Glasgow Health & Wellbeing Indicators Event

Thursday 4th February 2010 Boardroom, GCPH, 94 Elmbank St, Glasgow

1 Contents

Page 1. Delegate List 3

2. Introduction and overview 4

3. Summary of presentations 4

Gail Findlay, London Health Commission Grant Pettitt, London Health Commission Bruce Whyte, Glasgow Centre for Population Health Andrew Lyon, International Futures Forum

4. Discussion on themes: 11  Framework and possible indicators  What contribution could you or your organisation make  Feedback

5. Conclusions and next steps 12

Appendix 1: Workshop notes 13 Appendix 2: Seminar programme 19

2 1. Delegate List

Attendees

Name Organisation James Arnott Glasgow City Council – Development and Regeneration Services Jane Arthur Glasgow City Council – Education, Strategic Health Promotion and Improvement Working Group Kay Barton Scottish Government Sandy Bennett Glasgow City Council - Land and Environmental Services Duncan Booker Glasgow City Council – Chief Executive’s Office George Black Glasgow City Council – Chief Executive’s Office Linda de Caestecker NHS Greater Glasgow and Clyde Sandra Carlisle University of Glasgow Dawn Corbett Glasgow City Council – Chief Executive’s Office Lynda Campbell Glasgow Life Fiona Crawford Glasgow Centre for Population Health Rosalind Deans NHS Greater Glasgow and Clyde Nic Dickson Glasgow Life Gail Findlay London Health Commission Darren Keenan Glasgow City Council – Chief Executive’s Office Peter Kelly The Poverty Alliance Andrew Lyon International Futures Forum Chris Mooney Community Safety Partnership James McCormick Joseph Rowntree Foundation John McLaren Centre for Public Policy for the Regions Ian Nicol NHS Greater Glasgow and Clyde Mark O’Neill Glasgow Life Paola Pasino Glasgow City Council – Development and Regeneration Services Grant Pettitt London Health Commission Carol Tannahill Glasgow Centre for Population Health Bruce Whyte Glasgow Centre for Population Health

Apologies

Name Organisation Chris Brodie Slims Consulting Helen MacNeil Glasgow Council for Voluntary Organisations Catriona Renfrew NHS Greater Glasgow and Clyde

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2. Introduction and overview

This event was held to develop thinking about the possible format, content and aims for a set of Health and Wellbeing (HWB) indicators for Glasgow. The impetus for developing this work has come from responses to the City Economic Strategy (2007) and the Health Commission’s report, Growing a Healthier Glasgow (2009), and, in particular, the desire to be able to track progress on a set of key strategic indicators.

An important aim of the event was to open up the discussion on how to develop HWB indicators and to encourage support for this initiative. This report summarises the presentations and discussions from this first event, and points towards ways forward for developing a practical set of HWB indicators within a relatively short timescale.

3. Summary of presentations

Following the introductions by George Black and Carol Tannahill there were presentations by Gail Findlay (London Health Commission) and Grant Pettitt (Greater London Authority), Bruce Whyte of the Glasgow Centre for Population Health, and Andrew Lyon of the International Futures Forum.

Gail Findlay began by describing how the London Health Commission was launched in October 2000, with the aim and purpose to “galvanise leadership across London to reduce health inequalities and to improve the health of all Londoners”. The ten high level indicators chosen by the Commission were:-

 Unemployment  Ethnicity and Unemployment  Educational Attainment  Unfit Homes  Domestic Burglary  Air Quality  Road Traffic Accidents  Life Expectancy  Infant Mortality  Self Assessed good health

By measuring these indicators inequalities were uncovered geographically and by population group (an example of which is illustrated in Figure 1) and this has led to implications for action, such as improving health intelligence, moving from evidence to policy to action and increasing understanding.

4 Map 7: Percentage of 15 year olds achieving 5 or more GCSEs at grades A*-C, 2003/04 London Health Commission map showing inequality in educational achievement by London borough

The Health in London Report publishes these data annually and the report is then used as an essential resource/handbook by LHC Commissioners, LHC Forums, partner organisations, policymakers and analysts to inform and assist with decision making. Gail also touched on the impact of the Health Commission which (although difficult to separate from other factors) is thought to have assisted with keeping the spotlight on health inequalities since its inception.

