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 life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being. (WHO, 1984).

Determinants of health are closely interlinked and differentials in their distribution can lead to health inequalities. Some of these inequalities are attributable to biological variations while others are out of choice, where it may be impossible, or ethically unacceptable, to change their determinants. However, this strategy will seek to bring differentials down to the lowest possible level in cases where the uneven distribution of health status is inequitable and avoidable.

3 A Strategic Approach

Ealing Council (LA), in partnership with Ealing Primary Care Trust (EPCT), is leading on work to tackle these health inequalities, working with community groups and the voluntary sector. Various strategies and plans have been

7 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy developed to inform the process of addressing health inequalities and much of the work is already happening, see Evolving a Healthier Community for All: Position Statement 2005. (LBE 2005b)

Addressing health inequalities in Ealing is one of the key strategic objectives for Ealing’s Community Strategy (LSP 2003) under the ‘healthier places’ theme, where it seeks to reduce inequalities in the root causes of ill health, access to healthcare and in the delivery of health services. Ealing’s Local Neighbourhood Renewal Strategy (LBE 2002) is tackling the most acute levels of multiple social deprivation, concentrated in the borough’s poorest neighbourhoods and the Community Safety Strategy (LBE 2005a) has recognised that crime affects health in a number of ways, directly and indirectly and by influences on the health care system. Ealing PCT’s Local Delivery Plan (2005b) outlines how health promotion programmes will seek to address issues such as smoking cessation, nutrition and exercise, targeting these to areas of highest deprivation and dedicating resources to areas of greatest need which tend to be areas with highest proportions of ethnic minority groups and refugees.

Government policy has also been used to inform the strategic approach to ensure that the strategy falls in line with the national context. In response to the government’s policy document Tackling Health Inequalities: A programme for Action (DH 2003), Ealing has adopted the four similar themes to guide the health inequalities strategy action plan. These contribute to the national public service target (PSA) and tackle the wider determinants of health.

The four themes: 1. Addressing the underlying determinants of health; 2. Preventing illness and providing effective treatment and care; 3. Engaging communities and individuals; 4. Supporting families, parents and children.

National Public Service Agreement (PSA) Target:

By 2010, to reduce inequalities in health outcomes by 10% as measured by infant mortality and life expectancy at birth.

Specific interventions prescribed by the Government’s Cross Cutting Review (DH 2002) which are most likely to have an impact on the national target have been captured in the various local strategies like: All our Futures Ealing’s Strategy for Older People (LBE 2004c), Teenage Pregnancy Strategy (LBE 2003b), Food Matters Strategy (LBE 2004d), Supporting People Strategy. (LBE 2005d)

The Government is moving towards the introduction of Local Area Agreements (LAAs) to facilitate more effective Local Strategic Partnerships. Their focus is on four areas: children and young people; healthier communities and older people;

8 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy safer, stronger communities and economic development. These will be outcome- based, and will enable local partners to deliver national outcomes in a way that reflects our local priorities. The health outcomes expected from the LAAs are improved health of the population; increased life expectancy; and reduced health inequalities. These outcomes are reflected in the Integrated Commissioning Strategy for older people and will be in the forthcoming prevention strategy, reflecting ‘Independence Wellbeing and Choice’ (DH 2005a) and also feature in the draft Children and Young People’s Plan, implementing ‘Every Child Matters’ (DfES 2003)

The publication Choosing Health (DH 2004) that is directed more to preventative measures than cures and enabling people to choose healthier lifestyles, will help to influence our future commitments and strategic direction. These considerations are particularly relevant as this strategy will support delivery of Ealing’s Neighbourhood Funding for the next 2 years (2006/8) and will enable the Local Strategic Partnership to align investments with achievement of the national floor targets and SSCF mini area agreement1.

4 Health Inequalities Indicators in Ealing

Data from the 2001 Census2 was used to identify health inequalities in Ealing. These have been grouped under social class, ethnic groups and geographical areas. Indicators like life expectancy, multiple deprivation, individuals reporting “not good health”, prevalence of permanent sickness and disability, disease and prevalence of mental ill health have been used to map potential prevalence of health inequalities. In addition to this, wider determinants of health like employment, housing and homelessness, crime, income and education are considered and these will guide the borough to have a strategic approach in addressing health inequalities. For more detailed information on health indicators please see Evolving a Healthier Community for All: Health Indicators for Ealing 2005. (LBE 2005c) It can be noted that Ealing fares well against the national and London comparators, but when this is broken down to ward level, age or ethnicity, the gaps are wide and many could be addressed.

Health Inequalities between social classes in Ealing

Ealing has 25,700 people who provide some form of unpaid care although this proportion of 9% is lower than the England average of 10%. Being a carer has an

1 SSCF - Safer and Stronger Communities Fund

2The 2001 Census data are available at a number of different geographical levels. In this strategy information is presented at local level and electoral ward level. The maps show the data at Ward or Super Output Area (SOA) level. Super Output Areas are an aggregation of Output Areas (OAs), the smallest areas for which Census data is available. SOAs have a mean population of around 1,500 people.

In 2002, a new set of ward boundaries was introduced for Ealing. Figures are based on these new ward boundaries, as all the data from the 2001 Census has been published to these boundaries

9 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy impact on the potential earnings of the individual and the family and this may manifest itself in economic related limiting factors especially social classes with less wealth. Unpaid care in Ealing is mainly done by people aged 50- 59, this age group is still economically active and yet near retirement age hence there are financial implications.

