1. Addressing Inequalities in Health and Wellbeing at Population Level Redcar and Cleveland (1) HINSTAssociatesHINSTAssociates Professor Chris Bentley Chris.bentley19@gmail.com

2. After Ronald Labonte Well being and Health Physiological risks High blood pressure High cholesterol Stress hormones Anxiety/depression Behavioural risks Smoking Poor diet Lack of activity Substance abuse Psycho-social risks: Isolation Lack of social support Poor social networks Low self-esteem High self-blame Low perceived power Loss of meaning/purpose of life Risk conditions – e.g.: Poverty Low social status Poor educational attainment Unemployment Dangerous environments Discrimination Steep power hierarchy Gaps/weaknesses in services and support

3. 2005201020152020 Health Inequalities Different Gestation Times for Interventions A B C For example intervening to reduce risk of mortality in people with established disease such as CVD, cancer, diabetes For example intervening through lifestyle and behavioural change such as stopping smoking, reducing alcohol related harm and weight management to reduce mortality in the medium term For example intervening to modify the social determinants of health such as worklessness, poor housing, poverty and poor education attainment to impact on mortality in the long term

5. Oldham – by English Deprivation Quintile

6. Slope Index of Inequality - Oldham (males)

7. Slope Index of Inequality - Redcar and Cleveland (males)

8. Maidstone – slope index (males)

9. Slope Index of Inequality - Redcar and Cleveland (females)

10. Redcar and Cleveland Local deprivation quintile by LSOA

11. DISPROPORTIONATE NEED

12. Number of chronic disorders by age group Barnett, K et al. 2012

13. Multi-morbidity – the existence of several chronic health disorders in one individual – is a critical and increasing challenge for health and social services. The prevalence of this problem increases with deprivation; people in deprived circumstances having the same prevalence of multi-morbidity as more affluent patients who were 10 – 15 years older (Barnett, 2012).

14. The relationship between multiple lifestyle risks and mortality Buck, D; Frosini, F; 2012

15. Distribution of multiple risk behaviours Looking at combination of 4 key risk behaviours in 2008, i.e.: Smoking; Excessive use of alcohol; Fruit and vegetable consumption; Physical exercise Unskilled manual labour 3 times more likely to have all 4 risk behaviours than professionals People with no qualifications 5 times more likely to have all 4 risk behaviours than those with high level qualifications King’s Fund 2012

16. Enable all children, young people & adults to maximise their capabilities & control their lives. Policy objectives Effective evidence-based delivery systems. Reduce health inequalities and improve health and wellbeing for all Policy Goals Create an enabling society that maximises individual and community potential. Ensure social justice, health and sustainability are at heart of policies. Create and develop healthy and environment- ally sustainable places & communities. Ensure healthy standard of living for all. Create fair employ- ment & decent work for all. Give every child the best start in life. Equality & health equity in all policies. Strengthen the role and impact of ill- health prevention. Policy mechanisms

17. Inequality in Early Cognitive Development of British Children in the 1970 Cohort, 22 months to 10 years High Q at 22m Low Q at 22m Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97 High SES Low SES

18. `Sensitive periods’ in early brain development Vision 0 1237654 High Low Years Habitual ways of responding Language Emotional control Conceptualization Peer social skills `Numbers’ Hearing Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.) “Pre-school” yearsSchool years

19. Per cent achieving 5+ A* - C grades inc Maths and English at GCSE by IDACI decile of pupil residence: England 2007 % achieving 5+ A*-C GCSEs inc Maths and English Income Deprivation Affecting Children Index (IDACI) Least deprived Source: DCFS 2009 Most deprived

20. OutcomeMost deprivedLeast deprived Smoking during pregnancy¹38%13% Stillbirth5.9/1000 live births3.8/1000 live births 46 m Language development concerns²26%12% Behaviour to other children24%10% Total difficulties (on SDQ)20%7% Dental caries age 5 years³ (odds)4.61 Teenage pregnancy⁴3 x higher Death in 15-44 year olds⁵5 x higher 45-74 year olds Death due to CHD3.8 x more likely Death due to cancer2.3 x more likely Alcohol deaths12.3 x more likely Under-75 year old deaths3.6 x more likely Health inequalities in Scotland Sources : 1. Gray R, Bonellie SR, Chalmers J, Greer I, Jarvis S, Kurinczuk JJ, et al. 2009. 2. Scottish Government. Growing Up in Scotland: Health inequalities in the early years. 2010. 3. Levin KA, Davies CA, Topping GV, Assaf AV, Pitts NB. 2009. 4. Scottish Government 2003. 5. Scottish Government Health Analytical Services Division 2008.

21. Child wellbeing in Better-off Countries (UNICEF Review 2007)

22. (10) (9) Maidstone - Neighbourhood (LSOA) deprivation scores (decile – 10%)

25. Local index of child wellbeing material wellbeing domain

27. Local index of child wellbeing education domain

28. Literacy and numeracy in the UK Moser Report 1999 Skills for Life Survey 2011 (BIS)

30. Maidstone unemployment