1. Inequalities and wellbeing Public Services working Together

2. Health inequalities strategy review 2 Social Inequalities in health Source: Norwegian Ministry of health Care Services, 2007

3. Health inequalities strategy review 3 Pre-birthYoung adultsSchool ageEarly years Health Personal development Educational attainment Infant health Early development Achievement at end primary Developing positive behaviours Staying engaged at 16-18 Opportunities to access university Where you are born, who your parents are and your earliest life opportunities impact on all your life course Age months High social class Low social class High test scores

4. Health inequalities strategy review 4 In 2006 the most affluent 10% are earning relatively much more per week than in 1961 – the poorest 10% relatively the same Source: FES, IFS analyses Relative household income median income poorest 10% richest 10% The income gap between the richest and the poorest is growing not shrinking

5. Health inequalities strategy review 5 Living in poverty affects every part of peoples’ lives For example, children living in poverty are less likely to do well at school And women who grew up in poverty are less likely to earn at / above the average wage as adults 1958 cohort 1970 cohort 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 CSE/otherO-levelsA-levelsHigher other Degree or above Highest level of qualification Comparative hourly earnings with those with no qualifications 0 10 20 30 40 50 60 0-10 11-2021-3031 and over Pupils eligible for free school meals (percentages) Pupils with 5 GCSE grades A* to C (percentages)

6. Health inequalities strategy review 6 Poor health is both a cause and a consequence of poverty 26 30 34 38 42 44 48 54 0.93 0.94 0.95 0.96 0.97 0.98 0.99 1.00 Age in years Proportion alive Cumulative death rates 26 to 54 years by father’s social class men and women born in March 1946 Kuh et al, 2003 Key Social Class I Social Class V More people born in to Social Class V die in early middle age than those with fathers in Social Class I

7. Health inequalities strategy review 7 In 2008 there is 40 years difference in apparent health year between Rutland and Manchester Manchester has an apparent health year of 1984 Rutland has an apparent health year of 2023

8. Health inequalities strategy review 8 Peoples lifestyles & related risks are the causes of a growing burden of disease

9. Health inequalities strategy review 9 Some groups live lives that are riskier to their health 010203040 I II IIIn IIIm IV V Percentage of men Percentage of women 010203040 I II IIIn IIIm IV V For males, 30% of people have two of three behaviours in social class V compared to <10% in social class I For females, 20% of people have two of three behaviours in social class V compared to <5% in social class I Social class = Three behaviours= Two or more behaviours Key Social class People in social class V are three to four times more likely to have two of three lifestyle risks (smoking, harmful levels of alcohol consumption and poor diet) compared to those in social class I = Three behaviours= Two or more behaviours Key

10. Health inequalities strategy review 10 Problems are interrelated Substance misuse NEET Teenage pregnancy Truancy & Behaviour Youth crime 3 in 5 excluded young people report having offended Young people with emotional &behavioural difficulties are 4 times more likely to use illicit drugs NEETs are disproportionately likely to misuse drugs & alcohol 71%of young women who are NEET for 6 months & between 16-18 are parents by 21 Persistent truants are nearly 10 times more likely to be NEET at16 and 4 times more likely to be NEET at 18

11. Health inequalities strategy review 11 From mid life onwards smoking has a greater impact on life expectancy than socioeconomic status does

12. Health inequalities strategy review 12 In deprived areas, patients do not get the best quality of care QOF: % points available % satisfied - average across 5 domains from patient survey: Proportion of single handed practices: Scoring on the QOF (a measure of the quality of primary care) is higher in more affluent PCTs There are proportionally more single handed practices in deprived PCTs Patient satisfaction is higher in affluent PCTs

13. Health inequalities strategy review 13 Targeted interventions do work - Sheffield achieved a 7% greater reduction in CVD death rates in its most deprived communities (23% v 16%) Sheffield Initiative to Reduce CHD (CIRC)  Identify GP practices with high CHD mortality  Targeted support with specialist nurses to assist them in developing at risk registers and promoting statin prescribing  Differential increase in statin prescribing  in less privileged areas

14. Health inequalities strategy review 14 Meet… Mark Maggie Antonio Victoria Anatoly Margareta Charles Helen Mario Rebecca Sergej Tatjana

15. Health inequalities strategy review 15 Children’s health has been affected by a several external global factors Children are travelling more and exposed to diseases ((skin cancer) Fast food popular with children – growing consumption and rising rate of obesity TV is major source of entertainment Huge medical advances in life saving treatments- more lives saved Technology has transformed communication Genetic disorders – diagnosed and treated better (foetal transfusion) Sex, Drugs, Alcohol no longer have the stigma that they once did when people grew up with strongly involved grandparents of the war / Victorian era.

16. Health inequalities strategy review 16 We say we know we need to eat more fruit & vegetables – more so than others QWhat do you think ‘eating a healthy diet’ involves? Germany UK Italy Netherlands EU 25 Spain Sweden France Ireland 77% 70% 61% 59% 58% 49% 44% 35% Source: Eurobarometer 64.3 2005. Base c1,000 interviews in each country

17. Health inequalities strategy review 17 ….For childhood obesity, we reckon its up to the state 76 48 22 12 31 40 30 69 0 20 40 60 80 ParentsFood and drink manufacturers The individualThe state Who is at fault for obesity Who is responsible for addressing it? Source: Henley Centre (2005) Note: HCHLV is soon to release up to datedata. Early cuts of which show broadly similar trends

18. Health inequalities strategy review 18 How do we achieve more equal life chances Whose responsibility is it? Baby Born to affluent parents – will live 10-15 years longer than friends below Baby One of many low income teenage conceptions. Will live 10-15 years less than their friends above. Aged 10 Enjoying a good life, lots of opportunity, good education, etc Aged 10 Growing up in a disadvantaged environment, as are many kids in Europe Aged 20 Enter at university with good marks. Plays sport and eats a healthy diet Aged 20 Left school with no qualifications, casual labourer, drinks, smokes and takes drugs Aged 45 Fit and healthy with a good job Aged 45 Weighs 18 stone/114 kg, has high cholesterol, early stage type 2 diabetic Charles, Rebecca, Sergej, Helen Mark, Maggie, Anatoly, Victoria Aged 60 Died from massive stroke Aged 60 Retired early to spend time with grand-children and travel Adapted from: D. Harrison (2007)

19. Health inequalities strategy review 19 As public service leaders we can change people’s life chances and help shape the communities in which we live The challenges are to….. Raise community aspirations for change Identify the positive assets and build upon them Create and share common cultures across public services Work through commissioning and place shaping Build upon JSNA Lead together Identify and share our strengths

20. Health inequalities strategy review 20

21. Health inequalities strategy review 21 Visible leaders with mandate Success through partnership Seek out & act on public expectations Strategic vision with clear outcomes Clinically driven Excellent knowledge management Excellent business organisations Manage the system Empowered communities