According to the national classification of social classes based on occupation which range from I to V, it is noted that gradient for alcohol and drug dependence is more prevalent in manual workers, class V than among class I, which is the managerial class3. While we do not have actual figures confirming that occurrence in Ealing, national statistics will be applicable.

Limiting long time illness is more prevalent in lower supervisory occupations than and those in managerial.

Health Inequalities between ethnic groups in Ealing

The highest proportions of people reporting ‘Not Good’ Health were found in the White Irish (11%), Pakistani (10.4%) Black Caribbean (9.9%) and Indian groups (9.5%). The lowest rates of Not Good’ Health were in the Chinese (9%) and Mixed White/Asian groups (10%). The same trends were exhibited with limiting long–term illness (LLTI) although White British rank second to the Irish while Black Africans show the second lowest rates of 9.5% after the Chinese at 7.5%.

In young age groups, LLTI was highest among White and Mixed ethnic groups while in people aged over 50 years, Asian and Black groups reported higher levels. Chinese groups showed consistent low levels across all age groups. South Asian and Black Caribbean populations have between 1.5 and 3 times more consultations with their GP than the general population (ONS, 1999).

The highest rate of permanent sickness and disability was in the Pakistani group, where it is accountable for 7.1% of the population aged 16 to 74 years being economically inactive. The rates for White Irish group (6.9%) and Indian group (6.1%) were above the average for the population as a whole (9.5%). Other ethnic groups had much lower levels than the general population.

Analysis of death certificates suggests that migrants experience higher mortality for all causes than the average population.

Mental health records show that psychotic illness is higher for Black Africans compared to White. Africans, West Indians and Asians have higher rates of drug dependence. Black men and women are less likely to bring psychotic symptoms to the attention of their GP and there is evidence to suggest inequities to accessing appropriate mental health services among these groups.

3From 2001 the Social Class based on occupation has been replaced by the National Statistics Socio-economic Classification (NS-SEC) for official statistics and surveys.

10 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

Health Inequalities between populations in different geographical groups.

Highest levels of permanent sickness or disability are found in Northolt West End, Dormers Wells, Southall Green, Southall Broadway (all having ratio scores between 10% and 30% higher than England) and Norwood Green, with a ratio nearly 50% higher than the average for England

Hanger Hill ward has the highest life expectancy with average for males being 81.2 years and females, 83.4 years. Southall Green has the lowest life expectancy for males at 73.2 years, while Norwood Green has the lowest life expectancy for females at 77.9 years. In South Acton shows a variation with female life expectancy is above the average at 80.9 years while males have the lowest life expectancies in the borough at 73.7 years.

South Acton has the most deprived Super Output Area (SOA) out of the 195 SOAs in Ealing. 76% of children in this area are considered deprived. A super output area has a mean population of about 1500 people. There is widespread income deprivation amongst older people in Southall Green and Southall Broadway where 13 of the 15 SOAs in these wards are within the 10% most deprived in England. 54% of people over 60 years in this area are considered to be income-deprived.

Asthma related hospital admissions for 0 to 19 year olds are highest in Norwood Green and North Greenford, where there are over 10 cases per 1,000 young people. This can be contrasted with areas such as Acton Central and Southfield where the average is less than 2 cases per 1,000 young people. Proximity to major roads, including the M40 and A40, may be a factor.

Low birth weight is more prevalent in the west of the Borough. More than 9% of newborn babies in Southall Green, Lady Margaret, Southall Broadway, Greenford Broadway and Dormers Wells weigh less than 2,500g in comparison to 5% in the nearby wards of Elthorne, Walpole, Southfield and Ealing Broadway.

Southall Green, Southall Broadway, Dormers Wells and Norwood Green have the highest mortality from Coronary Heart Diseases (CHD) and other circulatory disorders. These are four of the five most deprived wards in Ealing. Conversely, Cleveland and Ealing Common have the lowest CHD mortality.

Ealing had just under 6,000 admissions to hospital with cancer as a primary diagnosis between April 2003 and March 2004. Hobbayne has the highest rate at 199 per thousand followed by Greenford. The lowest rates of 87 per thousand were in Perivale and Southall Green.

Health Inequalities between age groups

11 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

Over 25,000 people (8.3% of the total population of the Borough) said that their health was ‘Not Good’ and, as expected, increased steadily with age. This was just below the England average of 9%. Across the age groups, there is a peak of ‘Not Good’ health among men aged between 60 and 64. In women, the gradient is a lot smoother, with a small peak occurring in 55 to 59 age group and larger peaks within the most elderly age groups (85 years and over).

The pattern of limiting long term illness (LLTI) among men and women changes with age. Among younger age groups (aged 0 to 15) males were more likely than females to report an LLTI. From the ages of 35 to 59 females were more likely to report an LLTI. In older age groups, men were more likely than women to report an LLTI when aged 60 to 74; over the age of 75 the situation was reversed.

The proportion of people aged 16-74 who were economically inactive due to permanent sickness or disability increased steadily up until retirement age. The highest rates were in the 60-64 age group for men (35%) and in the 55-59 age group for women (27%).

The impact of looking after family, friends or neighbours is likely to be especially great if the carer is a child. The 2001 Census showed that in Ealing there were nearly 1,100 dependent children providing some form of unpaid care. 16% of these provide unpaid care for more than 20 hours a week.

35 SOAs (18%) are in the top 10% most deprived in England and top 20% most deprived in London for income deprivation affecting children. It is estimated that 28% of all children aged under 16 in the borough live in income deprived families.

Another section of the community at risk of poorer health status due to income deprivation is older people. Ealing has 28% SOAs ranking amongst the 20% most deprived for older people in England, compared with 35% in London. In Southall Broadway 54% of people over 60 years are considered income- deprived.

