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Ealing Health Inequalities Strategy – Appendix 1a HIS second draft Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy 2005-2010 Second Draft v2.1 Ealing Council and Ealing Primary Care Trust Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy Contents Forward 3 Acknowledgements 4 1 Introduction 5 2 Objective 6 3 A Strategic Approach 7 4 Health Inequality Indicators in Ealing 9 5 Gap Analysis of Services and Interventions 14 Tackling Local Health Inequalities 6 Key Priorities 17 7 Key Recommendations 18 8 Forward Strategy and Action Plan 20 Addressing the Wider Determinants of Health 21 Preventing Illness and Providing Effective 25 Treatment and Care Engaging Individuals and Communities 26 Supporting Families, Parents and Children 30 Background Papers 35 Local Documents 36 2 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy Forward Nationally everybody’s health is improving and people living in Ealing can now expect to live to 75.8 years if you are a man, or 80.8 years if you are a woman, similar to the national averages (75.7 and 80.6 years respectively). However, within some areas of Ealing your life expectancy could be as high as 81.2 years or eight years lower at 73.2 years for a man, and 83.4 or five and a half years lower at 77.9 years for a woman. There are other indications of health inequalities within the borough and these are in the accompanying ‘Health Indicators for Ealing’. The reasons for these differences, or gaps, are complex, interrelated and intergenerational. But many of them can be, and are being, addressed both within mainstream service delivery and through innovation. The many activities are tabulated in the accompanying ‘Position Statement of Health Inequalities Work in Ealing’. However, within Ealing there is an underlying issue of how we effectively target future work, to ensure that it reaches, and makes a difference to, those with the poorest health prospects. If we don’t, then the existing gaps in health inequalities as measured by the difference in life expectancy in the most disadvantaged areas, or infant mortality across social group, will continue to widen. Ealing’s Health Inequalities Strategy has been developed from the existing work, hence ‘Evolving a Healthier Community for All’, to enable us to narrow the gaps both in the short term, and for future generations. The strategy aims to reduce health inequalities in Ealing using needs based assessments and evidenced based interventions, to improve the health of the poorest of the population where the greatest burden of health problems exist. The strategy has been designed to enable co-ordination and guide services to improve the wider determinants of health, improve access to appropriate medical care, and support individuals to make their own healthier lifestyle choices. The challenge for us now is to take the vision and the expertise of our working partnerships and make the difference smaller. 3 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy Acknowledgements Our thanks for the development support and production of this suite of documents go to: The active members of the Health Inequalities Working Group: From LBE: Beryl Noori, John Coker, David Colley, Chantal Corrie, Naomi Hill, Sally Burrows, Lainya Offside-Kevani, Peter Brown, From the PCT: Fidelma Rogers, Jane Darrock, Dalya Marks, Anne Lyster, Stephen James, From the non-statutory sector: Jim Wong, Sarah Ashe, Colleagues who helped map the services currently provided, People who attended the Health Inequalities seminars in April and June 2005, People who commented on the draft documents. The Strategy and Position Statement was written and edited by Evelyn Gloyn and Estella Makumbi. January 2006 4 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy 1 Introduction Ealing’s Health Inequalities Strategy has been developed to reduce the gaps in the wider determinants of health, enhance availability of good medical care, and support healthier lifestyle choices with a view to address health inequalities. This will be achieved by addressing the underlying determinants of health; preventing illness, providing effective treatment and care; engaging communities and individuals; supporting families, parents and children. The strategy aims to reduce health inequalities using needs based assessments and evidenced based interventions, to improve the health of the poorest of the population where the greatest burden of health problems exist. Following the Acheson’s report into inequalities in health (Acheson 1998), the Government has recently prioritised the need to tackle the causes and consequences of health inequalities through a co-ordinated approach. This has been further reflected in the White Paper on Public Health ‘Choosing Health- Making Healthy Choices Easier’ (DH 2004) and more recently in the White Paper in health and social care ‘Our Health, our Care, our Say’ (DH 2006). Causes of health inequalities can be established by analysing the deviation from the wider determinants of health across the community. Social economic trends indicate that there are wide health status differences among social groups, which may persist from generation to generation if not addressed. The more affluent enjoy better health than less well off people. Those from lower income households have significantly higher mortality rates for nearly all major causes of death, particularly from coronary heart disease, strokes, lung cancer; and higher rates of morbidity, including mental health problems. Babies born to poorer families are more likely to be born prematurely; be at greater risk of infant mortality; and suffer from poverty, impaired development and chronic disease later in life. (DH 2002). The causes of these differences can be remedied by improving opportunities for increasing income, access to services and supporting healthier lifestyle choices of individuals. In August, the Department of Health published a Status Report (DH 2005b). This acknowledged difficulties in reporting on progress as some interventions have not had time show effective performance, and some data on factors affecting health inequalities are not readily available. However, the trend shows that the gap is still widening, although some progress has been made with reducing child poverty and housing, and there are signs of a narrowing of the gap in other 5 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy areas, circulatory (heart) disease mortality, cancer, flu vaccinations and educational attainment. Other areas, like smoking, remain less susceptible to change. It is acknowledged that Ealing is no exception to these health and social issues although the apparent wealth in some areas masks areas of relative deprivation where residents have serious health needs. Development of this Health Inequalities Strategy has been guided by mapping and analysing of socio-economic status of Ealing, health-related data, and consultation with service providers like the Council, Primary care Trust, community and voluntary organisations. 2 Objective . To reduce the Health Inequalities in Ealing This objective will be achieved by ensuring that our service delivery incorporates the following activities: 1. Identify and assist in co-ordination of a range of short, medium, and long term interventions, 2. Ensure that interventions are based on evidence of effectiveness, or best practice where evidence is not available, 3. Ensure that interventions are targeted towards communities most in need of health improvement, 4. Promote commitment to reducing health inequalities amongst a wide range of organisations and communities with effective partnership working, 5. Outline borough-wide mechanisms for monitoring and assessing the impact of interventions on health, 6. Acknowledge the contribution of a range of other specific local strategies and co-ordinate activities to avoid duplication. Health and Health Inequalities There are many definitions of both ‘health’ and ‘health inequality’. The World Health Organisation’s defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. (WHO, 1946) ‘Health inequality’ can be referred to as the gap in health status, and in access to health services, between different social classes and ethnic groups and between populations in different geographical areas. The main determinants of health stem from individual lifestyle factors, social and community networks and general socio-economic, cultural and environmental conditions as illustrated by Dahlgren and Whitehead’s rainbow model of health determinants (see Figure 1). 6 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy Figure 1 The main determinants of health This model highlights the existence of wider determinants of health that may be beyond the direct influence of the individual, affecting the wider environment. An individual’s social, and community, networks impact on these factors and links the rainbow between individual lifestyle factors and living and working conditions. This further guides our strategy towards the community involvement approach in tackling health inequalities. This health promotion approach helps an individual or group to identify and realise aspirations, satisfy needs and change or cope with the environment. Health is, therefore, seen as a resource for everyday
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