Health inequalities in Lambeth Health Inequality Conference -28th February 2012 Health inequalities in Lambeth Health inequalities In Lambeth Thank you for inviting me today How many of us hear every morning this sentence “Mind the gap”? And several time a day? How many of us will associate this sentence with health? May be after this presentation, when you take the tube! you will think “health inequalities”! Ruth Wallis Director Public Health, Lambeth 1

Health inequalities contribute to the health burden of Lambeth

There has been progress in addressing health inequalities Some progress : I did not include life expectancy for women because the gap did not reduce . I thought that on this slide we should focus on positive changes - Life expectancy gap between England and Lambeth reduced - Teenage pregnancy reduced - Educational achievement at key stage 2 similar to England for English - Proportion of children living in workless households reduced by 20% compared to 2003 3

Socioeconomic gradient of Health remains Life expectancy 0.5% 40% ‘disability free’ life expectancy 14% This slide from the Marmot review (Prof Marmot a leading figure on health inequalities) shows that how long we live is associated with the average income in neighborhood but also with the time we live free of some form of limiting illness Each dot on the slide is one neighborhood called LSOA with its associated income deprivation measurement. The upper line in pale green shows that the poorer you are,The more likely you are to be ill and to die younger. The lower dark green line show the number of years you can live without any sort of disability affecting your daily life The richer you are the older you get before you start to become disabled in some way. In most deprived areas you start to become disabled 15 years earlier than in better off areas Where is Lambeth population along this income deprivation? By 2010 , 40% of Lambeth population are likely to start becoming disabled in some way 10 years earlier than the wealthiest in England. A really important point: not just that there is a big gap between the top and the bottom but this is a gradient from top to bottom – not a cut off. At each level of income drop, life expectancy and health drops accordingly by neighbourhood income deprivation1999-2003 4

The risk of illness and deaths increases with deprivation The worst off in the borough lose 6 years of life free of disability Life expectancy of the better off is 5 to 6 years higher than for the worst off The risk of emergency admission for heart failure of worst off is twice the risk for better off The risk of CVD death of worst off is almost double of the risk of better off So let see some examples from Lambeth and how deprivation is associated with ill health and risk of dying early 5

Next steps Marmot recommendations Give every child the best start in life Enable all to maximise capabilities & have control over life Create fair & good employment Ensure healthy standard of living for all Create & develop healthy & sustainable places & communities Strengthen role & impact of ill health prevention Health and well being strategy Commissioning to improve health & reduce inequalities (access , prevention) Proportionate universalism Public Health role of Local authorities Next steps: Monitoring of financial deprivation & Health sector to identify which mitigating actions it should develop/extne/ amplify to minimise its impact Work with stakeholders to implement the Marmot recommendations There are 3 key strategic elements Public Health wish to recommend to LCCB: - Adopt “proportional universalism “ in NHS and promote this approach in other sectors proportionate universalism: universal interventions with a scale and intensity proportionate to level of disadvantage Ensure that commissioning reduce health inequalities by ensuring equity of access to care and equity of access to prevention contribute to a joint platform to address health inequalities in Lambeth through the health and well being strategy

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The Marmot Review 6 Objectives 4. Ensure a healthy standard of living 3. Create fair & good employment 5. Healthy & sustainable Communities 2. Enable all to maximise capabilities & have control over life Here are Marmot’s recommended objectives for making a difference Give every child the best start in life: (maternity and early years) – this is the top priority of all and the recommendation is that the proportion of overall expenditure allocated to early years is increased and focused on reducing the social gradient: evidence shows that social spending on children early in life cycle is likely to be more effective in enhancing children’s long term outcomes than later investment. This is about Good maternity care and support Supporting parents Supporting a child’s transition to school 2. Enable all to maximise their capabilities and have control over their lives – this is about equal access to good quality education 3. Create fair and good employment –this is about access to the employment market and good working conditions – the NHS as an emp[loyer has a very important role here 4. Ensure healthy standard of living – this is about decent living wage for all, again something for the NHS to get its own house in order about as well as broader economic development 5. Healthy & sustainable communities – this is about the relationship between society and mitigating the effects of climate change, conserving the environment, the way and the kind of food we produce and make available etc. Evidence shows that healthy societies can be achieved without large carbon footprints and to sustain healthy society we shall have to reduce our carbon footprint. The aims are to Prioritise policies and interventions that reduce both helaht inequalities & mitigate climate change Integrate planning, transport, housing, environmental and health policies to address the social determinants of health 6. Strengthen role and impact of ill health prevention : (public health , mainstreaming health promotion / prevention interventions) Increase spending over 20 years to 0.5 percent GDP 6. Strengthen ill health prevention 1. Give every child best start in life 8