1 Health inequalities – are we facing up to the challenges? Institute of Public Health in Ireland 5 th Floor Bishops SquareForestview Redmond’s HillPurdy’s Lane Dublin 2Belfast BT8 7ZX Tel: Tel: Fax: Fax:

2 Social determinants of health

3 Past and present

4 Inequalities in child health – understanding better The absolute risk of death, serious illness and disability in childhood is quite low (i.e death in childhood is a relatively rare event) and focussing on rare events may be misrepresentative - portraying that child poverty and the socio-economic gradient affects the health of small numbers of children Childhood is a dynamic time of growth and development and a paradigm that focuses on illness outcomes cannot measure the loss of a child’s potential in terms of their physical and mental health and their cognitive and behavioural abilities Patterns of childhood health and development strongly influence adult health, so a paradigm that only focuses on childhood death and illness will underestimate the true magnitude of child health inequalities and child poverty across the lifespan

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7 WHAT WOULD WORK IMPACT ON GAP ACTIONS/INTERVENTIONS INCLUDE (percentage points) Reducing conceptions in <18 years in R&M group by 44% to meet the 2010 target Reducing overcrowding in the R&M group, through its effects on SUDI Targeted interventions to prevent SUDI by 10% in the R&M group Reducing smoking in pregnancy rate by 2010 Reducing the prevalence of obesity in the R&M group to 23% Meeting the child poverty strategy Other – may include: Immediate actions Optimising preconceptions care Early booking Access to culturally sensitive healthcare Reducing infant and maternal infections Long term actions Continuing to improve: Infant nutritions Maternal education attainment Targeted prevention work with at risk teenagers and targeted support for pregnant teenage parents Increase the supply of new social housing, pilot innovative approaches to making temporary social stock permanent, encourage better use of housing stock Maintain current information given to mothers and target the Back to Sleep campaign and key messages to the target group Smoking cessation as an integral part of service delivery for the whole family during and after pregnancy - Support the contribution LAAs can make to tackling obesity - Develop planes to implement NICE obesity guidance with a focus of disadvantaged groups - Develop plans to help women with a BMI >30 to lose weight by providing a structured programme of support - Help lone parents into work - Ensure people stay in work and progress on their jobs - Develop a family focus in DWP’s work with all parents - Tax credit measures Provide comprehensive preconceptions services Provide advice/support for “at risk” groups within the target e.g. black and minority groups Increase direct access to community midwives Provide 24/7 maternity direct line for advice and access Implement NICE antenatal and postnatal guidelines Health equity audit of women booked by 12 weeks and >22 weeks. Commissioners and maternity service providers agree improvement plans in contract Improve uptake of immunisations in deprived populations Implement Baby Friendly Standards

8 Social determinants of health The unequal distribution of health-damaging experiences is not in any sense a natural phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements and bad politics

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10 CSDH – key elements 1.Improve daily living conditions 2.Tackle the inequitable distribution of power, money and resources 3.Measure and understand the problem and assess the impact of action

11 Public health – capacities Meaningful research Translating research into policy and action Prioritising health inequality concerns within design, implementation and monitoring of national/local policy Partnerships and strategic linkages Tools – health impact assessment Evaluation

12 The arguments Failure to recognise the inequality Failure to understand the inequality Failure to take appropriate responsibility for the inequality Seeing tackling inequality as additional or ‘non- core’ work Not knowing how to tackle the inequality Believing inequalities are insoluble Finding that the solutions lie outside our comfort zone

13 Are we facing up to the challenges? Yes, but we still have a lot of hearts and minds to win over and convince Prioritising health inequalities within work whose core aim is to improve population health will improve it’s potential to succeed