Working with deprived populations
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Working with deprived populations
Tackling health inequalities in primary care
Dr. Les Goldman, Bradford
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Aim
Examine concept of health inequality and how it affects work in general practice
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Objectives
Understand concept of health inequality
Understand how it applies to a local practice population
Be able to develop initiatives to tackle health inequality at practice level
Community Orientation
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How?
Short presentation
Group exercise - your experience of health inequalities
Group exercise - develop a practice plan
Discussion of our plans
Reflection on what we learned
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Definition
Unequal expectation of morbidity or mortality among different social groups
Reflects different exposure to risk due to Socio economic status Age Disability Ethnicity Gender
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Inequality
Older people are ill more
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Inequity
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Inequity v inequality
Older people and people with disabilities have poorer access to health services
Higher risk of death by suicide or homicide among men
Ethnic differences in disease incidence Diabetes Infant mortality
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Determinants of health
Acheson Report 1998
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Spectrum of health inequalities
Outcome - morbidity, mortalityAccess to health care
HomelessDisabled
Causes of ill health Smoking, drug addictionObesity, poor nutrition
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Interventions
Upstream Reduce income inequalities Improve pre-school education Government responsibility
Downstream At community or practice level Access / lifestyle / morbidity Practice / Commissioning Alliance / PCT
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Task 1
Your experience of health inequalities?
Has anything upset you?
Have you wanted to change something?
Feed back
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Task 2
Make plan to tackle a problem in practice (access / risk / outcome)
SMART Specific Measurable Attainable Relevat Time
bound
PDSA Plan Do Study Act Short repeated cycles of change
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PDSA
•What changes are to be made?
•Next cycle?
•ObjectiveQuestions/predictionsPlan to carry out the cycle (who, what, where, when?)Plan for data collection
•Carry out the planDocument problems and unexpected observationsBegin analysis of •the data
Complete the analysis of the dataCompare data to predictionsSummarise what was learned
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Factors to consider
Who will be involved In practice / outside practice In implementation
Time
Funding
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References
London Health Observatory www.lho.org.uk
Dept of Health www.dh.gov.uk
Acheson Report - Independent Inquiry into Inequalities in Health 1998
Tackling Health Inequalities - a Programme for Action Dept of Health Jul 2003