Grant Pettit followed on by describing the London Health Inequalities Strategy draft for public consultation (2009). He began by using a version of the Intersectoral action for Health WHO 1986 diagrams showing the challenges faced and the components of success in health inequalities:

The Challenge What we are trying to achieve

The London Health Inequalities Strategy (HIS) arose out of the HC 2000, GLA 2007. Grant stated that the four high level ambitions for the London Health Inequalities Strategy are to:-

 Improve the health of all Londoners; promoting both mental and physical well being  Reduce the gap between Londoners with the best and worst health outcomes  Promote the economic, social and environmental changes that will improve quality of life for all Londoners  Empower individuals and communities to take control of their lives and make healthier choices, with a particular focus on the most disadvantaged

And the objectives for the London Health Inequalities Strategy were summarised as the following:-

5 1) Empowering individuals and communities to improve health and well being. 2) Improving access to high quality health and social care services. 3) Reducing income inequality and the negative consequences of relative poverty. 4) Increasing the opportunities for people to access the potential benefits of work and other forms of meaningful activity. 5) Developing and promoting London as a healthy place for all.

With knowledge and learning as cross-cutting theme.

The preliminary stage of selecting indicators for the Health Inequalities Strategy includes work on the evidence base, the development of domains and comparison indicators for London and national/international. Examples of these included the aforementioned London Health Commission Health in London Report (London), the UK Government Sustainable Development Indicators (national) and the WHO Indicators of Healthy Cities or the United Nations Development Group: Common Country Assessment (international). The indicators in the current consultation draft are:-  Health Outcomes (e.g. life expectancy, infant mortality)  Health Related Behaviours (e.g. smoking prevalence, consumption of fruit & veg)  Socio-economic Variables (e.g. employment rate, child poverty)  Place and Environmental factors (e.g. crime, area deprivation, air quality)  Social Capital and Psych-social factors (e.g. satisfaction with life, volunteering)  Access to Healthcare and Health System (e.g. GP access, CBT access, vaccinations)

Grant then illustrated how the Health Inequalities Strategy indicators are mapped against Public Service Agreement objectives, Local Area Agreement outcomes and Local Area Agreement National Indicators. He stated that the HIS indicators were not intended as performance management indicators, but instead should be considered as a tool to engage local authorities in the delivery of the strategy and to monitor the effects of programmes on different population groups. Grant concluded by highlighting the links with the Marmot Review set of high level indicators, along with the World Class Commission Inequalities Indicator (which may be adopted by the HIS) and the potential for a London wellbeing indicator.

Bruce Whyte continued the focus on indicators by introducing the subject of a framework for health and wellbeing indicators in Glasgow. He set the scene by explaining how certain groups, programmes and reports have already laid the foundations for the development of a set of health and wellbeing indicators for Glasgow, including:-  The City Strategy Action plan (2007)  Growing a Healthier Glasgow (2009)  Community Planning Executive Group  GCPH work e.g. o Let Glasgow Flourish o Community Health Profiles o Miniature Glasgow o Comparisons with other European Regions o Culture and Health Bruce also referred to the following ‘determinants of health’ diagram in describing the case for health and wellbeing indicators:-

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The Case for health and Along with the example of a well-being indicators relevant case study (the Boston indicators project) of which more details can be found at: http://www.bostonindicators.org /Indicators2008/.

(Dahlgren, G and Whitehead, M, 1991) In terms of a framework for health and wellbeing indicators for Glasgow, Bruce identified the following key features:-

 A basket of indicators, rather than one index, representing a dynamic interlinked view of the city

 Focus on themes that are clear priorities for the city

 Providing a strategic overview

 Trends to be monitored over time

 Inequality, or difference, within the city to be monitored

 Comparisons to be made to other comparator UK cities and to European cities where possible

He then went on to propose specific domains, indicators and their sources, as summarised below:

Proposed Indicators

Domain Proposed Indicator Source Poverty Children in low-income families HMRC Economic Participation Employment rate NOMIS, Eurostat Education School Attainment Scottish Government Health Male and Female Life expectancy GROS, ONS Lifestyle Alcohol deaths GROS, ONS Social Capital Volunteering Scottish Household Survey Community Safety Violent Crime Violence Reduction Unit Environment Litter or air quality or greenspace Various Transport Non-car/physically active commuting Scottish Household Survey

Mindset Optimism/opinion on progress in an Surveys area/the city Cultural vitality Creativity index? City vibrancy/ attractiveness? ??? Three levels of comparison • Within Glasgow •UK city • European City

Using currently available data he gave examples of trends in various domains such as poverty, economic participation, transport and community safety, including:

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Examples (1) - Child Poverty Examples (2) – Employment

rate Children in workless households (in families on out of work benefits) by Glasgow SIMD income deprivation decile, 2006 Employment rate, Glasgow compared to other UK cities, Jan - Dec 2007 Source: HM Revenue & Customs data; SIMD Source: NOMIS, Annual Survey of Population

