Inequalities and wellbeing

Public Services working Together

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w Social Inequalities in health

Source: Norwegian Ministry of health Care Services, 2007

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w Pre-birth Young adultsSchool ageEarly years

Health

Personal development

Educational attainment

Infant healthEarly

development

Achievement at end

primary

Developing positive

behaviours

Staying engaged at

16-18

Opportunities to access university

Where you are born, who your parents are and your earliest life opportunities impact on all your life course

0

25

50

75

100

22 42 62 82 102 122

Age months

High social class

Low social class

High test scores

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In 2006 the most affluent 10% are earning relatively much more per week than in 1961 –

the poorest 10% relatively the sameSource: FES, IFS analyses

0

200

400

600

800

1000

1961

1966

1971

1976

1981

1986

1991

1996

2001

£ eq

uiv

alen

t in

com

e

Relative household income

medianincome

poorest10%

richest10%

The income gap between the richest and the poorest is growing not shrinking

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Living in poverty affects every part of peoples’ lives

For example, children living in poverty are less likely to do well at school

And women who grew up in poverty are less likely to earn at / above the average wage as adults

1958 cohort1970 cohort

00.050.1

0.150.2

0.250.3

0.350.4

0.45

CSE/other O-levels A-levels Higher other

Degree orabove

Highest level of qualification

Co

mp

arat

ive

ho

url

y ea

rnin

gs

wit

h t

ho

se w

ith

no

qu

alif

icat

ion

s

0

10

20

30

40

50

60

0-10 11-20 21-30 31 andover

Pupils eligible for free school meals (percentages)

Pu

pil

s w

ith

5 G

CS

E g

rad

es

A*

to C

(p

erc

en

tag

es

)

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wPoor health is both a cause and a

consequence of poverty

26 30 34 38 42 44 48 540.93

0.94

0.95

0.96

0.97

0.98

0.99

1.00

Age in years

Pro

po

rtio

n a

liv

e

Cumulative death rates 26 to 54 years by father’s social class men and women born in March 1946

Kuh et al, 2003

KeySocial Class I Social Class V

More people born in to Social Class V die in early middle age than those with fathers in Social Class I

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wIn 2008 there is 40 years difference in apparent health year between Rutland and Manchester

"Apparent health year" Male & Fem ale

2,050 to 2,0702,040 to 2,0502,030 to 2,0402,020 to 2,0302,010 to 2,0202,000 to 2,0101,990 to 2,0001,980 to 1,9901,970 to 1,9801,960 to 1,9701,940 to 1,960

Manchester has an

apparent health year of

1984

Rutland has an apparent health year

of 2023

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wPeoples lifestyles & related risks are the causes of a

growing burden of disease

0 2 4 6 8 10 12 14

Iron deficiency

Unsafe sex

Illicit drugs

Physical inactivity

Fruit & Veg intake

Overweight

Cholesterol

Alcohol

High blood pressure

Tobacco

Behavioural factors

explain the majority of years lost

Major burden of disease – leading 10 selected risk factors in developed countries

(% cause of disease burdens measured in Disease Adjusted Life Ye

0 2 4 6 8 10 12 14

Iron deficiency

Unsafe sex

Illicit drugs

Physical inactivity

Fruit & Veg intake

Overweight

Cholesterol

Alcohol

High blood pressure

Tobacco

Major burden of disease – leading 10 selected risk factors in developed countries

(% cause of disease burdens measured in Disease Adjusted Life Years)

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wSome groups live lives that are riskier

to their health

0 10 20 30 40

I

II

IIIn

IIIm

IV

V

Percentage of men Percentage of women0 10 20 30 40

I

II

IIIn

IIIm

IV

V

For males, 30% of people have two of three behaviours in social class V compared to <10% in social class I

For females, 20% of people have two of three behaviours in social class V compared to <5% in social class I

So

cia

l cla

ss

= Three behaviours = Two or more behavioursKey

So

cia

l cla

ss

People in social class V are three to four times more likely to have two of three lifestyle risks (smoking, harmful levels of alcohol consumption and poor diet) compared to those in social class I

= Three behaviours = Two or more behavioursKey

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Problems are interrelated

Substance misuse

NEET

Teenage pregnancy

Truancy & BehaviourYouth crime

3 in 5 excluded young people report having

offended

Young people with emotional &behavioural difficulties are

4 times more likely to use illicit drugs

NEETs are disproportionately

likely to misuse drugs & alcohol

71%of young women who are NEET for

6 months & between16-18 are parents by 21

Persistent truants are nearly 10 times more likely to be

NEET at16 and 4 times more

likely to be NEET at 18

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wFrom mid life onwards smoking has a greater impact on life expectancy than socioeconomic

status does

20 year survival by smoking status and classMALE

30%

40%

50%

60%

70%

80%

90%

never smoked current smoker never smoked current smoker

SC I & II SC IV & V

% s

urv

ival

50%

15%

63%

Smoking status has a bigger influence on 20 year survival

compared to social class

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In deprived areas, patients do not get the best quality of care