While people over 65 years old represent 3.4% of the total population of Ealing, this age group contributes to 7% of all suicides – double the population ratio.

Health Inequalities between genders

Nationally, the difference between male and female average life expectancy at birth is 4.6 years, in Ealing the difference is higher at 5 years (based on 1999- 2003 data).

The average life expectancy at birth, of males living in Ealing, is 75.8 years. This is very close to the London average of 75.7 years but lower than the national average of 76 years. The average life expectancy at birth of females in Ealing is 80.8 years. This is slightly higher than the London and national averages of 80.6 years.

12 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

The Census pattern of people reporting their health as ‘not good’ is higher in women than men. However, men are more likely to be permanently sick or disabled.

The spread of coronary heart disease (CHD) is slightly different for men, who have considerably higher rates of admission to hospital, than women. Over 75 men were admitted to hospital with CHD in 4 different Southall wards. The most women admitted in any single geographical ward was 56 (Hobbayne).

A smaller proportion of women carers were likely to be in full time employment compared to men. Women carers were more likely to be economically inactive because they were looking after a home or family.

The ratio between male and female suicides in Ealing is slightly higher at 3.2:1 than the national ratio of 3:1. Over one fifth of all suicides in Ealing (53 of 244 deaths) were committed by men between the ages of 25 and 34 years. Women are most likely to commit suicide in the age range 35-44 years (67% of the 58 female suicides), but women still only account for 29% of all suicides in that age range. Bereavement has been specifically noted as a precipitating factor for 26 individual suicides, of which 8 were committed by women and 18 committed by men.

If we want to reduce the gaps then we must develop local public and community services, based on need, to increase: opportunities for stable employment and income; access to services especially housing, education and healthcare, and opportunity to effect individuals’ lifestyle choices. Community involvement and responsive service improvement should be integral to future service delivery.

13 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

5 Gap Analysis of Services and Interventions Tackling Local Health Inequalities

Identified inequalities are presented in italicised text and the remedies are presented in normal text and further details are given in Evolving a Healthier Community for All: Position Statement of Health Inequalities Work in Ealing. Gaps are presented in bold and will be addressed through the Forward Strategy and Action Plan.

Determinant of health Inequalities in Geographical areas Inequalities between Age Inequalities affected by Inequalities between Ethnic Inequalities between Social groups Gender groups Classes. Environment Outdoor air pollution due to the Inequality in access to Inequality in full enjoyment Inequality in access to well Noise pollution from traffic proximity of major roads (A4 and footways and street lighting of the environment and open maintained open green affecting mental wellbeing A40) and Heathrow Airport; and Acton Town Centre spaces due to fear of crime. spaces Environmental Quality economic activity Liveability Programme 2003- Acton Town Centre Plan for the Environment Mental health protocol for Air Quality Action Plan 2003 6 Liveability Programme 2003- Community Safety strategy EH&TS (contact: 6 2005 [email protected]. Plan for the Environment Parks and Countryside uk) Community Safety strategy ([email protected]) Plan for the Environment Inequality in provision of 2005. play services for young people (including adolescents) GAP 1 Socio-economic Inequality stemming from priority Inequality in job Inequalities of employment Inequality in educational Inequalities in housing for environment housing estates in Southall, and opportunities for the young for women due to achievement between ethnic offenders Acton that are deemed to have and older generations. inadequate child care groups and rest of GAP 6 particular needs. GAP 3 facilities. population. Housing Strategy 2009 Recruitment and retention Education Development Inequalities in standard of Ealing Homes Inequality in access to policies Plan 2002-2007 temporary accommodation Homelessness Strategy 2003-2008 information on benefits and Workplace equality and (www.lgfl.net/lgfl/leas/ealing/ Draft West London Supporting People Strategy and pension entitlement. diversity policies, web/EGFL1/home.htm) Homelessness Strategy Action Plan (contact: Jobcentre Plus Improving Working Lives 2005-2008 [email protected]) (www.jobcentreplus.gov.uk) (NHS) Ealing Homelessness Surestart Inequalities in job Strategy 2003-2008 Inequality resulting from Early Years Development opportunities for BME and High level of permanent sickness antisocial behaviour and Childcare Partnership refugee groups. Educational achievement or disability and low life expectancy Community Safety Strategy Neighbourhood Nursery GAP 5 looked after children and low in wards with highest levels of 2005. Initiative income bracket. deprivation. Children’s Centres and Education Development GAP 2 Extended Schools Plan 2002-2007 ([email protected]) Early Years Development and Childcare Partnership Inequality in housing needs (www.lgfl.net/lgfl/leas/ealing/ of specific groups with web/EGFL1/home.htm) special cultural needs. GAP 4 Accidents and occupational health hazards at work Inequality in housing needs affecting manual workers of specific groups with EH&TS Backs 2005

