Tracking the impact on health and well-being in London The developing ‘framework of indicators’..a social determinants approach Gail Findlay and Mark Gamsu - Independent Consultants working with UCL IoHE 26th March 2012

Health impacts of an economic downturn Overall mortality mixed results Increase in suicides, parasuicides, infectious disease, homicides Fall in road traffic accidents Mental health will suffer in the short/med/long-term Long-term impacts on CV and general mortality Reduced government spending

Impacts of the economic downturn on… …employment: Increased unemployment, particularly for certain demographics (NEETs, LT unemployed, disabled); impact on working conditions? …income: Sharp changes because of increased unemployment  debt, poverty …housing: more landlord and mortgage repossessions, homelessness, overcrowding etc.

Potential impacts of the welfare reforms on… …employment: Will the reforms increase the number of people in employment? …income: Reduced incomes for most people in receipt of benefits …housing: Changes to LHA and the caps will hit London disproportionately  poverty, homelessness, overcrowding, internal migration

Population groups likely to be most affected: People who become unemployed Those newly out of education – NEET LT unemployed, disabled, other population groups facing additional barriers to employment Families with children – particularly lone parents and larger families People on means-tested benefits People living in private rented accommodation People living in certain areas of London

Draft criteria Sensitive to short and medium term change Sensitive to actual and emerging impacts/direction of travel Available from routinely collected data – but not necessarily from conventional sources (eg. CVS data) Providing info about impact: At different geographical levels: neighbourhood to pan London On existing or emerging vulnerable groups On inequalities Potential for modeling/enabling analysis of forward projections/trends

Unemployment NEETs Unemployment rates (by deprivation, ethnicity and other groups) People losing jobs - new JSA claimants People not getting jobs Long term unemployed Economically inactive People coming off benefit to JSA Nature of vacancies – types of jobs available versus skills in population

Quality of Work Sickness Absence Number of grievances relating to work place stress/poor health PAYE: Registered Self Employed FT/PT working Duration of employment contracts

Income - Poverty Child Poverty Pensioner Poverty Working Age Poverty Number of people on means tested benefits Fuel Poverty Measure Low pay threshold; pay gradient; shifts in profiles of levels of pay; inequality measures/ratios

Income - Debt Number of people in problematic debt Personal insolvency Number of people taking doorstep loans Types of debt - credit card etc Number of people in mortgage arrears Number of people in rent arrears Households in arrears

Income - other Take up of and growth of soup kitchens Purchasing behaviour in large supermarkets Housing benefit case load and flows

Housing Overcrowding and other relevant housing‘ conditions’ Types of tenure in bands of cost Council and Social Landlord waiting lists; % homes affordable under LAA Number of rough sleepers Number of young people not in stable accommodation Temporary Accommodation Utilization Landlord possession orders Local housing availability

Health and well-being impact Anti-depressant prescribing Incidence of mental health problems Referrals for CBT Suicide and para-suicide Calls for help - Samaritans Diagnosis of pulmonary TB and ? other infectious diseases? IB/ ESA claims Changes to GP lists Alcohol related A&E admissions?

Health and Well-being impact - cont New well-being index Impact on Communities: Acquisitive crime Community profiles: eg numbers of betting shops; pay day lenders; pawn shops; vacant shops/properties Impact on Children: Readiness for school ??

QUESTIONS FOR DISCUSSION Comments on the draft framework …and on any of the suggested indicators? Are there any key areas and/ or good indicators missing? Suggestions for indicators for children specifically? How can we engage local authorities and promote their use of this indicator framework? Suggestions of other ‘key players’ we should engage in the development of this framework?

For more information and to feed in comments and ideas on the framework Please contact: Gail Findlay Tel: Mark Gamsu Tel: