Addressing Inequalities in Health and Wellbeing at Population Level

1. Addressing Inequalities in Health and Wellbeing at Population Level HINST Associates Redcar and Cleveland (1) Professor Chris Bentley Chris.bentley19@gmail.com

2. Physiological risks High blood pressure High cholesterol Stress hormones Anxiety/depression Well being and Health Behavioural risks Smoking Poor diet Lack of activity Substance abuse Risk conditions – e.g.: Poverty Low social status Poor educational attainment Unemployment Dangerous environments Discrimination Steep power hierarchy Gaps/weaknesses in services and support Psycho-social risks: Isolation Lack of social support Poor social networks Low self-esteem High self-blame Low perceived power Loss of meaning/purpose of life After Ronald Labonte

3. Health Inequalities Different Gestation Times for Interventions For example intervening to reduce risk of mortality in people with established disease such as CVD, cancer, diabetes A For example intervening through lifestyle and behavioural change such as stopping smoking, reducing alcohol related harm and weight management to reduce mortality in the medium term B For example intervening to modify the social determinants of health such as worklessness, poor housing, poverty and poor education attainment to impact on mortality in the long term C 2005 2010 2015 2020

5. Oldham – by English Deprivation Quintile

6. Slope Index of Inequality - Oldham (males)

7. Slope Index of Inequality - Redcar and Cleveland (males)

8. Maidstone – slope index (males)

9. Slope Index of Inequality - Redcar and Cleveland (females)

10. Redcar and Cleveland Local deprivation quintile by LSOA

11. Disproportionate Need

12. Number of chronic disorders by age group Barnett, K et al. 2012

13. Multi-morbidity – the existence of several chronic health disorders in one individual – is a critical and increasing challenge for health and social services. • The prevalence of this problem increases with deprivation; people in deprived circumstances having the same prevalence of multi-morbidity as more affluent patients who were 10 – 15 years older (Barnett, 2012).

14. The relationship between multiple lifestyle risks and mortality Buck, D; Frosini, F; 2012

15. Distribution of multiple risk behaviours Looking at combination of 4 key risk behaviours in 2008, i.e.: Smoking; Excessive use of alcohol; Fruit and vegetable consumption;Physical exercise • Unskilled manual labour 3 times more likely to have all 4 risk behaviours than professionals • People with no qualifications 5 times more likely to have all 4 risk behaviours than those with high level qualifications King’s Fund 2012

16. Reduce health inequalities and improve health and wellbeing for all Policy Goals Create an enabling society that maximises individual and community potential. Ensure social justice, health and sustainability are at heart of policies. Policy objectives Give every child the best start in life. Create fair employ-ment & decent work for all. Create and develop healthy and environment-ally sustainable places & communities. Strengthen the role and impact of ill-health prevention. Enable all children, young people & adults to maximise their capabilities & control their lives. Ensure healthy standard of living for all. Policy mechanisms Equality & health equity in all policies. Effective evidence-based delivery systems.

17. Inequality in Early Cognitive Development of British Children in the 1970 Cohort, 22 months to 10 years High SES Low SES High Q at 22m Low Q at 22m Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97

18. `Sensitive periods’ in early brain development “Pre-school” years School years High `Numbers’ Peer social skills Conceptualization Sensitivity Language Habitual ways of responding Emotionalcontrol Vision Hearing Low 1 2 3 4 5 6 7 0 Years Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.)

19. Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by IDACI decile of pupil residence: England 2007 % achieving 5+ A*-C GCSEs inc Maths and English Most deprived Income Deprivation Affecting Children Index (IDACI) Least deprived Source: DCFS 2009

20. Health inequalities in Scotland Sources : 1. Gray R, Bonellie SR, Chalmers J, Greer I, Jarvis S, Kurinczuk JJ, et al. 2009. 2. Scottish Government. Growing Up in Scotland: Health inequalities in the early years. 2010. 3. Levin KA, Davies CA, Topping GV, Assaf AV, Pitts NB. 2009.4. Scottish Government 2003. 5. Scottish Government Health Analytical Services Division 2008.

21. Child wellbeing in Better-off Countries (UNICEF Review 2007)

22. Maidstone - Neighbourhood (LSOA) deprivation scores(decile – 10%) (10) (9)

25. Local index of child wellbeingmaterial wellbeing domain

27. Local index of child wellbeingeducation domain

28. Literacy and numeracy in the UK Moser Report 1999 Skills for Life Survey 2011 (BIS)

30. Maidstone unemployment