St3 health inequalities session

West Lothian GPST3 ERP30/01/13

Inequalities in Health;Equality & Diversity;Promoting Health & Preventing Disease;

Screening

Options for today...

Health Inequalities

Background/Context

Social Determinants of Health

Inequalities/Disadvantaged Groups

Why is it important?

Advocacy

Deep End

Health Promotion

Obesity Mindmap –

Screening

Screening definition

Quiz!

Mgt McCartney article –discussion

Equality & Diversity / Ethics

A Multi-Faith Resource for Healthcare Staff (NES 2006) NES link

A word on Ethics

Inequalities in health and healthcare

Inverse care lawJulian Tudor Hart 1971

Inequalities in health and healthcare

"The availability of good medical care tends to vary inversely with the need for it in the population served.”

=

Those who need medical care the most are the least likely to get it.

The Black Report

Report on Inequalities in Healthcare Commissioned by Health Minister David Ennals in 1977 Chaired by Sir Douglas Black, former RCP President Demonstrated continued improvement in health across

all classes during the first 35 years of the NHS but there was still a correlation between social class and infant mortality rates, life expectancy and inequalities of the use of health care services

The government changed and when released in May 1980 the press release drew attention away from many of the findings due to the implications for expenditure

The Acheson Report

Independent Inquiry into Inequalities in Health Report 1998

Chaired by Sir Donald Acheson (former CMO)

Demonstrated that despite a downward trend in mortality from 1970-1990 the lower social classes experienced a much less rapid mortality decline

WHO Commission on Social Determinants of Health 2008

Commission on Social Determinants of Health. Closing the gap in a generation.

WHO, 2008 www.who.int/social_determinants/thecommission/fi

nalreport/en/index.html


Improve daily living conditions

Tackle the inequitable distribution of power, money, and resources


Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health and raise public awareness about the social determinants of health

Marmot Report

Prof M Marmot

Strategic review of health inequalities in England post-2010.

Marmot review final report.

University College London. www.ucl.ac.uk/gheg/marmotreview/Documents

Six policy recommendations to reduce health inequalities

1. Give every child the best start in life: increase the proportion of overall expenditure allocated to the early years and ensure it is focused progressively across the gradient

2. Enable all children, young people, and adults to maximise their capabilities and have control over their lives: reduce the social gradient in skills and qualifications

3. Create fair employment and good work for all: improve quality of jobs across the social gradient

Six policy recommendations to reduce health inequalities

4. Ensure a healthy standard of living for all: reduce the social gradient through progressive taxation and other fiscal policies

5. Create and develop healthy and sustainable places and communities

6. Strengthen the role and effect of the prevention of ill health: prioritise investment across government to reduce the social gradient

TIME TO CARE

Health Inequalities, Deprivation and General Practice in Scotland

RCGP Scotland Health Inequalities Short Life Working Group Report

December 2010

Age & Sex Standardised Census Health Measures by Greater Glasgow & Clyde Deprivation Decile

0

50

100

150

200

250

1 2 3 4 5 6 7 8 9 10

Deprivation Decile

Age

-Sex

Sta

ndar

dise

d R

atio

sir64

shr64

smr74

Linear (WTEGPs)

People living in more deprived areas in Scotland develop multimorbidity 10 years before those

living in the most affluent areas

CONSULTATIONS ARE NOT ENOUGH

Strengthening local health systems by :-

BETTER LINKS WITH PATIENTS

BETTER LINKS WITH HEALTH IMPROVEMENT

BETTER LINKS WITH OTHER NHS PRIMARY CARE SERVICES

BETTER LINKS WITH THE REST OF THE NHS, INCLUDING OUT OF HOURS, ELECTIVE REFERRALS AND HOSPITAL SERVICES

BETTER COLLABORATION WITH LOCAL AUTHORITY SERVICES

BETTER COLLABORATION WITH VOLUNTARY SERVICES ANDLOCAL COMMUNITIES

HUB

ContactCoverageContinuityComprehensiveCoordinatedFlexibilityRelationshipsTrustLeadership

SPOKES + RIMS

Keep WellChild HealthElderlyMental HealthAddictionsCommunity CareSecondary CareVoluntary sectorLocal Communities

INVENTING THE WHEEL

INTEGRATED CARE DEPENDS ON MULTIPLE RELATIONSHIPS

INVESTMENT IN RELATIONSHIPS BUILDS SOCIAL CAPITAL

Conclusions Practitioners lack time in consultations to address the multiple,

morbidity, social complexity and reduced expectations that are typical of patients living in severe socio-economic deprivation.

Opportunities for anticipatory care are often fleeting and may be lost if there is not the opportunity to connect quickly with other disciplines and services that are closely linked to the practice.

Practices provide contact, coverage, continuity, flexibility and coordination, and need to be recognised and supported as the hubs around which other services operate.

Conclusions The only route by which practices in severely deprived areas can

improve patient's health and narrow health inequalities is by increasing the volume and quality of the care they provide.

When public funding is under severe pressure it is especially important that NHS resources are targeted where they are most needed.

NHS support services should be audited in terms of the support they provide for practices working in the front line.

Further work with GPs and practice teams outwith the ‘deep end’ practices and in remote and rural areas is required to establish the impact of deprivation on patients and primary health care workers in these areas

OPTIONS FOR TODAY

Health Inequalities

Social Determinants of Health

Inequalities/Disadvantaged Groups


Advocacy

Deep End

Health Promotion

Obesity Mindmap –

Screening

Screening definition

Quiz!

Mgt McCartney article –discussion

Equality & Diversity / Ethics

A Multi-Faith Resource for Healthcare Staff (NES 2006) NES link

A word on Ethics

What influences the health of an individual?

Of a community?

Of society?

What groups may be particularly affected by these factors?


What can we do about it?

Deep End Exercise

Obesity Exercise

What are the components of a good screening programme?

Screening Quiz

Any thoughts on the Breast Screening controversy?

Equality and Diversity

A Multi Faith Resource For Healthcare Staff