Addressing Inequalities in Health and Wellbeing at Population Level Redcar and Cleveland (1)...
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Addressing Inequalities in Health and Wellbeing at Population Level Redcar and Cleveland (1) HINSTAssociatesHINSTAssociates Professor Chris Bentley [email protected]
Addressing Inequalities in Health and Wellbeing at Population
Level Redcar and Cleveland (1) HINSTAssociatesHINSTAssociates
Professor Chris Bentley [email protected]
Slide 2
After Ronald Labonte Well being and Health Physiological risks
High blood pressure High cholesterol Stress hormones
Anxiety/depression Behavioural risks Smoking Poor diet Lack of
activity Substance abuse Psycho-social risks: Isolation Lack of
social support Poor social networks Low self-esteem High self-blame
Low perceived power Loss of meaning/purpose of life Risk conditions
e.g.: Poverty Low social status Poor educational attainment
Unemployment Dangerous environments Discrimination Steep power
hierarchy Gaps/weaknesses in services and support
Slide 3
2005201020152020 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
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Oldham by English Deprivation Quintile
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Slope Index of Inequality - Oldham (males)
Slide 7
Slope Index of Inequality - Redcar and Cleveland (males)
Slide 8
Maidstone slope index (males)
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Slope Index of Inequality - Redcar and Cleveland (females)
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Redcar and Cleveland Local deprivation quintile by LSOA
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DISPROPORTIONATE NEED
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Number of chronic disorders by age group Barnett, K et al.
2012
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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).
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The relationship between multiple lifestyle risks and mortality
Buck, D; Frosini, F; 2012
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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 Kings Fund 2012
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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, health and 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
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Inequality in Early Cognitive Development of British Children
in the 1970 Cohort, 22 months to 10 years 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
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`Sensitive periods in early brain development Vision 0 1237654
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 yearsSchool
years
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Per cent achieving 5+ A* - C grades inc Maths and English at
GCSE by IDACI decile of pupil residence: England 2007 % achieving
5+ A*-C GCSEs inc Maths and English Income Deprivation Affecting
Children Index (IDACI) Least deprived Source: DCFS 2009 Most
deprived
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OutcomeMost deprivedLeast deprived Smoking during
pregnancy38%13% Stillbirth5.9/1000 live births3.8/1000 live births
46 m Language development concerns26%12% Behaviour to other
children24%10% Total difficulties (on SDQ)20%7% Dental caries age 5
years (odds)4.61 Teenage pregnancy3 x higher Death in 15-44 year
olds5 x higher 45-74 year olds Death due to CHD3.8 x more likely
Death due to cancer2.3 x more likely Alcohol deaths12.3 x more
likely Under-75 year old deaths3.6 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.
Slide 21
Child wellbeing in Better-off Countries (UNICEF Review
2007)
