Health Inequalities in

Gloucestershire

GHWB, Tuesday 26th May 2015

Overview

• Rationale for tackling inequalities in health

• Present a variety of data that illustrates how health

inequalities affect our population

• Discuss what works in tackling health inequalities

• Present local examples of work

• Identify next steps

What do we mean by health inequalities?

• Any variation in health between different groups of

people

• For example the variations that cannot be explained

by biological factors such as age, sex or genetic

inheritance alone. Such as social, environmental

and behavioural factors such as education, housing,

smoking and access to services.

Why are we concerned about health

inequalities?

• Health inequalities are persistent

• Gloucestershire is one of the healthiest counties in

England. However, we know that the health and

wellbeing of some of our communities is not

improving at the same rate as others.

• Renewed policy drivers focusing on health

inequalities

• Pressure to reduce the cost of health inequalities to

the rest of the system - £5.5 billion per year to the

NHS and between £20 and £32 million in terms of lost

taxes and higher welfare payments.

The Wider Determinants of Health

We know that many factors combine together to affect

the health of individuals and communities. Factors

such as:

• our income and education level

• our employment

• the environment in which we live

• our relationships with friends and family

• access and use of health care services.

These influences are often shown using the diagram

developed by Dahlgren and Whitehead (1991).

What do we know about

health inequalities locally?

Social Deprivation

• Although Gloucestershire benefits from high standards of

living, wealth is not evenly distributed and pockets of

deprivation do exist.

• The index of Multiple Deprivation 2010 combines some

thirty eight indicators, chosen to cover a range of economic,

social and housing issues, into a single deprivation score for

each small area in England

• The Index of Multiple Deprivation 2010 have been produced

at Lower Super Output Area (LSOA) level which are small

geographical units covering between 1000 and 3000 people

• In 2010 there were 367 LSOAs in Gloucestershire and of

those, eight are amongst the most deprived 10% in

England and are the hotspots in Gloucestershire in terms

of overall multiple deprivation

• All are located in Cheltenham and Gloucester districts and

account for 12,700 residents and amount to 2% of the total

population of the county

• Residents in those areas are more likely to experience

higher recorded crime rates, more low birth weight babies,

higher rates of prevalence of heart disease and bronchitis,

more likely to leave school with no work, education or

training destination, more likely to be dependent on

Community and Adult Care services, have lower incomes,

high unemployment rates and a poorer living environment

compared to the rest of the county.

Life Expectancy

65

70

75

80

85

90

2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 2011-13

Lif

e E

xp

ecta

ncy a

t B

irth

(years

)Gloucestershire life expectancy by deprivation

Least deprived females

Most deprived females

Least deprived males

Most deprived males

Gloucestershire life expectancy by deprivation (Note: y-axis does not start at 0 for comparison purposes)

Local Health Challenges

The four main causes of death and serious illness both

locally and nationally are:

• Circulatory diseases (heart disease and stroke)

• Cancers

• Respiratory diseases (lung diseases) such as chronic

obstructive pulmonary disease (COPD)

• Liver disease

Mental Health

Source: Public Health Outcomes Framework

Tooth decay by district

Source: Public Health Outcomes Framework

Smoking prevalence

Source: Public Health Outcomes Framework

Early Years and Education

• Gaps in achievement between the poorest children and their

better-off counterparts are clearly established by the age of

five

• Children from poorer backgrounds often lack a firm

grounding in the key skills of communication, language,

literacy and maths

• In Gloucestershire we are below the national average for

children achieving a good level of development at the end of

reception

School readiness

Source: Public Health Outcomes Framework

Pupil Attainment in Key Stage 2

Children in Gloucestershire generally attain well

however this masks an underlying pattern of lower

achievement for pupils in many of the more vulnerable

groups such as those with special needs or in receipt of

free school meals

Percentage achieving level 4 or above in KS2 by

eligibility for FSM

GCSE Results

0%

10%

20%

30%

40%

50%

60%

70%

2010 2011 2012 2013 2014

% a

ch

iev

ing

5+

A*-

C i

nc. E

ng

& m

ath

s

Pupils known to be eligible for free school meals All other Pupils

Learning Disability

Source: NOMIS and Learning Disability Profiles

• 87.4% of adults with a learning disability in Gloucestershire

were unemployed in 2014 compared with only 5.5% of the

total population

Housing

• Limited affordable housing and the quality and condition of

available housing are believed to contribute to poor and

unsafe living conditions, social isolation, lack of community

integration and increased likelihood of anti social behaviour

as well as a range of health conditions

• Overall the Building Research Establishment (BRE) has

calculated that poor housing costs the NHS at least £600

million per year

• Using modelling techniques, it is estimated that in

Gloucestershire there are over 45,900 dwellings with a

category one hazard which, if improved, would result in an

annual saving to the NHS of £4.6 million.