70.0 90

60.6 80 76.0 77.2 74.4 73.9 60.0 73.3 70.5 52.9 70 66.7 66.7 64.2 63.1 63.3 63.8 50.0 48.4 60 42.1 50 40.0 Glasgow: 35.4 37.4 % 40 30.0 27.5 25.5 % of all children 30 Scotland 19.7 19.9 20.0 20

12.4 10 10.0 7.2

0

d h l l n g to o m 0.0 a r GB s o l u astle rp ha Leeds Bri c e g cot inb iv 1 (least 2345678910 (most S Glasgow Sheffield ew L Ed N irmin deprived) deprived) B Nottingham Manchester

And:

Examples (3) – Life Expectancy Examples (6) – Active travel

Mode of transport to work, Glasgow, 1999-2006 Female Life Expectancy within Glasgow neighbourhoods, 2001-2005 Scottish Household Survey Source: Compiled by GCPH using GROS population estimates and death registrations 60.0 85 83.1

50.0 80 Scotland = 79.1 Driver/passenger

40.0 75

72.1 Public transport 30.0

70

20.0 Walking or 65 cycling

10.0

60

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Bruce also referred to the Audit Commission’s ‘Local Quality of Life Indicators’ (2005) which – although more extensive than the proposed health and wellbeing indicators – were seen to provide “an overarching ‘snapshot’ of the key issues that local authorities and their partners need to consider” and the following potential uses of such data were identified:-  Paint a picture of quality issues locally;  Facilitate comparisons of performance between different areas;  Stimulate debate and raise public awareness;  Inform local sustainable community strategies and local agreements;  Review, justify and set local objectives and priorities;  Monitor, change and assess, and evaluate progress over time; and  Enhance partnership working, shared ownership and joint action.

By way of conclusion, Bruce stated that it would be possible to create a concise set of health and wellbeing indicators for Glasgow with ‘Within Glasgow’ comparisons possible for most indicators and at least half of the indicators could be compared to other UK cities. The main gap would be for European city comparisons, but a detailed study of European data sources has not been conducted to date and may reveal further potential data resources. He went on to state that the framework outlined in this paper would provide a sophisticated and dynamic perspective on health and wellbeing in Glasgow, and would allow us to compare ourselves outwardly (to other cities) and inwardly (within Glasgow).

He also advised that the basket of indicators presented are clearly summary measures and have been chosen for practical reasons; alternatives could be put forward and that, whatever the indicators chosen, the strength of the framework is in

8 having a focus on a range of key domains in order to understand what is happening in the city at a strategic level, to encourage debate and discussion and to influence policy direction. Finally, Bruce clarified the next steps required in order to develop this work, such as the need to:-

 Agree the proposed framework;  Clarify the domains in which we are most interested;  Suggest indicators to populate the framework at local and city level and for making UK/European comparisons;  Establish how a new set of indicators could be used and their relationship to existing monitoring systems such as the SOAs and HEAT targets;  Agree how different organisations can contribute to the development of this work.

Andrew Lyon rounded off the day’s presentations by framing the Glasgow health and wellbeing indicators framework in the context of an increasingly complex world (slide 1) and gave an example of how individuals and societies might react to these challenges and the opportunity for transformation (slide 2):

www.internationalfuturesforum.com

He then focussed on how the core issue of how we can prepare ourselves for the coming challenges which Glasgow might face by stating that:-  Glasgow has changed significantly in the last decade and will continue to do so;  There will be other changes in the world, some of them sudden;  The present financial meltdown and flobal downturn is ‘forcing us all to rethink the received wisdom on optimal strategies for rapid and inclusive growth;  Need to balance current policy concerns and research that anticipates emerging needs.

He then widened the focus out the Global situation by stating that we:-  Need to deal with a number of factors simutaneoulsy – specialisation not enough  Need to develop a mental model that allows us to see new patterns in what we are looking at  Need to collaborate, share perspectives, access collective intelligence

9 Andrew also used some examples of the ‘Three Horizons’ model, along with an example the International Futures Forum Interactive World Model and World Game, to show how dominant paradigms fluctuate over time, and how fresh thinking can be brought into play to deal with such complexity.

