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290612 sha welfare reform and health

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Dr John Middleton

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290612 sha welfare reform and health

  1. 1. Recession, Welfare reform poverty and healthDr John MiddletonDirector of public HealthSandwell
  2. 2. Reality very different
  3. 3. And the peculiar evil is, the less money you have ,the less inclined you feel to spend it on wholesome food. A millionnaire may enjoy breakfasting on orange juice and Ryvita biscuits; an unemployed man doesn’t When you are unemployed, which is to say when you are underfed, harassed,bored, and miserable you don’t want to eat dull wholesome food…… George Orwell, The Road To Wigan pier.
  4. 4. • Harvey Brenner Int Journal Epidemiology• 2005, 34, 6: 1214
  5. 5. Recession and policy changesHealth impacts of economic downturn• Widening health inequalities• Worse mental health –including depression, and possibly lower levels of wellbeing• More suicides and attempted suicides;• Possibly more homicides and domestic violence• Fewer road traffic fatalities• Worse infectious disease outcomes such as tuberculosis and HIV
  6. 6. Male life expectancy at birth, local authorities 2008-10Life expectancy (years) 86 84 82 80 78 76 74 72 70 0 30 60 90 120 150 Local authority rank - based on Index of Multiple Deprivation
  7. 7. Young people not in employment, education or training (NEET), local authorities 2008 Not in educationemployment or training % 14 12 10 8 6 4 2 0 0 30 60 90 120 150 Local authority rank - based on Index of Multiple Deprivation
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  9. 9. Changes in real income for each 10% band of population, 1979 -1991/92, after housing costs Percentage 10% (Poorest) -17 20% 0 30% 6 40% 16 50% 23 60% 29 70% 33 80% 39 90% 46 100% (Wealthiest) 62 -20 0 20 40 60 80Source: Households below average income 1979-1991/92, Department of Social Security (1994)
  10. 10. Why ‘Child’ Poverty?Isn’t all poverty something we want to address?Source: The poverty site http://www.poverty.org.uk/09/index.shtml
  11. 11. Child poverty means family poverty• 1 in 3 children in Sandwell live in relative poverty. This means approximately 24,000 children• Of the 40,580 families with children dependents in Sandwell in 2008, more than 95% were in receipt of Child Tax Credit (CTC) or equivalent.• For every 10 families in Sandwell receiving CTC, 7 were in work and 3 were out of work. The distribution of worklessness matches well-known patterns of deprivation. Child Poverty Statistics, HMRC 2009
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  13. 13. Life expectancy & disability free life expectancy at birth, by neighbourhood income level, England and Sandwell 1999-2003Age Neighbourhoods by income deprivation (population percentiles) 24
  14. 14. Sandwell, Deaths by Coronary Heart Disease Sandwell, Deaths by Coronary Heart (CHD) ICD10 Disease (CHD) ICD10 I20 – I25 (5 I20 – I25 (5 year rolling average) year rolling average) Mortality Directly Standardised Mortality Rate, Total Rate, Population Aged Under 65 Years Population Directly Standardised Wednesbury Wednesbury Wednesbury Wednesbury North North Friar Park Friar Park North North Friar Park Friar Park Great Barr with Yew tree Great Barr with Yew tree Great Barr with Yew tree Great Barr with Yew tree Charlemont Charlemont Charlemont Charlemont Wednesbury Wednesbury Wednesbury Wednesbury Princes End Princes End with Grove Vale with Grove Vale Princes End Princes End with Grove Vale with Grove Vale South South South South Hateley Heath Hateley Heath Newton Newton Hateley Heath Hateley Heath Newton Newton Great Bridge Great Bridge Great Bridge Great Bridge Tipton Green Tipton Green Tipton Green Tipton Green West Bromwich West Bromwich West Bromwich West Bromwich Greets Green Central Greets Green Central Greets Green Central Greets Green Central and Lyng and Lyng and Lyng and Lyng Oldbury Oldbury Oldbury Oldbury Tividale Tividale Tividale Tividale St. Pauls St. Pauls St. Pauls St. Pauls Soho and Soho and Soho and Soho and Rowley Rowley Smethwick Victoria Smethwick Victoria Rowley Rowley Smethwick Victoria Smethwick Victoria Langley Langley Langley Langley Bristnall Bristnall Bristnall Bristnall Blackheath Blackheath Blackheath Blackheath Abbey Abbey Abbey Abbey Cradley Heath Cradley Heath Cradley Heath Cradley Heath Old Warley Old Warley Old Warley Old Warley and Old Hill and Old Hill and Old Hill and Old Hill
  15. 15. The Marmot Review• The best evidence for what we need to do• The biggest influences on health & wellbeing are the ‘social determinants’ of health• The ability to influence these sits largely with the local authority 27
  16. 16. • Reducing social inequalities: UK Marmot review• Early years education and family support: increase % spend in early years • Evidence base: Family nurse partnership • Perry preschool study • Triple P parenting • Surestarts and Childrens centres