Fuel Poverty

• Highest levels of fuel poverty are associated with single parent families

and elderly households with family and also with households with a

younger head of household (under 25 years).

• For example, the Cheltenham Borough Council Housing Condition

Survey 2011 reveals that 11.8% of their population spend in excess of

10% of annual household income on fuel and are in fuel poverty. Rates

of fuel poverty are higher for households living in housing constructed

between 1919 and 1945 and in the St Pauls area.

• The 2011 Gloucester survey shows that 10.8% of Gloucester residents

spend in excess of 10% of annual household income on fuel and are in

fuel poverty. Rates of fuel poverty are higher for households living in pre-

war housing and in the Barton and Tredworth and Moreland Areas.

Social isolation

Source: CACI ACORN

Volunteering

Source: CACI ACORN

Service accessibility

Source: Gloucestershire County Council Accessibility Matrix 2014

What are we doing to

tackle inequalities?

What are we already doing?

• Building Better Lives is a 10 year policy direction, and explains how support for

people with a disability in Gloucestershire will develop. It affects all ages and all

disability groups (physical disability, learning disability, mental health, sensory

disability etc.)

• Fuel Poverty Advice Line: outreach activity targeting vulnerable clients and

including in depth home visits which will focus on three main areas of the county:

• Gloucester- Matson & Robinswood, Podsmead, White City and Barton & Tredworth

• Cheltenham- Spring Bank and Hesters Way

• Cirencester- Watermoor and Beeches

• Gloucestershire NHS Stop Smoking Service. The service is universal but has

targets for deprived areas, pregnant women and those with enduring mental

health issues. These groups equate to 74% of the total target. So far this year

(2015) 92% of quitters have come from these groups.

• Healthy Individuals Programme: provides a framework and action plan to

deliver measureable improved outcomes around self-care including improved life

expectancy, enhanced quality of life for those with a long term condition and their

carers, and a reduction in health inequalities.

• Community Health Trainers support those aged 18+ who live in the most

deprived communities throughout Gloucester, Cheltenham, the Forest of

Dean, Stroud and Tewkesbury. Clients must come from the top 2 quintiles

of deprivation (locally) or from our vulnerable groups (focusing on those

protected characteristics listed in the equality act)

• Breastfeeding Peer Support: Support is targeted at those children’s

centres that have the lowest Breastfeeding rates – these are generally in

the most deprived areas.

• Health Improvement Delivery Team: The team work across lifestyles but

focus their support in areas of deprivation and vulnerable groups. One

member of staff has a specific remit to work with our most vulnerable

including travellers, homeless, BME groups, Lesbian,Gay,Bisexual and

Transgender groups

• Social Prescribing: A number of social prescribing pilot projects set up

and running across the county (in six localities), each using an evidence-

based approach, to better link and support patients with non medical needs

to access a range of community opportunities in their own locality.

• ASSIST (training peer supporters for young people around smoking) targets

those schools that have the highest prevalence of smoking according to the

online pupil survey – tends to be areas of deprivation

• HENRY (health and nutrition for early years) also targets children’s centres in

areas where child obesity is high according to NCMP data – again this tends

to be areas of deprivation

• MECC: The training is aimed at those that work or connect with our most

vulnerable and deprived – among those trained this year are HCA’s,

pharmacists, village agents, families first workers, environmental health

• Safe Days and Nights for All and Older but not Overlooked (Police and

Crime Plan)

• Early Years Commissioning Framework – helping to improve outcomes for

children and families in the early years

What works – return on investment?

• Housing interventions to keep people warm, safe and free from

cold and damp are an efficient use of resources. Every £1 spent

on improving homes saves the NHS £70 over 10 years.

• Smoking prevention programmes in schools can return as much

as £15 for every £1 spent.

• Every £1 spent preventing teenage pregnancy saves £11 in

health care costs.

• Worklessness costs the economy more than £100 billion every

year. Business in the Community estimates that its programmes

getting disadvantaged groups back into work return £3 in reduced

costs of homelessness, crime, benefits and NHS care for every

£1 spent.

What Works?

• Good quality parenting programmes

• Building mental health resilience in children and young people

• Increasing the number of young people in education,

employment and training

• Increasing employment opportunities

• Improving workplace health

• Ensuring a healthy living standard for all

• Improving access to green spaces

• Top five activities for Primary Care

What more do we need to do?

• Ensure programmes across partners are aligned or linked

so that there is no duplication of effort and to maximise

impact and value for money

• Identify clear actions for each partner around the table to

deliver on and hold each other to account

• Properly engage with residents; service users and

stakeholders to ensure that what we commission is

relevant and effective

• Communicate clearly our reasons for choosing to include

things in the refreshed delivery plan or to leave them out.