14 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

Determinant of health Inequalities in Geographical areas Inequalities between Age Inequalities affected by Inequalities between Ethnic Inequalities between Social groups Gender groups Classes. mental health needs Draft Musculoskeletal GAP 4a Strategy (see PCT Local Delivery Plan 2006-8) Lifestyles /health Economic and physical access to Inequality in access to Inequalities from women Inequalities in opportunity to Inequalities stemming from behaviour food physical exercise among smoking during pregnancy. access mainstream service inadequate accommodation Ealing Food Matters Strategy and teenage girls. Ealing Smoking Cessation and financial institutions in for rough sleepers and street Action Plan 2003-2006 GAP 7 Service some BME groups. drinkers affected by 5 a day work in Acton and Southall Sure Start Ealing Food Matters alcoholism. Smoking in children Strategy and Action Plan Alcohol Action Plan 2005 Access to information Enforcement of underage Economic and physical 2003-2006. Homelessness Strategy Ealing Council’s Response sales of tobacco access to food EH&TS Somali Project 2004 2003-2008 programme Community safety initiatives Ealing Food Matters and Healthy Living Initiatives in regarding reducing Action Plan 2003-2006 High levels of HIV in some Teenage conception rates Southall smuggling including Maternity and refugee communities. Teenage Pregnancy Acton Health Umbrella Smoking cessation services infant nutrition co-ordinator Ealing HIV Services Strategy And Action Plan NHS Direct pilot in Northolt High school Directory 2004-2005 2005-2006 Access to suitable drug Rising obesity in young treatment services for Smoking at work Access to health promotion people women Ealing Council and PCT information among BME Ealing Food Matters GAP 7a working with others towards GAP 8 Strategy and Action plan ‘Achieving Smoke Freedom’

2003-2006 Access to services for for Ealing Higher proportion of BMEs Developing obesity victims of domestic violence in drug treatment services prevention and treatment GAP 7b compared to London or services (see PCT Local nationally Delivery Plan 2006-8) GAP 8a

Child protection and mental health issues arising from cultural differences GAP 8b

Access to effective Lack of GPs in Southall area. Inequalities in lack of Patient Inequalities in lack patient Inequalities in lack of patient Access to health or public services (health and Southall Primary Care drop-in choice among older people. choice for gender sensitive choice due to language services information e.g. social care) centre. LIFT schemes to provide (see PCT Local Delivery cultures. barrier. web based information for accessible multifunctional space Plan 2006-8) GAP 9 Patient Advice and Liaison low income social groups. for preventative and diagnostic ‘All Our Futures’, Ealing’s Service GAP 10 services Strategy for older people Inequalities in health needs PCT’s Referral management of carers Inadequate access to social Access to patient choice centre and improvements to minor Inequalities which may arise GAP 9a services and health services Local Delivery Plan includes injuries services due to inadequate care for due to language barrier plans to improve physical (see PCT Local Delivery Plan Children with disabilities Inequalities arising from low culture and lack of disabilities services 2006-8) Services improved through take up of alcohol treatment information on services Children with Disabilities services among women. available. Inequalities in access to Inequalities from high prevalence Pathfinder Trust Alcohol Action Plan 2005 PCT’s translation and primary care services of Diabetes in Southall Children’s Fund Prevention interpreting service among low income social Diabetes Strategy Strategy Inequalities due to Access to information groups

15 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

Determinant of health Inequalities in Geographical areas Inequalities between Age Inequalities affected by Inequalities between Ethnic Inequalities between Social groups Gender groups Classes. inadequate access to breast through various channels Primary Care Access Centre Inequalities which may arise and cervical cancer e.g. libraries, internet and in Southall from families living with HIV screening churches. PCT’s Referral management GAP 10a Cancer Strategy Group Working with communities centre PCT Breast and Cervical community groups. (see PCT Local Delivery Screening Advisory Group Plan 2006-8) Inequality due to lack of Inequalities which may arise counselling and therapeutic from gay men living with HIV interventions for Asian GAP 10b people. Alcohol Action Plan 2005

Inadequate access to social services and health services for those living with HIV, particularly from sub- Saharan Africans. GAP 10c

16 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

6 Key Priorities:

Consultation with service providers in Ealing, analysis of research data, gap analysis, the Coronary Heart Disease Equity Audit and mapping of health inequalities work currently taking place have highlighted key priority areas for Ealing.

These priorities are not in any order of importance and complement each other in enabling Ealing to reach the desired position with regards to reducing inequalities in health outcomes in the borough. They are reflected in the four themes of our action plan but due to their crosscutting nature they cannot be considered under one specific theme.

The Priorities

1. Ensure Council and healthcare services are responsive to various needs of the communities they serve through:  assessing objectively and systematically the population’s needs,  monitoring and evaluating service provision and uptake.

2. Tackling poor standard of housing, and housing related issues, to improve the quality of life for:  children,  vulnerable adults including people with physical disabilities, learning disabilities, and/or mental health needs,  older people,  other vulnerable groups.

Other vulnerable groups include those who face discrimination due to race, gender, religion or belief, sexual orientation, carers, refugees and asylum seekers, Travellers and Gipsies.

3. Facilitating the development of co-ordinated programmes across all services to inform service improvement for reducing coronary heart disease, diabetes, cancer, stroke, tuberculosis, sexually transmissible infections and falls.

4. Promotion of mental health, wellbeing and increasing life chances for all children through:  improving home life,  healthy schools,  educational achievement,  rehabilitation of youth offenders,  increasing opportunities for employment for young people.

