“Tackling Health Inequalities in London: How the LHO is supporting the NHS” Dr Bobbie Jacobson Director

Collating/ Processing Data Turning Data into Health Intelligence Collecting Data/ Information Using Health Intelligence To Improve Health & Care Health Intelligence in London Made Easy: The LHO's Business Public/ Other Sectors Public Health Observatory role

Aims of the London Health Observatory

The Association of Public Health Observatories (APHO) - At A Glance NATIONAL LEAD AREAS Eastern Region PHO Primary Care, Methodologies London LHO Health Inequalities, Social Exclusion and Regeneration North West PHO Access to Communicable Disease data, Health Protection, Drug Misuse North East PHO Mental Health, Prison Health, Children and Young People South East PHO Coronary Heart Disease & Stroke, Men’s Health East Midlands PHO Teenage Pregnancy West Midlands PHO Cancers, Older People, Environment South West PHO Accident Prevention, Sexual Health Yorkshire & Humber PHO Diabetes

LHO Work Programmes 2003/04 “At a Glance” Work ProgrammeFunding Network Development & CommunicationsCore DoH/RDPH Website Information & DevelopmentCore DoH/RDPH Access to Routine DataCore DoH/RDPH SKIL - Sharing Knowledge in London - Non-Routine Data/Information Access Core DoH + R&D Drugs & Health Intelligence ProgrammeNational Treatment Agency PCT Information programmePCT London Health Impact AssessmentRDPH and charges “Diversity Counts”: London's Ethnic Health Intelligence Programme Core DoH/RDPH Tackling Health InequalitiesCore DoH/RDPH, GLA, CHI Mental HealthLondon Regional Development Centre for Mental Health National/International workDoH/EU

LHO’s Health Inequalities Programme: What are we doing now? Inequalities cuts across all LHO programmes London Indicators work (Geography, ethnicity, age, gender): - Mortality - Admissions and Access to health care - Self assessed health - Determinants of health Understanding London’s High Infant mortality rates: an analysis of “sole-registered” births National Lead work: - Local Basket of Health Inequalities Indicators (DH) - Developing a Guide to Health Equity Audit (DH/HDA) - Developing a Proxy for Infant Mortality at PCT level (CHI)

Uncovering Invisible Health Inequalities Harrow Barnet Hillingdon EnfieldWaltham Forest Havering Bexley Bromley Croydon Sutton Kingston Richmond Hounslow Redbridge

The Health Equity Audit: A Definition Source: “Health Equity Audit Made Simple.”

Supporting Health Equity Audit: Next Steps Working with London’s PCTs to pilot tools for benchmarking (equity profiling) Explaining the gap in Life Expectancy in London (priorities for action) Modelling the effect of effective interventions across the age spectrum (closing the audit loop) Analysing inequities in access to health care - The new London HES service

Ways of Profiling Health Inequalities: The Example of Southwark Infant mortality rates by local authority and deprivation A: 45.3 Islington B: 56.2 Newham C: 61.3 Tower Hamlets AB C

Key Messages Health inequalities are everybody’s business: they exist across the whole spectrum of health and health care Health inequalities in London become painfully visible at PCT and Neighbourhood level The Geography of health inequalities is not the same across all health issues Sensible objectives for local change need to be based on an understanding of what is comparable and what is achievable LHO’s future work programme aims to: - Increase our understanding of the dimensions of inequality across London - help local organisations benchmark progress compared with others across London - Provide a method of predicting the effect of key interventions on the gap in Life expectancy for local interagency use - Provide new responsive HES service to assess inequities in access to Health care in London