BUILD BACK FAIRER Michael Marmot @MichaelMarmot http://www.instituteofhealthequity.org/about-our-work/latest-updates-from- the-institute/build-back-fairer Cheshire and Merseyside July 2021 In Cheshire and Merseyside: - 33% of residents live in most deprived 20% of neighbourhoods in England. - 26% of children live in poverty HEALTH EQUITY IN ENGLAND: THE MARMOT REVIEW 10 YEARS ON 3 “We have lost a decade. And it shows.” 4 Increases in life expectancy at birth stalling in England 5 Annual life expectancy improvement in weeks, 2011 to 2017 6 There are large differences in life expectancy by area deprivation in England 7 Differences in life expectancy by deprivation widen in Women England’s regions Least deprived London Most deprived 8 Life expectancy at birth by sex and deprivation deciles in London and the North East regions Women 9 Life expectancy, Cheshire and Merseyside LA, North West, England 2017-19 86 84 82 80 Years 78 76 74 72 Liverpool Knowsley St. Helens Halton North West Wirral Warrington Sefton Cheshire Cheshire region West and East Chester Female Male England - Male average England - Female average Source: Public Health England Male and female life expectancy at birth (2017–19) & average Index for Multiple Deprivation score (2019) Life expectancy 85 84 Cheshire West and Chester Cheshire East 83 Sefton 82 Warrington North West 81 Halton Knowsley Cheshire West and St Helens Male Chester Liverpool 80 Cheshire East Female Linear (Male) 79 Warrington Sefton Linear (Female) North West 78 St Helens 77 Halton Knowsley Liverpool 76 12 17 22 27 32 37 42 47 IMD score Source: ONS Healthy life expectancy at birth 2017-2019 70 68 66 64 62 Years 60 58 56 54 52 Halton Liverpool St. Helens Knowsley North West Wirral Sefton Warrington Cheshire Cheshire region East West and Chester Female Male England - Female average England - Male average Source: ONS Gap in life expectancy – difference between most and least deprived decile in each LA in C&M 2017-2019 14 12 10 8 Years 6 4 2 0 Warrington Cheshire Halton Cheshire Liverpool Knowsley Wirral St Helens Sefton West and East Chester Female Male England - Female average England - Male average Source: Public Health England Fair Society, Healthy Lives: 6 Policy Objectives A. Give every child the best start in life B. Enable all children, young people and adults to maximise their capabilities and have control over their lives C. Create fair employment and good work for all D. Ensure healthy standard of living for all E. Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill health prevention The most deprived decile households would spend 75% of their disposable income to meet the NHS Eatwell Guide 15 Public sector expenditure (% of GDP) declined in the UK Expenditure by service 16 Proportionate Universalism Levelling–up the social gradient in health Council spending per person decreased the most in more deprived areas 19 20 Children living in poverty before and after housing costs in England 21 The UK 2020: the poor poorer IFS Deaton Review 2020 22 Average weekly earnings, aged 16+ years, in Cheshire and Merseyside, North West and England 2020 500 490 480 470 460 450 440 430 Weekly earnings (£) Weekly 420 410 400 Sefton St. Helens North West Liverpool Halton Warrington Wirral Knowsley Cheshire Cheshire East region West and Chester England average Source: Public Health England 24 After a small dip, violence increased the most for those in more deprived areas Most deprived Least deprived 25 Prevalence of obesity at ages 18 and over by Cheshire and Merseyside CCGs, 2019/20 and % change from previous year NHS Southport and Formby CCG NHS Cheshire CCG NHS Warrington CCG Percentage point change average for NHS South Sefton CCG England NHS St Helens CCG NHS Liverpool CCG Prevalence (%)for England NHS Wirral CCG NHS Halton CCG NHS Knowsley CCG 0 5 10 15 20 Percentage Percentage point change from 2018/19 to 2019/20 Prevalence (%) Source: QOF BUILD BACK