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South Birmingham Board Health Inequalities Session 23 Mar

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An NHS Board development session on health inequalities focusing on South Birmingham

Published in: Health & Medicine, Spiritual
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South Birmingham Board Health Inequalities Session 23 Mar

  1. 1. 23rd March 2011 NHS South Birmingham Board Seminar Jim McManus Joint Director of Public Health, Birmingham City Council Health Inequalities – some challenging issues
  2. 2. National Audit Office 2010 not on course!
  3. 3. Leading causes of death Common Risk Factors
  4. 4. Don’t wait for change or direction…move now Life Expectancy by Ward Still there whatever the back office system
  5. 5. Nothing new under the sun?
  6. 6. Age Structure
  7. 7. Population Change 2000-2007
  8. 8. Population Change 2000-2007
  9. 9. Age Structure 2
  10. 10. Life Expectancy Males - PSA Target 77.56 Years by 2010 0.6 years under trajectory in 2005-07, 0.7 years under trajectory in 2006-08 Birmingham BEN HOB SOUTH 1995-1997 72.1 73.5 71.2 73.7 2005-2007 75.6 76.01 73.65 76.32 2006-2008 75.9 76.3 74.2 76.6 Females – PSA Target 81.70 Years by 2010 0.18 years under trajectory in 2005-2007, 0.1 years under trajectory in 2006-2008 Birmingham BEN HOB SOUTH 1995-1997 78.0 78.5 77.6 78.8 2005-2007 80.8 80.44 80.13 81.62 2006-2008 81.0 80.6 80.6 81.8
  11. 11. Male life expectancy - 3 years rolling average 70.00 71.00 72.00 73.00 74.00 75.00 76.00 77.00 78.00 79.00 80.00 1995- 1997 1996- 1998 1997- 1999 1998- 2000 1999- 2001 2000- 2002 2001- 2003 2002- 2004 2003- 2005 2004- 2006 2005- 2007 2006- 2008 2007- 2009 2008- 2010 2009- 2011 Years Yearsofage Birmingham England PSA trajectory* Projection PSAtargetbaselineyear Latest Targetyear Data source: England and Birmingham MLE- ONS England MLEProjection - Government Actuary's Department Trajectories - PHIT
  12. 12. Female life expectancy - 3 years rolling average 75.00 76.00 77.00 78.00 79.00 80.00 81.00 82.00 83.00 84.00 85.00 1995- 1997 1996- 1998 1997- 1999 1998- 2000 1999- 2001 2000- 2002 2001- 2003 2002- 2004 2003- 2005 2004- 2006 2005- 2007 2006- 2008 2007- 2009 2008- 2010 2009- 2011 Years Yearsofage Birmingham England PSA trajectory* Projection Baselineyear Latest Targetyear Data source: England and Birmingham MLE- ONS England MLEProjection - Government Actuary's Department Trajectories - PHIT
  13. 13. Male AAACM by IMD Quintile in Birmingham 1995 - 2008 Three year rolling average 0.00 200.00 400.00 600.00 800.00 1000.00 1200.00 1400.00 1995 /1997 1996 /1998 1997 /1999 1998 /2000 1999 /2001 2000 /2002 2001 /2003 2002 /2004 2003 /2005 2004 /2006 2005 /2007 2006 /2008 Years DSR Affluent Less Affluent Average Less Deprived Deprived Data source: ONS death registrations PHIT calculation
  14. 14. Female AAACM by IMD Quintile in Birmingham 1995 - 2008 Three year rolling average 0.00 100.00 200.00 300.00 400.00 500.00 600.00 700.00 800.00 900.00 1995 / 1997 1996 / 1998 1997 / 1999 1998 / 2000 1999 / 2001 2000 / 2002 2001 / 2003 2002 / 2004 2003 / 2005 2004 / 2006 2005 / 2007 2006 / 2008 Years DSR Affluent Less Affluent Average Less Deprived Deprived Data source: ONS death registrations PHIT calculation
  15. 15. Birmingham by Cadbury Neighbourhood Classifications Understanding these as drivers and intervening variables Transit or Escalator– move to more deprived areas Isolate – move to equally or more deprived areas Gentrifier -
  16. 16. CVD Mortality and Cost • There is an opportunity across City to avoid £12.8 million (annual) worth of admissions to hospital through moderately ambitious preventive interventions chosen well • Doing case finding would give us the potential to reduce CVD risk and we can then model this against life expectancy
