Health Inequalities: What’s that got to do with CLD? Community Learning and Development Annual Conference 30 th Oct 2015 Clare Beeston: Principal Public Health Adviser NHS Health Scotland

Life expectancy in Glasgow in

3 Male life expectancy in most deprived 15% and least deprived 85% areas in each Scottish Local Authority

What do we mean by health inequalities? Health inequalities are: Unfair differences in health within the population across social classes and between different populations These differences are unfair because: Are not random, or by chance, but largely socially determined Are not inevitable.

Mortality gap between local authorities and income inequalities in GB (Sources: Thomas & Dorling 2010, IFS 2012)

What causes health inequalities? Wider environmental influences Economic & work Physical Educ & learning Social & cultural Services Individual experiences Economic & work Physical Educ & learning Social & cultural Services Fundamental causes Global forces, political priorities, societal values leading to: Unequal distribution of power, money and resources INEQUALITIES Effects Inequalities in the distribution of health and wellbeing HEALTH INEQUALITIES Undo MitigatePrevent

Least likely to reduce health inequalities Interventions reliant on people opting in Information based campaigns – esp lifestyle Written materials Messages designed for the whole population (e.g. whole school education programmes) Interventions that involve significant price or other barrier

Most likely to reduce health inequalities Structural changes to the environment; Legislation, regulatory and fiscal policies; Income support, reduced price barriers; Accessibility of public services, prioritising disadvantaged groups and individuals; Intensive support for disadvantaged population groups; Starting young.

PrincipleCLD role might be….. Fundamental causes Policies that redistribute power, money and resources Social equity and social justice prioritised Supporting excluding groups to participate in decision making – voting, consultations etc Support Living wage (and good work) Wider environmental influences Use of legislation, regulation, standards and fiscal policy Structural changes to the physical environment Reducing price barriers Ensuring good work is available for all Equitable provision of high quality and accessible education and public services Supporting communities on issues important in their neighbourhood – eg Housing, green space, play.- Place Standard Individual experiences Equitable experience of socio-economic and wider environmental influences Equitable experience of public services Targeting high risk individuals Intensive tailored individual support Focus on young children and the early years Culturally/inequalities sensitive practice Linked public services for vulnerable/high risk individuals Adult learning for low literacy/numeracy Supporting parents, esp lone parents to move to sustainable paid employment

Place Standard Provides a framework for communities to identify what is most important in their neighbourhood – to take action

Reducing Health Inequalities: Best Buy programmes: Ensure adequate incomes and reduce income inequalities Reduce unemployment in vulnerable groups or areas Improve physical environments –housing, roads, green space, social and communal facilities Support specifically vulnerable groups through investing in intensive service and support in the context of universal provision Support early years (including wellbeing of parents of most vulnerable) Use regulation and price to reduce risky behaviours Empowering communities - so all (including the most excluded) can participate in decision making Challenging organisations – to allow meaningful participation – relinquish power

Health Inequalities – whats it got to do with CLD?

Summary Health inequalities are about inequality (not lifestyle) They are not inevitable Need to reduce inequalities in life circumstances (education, employment, housing, income etc) Requires action across all causes: Fundamental causes, wider environment and individual Requires action at all levels – national and local, political and practitioner etc CLD have key role – capacity building and empowering individuals and communities

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