17 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

5. Improving the quality of life of older people in Ealing through the promotion of healthy living and an active life in later years through the development of a ten year strategic plan focussing on services that sustain and promote people’s independence in particular:  Transport  Leisure activities  Education  Employment  Safety

7. Key recommendations

There is much activity to be celebrated. However, the persistent nature of health inequalities means that we must continue to:

a) Strengthen and improve effective partnership working to address the underlying determinants of health, and improve access to appropriate medical care, through structured decision-making processes, improved accountability, development of joint service plans and robust systems in place to measure progress. We aim to achieve this by:

i) Maintaining a high level of awareness of health inequalities among senior-level management with regular updates regarding effective actions to tackle health inequalities.

ii) Developing and maintaining a comprehensive picture of local health inequalities between geographical areas and between different groups of people; needs led, culturally appropriate services. This includes systems for data collection and sharing information, research and evaluation, and analysis, dissemination of learning, controlled by agreed protocols where necessary.

iii) Developing improved short-term indicators to deliver long term improvements in health and increases in life expectancy.

iv) Focusing services so the most disadvantaged and vulnerable groups make most progress: engaging with a wide range of stakeholders, including public, patients, and with ‘hard-to-reach groups’ who do not normally access services.

v) Considering pooled budgets across local partnerships to enable effective delivery. Commissioning should take account of the cost- benefits of interventions.

vi) Using a systematic approach to developing, using and sharing innovative evidence based interventions or, in their absence, good

18 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

practice models, to enable frontline workers to respond to community need and to target information and services to different groups in different ways. Learning and processes that lead to effective outcomes should be integrated into mainstream service delivery.

vii) Using analytical tools such as evaluations, health impact assessments and health equity audits to monitor the impact of new and existing initiatives with a health inequalities dimension. Consideration will need to be given to the current capacity available across partner agencies to undertake this work. b) Support the continued focus of statutory agencies to secure human rights, equity in employment and service provision on ethnicity, sex, age, and disability. c) Adopt a community development approach to improving service delivery by:

i) Investing in capacity building to engage with partners at all levels.

ii) Developing the skills and means to enable stakeholder participation and engagement in service planning and delivery.

iii) Identifying, supporting and developing the skills and activities of local people to provide opportunities for them to go into local public services and/or deliver community focused health initiatives. This will be supported by workforce development policies to engage local talent (short, medium and long term). d) Enable local input to be fed into national policy-making and local service improvement.

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Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

8. Forward Strategy and Action Plan

The forward strategy will take the key recommendations into future service improvements, commissioning and delivery, and the action plan will enable activity to address current identified gaps. They will be based on the following principles:

 Preventing health inequalities worsening by reducing exposure to risks and addressing the underlying causes of ill health,  Working through the mainstream by making services more responsive to the needs of disadvantaged populations,  Targeting specific interventions through new ways of meeting need, particularly in areas resistant to change,  Supporting action from the centre by clear policies effectively managed,  Delivering at local level and meeting national standards through diversity of provision.

This forward strategy and action plan recognises that local planners, frontline staff and the local communities know best what the problems are and how to deal with them. At the heart of its delivery is the recognition that sustainable change can only be achieved with the support, enthusiasm and commitment of local people working in partnership with a wide range of local organisations and statutory and voluntary organisations. It is not confined to the most disadvantaged and socially excluded only, but covers the needs of the wider community as well.

21 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

1.0 Addressing the Wider Determinants of Health

Action Milestone Timescale Responsibility Risk Pollution and the Physical Environment 1. Review play services needed by Inclusion in draft Play Strategy 2005 December 2005 Education: Failure to recognise children, young people and Jeff Parkinson leisure needs of adolescents (5-18s) Action planning to involve Active Ealing, March 2006 Play Service young people could (GAP 1) Ealing Homes and RSL providers Manager adversely affect self esteem and social networks of young people, low physical activity levels Unemployment, poverty and deprivation 2. Support the Economic Development Economic Development Strategy draft June 2005 RaMP: Failure to set Strategy to address: Marc Dorfman economic a) development of people, especially development to those with low level literary skills, or Scrutiny and Strategy (for 2006-2016) March 2006 improve the local language barriers, (GAP 5) launch employment b) ‘hard to reach’ unemployed people, opportunities for the (GAP 2, GAP 10a, GAP 10b, GAP Rolling Programme Action Plan for 2006- June 2006 identified groups will 10c) 2009 make health c) people from ethnic minorities and inequalities widen deprived communities, (GAP 2, GAP between those in 10c) employment and d) advice and support for SME ethnically those unable to diverse businesses, (GAP 5) access employment e) increased capacity of affordable housing, (GAP 4) f) development of a skilled workforce, particularly for public sector jobs, including school leavers and older people (GAP 3, GAP 10a, GAP 10b, GAP 10c) Housing and Homelessness 3. Develop information services for Healthier living environments in temporary 2005-2007 Housing Needs: Failure to address clients to enable better sharing of accommodation Ieaun apPrees these gaps will

22 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

1.0 Addressing the Wider Determinants of Health

Action Milestone Timescale Responsibility Risk information, and access to health Increase awareness of the availability of 2007 adversely impact on services. housing advice services targeted to children, young adults (GAP 4, GAP 6, GAP 7a, GAP 8a, promote early intervention to prevent who may become GAP 10a) homelessness. parents, ethnic minorities, refugees, Increased housing support to offenders Feb 2006 asylum seekers, and access to mental health services, and Travellers and health services through implementation of gypsies, those who the London Resettlement Strategy pilot are fleeing domestic violence. Implementation of the Supporting People 2005-2010 Strategy

Establishment of West London landlords June 2006 forum for private sector landlords

West London Homeless website area to 2005-2008 be set up

4. Contribute to implementation of the Development of sub-regional April 2006 West London Homelessness Strategy arrangements with PCTs to ensure that Action Plan, focusing on prevention of homeless people have proper access to homelessness health care provision including consistent (GAP 4, GAP 7a, GAP 8a) access to GP and health visitor services

Consider employing link workers in 2006 hospitals on a sub-regional basis to provide a housing advice and homelessness prevention service to patients before discharge.

Consider development of a sub-regional 2006 protocol for provision of GP and consultant reports.