The Three Horizons PREVALENCEPREVALENCE

H1

H2

H3

TIMETIME

HorizonHorizon 11 isis aa currentcurrent paradigmparadigm thatthat worksworks wellwell untiluntil InIn thethe background,background, aa completelycompletely newnew paradigmparadigm isis changeschanges inin thethe environmentenvironment plusplus itsits ownown diminishingdiminishing emergingemerging asas HorizonHorizon 33.. ItIt appearsappears forfor aa longlong timetime toto returnsreturns putput itit onon aa aa curvecurve ofof decline.decline. MeanwhileMeanwhile bebe marginalmarginal andand ineffectiveineffective butbut sincesince itit matchesmatches HorizonHorizon 22 ,, awareaware ofof thisthis inin diversediverse waysways isis betterbetter thethe newnew environmentenvironment itit eventuallyeventually takestakes over.over. innovatinginnovating moremore effectiveeffective approachesapproaches whichwhich TheThe HorizonHorizon 22 innovationsinnovations havehave servedserved asas enablingenabling eventuallyeventually overtake.overtake. thethe transformation.transformation.

Variant 1: Rough Transition: Collapse and Recovery Collapse and Recovery PREVALENCE VIABILITY

Emissions overshoot and Cascade of positive Tipping points Gradual feedback Across the emergence of World what works in System the new global Innovation conditions H1 H1 failing to keep up with the Collapse and H2 H2 rate of 21 century change dark age Prototypes of Much of the Future industrial age H3 viability is lost H3 TIME marginalised TIME

In this variant the supremacy of the Horizon 1 In the background Horizon 3 continues to develop In this variant the supremacy of the Horizon 1 In the background Horizon 3 continues to develop paradigm creates runaway success but at the expense and after the initial upset and chaos of the collapse paradigm creates runaway success but at the expense and after the initial upset and chaos of the collapse of some critical condition. Failure to capture coupled demonstrates its ability to match the new conditions of some critical condition. Failure to capture coupled demonstrates its ability to match the new conditions with weaker innovation in Horizon 2 leads to sudden and emerges as the next viable paradigm. with weaker innovation in Horizon 2 leads to sudden and emerges as the next viable paradigm. collapse. Horizon 2 is unable to make up for this. collapse. Horizon 2 is unable to make up for this.

He summarised the World Game as a tool which could be used to:-

 Explore the city’s wellbeing and its challenges and achievements from 12 perspectives. Identify the greatest challenges of the coming period to meeting objectives  Compare within and out with the city  Explore connections, game play, develop rapid scenarios, identify far- sighted actions  synthesis and reflection, explore potential contributions to the core challenges, strategic questions, actions

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4. Discussion on themes:

As detailed below - Appendix 1 has a fuller description of the workshop feedback.

Framework and possible indicators

Framework - General support Housing Social Capital for holistic - Can urban – How to measure? indicators design and Volunteering? - Overall wellbeing be Voting? goal/purpose? integrated? - Subjective vs objective measures

Sustainability Cultural vitality - Food security, Framework - Good indicator - Ecological - Breakdown by but can it capture footprint popn groups the wealth of activities across the city?

Economic participation Alcohol Lifestyle/ early - Too narrow/ years - How to measure negative an - Child wellbeing indicator? - Child indicator?

Feedback - purpose, content, concerns

Need to hold Need for

partner orgs evidence base Buy-in to account Could /ownership inequalities be And leadership widened? Definitions req’d issues – e.g. what is acceptable Keep it simple poverty?

Indicators Link to User should be relevant to Marmot high indicators for level the people Think about strategies a dialogue indicators and priorities before with citizens of Glasgow developing indicators

Is there a Certain poverty of indicators too Should there be aspiration? negative? Is Health and two Wellbeing the populations? correct title? - All Glasgow and - 0-5 years

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5. Conclusion and next steps

This first event was a very useful meeting in terms gathering support for the concept of set of HWB indicators for the city, understanding the key themes and indicators to focus on, identifying gaps, making links to policy and developing momentum.

A follow-up seminar is planned for April to develop this work further.

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Appendix 1

Health & Wellbeing Indicators Event Flipchart notes

Thursday 4th February 2010

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Discussion of framework and possible indicators

Framework

 Supportive of summary framework with “holistic” indicators (links to other sources/influenced by collective actions/making un-anticipated connections)

Indicators

 Cultural Vitality population participation rate in cultural activity (CSG will contribute) source use : Existing surveys/educational links ..

 Sustainability (extra domain) is Glasgow going to survive the following century? Food security/energy security/the elements

Indicators: ? measure ecological foot print. Source: International Info?

 Lifestyle  Holistic Early Years indicator –> Child Well Being indicator

Source – Summary of all existing indicators

 Economic Participation Do we add “meaningful activity” as an indicator? Outside of employment or volunteering .. Is there an opportunities index? - motivations/awareness/use

HOW WOULD WE USE IT? Use to use of challenge existing services and resources

 Use to develop more effective partnerships

WHERE COULD IT TAKE US?

 Stimulates a “vision” of the third horizon  Stimulates awareness of the contribution to health of non-NHS (healthy) orgs.

