NDCs and Health Overview of Phase 1

Liddy Goyder, ScHARR University of Sheffield

The health “theme team”University of Sheffield• Liddy Goyder• Jean Peters• Lindsay Blank• Libby EllisSheffield Hallam University• NDC team, Mike GrimsleyMORI and SDRC for health data

Overview

• What are NDCs and what do they do?• What are “health” issues for NDCs?• “Health-related” activity in NDCs:

example of healthy eating initiatives • So has health improved in NDCs?• Do we expect NDCs to have an impact

on population health in the future?

The NDC Programme

• Launched in 1998• Ten year, community led, holistic ABI in 39

deprived English localities• Five outcome areas: housing and

environment,jobs, education, crime, health• £50 million per partnership• Compares to about £600 million from

mainstream service providers • Plus funding and activity through other ABIs

Complexity of ABI evaluation

• Dealing with attribution when so many previous/present initiatives

• Change in any ABI related to wider local/ regional/national changes

• Area based interventions but aimed at individuals

• Spillover/displacement

Delivery Plans 2004Top 7 outcomes for health

• Health promotion: diet, exercise, health and well-being (31)

• Death rate/SMR and life expectancy (30)

• Mental health (16)

• Health services-access (15)

• Smoking (12)

• Teenage pregnancy (12)

• Self reported health (10)

Interventions that are likely to improve health and reduce

inequalities income and employment educational attainment quality of housing/physical environment crime and fear of crime

facilitating “healthy lifestyles” access to/quality of health services

Wide variation in health indicators across Partnerships

• Over 20 percentage point difference between Partnerships in residents with good health

• “Health is worse over past year” ranges from 28% in Coventry to 10% in Lambeth

• General health is highly correlated with deterioration in health over past year (-0.88)

• NDC average SF36 mental health well being score ranges from 66 to 75 in 2004

% NDC population consuming 5 portions of fruit and vegetables

per day

NDC Area

Ply

mouth

Mid

dle

sbro

ugh

Hart

lepool

Derb

yH

ull

Know

sle

yB

risto

lO

ldham

Doncaste

rM

ancheste

rS

underland

Sheffie

ldLuto

nS

alford

Nottin

gham

Liv

erp

ool

Sandw

ell

Bra

dfo

rdC

oventr

yS

outh

am

pto

nN

ew

castle

Fulh

am

Rochdale

Kin

gs N

ort

on

Wolv

erh

am

pto

nN

orw

ich

Brighto

nB

irm

ingham

Lew

isham

Leic

este

rW

als

all

New

ham

Tow

er

Ham

lets

Islin

gto

nH

ackney

Haringey

Bre

nt

Lam

beth

South

wark

% e

atin

g 5

fru

it o

r ve

g d

aily

40

35

30

25

20

15

10

5

0

Spending by Theme 2001-4

104

87

68

47

45

45

66

0 20 40 60 80 100 120

Housing & PE

CommunityDevelopment

Education

Worklessness

Health

Community Safety

Average

Total NDC Expenditure (£000,000)

NDC Health Expenditure by Year

30

12

3

33

21

8

0 10 20 30 40 50 60

2003/04

2002/03

2001/02

Total NDC Health Expenditure (£ 000,000)

Average Theme Expenditure

Health Expenditure

NDC Health Reports- Main Topics

• Improving access to health services• Complementary therapies• Exercise & Healthy eating• Improving mental health• Reducing Teenage Pregnancy• Supporting Teenage Parents• Drugs

Health Theme Evaluation

• Analysis of NDC business plans• Mapping of health areas and selection

of topics/ year• Identification of case studies -

– to illustrate range of approaches – variations in stages of development

• Multiple visits and face to face interviews with NDC programme manager, project leads etc

Survey and routine data sources (MORI and SDRC)

• Health– General health over past year and compared with a year ago– Long standing illness, disability or infirmity and whether this limits

activities– SF36 mental wellbeing index derived from five questions on how

respondent felt over past month

• Lifestyle– 5 portions of fruit and vegetables– Smoking– Physical activity

• Services– When last saw a doctor– Ease of access– Satisfaction with doctor– When last used a local hospital– Satisfaction with hospital