FAIRER: THE COVID-19 MARMOT REVIEW The Pandemic, Socioeconomic and Health Inequalities in England 27 Male age-standardised mortality rates from all causes, COVID-19 and other causes (per 100,000), by deprivation deciles in England ONS. Deaths involving COVID-19 by local area and socioeconomic deprivation, 2020 28 Death rates at ages 9 and over involving COVID- 19 by ethnic group and sex relative to the White population, England 29 Excess Mortality 30 Slower HLE improvement 2010-2019 Higher excess mortality 2020 31 HEALTH AS A MEASURE OF SOCIETAL SUCCESS Pre-Pandemic. LE stalling, inequalities increasing, LE for poorest people falling Slow down in LE nearly slowest of rich countries. Pandemic. Highest excess mortality Link? • Poor governance and political culture • Social and economic inequalities increasing • Reduction in spending on public services – we are ill- prepared • England was unhealthy coming in to the pandemic 32 Age standardised COVID-19 mortality per 100,000, England, the North West, Cheshire and Merseyside local authorities, 14 month total (March 2020 to April 2021) Liverpool Knowsley St Helens North West Sefton Wirral Halton Warrington Cheshire West and… Cheshire East 0 50 100 150 200 250 300 350 400 Source: ONS Females Males Males England average Females England average Mortality rate (per 100,000) Age-standardised COVID-19 mortality rate per 100,000, metropolitan counties in England & Grt London, 14 month total (Mar 2020 - Apr 2021) 300 250 200 150 Mortality rate Mortality 100 50 0 West Yorkshire Tyne and Wear South Yorkshire Merseyside Greater Greater London West Midlands Manchester England Source: ONS Age and sex standardised COVID-19 mortality ratios by IMD 2019 deciles of MSOAs* in Cheshire and Merseyside, Mar 2020 - Apr 2021 Mortality ratio 1.75 1.50 1.25 C&M mortality 1.00 E&W 0.75 1 2 3 4 5 6 7 8 9 10 Most deprived Least deprived IMD 2019 decile Source: ONS BUILD BACK FAIRER IN GREATER MANCHESTER: HEALTH EQUITY AND DIGNIFIED LIVES Life expectancy decline in 2020 (provisional) Female Male North West 1.2 years 1.6 years England 0.9 years 1.3 years Source: Public Health England 38 Framework for Building Back Fairer in Greater Manchester Recommendations 1. Build Back Fairer for future • Prioritise children and young people generations 2. Build Back Fairer resources • Rebalance spending towards prevention • Build Back Fairer opportunities for all • Build Back Fairer commissioning 3. Build Back Fairer standards • Standards for healthy living 4. Build Back Fairer Institutions • Extend anchor institution approaches • Scale up social value contracting and extend business role 5. Build Back Fairer • Develop Build Back Fairer equity targets Monitoring and Accountability for Greater Manchester 6. Build Back Fairer through • Build Back Fairer devolution greater local power and control Public health local authority allocations (£/person), Cheshire and Merseyside, 2021–2022 140 120 100 80 60 40 Pounds per person Pounds 20 0 Knowsley Wirral Liverpool Halton St. Helens Sefton Warrington Cheshire Cheshire West and East Chester England average Source: Department of Health and Social Care Public health spending reduction in real terms (£/person), 2014–21, regions in England and England average Source: MHCLG (2020) and PHE (2020) from IPPR Monitoring and Accountability MARMOT BEACON INDICATORS Listening and giving a voice: Feeding Liverpool Developing Liverpool’s Good Food Plan • Tackling the root causes of poverty • Listening to experiences of hunger and food insecurity • Reducing food deserts – improving transport links • Providing emergency food parcels • Food pantries, community markets and shops – locally available food WMA Health Equity Report 1. Workforce Education and Training 2. Working with Individuals and Communities 3. Health Sector as Employers 4. Working in Partnership 5. Workforce as Advocates Martin Luther King Building Back Fairer: Cheshire and Merseyside.