  17. 17. • Educational attainment is a predictor of health outcomes. • Higher educational attainment is associated with healthier behaviour. • There is a gradient in limiting illness by level of educational attainment. • There is a gradient in mortality by educational attainment.Education and Skills
  18. 18. Children achieving a good level of development at age five, local authorities 2011 Good levelof development at age 5 % 80 75 70 65 60 55 50 45 40 0 30 60 90 120 150 Local authority rank - based on Index of Multiple Deprivation
  19. 19. • Reducing social inequalities: UK Marmot review• Maximise the capabilities and control young and adultspeople have over their lives : reduce the social gradient of skills and qualifications
  20. 20. • Reducing social inequalities: UK Marmot review• Create fair employment and good quality work for all and improve quality of work across social gradients
  21. 21. Work is good More than just a source of cash Psychological and social benefits Structures people’s daysNot working affects lifeexpectancy Should be rewarding andfulfilling(Marie Jahoda)
  22. 22. • Reducing social inequalities: UK Marmot review• Ensure healthy standard of living for all reducing the social gradient through progressive taxation and other fiscal policies
  23. 23. Sandwell welfare rightsservices
  24. 24. 37
  25. 25. How unemployment influences healthMaterial and psychosocial effects, can lead to:• an inability to afford to live a healthy life• distress, anxiety, depression and a worsening of physical health• a loss of self identity and self esteem• an increase in smoking and alcohol consumption and decrease in physical activity.
  26. 26. Employment and Life Expectancy• Those experiencing unemployment are likely to have higher mortality rates over their next decade, than those working.• Mortality rates are higher in manual compared to professional professions.
  27. 27. • Reducing social inequalities: UK Marmot review • Healthy and sustainable physical environments-
  28. 28. Green Space
  29. 29. Green Space Greener living environments: lower health inequalities, England Deaths from circulatory disease Income group 4 is most deprived Source: Mitchell & Popham, Lancet 2008
  30. 30. Healthy towns-Sandwell Healthy Urban Development UnitOutcomes• Healthy urban development approach• Working with town planners and transport engineers – to influence policy and design• Emphasis on environment and open spaces- create safer places where people• Encouraged to walking and cycling• Health impact assessment on all developments• Spin off for comments on health care impacts eg new nursing homes
  31. 31. Housing and Health
  32. 32. Achievements so farService Investment Estimated annual savings to NHSHealth Homes Advocate £30,000 £44,800HUB £7,000Handy Person Service £100,000 £132,000Affordable warmth £250,000 £105,000Home improvement agency £25,000 £56,000
  33. 33. • Reducing social inequalities: UK Marmot review• Strengthen the role and effect of prevention of ill health priority for investment to reduce social gradients-
  34. 34. Breakdown of life expectancy gap bydisease for males andfemales, Sandwell (DHHealth Inequalities Tool)
  35. 35. CHD Mortality 2000-2005
  36. 36. Male life Expectancy at birth, Sandwell and England 79.0 77.9 78.0Life Expectancy (Years) 77.0 Gap: 3.4 years Gap: Gap: Gap: Gap: 76.0 2.5 2.9 3.5 3.6 years years years years Sandwell 75.0 England 74.0 74.4 73.0 72.0 2003-05 2004-06 2005-07 2006-08 2007-09 3 year periods 54
  37. 37. 55
  38. 38. Three dividends for a healthier future The health dividend
  39. 39. Domestic burglary Sandwell 2001- 2005 Full implementation drug intervention project doubling numbers of drug users in treatment 1300 fewer domestic burglaries 33% fall
  40. 40. Three dividends for a healthier future The inclusion dividend
  41. 41. The Future?  Easy to use Patient Graphic interface  Wireless or wired devices, POTS and IP Communications Software based product – operates on a variety of devices in expanding applications Tablet PC CareCompanion II Handheld devices  Standard protocols – easy customization
  42. 42. i- House,demonstrationhouse WestBromwich 2008
  43. 43. Three dividends for a healthier future The green dividend
  44. 44. Good corporate citizen award38 apprenticesRationalisation of offcies : 6leases surrendered890 tonnes of CO2 reduction£200k saved
  45. 45. Citizen Wage?  Time to resurrect the concept Recognises work not covered bythe conventional economic system  Advantages to employers and industry
  46. 46. Everyone’s business!• Consider health impact of our activity• Read the Public Health Report• Read the Marmot Review summary• Visit Sandwell Trendswww.sandwelltrends.co.uk 67
  47. 47. • THANKYOU • John Middleton• Director of Public Health for Sandwell• John.middleton@sandwell-pct.nhs.uk• Vice President, UK Faculty of Public Health • vpPolicy@fph.org.uk

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