not calculable )
Health Inequalities Outcomes Males
New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Population Health Outcomes Males
% change in life expectancy gap
New life expectancy in MDQ (years)New life expectancy gap (years)
Baseline data
MalesIntervention Impact
User input 3: model dataUser input 1: population
User input 2: current activity
Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions
Females
76-0.90%
Deaths prevented in MDQ 676.417.17-0.30%
21
Alcohol-related hospital admissions prevented in MDQ 331% change in alcohol-related admission rate gap -1.47%
Health Inequalities Outcomes Males
69.46
% change in life expectancy gap10.94-0.58%
New life expectancy in MDQ (years)New life expectancy gap (years)
Preliminary findings
• All 3 interventions can have an impact on health inequalities
• Accurate targeting is critical
• Modelled impact is dependent on input data and assumptions
….but the magnitude of impact is fairly robust
• For all interventions the predicted impact is modest
Tackling health inequalities: the scale of the challenge
Tackling health inequalities: what is likely to work?
Likely to be more effective*:
• Structural changes in the environment
• Legislative and regulatory controls • Fiscal policies • Income support • Reducing price barriers • Improving accessibility of services• Prioritising disadvantaged groups • Offering intensive support • Starting young
Likely to be less effective*:
• 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 • Approaches which involve
significant price or other barriers• Programmes that raise housing
costs
*Edited, from MacIntyre, S. What are inequalities in health and what causes them? Briefing Paper for Ministerial Taskforce on Inequalities. Scottish Government; 2008.
Conclusions
• HITS outputs provide practical tools to inform decision making
• The 3 interventions modelled can have a measurable impact on health inequalities
• However, the impact of downstream individual interventions is likely to be small…and highly dependent on targeting
• Upstream universal interventions are likely to have a larger role to play in tackling health inequalities in Scotland
What’s next?
• Outputs scheduled for publication in early 2012
• Feedback very welcome!
Acknowledgements
ScotPHO colleagues: Diane Stockton, Gerry McCartney, Colin Fischbacher, Jamie Reid
HITS Steering Group