Health Service Projects

• Buildings - health centres• Staff - directly employed or seconded

from NHS, esp PCTs• Innovative delivery - the “health bus”• Community involvement -”first

response”• Complementary therapies

Healthy Eating

•Healthy food:•Limited Consumption•Limited Access•Limited Affordability

•Lack of confidence and skills in using fresh fruit and vegetables

•Lack of awareness / knowledge of impact on health

NDC Approaches to Healthy Eating Interventions

• Food growing• Mapping provision of food sources• Cooking or provision of meals• Education and support groups and

sessions• Art and Health

Key Healthy Eating Projects

•Food Co-ops & Delivery Schemes (12)

•Food Growing & Allotments (10)•Cook & Eat / Cooking Skills (15)•Breakfast Clubs (8)•Lunch Clubs (6)•Breastfeeding Support (7)•School Meals (6)

Has health improved in NDCs?

32

32

21

19

33

30

22

19

0 5 10 15 20 25 30 35

Long standing illness (NDC)

Long standing illness(Comparator)

Health worse than 12 monthsago (NDC)

Health worse than 12 monthsago (Comparator)

2002

2004

Are NDCs “closing the gap”?

77

15

8479

40

78

15

84 84

38

86

15

90

81

26

0

10

20

30

40

50

60

70

80

90

100

Health good/fairlygood

Health better Satisfied with doctor Satisfied with localhospital

Residents whosmoke

2002 2004 National

Improving Health Indicators?

• Satisfaction with local hospitals and access to doctors have seen the most improvement from 2002 to 2004

• However, ease of access to see a doctor in comparator areas improved by three times the rate in NDC areas.

• Mental health prescribing has increased, but not as much as national trends

• SMRs, SIRs and hospital admissions show no significant reductions and drug misuse admissions have increased

Change in general health 2002-2004 by Partnership

-8

-6

-4

-2

0

2

4

6

8

10

Lam

beth

Wal

sall

Bre

ntK

now

sley

Live

rpoo

lP

lym

outh

New

ham

Cov

entr

yF

ulha

mB

irmin

gha

Brig

hton

Wol

verh

amD

onca

ster

New

cast

leN

ottin

gham

Mid

dles

bro

Leic

este

rH

artle

pool

Old

ham

Hul

lD

erby

Bris

tol

Bra

dfor

dR

ochd

ale

Nor

wic

hH

ackn

eyS

andw

ell

Birm

ingh

aLu

ton

Sou

tham

ptM

anch

este

rT

ower

She

ffie

ldS

outh

war

kIs

lingt

onH

arin

gey

Lew

isha

mS

alfo

rdS

unde

rland

NDC NDC average Comparator

Do we expect health to improve in NDC residents?

• Evidence from longitudinal sample• Change significantly different from comparator

areas after adjustment for confounding variables• Changes that we know are associated with better

health:

- More likely to have stopped being unemployed

- More likely to have started education/training

- More likely to have increased social capital (people are friendly/neighbours look out)

- But no positive change in health related behaviour

Partnership, tenure, education, age, gender, ethnicity, household composition, household worklessness (& years resident)

Socialnetworks

Trust

Cohesion & Reciprocity

Engagement &efficacy

Use of &satisfaction with

healthservices

Self-reportedhealth:

General healthHealth change

SF-36 MHI

Lifestyle:smoking

dietexercise

Social capital:

Security,fear of crime

Health models: pathways

AB

C

D

E

F

G

H

I

20611482334514191969 20611482334514191969N =

Change wave 1 to 2: Diet quality

Large increase

Small increase

No change

Small decrease

Large decrease

Gen

eral

hea

lth s

core

: M

ean

& 9

5% C

I2.3

2.2

2.1

2.0

2002 General H

2004 General H

20271453328313931930 20271453328313931930N =

Change wave 1 to 2: Diet quality

Large increase

Small increase

No change

Small decrease

Large decrease

Menta

l health s

core

: M

ean &

95%

CI

72

71

70

69

68

67

66

2002 Mental H

2004 Mental H

Summary

• Unique source of longitudinal data on health and related factors in varied and deprived communities

• Need intermediate outcomes (health behaviour) to demonstrate impact

• Evidence that interventions associated with behaviour change but be cautious in attributing causality