FHWAFHWAHealth and Health InequalitiesHealth and Health Inequalities

Dr Gina Radford

DPH

SMRs, Fife, 1995 - 2004

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1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

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Heart Disease

Cerebrovascular Disease

All Malignant Neoplasms

Respiratory Disease

All cause mortality rate per 100000 All cause mortality rate per 100000 population aged under 65, by population aged under 65, by

interzone, Fife and Scotland, 2006interzone, Fife and Scotland, 2006

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Fife Scotland

Interzone

Determinants of health

ROA areas

20% most deprived population

20% least deprived population

Fife

All cause mortality rate per 10000 population under 65 (2005)

44.7 42.4 16.7 31

Hospital admissions for alcohol misuse rate per 10000 population (2002-2004)

95.9 89.7 19.2 48.5

Percentage of women smoking in pregnancy (2002-2004)

47.2 46.8 7.8 28.5

Percentage of working age population claiming Job Seekers Allowance (2005)

7.5 6.9 1.1 3.4

Percentage of working age population in receipt of Incapacity Benefit, Severe Disablement Allowance or Compulsory New Deal (2005)

18.2 17.1 2.9 9.1

Reducing Health InequalitiesReducing Health Inequalities

Health varies in Fife in relation to• Socio-economic status• Gender • Ethnicity• Place of residence• Other inequalities

Percentage of S4 children attaining English and Maths at SCQF level 3 and above, 2006

Looked after children 40%

Fife 89%

Scotland 91.3%

Risk factors for teenage pregnancy

• Poor attendance rates and dislike of school

• Poor educational attainment

Feeling like they belong somewhere, like they’re living their life.

More likely to reduce More likely to reduce inequalitiesinequalities

• Improving accessibility of services

• Prioritising disadvantaged groups

• Offering intensive support

• Starting young

Disadvantaged groups

tend :

• to be harder to reach• to find it harder to change behaviour• to receive less benefit from lifestyle change or access to services

interventions with more disadvantaged groups may need to be much more intensive and targeted than might be appropriate for more advantaged groups: information based approaches such as food labelling, pamphlets in doctors’ surgeries, and mass media campaigns, or those which require people to take the initiative to sign up for, may be less effective among more disadvantaged groups

An intervention which, in general, works (e.g. dental health education) might have

– no effect on health inequalities if all SES groups benefit equally

– increase health inequalities if the rich benefit more

– reduce health inequalities if the poor benefit

more

Less likely to reduce inequalitiesLess likely to reduce inequalities

• Information based campaigns• Written materials• Campaigns reliant on people taking the

initiative to opt in• Campaigns/messages designed for the

whole population• Whole school health education approaches

Young people are the future generation so we need to help them before they become useless to society.

What use is a twenty-five year old man with no qualifications, no job and messes around with alcohol and drugs?

Priority areas for Fairer Scotland Fund Priority areas for Fairer Scotland Fund Health Inequalities funding – the contextHealth Inequalities funding – the context

• SOA• Community Plan• Fairer Fife Framework• FSF principles• JHIP• Equally Well

Fairer Fife Framework Action Areas Priority 1 Priority 2

Targeting resources to people living in the most disadvantaged life circumstances

17 8

Improving mental health and emotional well-being

4 10

Increasing opportunities for people to have a healthier lifestyle in relation to where they live, work and spend their time

3 2

Increasing community involvement in the planning and delivery of health improvement work –

3 3

Improving access to services and support that impact on peoples health and well-being –

3 8

What people told usWhat people told us

Equally well priority areas Priority 1 Priority 2

Children, particularly in the early years

11 3

“Killer diseases” such as heart disease, cancer, diabetes (and associated risk factors such as smoking, obesity etc)

12 2

Mental health and wellbeing 4 12

The harm caused by drugs, alcohol and violence

5 12

What people told usWhat people told us

• People living in most disadvantaged areas in Fife 19

• People represented by one of the six equality strands 2

• Race 4

• Gender 2

• Disability 6

• Age 6

• Religion/belief 3

• Sexuality 4

• Other e.g. people addicted to drugs/alcohol; long-term unemployed

Early Years and vulnerable young peopleHomelessness and housing issuesPeople with mental health issuesOthers

16

What people told usWhat people told us

What people told usWhat people told us

Other issuesOther issues• Integrated approaches• Improving access to services• Early intervention across lifestages• Clusters of disadvantage/identified families

not geographical areas

• Vulnerable families• Mental health & wellbeing• Homelessness & housing issues• Alcohol• Disadvantaged life circumstances

5 areas emerged5 areas emerged

Seasons Greetings

Consensus VotingYou have three votes• Vote once for each of

your top three priorities from the list

• Your votes are worth 3 points, 2 points and 1 point

• Use more points for your higher priority

List• Disadvantage (Areas

and/or Individual Circumstances)

• Mental health and wellbeing 

• Alcohol • Vulnerable families• Homelessness and

housing issues