Middletonja

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Middletonja

  1. 1. Health inequalities, Marmot and English health policySocialist Health Association, Manchester, July 25th 2011 John Middleton Director of Public Health for Sandwell
  2. 2. Socialist health association – inequalities in health meeting Introduction- welcome to Sandwell History of public health Spearhead inequalities • Reducing social inequalities: UK Marmot review • Implementing effective interventions • Current UK health policy context
  3. 3. About Sandwell• Located in the Black Country• High levels of deprivation• Inequalities in health• Multi-cultural community• Six distinct towns
  4. 4. Six Towns in the West Midland Known as Sandwell
  5. 5. Welcome to Sandwell
  6. 6. Welcome to Sandwell
  7. 7. Neptune forge 1930
  8. 8. Neptune health park, 1999
  9. 9. An history of English history of public health
  10. 10. The Changing landscape for public health in England, John Middleton Warrington, March2nd 2011 30% of the life expectancy gain since the formation of the NHS is due to effective medical interventions Bunker ,Frazier and Mostellar, Milbank Quarterly, 1994 Through the work of the DH National Support Team for health inequalities we now have effective tools to use to reduce inequalities by case finding and treating people at highest risk of cardiovascular disease and other conditions
  11. 11. its not whoyour doctoris, its whoyou vote for,that mostaffects yourhealth
  12. 12. Sandwell, Deaths Sandwell, Deaths by Coronaryby Coronary Heart Disease (CHD) Heart Disease (CHD) ICD10 ICD10 I20 – I25 (5 year rolling I20 – I25 (5 year rolling average) Mortality Rate, average) Population Aged Under 65Directly Standardised Mortality Years Rate, Total 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
  13. 13. The economic Town Profilesclimate and health
  14. 14. Fear of job loss Economic Downturn Early retirement Jobs at risks (Jobcentre Plus) Increasing numbers in higher / Precarious Work further education Higher education Unemployment enrolment numbers (HESA) Reduced income % low pay jobs & household income Potentially measured by: Fuel Poverty per head (ONS) Unemployment numbers Housing tenure Health Consequences Unemployment rate (unemployed / economically active population)) social rented housing Influenced by demography of those JSA claimants (updated monthly) needs register (HSSA) affected ( EoE forecasting model – EEDA) Economically inactive (not in employment or unemployed) Incapacity benefit claimants (sub divided by type) Measured Increase Increase Increase Decrease Decrease Other by smoking alcohol overweigh physical psychological t & activity well-being obesity Mortalit Smoking Alcohol Suicide & Land y attributa attributa injury transport ble ble undetermined accident mortality mortality mortality rate rate Morbidit Smoking Alcohol % Prescribing y prevalenc consumpti recorded data of anti- e over 16 on obese depressants yr adults 16 (ADQ) + Healthca COPD Alcohol Admissions All re admission related for self-harm admissions utilisat s admission Adults in All 1st OPD ion Acute MI s contact with attendanceKey Questions: admission mental health s1.What is the likely impact of the economic downturn upon health services s at an individualAll A&E and population level ?(literature search) admissions2.What can be done to mitigate the impact of an economic downturn on health? (literature search)3.Is the economic downturn impacting upon healthcare service use within the East of England? (data analysis– contemporary)
  15. 15. Health and wealth Health and recession
  16. 16. Reality very different
  17. 17. Health and wealth Poverty and health
  18. 18. • Harvey Brenner Int Journal Epidemiology 2005, 34, 6: 1214
  19. 19. Shaw et al.Critical public health2001,11:289-304
  20. 20. Shaw et alCritical public health,2001;11:289-303
  21. 21. Spearhead authorities in Englanddistance from target for reducinginequalities
  22. 22. Changes in real income for each 10% band ofpopulation, 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% 46100% (Wealthiest) 62 -20 0 20 40 60 80 Source: Households below average income 1979-1991/92, Department of Social Security (1994)
  23. 23. Households below average income survey
  24. 24. Health and wealth Health access and inequality
  25. 25. Health and wealthEnvironmental justice
  26. 26. Inequalities in health: evidence (Acheson) • Income inequalities • Early years education • Tobacco control • Workplace health interventions • Food and nutrition • Transport and access• Health inequalities impact assessment

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