CONTRIBUTION

 Lifestyle – “child well being” indicator

Who : Ensure all partners have ownership > NHS/GCPH

What contribution could you or your organisation make?

 Long term continuing commitment need to hold partner organisations to account.

 What are the privileges? And keep to them between now – back end of summer

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Discussion of framework and possible indicators

 Links to Marmot high level indicators  5 themes of Community Planning or Scottish Government targets and 8 themes.  Need to map themes across  Title important. Is HWB correct?  Alcohol deaths does not adequately express lifestyle issues. Do we need a different indicator? Should there be a lifestyle indicator at all given causes are environmental?  Children & young people domain?  Transport should the indicator be public transport? What about access issues?  Poverty of aspiration  Tourism

How would we use it and where could it take us?

 How would the active travel indicator impact on inequality? Could inequalities be widened? You need the evidence base.  Need breakdowns by different population groups e.g. employability by age, disability, gender, deprivation  Strategic set of indicators is missing. Need to keep it simple  Agree priorities and keep it simple.  5 themes what are the priorities e.g. alcohol. Think about strategic priorities before developing indicators  Are the domains broad determinants of health and are the interests in part indicators as a marker of broad progress on determinants of health.  Michael Parkinson  Indicators of importance to people  LE, violence, alcohol, school attainment, employment all headline indicators  Environment – greenspace general approval  Sustainability – e.g. Glasgow ecological footprint. Mark O’Neil

15 Discussion of framework and possible indicators

FRAMEWORK

 Overall goal – purpose?  Ambition/buy in/leadership? Key to success  QOL vs SOL – move to former by high profile Index of success

Seen as: International Leader

INDICATORS

 Too many to concentrate on  Too negative in emphasis (problems orientated i.e. (Bad Glasgow!)  Two populations I. All Glasgow II. Young Glasgow (next generation) - 0 – 5/10 years old - Different indicators - Allows early signs of success

 Highlights importance of early years policies/funding in driving change.

How would we use it and where could it take us?

How would we use it?  As top priority  How to get buy in from those “excluded” as important  Affect funding for influences  Key component of budget rounds

Where could it take us?  QoL  Next generation and next again. Improving on previous (problem of stating the bleedin’ obvious)  More focused ambitions

Definitions – poverty eradicate child poverty (what’s acceptable) – sustainability – personal responsibilities and failure

16 Discussion of framework and possible indicators

 More work on themes and indicators e.g social capital

 Readable

Coherence

Consensus

No change

A give B give

Din

Exp

Failed Dodo Unicorns

Everyone must change

AL

How would we use it and where could it take us?

 Take temperature/stock  Inform strategic dialogue conversation  Address single issues in whole context  Dialogue with citizens  Focus for expert. Input - Questions of meaning  Anticipatory Strategy  Scenario Planning

Where front foot

SOCIAL CAPITAL/IDENTITY

How to measure it? objective imd: Volunteering Voting? Subjective imd: surveys

We cannot agree on : Cultural Vitality

Yes It’s a good indicator for the wellbeing of the city. A bigger role for subjective measures

No Not an indicator that can be applied throughout highlights social differences access to culture and sports measured in accessibility.

Why is housing missing?

Contribution  Unintended consequences

Relationship between indicators Learning  Integrate “Wellbeing/Quality of Life” in urban morphology/design

1. Invested 2. Deviance

We think we know what to do housing – resources. Quality and design fallen off

Returning to questions it again

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Appendix 2

Seminar and workshop

on Health and Wellbeing Indicators for Glasgow

th 4 February 2010, 9.00am - 1pm

Glasgow Centre for Population Health, House 6, 94 Elmbank Street Glasgow G2 4DL

Programme

9.00 – 9.30 Coffee

9.30 - 9.40 Introductions and Welcome George Black, Glasgow City Council

9.40 – 9.50 Background to work Carol Tannahill, Glasgow Centre for Population Health

9.50 – 10.20 Use of health and wellbeing indicators in London Gail Findlay & Grant Pettitt, London Health Commission

10.20 – 10.50 A framework for health and wellbeing indicators in Glasgow Bruce Whyte, Glasgow Centre for Population Health

10.50 – 11.20 Outline of 3 Horizons Model and World Model Andrew Lyon, International Futures Forum

11.20 – 11.40 Coffee

11.40 – 12.40 Table discussion on themes:  Discussion of framework and possible indicators  How would we use it and where could it take us?  What contribution could you or your organisation make?

12.40 – 12.55 Plenary – brief feedback

12.55 – 13.00 Next steps and summing up from Chair

13.00 Lunch

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