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?