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Addressing Inequalities in Health and Wellbeing at Population Level. HINST Associates. Redcar and Cleveland (1) . Professor Chris Bentley [email protected]. Physiological risks High blood pressure High cholesterol Stress hormones Anxiety/depression. Well being and Health. - PowerPoint PPT Presentation
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Addressing Inequalities in Health and Wellbeing at Population
LevelRedcar and Cleveland (1)
HINSTAssociates
Professor Chris [email protected]
After Ronald Labonte
Well being and Health
Physiological risksHigh blood pressureHigh cholesterolStress hormonesAnxiety/depression
Behavioural risksSmokingPoor dietLack of activitySubstance abuse
Psycho-social risks:IsolationLack of social supportPoor social networksLow self-esteemHigh self-blameLow perceived powerLoss of meaning/purpose of life
Risk conditions – e.g.:PovertyLow social statusPoor educational attainmentUnemploymentDangerous environmentsDiscriminationSteep power hierarchyGaps/weaknesses in services and support
2005
2010 2015
2020
Health InequalitiesDifferent Gestation Times for Interventions
A
B
C
For example intervening to reduce risk of mortality in people with established disease such as CVD, cancer, diabetes
For example intervening through lifestyle and behavioural change such as stopping smoking, reducing alcohol related harm and weight management to reduce mortality in the medium term
For example intervening to modify the social determinants of health such as worklessness, poor housing, poverty and poor education attainment to impact on mortality in the long term
Life expectancy and disability free life expectancy at birth, persons by neighbourhood income level, England, 1999-2003
45
50
55
60
65
70
75
80
85
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100 Neighbourhood Income Deprivation - Population Percentile
Source: ONS …………………………………………………………………………..
Age
Life expectancy
DFLE
Pension age in 2024
Poly. (DFLE)
Poly. (Lifeexpectancy)
Oldham – by English Deprivation Quintile
Slope Index of Inequality - Oldham (males)
Slope Index of Inequality - Redcar and Cleveland(males)
Maidstone – slope index (males)
Slope Index of Inequality - Redcar and Cleveland(females)
Redcar and ClevelandLocal deprivation quintile
by LSOA
DISPROPORTIONATE NEED
Number of chronic disorders by age group
Barnett, K et al. 2012
• Multi-morbidity – the existence of several chronic health disorders in one individual – is a critical and increasing challenge for health and social services.
• The prevalence of this problem increases with deprivation; people in deprived circumstances having the same prevalence of multi-morbidity as more affluent patients who were 10 – 15 years older (Barnett, 2012).
The relationship between multiple lifestyle risks and mortality
Buck, D; Frosini, F; 2012
Distribution of multiple risk behaviours
Looking at combination of 4 key risk behaviours in 2008, i.e.:
Smoking; Excessive use of alcohol; Fruit and vegetable consumption; Physical exercise
• Unskilled manual labour 3 times more likely to have all 4 risk behaviours than professionals
• People with no qualifications 5 times more likely to have all 4 risk behaviours than those with high level qualifications
King’s Fund 2012
Enable all children,
young people & adults to
maximise their capabilities & control their
lives.
Policy objectives
Effective evidence-based delivery systems.
Reduce health inequalities and improve health and wellbeing for all
Policy Goals
Create an enabling society that maximises individual and
community potential.
Ensure social justice, healthand sustainability are at heart of
policies.
Create and develop
healthy and environment-
ally sustainable places &
communities.
Ensure healthy
standard of living for all.
Create fair employ-ment & decent
work for all.
Give every
child the best
start in life.
Equality & health equity in all policies.
Strengthen the role and impact of ill-
health prevention.
Policy mechanisms
Inequality in Early Cognitive Development of British Children in the 1970 Cohort, 22 months to 10 years
0
10
20
30
40
50
60
70
80
90
100
22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86 90 94 98 102 106 110 114 118
months
Ave
rage
pos
ition
in d
istr
ibut
ion
High Q at 22m
Low Q at 22m
Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97
High SES Low SES
`Sensitive periods’ in early brain development
Vision
0 1 2 3 7654
High
LowYears
Habitual ways of responding
Language
Emotional control
Conceptualization
Peer social skills`Numbers’
Hearing
Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)
“Pre-school” years
School years
Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by IDACI decile of pupil residence: England 2007
25.329.9
34.239.2
44.749.5
53.857.8
61.968.4
01020304050607080
0-10% 10-20%
20-30%
30-40%
40-50%
50-60%
60-70%
70-80%
80-90%
90-100%
% achieving 5+ A*-C GCSEs inc Maths and English
Income Deprivation Affecting Children Index (IDACI) Least deprived
Source: DCFS 2009
Most deprived
Outcome Most deprived Least deprived
Smoking during pregnancy¹ 38% 13%
Stillbirth 5.9/1000 live births 3.8/1000 live births
46m
Language development concerns² 26% 12%
Behaviour to other children 24% 10%
Total difficulties (on SDQ) 20% 7%
Dental caries age 5 years³ (odds) 4.6 1
Teenage pregnancy⁴ 3 x higher
Death in 15-44 year olds⁵ 5 x higher
45-74 year olds
Death due to CHD 3.8 x more likely
Death due to cancer 2.3 x more likely
Alcohol deaths 12.3 x more likely
Under-75 year old deaths 3.6 x more likely
Health inequalities in Scotland
Sources : 1. Gray R, Bonellie SR, Chalmers J, Greer I, Jarvis S, Kurinczuk JJ, et al. 2009. 2. Scottish Government. Growing Up in Scotland: Health inequalities in the early years. 2010. 3. Levin KA, Davies CA, Topping GV, Assaf AV, Pitts NB. 2009. 4. Scottish Government 2003. 5. Scottish Government Health Analytical Services Division 2008.
Child wellbeing in Better-off Countries (UNICEF Review 2007)
(10)
(9)
Maidstone - Neighbourhood (LSOA) deprivation scores
(decile – 10%)
Local index of child wellbeingmaterial wellbeing domain
Local index of child wellbeingeducation domain
Literacy and numeracy in the UK
Moser Report 1999
Skills for Life Survey 2011 (BIS)
Maidstone unemployment