23 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

1.0 Addressing the Wider Determinants of Health

Action Milestone Timescale Responsibility Risk

Production of information pack for 2006 homeless families and single homeless people

Develop proposals for a homelessness 2006 education package to prevent homelessness among young people

Maintain numbers of rough sleepers at 2007/8 near zero

Monitoring housing advice use against 2006 ethnic origin, disability and other demographic measures to ensure a good service is accessible to all, identify any inequalities and put in specific measures to counter any weaknesses 5. Reduce the number of people Develop Affordable Warmth Strategy and 2006/7 Strategic Housing Older people with low experiencing fuel poverty by Action Plan Services: incomes will be increasing the energy efficiency of Kam Sandhu adversely affected homes and increasing uptake of and this may impact energy efficiency grants (GAP 2, GAP on increased risk of 10) disease and accidents 6. Implementation of the BME and Accessible and co-ordinated advice and 2006 Strategic Housing Ethnic minority groups Housing Strategy Action Plan 2005/6 services for all identified groups, including Services: may be adversely in accordance with the council’s Race Travellers John Coker affected and the gap Equality Scheme become wider, (GAP 4, GAP 10a, GAP 10b, GAP Ethnic minority communities engaged to particularly where 10c) ensure services are appropriate to need health inequalities are of multiple origin, Information on housing support needs of relating to any ethnic minorities collated and combination of low disseminated to stakeholders income,

24 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

1.0 Addressing the Wider Determinants of Health

Action Milestone Timescale Responsibility Risk unemployment, Research commissioned on housing ethnicity, poor needs of specific client groups (based on housing, poor needs analysis) education

Strategy developed to increase provision of affordable larger housing

Recommendations from equality impact assessments requiring services to be sensitive to cultural differences

25 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

2.0 Preventing Illness and Providing Effective Treatment and Care

Action Milestone Timescale Responsibility Risk Reducing Risk through Effective Prevention Failure to address 7. Circulatory diseases, focus on these gaps will not contributory factors: enable the cycle of a) Increase physical activity for Teenage girls activity programme to be 2005-2008 Active Ealing: health inequality to teenage among teenage girls integrated into local area agreement as a Sima Stannage be broken, (GAP 7) stretch target. especially where the b) Produce a Tobacco Control health inequalities Strategy (GAP 7a, GAP 8, GAP Tobacco Control Strategy and Action Plan 2006 Health are of multiple origin, 8a, GAP 8b, GAP 9, GAP 9a, Inequalities relating to any GAP 10) Strategy Co- combination of ordinator: factors Evelyn Gloyn

26 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

3.0 Engaging Individuals and Communities

Action Milestone Timescale Responsibility Risk Crime and Substance Misuse

8. Working with street population to link Establish street population assertive 2005-2006 Community People most at risk of to appropriate services including outreach service to reduce antisocial Safety with St social exclusion may treatment and health, housing and behaviour and move clients away from the Mungos also have lifestyles benefits (GAP 8a, GAP 10) street lifestyle that affect health, substance misuse, alcohol, unprotected sex, smoking, and may also affect unborn children

Supporting Vulnerable Groups 9. Older people Implementation of ‘All our Futures’ Action 2003-2006 Older People’s Older people’s needs Plan Partnership may be overlooked Research need for more extra care Development of Quality of Life/ Autumn 2006 Board due to other priorities, housing and increased support for preventative strategy Geraldine adversely affecting older people to remain in their own O’Shea and their ability to remain homes across all sectors (GAP 9, Leanda independent. GAP 10) Richardson This focus also affects carers (19% women and 15%of men in this group) 10. Local information to local people March 2006 Health Failure to find Increased utilisation of local community Inequalities effective methods of List of local press ad radio to be radio and press Strategy Co- communication with disseminated to communications units, ordinator ethnic minorities may human resources units and people Evelyn Gloyn adversely affect their working in community development access to knowledge, and health promotion (GAP 8, GAP services and 10) opportunities

27 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

3.0 Engaging Individuals and Communities

Action Milestone Timescale Responsibility Risk 11. Engage people with mental ill health, Supporting Failure to address and carers, to address: People Team lack of service and support may lead to a) lack of suitable accommodation and Implementation of the Supporting People 2005-2010 inadequate housing services for people with dual diagnosis Strategy conditions and (especially in the area of substance possible misuse and learning disability) (GAP homelessness 4a, GAP 7a, GAP 8a) resulting in poor health status for b) lack of respite services (GAP 4a, GAP identified groups and 7a, GAP 8a) communities . c) lack of female hostel accommodation (GAP 4a) d) lack of crisis accommodation (GAP 4a, GAP 7a, GAP 8a e) adult placement services (GAP 4a) f) lack of registered accommodation (GAP 4a) g) accommodation and support which are ethnicity specific particularly for Somalis and Afghan communities who make up 80% of asylum seekers in recent years many of whom have been given leave to stay and who do not have a robust social network (GAP 4, GAP 8b) 12. Carry out consultation on health needs Outcomes from the Carer’s Healthcare 2006-2010 Commissioning Failure to address the of carers (GAP 9a) Needs Consultation used to enhance the Team: health needs of this Action Plan of the Supporting Carer’s Sylvia Robinson group may have long

