1. Working with deprived populations Tackling health inequalities in primary care Dr. Les Goldman, Bradford

2. Aim Examine concept of health inequality and how it affects work in general practice

3. Objectives Understand concept of health inequality Understand how it applies to a local practice population Be able to develop initiatives to tackle health inequality at practice level Community Orientation

4. How? Short presentation Group exercise - your experience of health inequalities Group exercise - develop a practice plan Discussion of our plans Reflection on what we learned

5. Definition Unequal expectation of morbidity or mortality among different social groups Reflects different exposure to risk due to Socio economic status Age Disability Ethnicity Gender

6. Inequality Older people are ill more

7. Inequity

8. Inequity v inequality Older people and people with disabilities have poorer access to health services Higher risk of death by suicide or homicide among men Ethnic differences in disease incidence Diabetes Infant mortality

9. Determinants of health Acheson Report 1998

11. Spectrum of health inequalities Outcome - morbidity, mortality Access to health care Homeless Disabled Causes of ill health Smoking, drug addiction Obesity, poor nutrition

12. Interventions Upstream Reduce income inequalities Improve pre-school education Government responsibility Downstream At community or practice level Access / lifestyle / morbidity Practice / Commissioning Alliance / PCT

13. Task 1 Your experience of health inequalities? Has anything upset you? Have you wanted to change something? Feed back

14. Task 2 Make plan to tackle a problem in practice (access / risk / outcome) SMART Specific Measurable Attainable Relevat Time bound PDSA Plan Do Study Act Short repeated cycles of change

15. PDSA What changes are to be made? Next cycle? Objective Questions/predictions Plan to carry out the cycle (who, what, where, when?) Plan for data collection Carry out the plan Document problems and unexpected observations Begin analysis of the data Complete the analysis of the data Compare data to predictions Summarise what was learned

16. Factors to consider Who will be involved In practice / outside practice In implementation Time Funding

17. References London Health Observatory www.lho.org.uk Dept of Health www.dh.gov.uk Acheson Report - Independent Inquiry into Inequalities in Health 1998 Tackling Health Inequalities - a Programme for Action Dept of Health Jul 2003