Addressing Inequalities in Health and Wellbeing at Population Level

HINSTAssociates

Professor Chris BentleyChris.bentley19@gmail.com

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

Health Seeking Behaviour

Enable all children,

young people & adults to maximise

their capabilities & control

their lives.

Create and develop

healthy and environment-

ally sustainable

places & communities.

Ensure healthy

standard of living for all.

Create fair

employment &

decent work for

all.

Give every child the

best start in

life.

Strengthen the role and impact of ill-

health prevention.

HealthcarePublic Health

Marmot ‘Plus’ policy Objectives

2005

2010 2015

2020

Health Inequalities

Different 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 PercentileSource: ONS …………………………………………………………………………..

Age

Life expectancy

DFLE

Pension age in 2024

Poly. (DFLE)

Poly. (Lifeexpectancy)

Haringey: Slope Index of Inequality (Males)

HaringeyIndex of Multiple Deprivation (IMD)

% of residents from each English

quintile

Haringey: Slope Index of Inequality (Males)

Slope Index of Inequality - Redcar and Cleveland(males)

MaidstoneIndex of Multiple Deprivation (IMD)

% of residents from each English

quintile

Maidstone – slope index (males)

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

rag

e p

osi

tio

n in

dis

trib

uti

on

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

Low

Years

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

0

10

20

30

40

50

60

70

80

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