1
Social determinants of health and health inequalities: focus on nutrition
Gwen Nightingale
Deputy Director, Obesity and Food Policy (job-share)
Department of Health, England
Presentation to High Level Group - 4 May 2015
Significant health inequalities exist in England
• The life expectancy gap is 9 years for men and 7 years for women
between the most and the least deprived areas, with a gap in expected
years in good health of 19 years.
• Average healthy life expectancy is only 52 years in the most deprived
deciles, and it exceeds 67 years (State Pension age by 2028) only in the
three least deprived deciles.
• People in unskilled occupations have 60 per cent higher prevalence of
long term conditions (LTCs) than those in professional occupations, and
more deprived people are more likely to have two or more LTCs and from
a younger age. Long term conditions account for around 70% of total
health and care spend in England.
• Diabetes is two to three times more prevalent in the most deprived areas
than in the least deprived, and two to six times more prevalent in South
Asian groups than the general population. Treating type II diabetes costs
the NHS £8.8 billion per year.
2
Inequalities in England
Reducing health inequalities is enshrined in law
A legal requirement was introduced in 2013 to have regard to the need to
reduce health inequalities across the health system - including for Ministers
themselves.
The Secretary of State for Health must:
• have regard to the need to reduce inequalities between the people of
England with respect to the benefits that may be obtained by them from
the health service;
• include in his annual report on the performance of the health service in
England, an assessment of how effectively he has discharged his duty to
have regard to the need to reduce inequalities;
• set out in a letter to NHS England, which is published and laid before
Parliament, his assessment of how it has discharged its duty to have
regard to the need to reduce health inequalities, based on NHS England’s
annual report.
3
Inequalities in England
Our approach: Working with industry has led to healthier
product availability, benefitting all groups
4
1. Working with industry
Organisations signing up to the Responsibility Deal have committed to take
action voluntarily to improve public health through their responsibilities as
employers, as well as through their commercial actions and their community
activities. Over 700 partners have signed up.
Examples include:
600 million kcals removed from Tesco Finest and Everyday Value sandwiches
Britvic plan to stop selling full sugar Fruit Shoot saving 2.2 billion kcals.
Further examples of changes
5
1. Working with industry
Sugar-free Pepsi Max to be offered to cinema goers as default. All branding will be Pepsi Max.
250 kcal cap on single serve confectionery
The partnership specifically targeted fruit and vegetable
consumption – where inequalities exist
6
1. Working with industry
• Lower income homes eat less
fresh fruit, Vegetables and oily
fish
• Through the voluntary
agreement, the Association of
Convenience Stores (ACS)
pledged to promote fresh fruit
and vegetables. The ACS is a
trade organisation for 'symbol'
stores, eg Costcutter, NISA, and
individual local shops, often
found in the most deprived
areas.
Working with industry has led to healthier product availability,
benefitting all groups - Salt Reduction
In 2014 we introduced a revised set of salt reduction targets that challenge
industry to reduce further the amount of salt in 76 categories of food by
December 2017.
Since the start of the Responsibility Deal, around 75% of the retail market
and 65% of major high street restaurants and contract caterers have
committed to reduce salt. This includes all the major supermarkets, many big
manufacturing brands, restaurant chains and contract caterers.
Some examples under this pledge:
• McCain has reduced added-salt in its product portfolio by 22%,
• Heinz has achieved up to 50% salt reductions, and
• Sainsbury’s has removed 2.5 tonnes of salt per year from own brand
products.
7
1. Working with industry
Schools play an important role
8
2. Action on obesity
• The School Food Standards severely restrict foods high in fat, salt and sugar, as
well as low quality reformed or reconstituted foods. They ensure that pupils always
have healthy options for their school lunch.
• Every pupil in reception, year 1 and 2 attending a state-funded school is now entitled
to a nutritious, free school lunch.
• Children aged four to six attending a fully state-funded infant, primary or special
school, are entitled to receive a free piece of fruit or vegetable each school day.
• Pupils attending pre-school, nursery, primary or secondary school are eligible for
subsidised milk.
• In the new national curriculum, learning about food is a key component for every
pupil up to the age of 14. Pupils in primary schools will learn about healthy eating
and a good, balanced diet. In secondary schools, the teaching of food is
compulsory for 11- 14 year olds and all pupils will learn about nutrition and diet.
• The School Sports Premium, School Games and the Change4Life School Sports
Clubs programme ensure all children have the opportunity to take part in sport and
be physically active
Local government also plays a significant role
9
2. Action on obesity
• Local government has responsibility for public health and takes this
into account when exercising its licensing and planning duties.
• This is an opportunity to recognise that more deprived areas tend to
have a higher concentration of food outlets that are unhealthy and
take action to influence future development and change the
balance.