  17. 17. Admissions avoided with 3-4% reduction in risk factors Admissions avoided with 5-6% reduction in risk factors
  18. 18. Children Key Points • From topic to geography • Geographical clusters with longitudinal affect-cumulative challenges • Focus on outcomes and not outputs- Brighter futures Logic model • Focus on Inequalities- reduction in rates between geographical areas and target groups • Engaging with children and young people on the results
  19. 19. Childrens Composite Scores See detailed Map and Sheet
  20. 20. Pupil Census-Somali Speakers
  21. 21. Pupil Census-Pashto/Pakto Speakers
  22. 22. Pupil Census-Polish Speakers
  23. 23. Income Deprivatio n Affecting Children Index 2007
  24. 24. Child and Adolescent Mental Health Services Tier 3 Social Gradient for Accessing CAMHS Tier 3 services by CWI Decile 2008 BCH 0.00% 0.20% 0.40% 0.60% 0.80% 1.00% 1.20% 1.40% 1.60% 1 2 3 4 5 6 7 8 9 10 Child Wellbeing Index Decile (Where 1 is Most Deprived) Add Trendline
  25. 25. Economic well being: Children's centres registrations Social Gradient for Childrens centres registration by CWI Quintile 2008/9 BCC: Children data 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 1 2 3 4 5 Child Wellbeing Index Quintile (Where 1 is Most Deprived) Add Trendline
  26. 26. Rates of Chlamydia infection Rates of Positive Chlamydia tests by Birmingham ward 2006 Source: HPU 2008 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00% Oscott Nechells Aston ShardEnd Kingsbury PerryBarr Longbridge Weoley Soho SuttonFo-urOaks Handsworth Kingstanding SuttonVesey HodgeHill Moseley Erdington Brandwood King'sNorton Ladywood Sandwell Bournville Sheldon Northfield StocklandGreen SuttonNewHall Edgbaston WashwoodHeath Sparkhill BartleyGreen HallGreen SmallHeath FoxHollies Quinton SellyOak Acock'sGreen Harborne Sparkbrook Billesley Yardley Birmingham Average
  27. 27. Hospital admissions for accidents
  28. 28. Stay Safe: Impact of deprivation Social Gradient for Children in Need by CWI Quintile 2009 Source: Birmingham City Council 0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 40.00 45.00 50.00 1 2 3 4 5 Child Wellbeing Index Quintile (Where 1 is Most Deprived)
  29. 29. The space for emotional intelligence The Challenge for most of us and the opportunity! • We are doing tertiary prevention first because of where we are epidemiologically • Understand REALLY which levers pull short, medium and long term Short Term – primary care Medium to Long Term – LA and other players
  30. 30. Our Burdens of Disease Primary Secondary Tertiary
  31. 31. Domains of Public Health Health Improvement Health Protection Service Public Health Where does this go and when will it stop being entirely NHS focused? Diverse accountabilities What about the PH role in Commissioning?
  32. 32. Principles
  33. 33. Evidence: Housing and CVD
  34. 34. Evidence: Neighbourhood Economics and CVD
  35. 35. From Neighbourhood Disadvantage to Disease
  36. 36. Life Style Key figures for life style Deprivation in Birmingham, West Midlands and England Year Birmingham West Midlands England Adults who smoke 2003/5 24.9% 24.0% 24.1% Binge drinking adults* 2003/ 2005 17.8% 17.9% 18.0% Healthy eating adults** 2003/ 2005 25.1% 25.1% 26.3% Physically active adults*** 2007/8 16.9% 19.1% 21.3% Obese adults**** 2003/ 2005 23.4% 26.5% 23.6%
  37. 37. Population Change 2000-2007
  38. 38. CVD Mortality and Cost • There is an opportunity across City to avoid £12.8 million (annual) worth of admissions to hospital through moderately ambitious preventive interventions chosen well • Doing case finding would give us the potential to reduce CVD risk and we can then model this against life expectancy
  39. 39. Admissions avoided with 3-4% reduction in risk factors Admissions avoided with 5-6% reduction in risk factors

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