y = -0.0009x + 0.9771

R2 = 0.1555

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

0.00 10.00 20.00 30.00 40.00 50.00 60.00

IMD

% a

chie

vem

ent

QOF Total Points / available %

QOF: % points available

y = -0.0011x + 0.8636

R2 = 0.1058

0.6

0.65

0.7

0.75

0.8

0.85

0.9

0.95

0.00 10.00 20.00 30.00 40.00 50.00 60.00

IMD

% s

atis

fied

- av

erag

e ac

ross

5 d

omai

ns fr

om p

atie

nt s

urve

y

% satisfied - average across 5 domains from patient survey

% satisfied - average across 5 domains from patient survey:

y = 0.0059x + 0.0744

R2 = 0.1799

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.00 10.00 20.00 30.00 40.00 50.00 60.00

IMD

Pro

porti

on o

f Sin

gle

Han

ded

Pra

ctic

es (S

HP

s)

Proportion of Single Handed Practices (SHPs)

Proportion of single handed practices:

• Scoring on the QOF (a measure of the quality of primary care) is higher in more affluent PCTs

• There are proportionally more single handed practices in deprived PCTs

• Patient satisfaction is higher in affluent PCTs

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wTargeted interventions do work - Sheffield achieved

a 7% greater reduction in CVD death rates in its most deprived communities (23% v 16%)

Sheffield Initiative to Reduce CHD (CIRC)

Identify GP practices with high CHD mortality Targeted support with specialist nurses to assist them in developing at risk registers

and promoting statin prescribing Differential increase in statin prescribing in less privileged areas

Circulatory disease mortality, Sheffield, 1997 - 2008

0

20

40

60

80

100

120

140

160

180

2006200520042003200220012000199919981997

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Meet…

Mark MaggieAntonio VictoriaAnatoly Margareta

Charles HelenMario RebeccaSergej Tatjana

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wChildren’s health has been affected by a several external

global factors

Children are travelling Children are travelling more and exposed to more and exposed to diseases ((skin cancer)diseases ((skin cancer)

Fast food popular with Fast food popular with children – growing children – growing consumption and rising consumption and rising rate of obesity rate of obesity

TV is major source of TV is major source of

entertainmententertainment

Huge medical Huge medical advances in life advances in life saving treatments-saving treatments-more lives savedmore lives saved

Technology has Technology has transformed transformed communicationcommunication

Genetic Genetic disorders – disorders – diagnosed and diagnosed and treated bettertreated better

(foetal (foetal transfusion)transfusion)

Sex, Drugs, Alcohol no longer have the stigma that they once did when people grew up with strongly involved grandparents of the war / Victorian era.

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wWe say we know we need to eat more fruit &

vegetables – more so than others

Q What do you think ‘eating a healthy diet’ involves?

Germany

UK

Italy

Netherlands

EU 25

Spain

Sweden

France

Ireland

77%

70%

61%

59%

59%

58%

49%

44%

35%

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w….For childhood obesity, we reckon its up to the

state

76

48

2212

3140

30

69

0

20

40

60

80

Parents Food and drinkmanufacturers

The individual The state

Who is at fault for obesity

Who is responsible for addressing it?

Source: Henley Centre (2005)Note: HCHLV is soon to release up to datedata. Early cuts of which show broadly similar trends

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w How do we achieve more equal life

chancesWhose responsibility is it?

Baby

Born to affluent parents – will live 10-15 years longer than friends below

Baby

One of many low income teenage conceptions. Will live 10-15 years less than their friends above.

Aged 10

Enjoying a good life, lots of opportunity, good education, etc

Aged 10

Growing up in a disadvantaged environment, as are many kids in Europe

Aged 20

Enter at university with good marks. Plays sport and eats a healthy diet

Aged 20

Left school with

no qualifications, casual labourer, drinks, smokes and takes drugs

Aged 45

Fit and healthy with a good job

Aged 45

Weighs 18 stone/114 kg, has high cholesterol, early stage type 2 diabetic

Charles, Rebecca, Sergej, Helen

Mark, Maggie, Anatoly, Victoria

Aged 60

Died from massive stroke

Aged 60

Retired early to spend time with grand-children and travel

Adapted from: D. Harrison (2007)

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As public service leaders we can change people’s life chances and help shape the communities in which we live

The challenges are to…..

• Raise community aspirations for change

• Identify the positive assets and build upon them

• Create and share common cultures across public services

• Work through commissioning and place shaping

• Build upon JSNA

• Lead together

• Identify and share our strengths

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wVisible leaders with mandate

Success through partnership

Seek out & act on public expectations

Strategic vision with clear outcomes

Clinically driven

Excellent knowledge management

Excellent business organisations

Manage the system

Empowered communities