• Local government also administer the National Child Measurement
Programme – which measures over a million children every year in
Reception and Year 6. It provides robust public health surveillance
data on child weight status at a local authority level.
Change 4 Life is aimed at families with children 5 to 11
years old to eat well and move more
10
3. Change 4 Life
The Change4Life programme is an evidence-based social marketing campaign. It
supports everyone in making simple changes to adopt a healthier diet and increase
their physical activity. The most recent January 2015 Change4Life ‘Sugar Swaps’
campaign has more than 380,000 people signed up.
Change4Life has enjoyed considerable success to date
• As of January, 1,495,106 families had joined Change4Life, accounting for
2,514,643 people
• 220,000 primary school children participated in sport as part of the Change4Life
Sports Clubs in schools; independent evaluation showed that 38,000 more
children are getting their 60 Active Minutes every day, directly attributable to
Change4Life Sports Clubs16
• Over 200 national organisations have collectively provided £52 million of in-kind
support to the programme
• Over 70,000 local supporters, including schools, general practices, charities and
leisure centres, have joined, reporting that they collectively deliver 380,000 hours
of unpaid time17 to the movement each year.
• 56% of community venues (such as schools, local authority services, the NHS,
childminding, charities and small businesses) display Change4Life materials at no
cost
• The campaign has garnered over £90 million of free media coverage
• The brand is well liked and trusted by the public. In five years, Change4Life has
established itself as an engaging, trusted brand capable of inspiring positive
change at scale, within families
11
3. Change 4 Life
The Programme
• NHS Health Check is a risk assessment and management programme for
preventing heart disease, diabetes and other non-communicable diseases
(NCDs) for people aged 40-74
• Key components are risk assessment and / or risk management and reduction
actions e.g. referral to either lifestyle or clinical interventions
• Programme potential includes preventing at least 650 premature deaths and
1,600 heart attacks / strokes each year and detecting at least 20,000 cases of
diabetes or kidney disease earlier.
• Key metrics are offers made and take up of NHS Health Check. The real test of
success will be contribution to NCDs prevention through health improvement
and follow-up of conditions identified.
• Local government administers the Health Check.
Enter the
presentation
's title using
the menu
option View
> Header
and Footer
The NHS Health Check has huge potential … 4. NHS Health Checks
… especially in relation to health inequalities
• Many local authorities focus on encouraging take up in high risk and
communities with deprivation.
• East London serves one of the most ethnically diverse and socially deprived
populations in the UK with very high rates of premature cardiovascular
disease particularly among South Asians. A study showed that South Asian
and black African/Caribbean people were more likely than white people to
attend an NHS Check. Older people over 60 years were more likely to
attend than younger people. Women were more likely to attend than men
and attendance was more likely in the most deprived quintile.
• We are testing the impact of behavioural insight and marketing
interventions on improving uptake.
• Further evaluation of the programme is underway.
RESTRICT
ED -
POLICY
4. NHS Healthchecks
14
The Troubled families programme was launched in 2012 with the aim of turning
around the lives of 120,000 troubled families through the support of a family support
worker. The programme is being expanded to support up to 400,000 additional
families between 2015-2020 and will include a new health strand and focus.
5. Family interventions
The Troubled Families Programme and the Family Nurse Partnership
Programme target services at families
• Families who are targeted by the programme have multiple issues related to
employment, education, crime, housing, child protection, parenting or health
• Research found that over half (53%) of troubled families had a current record of
obesity, rising to 93% between the ages of 35 and 54.
• Over 105,000 families have had their lives turned around
The Family Nurse Partnership is a voluntary home visiting programme for first time
young mums, aged 19 or under (and dads). A specially trained family nurse visits the
young mum regularly, from early in pregnancy until the child is two.
The programme is underpinned by an internationally recognised robust evidence
base, which shows it can improve health, social and educational outcomes in the
short, medium and long term, while also providing cost benefits.
15
Healthy Start aims to help give
families the very best start in life.
Available to pregnant women or those
with a child under 4, the Healthy Start
scheme helps buy basic foods like
milk or fruit. Coupons are also
available to swap for free vitamins
suitable for pregnant women,
breastfeeding women and children
aged 6 months to 5 years old. The
programme also links to healthy
lifestyle advice.
Further support is available to women and families on
low incomes 5. Family interventions
Further information
16
Gwen Nightingale and Maeve Walsh:
Websites
Change for life http://www.nhs.uk/change4life/Pages/change-for-life.aspx
Responsibility deal https://responsibilitydeal.dh.gov.uk/
NHS Health checks http://www.healthcheck.nhs.uk/
Troubled families https://www.gov.uk/government/policies/helping-troubled-
families-turn-their-lives-around
Family Nurse Partnerships http://fnp.nhs.uk/
Healthy Start https://www.healthystart.nhs.uk/