28 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

3.0 Engaging Individuals and Communities

Action Milestone Timescale Responsibility Risk Strategy term health impacts for both the carers and the people they care for. 13. Implement Domestic Violence (DV) Needs analysis and gaps analysis of 2005-2006 Domestic Failure to address action plan 2005-2006 (GAP 7b) Domestic Violence in Ealing Violence Co- these gaps will ordinator adversely impact on Recommendations from the needs Joyce Parker children, young adults analysis to be taken forward into an action who may become plan for 2006-2007 parents, those who are fleeing domestic Increase number of refuge ‘beds’ from 18 violence to 30 (also links to Housing Strategy) 14. Research to identify support Ealing’s Safeguarding Board to April 2006 Ealing Failure to address mechanisms and needs of groups incorporate some work on FGM into its Safeguard these gaps will affected by practices such as female three year plan Childrens Board adversely impact on circumcision, forced marriages, children, some ethic ‘honour’ killings (across West London) minorities (GAP 9, 8b) 15. Travellers Strategic Failure to address Housing these gaps will Participate in a pan-London Establish Travellers working group October 2005 Services adversely impact on acomodation needs survey of Gill Tennet children, young adults Travellers in line with ODPM Findings from needs analysis will inform a 2006 who may become requirements. (GAP 4, GAP 8, GAP 9, pan-London Travellers Accommodation parents, Travellers GAP 10) Strategy and gypsies, those who are fleeing domestic violence 16. Neighbourhood renewal action to Increased uptake of ‘welfare to work’ 2006-2008 Neighbourhood Failure to address address community capacity in wards scheme, in wards with highest levels of Renewal these gaps will impact with highest levels of deprivation (GAP deprivation. on those who are 2) disadvantaged due to sickness or disability and through the place

29 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

3.0 Engaging Individuals and Communities

Action Milestone Timescale Responsibility Risk where they live 17. People living with HIV (GAP 10a, GAP Establishment of an Integrated Community June 2006 Adult Services- Failure to address 10b, GAP 10c) HIV Team bringing together social Disabilities these gaps will impact services, housing and PCT staff into a Division on families living with single point of contact. HIV, gay men and adversely affect Black Development of Commissioning and African communities Sexual Health Strategy 18. People who are transsexual or Establish a relevant and appropriate June 2006 Health Failure to address this transgender (GAP identified through process for engagement with these Inequalities gap will impact on equalities impact assessment) groups. Strategy Co- transsexual and ordinator transgender people Carry out a health needs assessment March 2007 Evelyn Gloyn

30 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

4.0 Supporting Families, Parents and Children Action Milestone Timescale Responsibility Risks Maternal and Child Health and Child Development

19. Staff training to be developed and Midwives, health visitors and counsellors March 2006 Universal Child Failure to address rolled out to support parenting skills, trained to deliver advice on improving Health Service: these will impact on how to recognise and cope with post parenting skills, including use of the Anne Lyster child development natal depression (GAP 2, GAP 8, Maternal Mood Assessment Tool for to that may lead to GAP 9, GAP 10) tackle postnatal depression. Delivered as increased health part of the universal child health service, problems in later life, working with children’s centres and lack of social extended schools, and health workers networks, low self working with ethnic minority communities esteem affecting mental wellbeing Research on needs of child carers Outcomes from the Carer’s Healthcare 2006-2010 Commissioning resulting in poorer (GAP 1) Needs Consultation used to enhance the Team: health, and lack of Action Plan of the Supporting Carer’s Sylvia Robinson access to Strategy opportunities, and will also adversely affect children from ethnic minorities, refugees, asylum seekers and Travellers and gypsies. Improving Life Chances for Children and Young People 20. Implement Supporting People Strategy September 2005- Strategic Failure to address (GAP 2, GAP 4, GAP 6, GAP 7a, 2008 Housing these may lead to GAP 8a, GAP 9 GAP 10) Services: insecurity, low self Service Head, esteem, mental ill John Coker health, problems getting jobs, or access to further education and skills, or developing social networks to support

31 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

4.0 Supporting Families, Parents and Children Action Milestone Timescale Responsibility Risks them. They may also have lifestyles that affect health, including substance misuse, alcohol, unprotected sex, smoking, and may also affect unborn children 21. Consultation of housing support needs of teenage parents across all tenures Analysis of consultation with young September 2006 Jennifer Teenage parents (GAP 3, GAP 4, GAP 5, GAP 7a, parents used to develop support for Nsubuga often suffer multiple GAP 9, GAP 10) teenage parents in respect of their housing Teenage problems that impact needs Pregnancy Co- on their health and Ordinator the health of their children 22. Low income Failure to address these will adversely Improve generalist advice services, Jobcentre plus affect those on low especially with respect to mental income, lone health, family, debt, benefits and parents, ethnic community care (GAP 2, GAP 3, GAP minorities, people 4, GAP 5, GAP 7a, GAP 8, GAP 8a, with disabilities, older GAP 9, GAP 10) people 23. Services for Children Failure to address these will affect a) Develop region wide workforce career Engagement with partners to facilitate April 2006 Workforce delivery of services pathways to fill vacancies on social public workforce development Development to children, and by workers and health workers to Workstream for not promoting local encourage recruitment people from Children career opportunities local communities (GAP 1, GAP 3, it will not offer GAP 5) employment opportunity, or b) Develop the youth forum or youth Production of Youth Forum/Parliament September 2006 Engagement aspiration to develop parliament and its programmes (GAP programme as part of Youth Matters Workstream for skills to affected

32 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

4.0 Supporting Families, Parents and Children Action Milestone Timescale Responsibility Risks 1, GAP 2, GAP 3) Children individuals, or support community c) Develop 14-19 strategy for Ealing, Draft 14-19 strategic plan April 2006 14-19 development.Could (GAP 1, GAP 2, GAP 3, GAP 4, GAP Workstream impact on 5, GAP 7, GAP 10) Jan Parnell safeguarding. d) Develop protocol to continue link to Transition social worker in Children with 2006/7 Children with Failure to engage adult social care services when disabilities team to continue link to adult Disabilities trust with the youth forum change for children implemented social care services when change for and other vulnerable (GAP 2, GAP 3, GAP 4 GAP 4a, GAP children implemented groups will not 5, GAP 6, GAP 8, GAP 9, GAP 9a, enable services to GAP 10) meet need, and therefore not improve health. Since these gaps relate to ethnic minorities and other vulnerable groups who are more likely to have poorer educational outcomes, problems in home life, the gap in health inequality is likely to widen. 24. Trading Standards Failure to effectively regulate harmful Working together with other Resources to be secured and partnerships September 2006 Doug Love substances will stakeholders to control illegal tobacco with other stakeholders to be developed. endorse the and alcohol activity and underage message that sales of knives, solvents, alcohol, children are not tobacco in deprived areas (GAP 2, being protected. It GAP 3, GAP 7, GAP 10) can also undermine support for parents, and may increase fear of crime

33 Evolving a Healthier Community for All: Ealing’s Health Inequalities Strategy

4.0 Supporting Families, Parents and Children Action Milestone Timescale Responsibility Risks Reducing Teenage Pregnancy and Supporting Teenage Parents 25. Teenage pregnancy and parenthood To set up and co-ordinate local data June 2006 Teenage Failure to have local strategy (GAP 2 GAP 3) collection to ensure availability of up-to- Pregnancy Co- appropriate data date data for more effective targeting. ordinator: means that local Jennifer needs are not Nsubuga prioritised

34 Draft for Consultation

Background Papers

Acheson, D. (1998) Independent inquiry into inequalities in health. Report of the Scientific Advisory Group. London: Stationery Office.

Dahlgren, G., Whitehead, M. (1992). Polices and Strategies to promote equity in health. WHO: Copenhagen.

DfES (2003) Every Child Matters London: The Stationery Office.

DH (2002) Tackling health inequalities. Summary of the 2002 cross-cutting review. London: Department of Health.

DH (2003) Tackling health inequalities: a programme for action. London: Department of Health. www.doh.gov.uk/healthinequalities/programmeforaction

DH (2004) Choosing health. Making healthy choices easier. Public Health White Paper. London: Department of Health.

DH (2005a) Independence, Well-being and Choice: Our Vision for the Future of Social Care for Adults in England London Department of Health.

DH (2005b) Tackling health inequalities: Status Report on the Programme for Action. London: Department of Health. http://www.dh.gov.uk/assetRoot/04/11/76/97/04117697.pdf

DH (2006 Our health our care our say: a new direction for community services. London: Department of Health. http://www.dh.gov.uk/assetRoot/04/12/74/59/04127459.pdf

HDA (2004) Promoting healthier communities and narrowing health inequalities: a self- assessment tool for local authorities. Health Development Agency. Office for National Statistics (2000) Health Survey for England. The Health of Older People. London: The Stationery Office

Office for National Statistics (1999) Health Survey for England. The Health of Minority Ethnic Groups. London: The Stationery Office.

ODPM (2005) Creating Healthier Communities: A resource pack. Office of the Deputy Prime Minister.

World Health Organisation (1946) Preamble to the Constitution of the WHO as adopted by the International Health Conference, New York, 19 June-22 July 1946

World Health Organisation (1984) Health Promotion: A WHO Discussion Document on the Concepts & Principles. in: J. Institute of Health Education 23/1, 1985

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Local documents

Ealing Drug Alcohol Action 2005a Needs Analysis 2005-2006 Ealing DAAT Team Ealing Drug Alcohol Action 2005b Harm Minimisation A Strategy for Ealing DAAT Team Ealing Primary Care Trust 2003 Annual Public Health Report 2003/4 http://www.ealingpct.nhs.uk/content/download s/Annual%20Public%20Health%20Report%20 2003-2004.pdf Ealing Primary Care Trust 2005a CHD Equity Audit-Ealing http://www.ealingpct.nhs.uk/content/download s/CHD%20Equity%20audit%20final.pdf Ealing Primary Care Trust 2005b Local Delivery Plan 2006-2008 http://www.ealingpct.nhs.uk/content/publicatio ns/default.asp

London Borough of Ealing 2002 Ealing’s Local Neighbourhood Renewal Strategy and Action Plan http://www.ealing.gov.uk/council/lsp/neighbour hood+renewal+strat.asp#neighbourhood London Borough of Ealing 2003a Air Quality Action Plan http://www.ealing.gov.uk/services/environment /pollution/air+pollution/air+quality+asp

London Borough of Ealing 2003b Teenage Pregnancy Strategy London Borough of Ealing 2004a Housing and BME Strategy Needs Contact Beryl Noori Housing Strategy Team London Borough of Ealing 2004b Needs Analysis and Draft Priorities for Supporting People Contact [email protected] London Borough of Ealing 2004c All our Futures, strategy for Older People London Borough of Ealing 2004d Ealing’s Food Matters, a food strategy for the borough London Borough of Ealing 2005a Community Safety Strategy 2005-2008

London Borough of Ealing 2005b Evolving a Healthier Community for All: Position Statement London Borough of Ealing 2005c Evolving a Healthier Community for All: Health Indicators for Ealing London Borough of Ealing 2005d Supporting People Strategy LSP 2003 Community Strategy http://www.ealing.gov.uk/council/lsp/full+comm unity+strategy.asp West London Alliance 2005 West London People an Introduction to Communities and Faiths http://www.westlondonalliance.org/

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