FAULDHOUSE AND THE BREICH VALLEY HEALTH INEQUALITIES REPORT 1.0 Introduction A motion, tabled by Councillor Neil Findlay requesting information on how health inequalities in the ward are being addressed, was endorsed by the LAC at its meeting on 10 November 2009. The terms of the motion are set out below: ‘Motion: Health Inequalities in West Lothian. The recently published West Lothian Council community planning progress report (page 12) shows that there are 19 data zones in the worst 15% in Scotland within the health domain. Of these 19 the Fauldhouse and Longridge area has the lowest male life expectancy of 71.61 for males and second lowest for females at 76.41. This compares with Livingston Murieston at 81.83 for males and Bathgate west 84.97 for females. Areas of Stoneyburn, Addiewell, Polbeth and West Calder will be similar in their health profile but will not be highlighted due to the way in which these statistics are calculated. Committee expresses its deep concern about these inequalities and instructs Council officers to liaise with its community planning partners to:- Identify projects that will begin to address the health inequalities that exist in the Breich Valley Bring back a detailed and costed report on the above within 6 months of this meeting Identify areas of council spend that have been or are being targeted at reducing health inequalities i.e. where money is being taken from one geographical area and targeted at another with greater need.’ This paper is a response to the motion and reflects the range of activities, across the Community Planning Partnership (CPP) that are currently underway in the ward to address health inequalities. 2.0 National Context Health inequalities can be defined as the differences found in various aspects of health between different groups in society. The major causes of health inequalities are related to socio-economic circumstances such as employment, income, housing and education. Diversity (age, disability, gender, race, religion or belief, sexual orientation) and life circumstances interact and pose increased risks to health. People do not just live in poverty, they may also be a lone parent, may have a long-term disability that affects the work they can do, or live with discrimination which has an impact on their mental health. 1 The Scottish Government report ‘Equally Well’ (2008) outlined the approach required to address the inequalities in the health of people in Scotland. The report stated that these inequalities were unfair and unjust, because they are based on social structures and factors as described above. These inequalities mean that some people are more likely to be ill or have low levels of wellbeing and as a result, die younger than others. The report further concluded that “reducing such inequalities in health will play a significant part in creating a skilled, resilient population with the sense of wellbeing and control over their own lives, keen to look after their own health and able to participate in the economy and employment opportunities of the future.” The report identified priorities where action was most needed to reduce inequalities in healthy life expectancy and wellbeing, as follows: Priority 1: Children’s very early years, where inequalities may first arise and influence the rest of people’s lives. Priority 2: The high economic, social and health burden imposed by mental illness, and the corresponding requirement to improve mental wellbeing. Priority 3: The “big killer” diseases: cardiovascular disease and cancer. Some risk factors for these, such as smoking, are strongly linked to deprivation. Priority 4: Drug and alcohol problems and links to violence that affect younger men in particular and where inequalities are widening. As well as these priorities and taking account of the evidence about what causes inequalities in health, the Task Force agreed key principles to drive this work. These are: Principle 1: Improving the whole range of circumstances and environments that offer opportunities to improve people’s life circumstances and hence their health. Principle 2: Addressing the inter-generational factors that risk perpetuating Scotland’s health inequalities from parent to child, particularly by supporting the best possible start in life for all children in Scotland. Principle 3: Engaging individuals, families and communities most at risk of poor health in services and decisions relevant to their health. Principle 4: Delivering health and other public services that are universal, but also targeted and tailored to meet the needs of those most at risk of poor health. A subsequent submission statement to the Joint Ministerial Task Force on Health Inequalities from COSLA and the Improvement Service (March 2010) demonstrates ongoing local authority support for the three social policies that are designed to create a fairer more equitable Scotland: Equally Well, the Early Years Framework and Achieving our Potential. 2 The UK government paper in 2003 Tackling Health Inequalities: A Programme for Action reviewed the evidence from the Independent Inquiry into Inequalities in Health, and identified that in order to achieve the targets and tackle the underlying determinants of inequalities, action would be required across government. Actions likely to have greatest impact over the long term are: improvements in early years support for children and families improved social housing and reduced fuel poverty among vulnerable populations improved educational attainment and skills development among disadvantaged populations improved access to public services in disadvantaged communities in urban and rural areas, and reduced unemployment, and improved income among the poorest. 3.0 West Lothian Context 3.1 Single Outcome Agreement In November 2009 the Community Planning Partnership agreed its Community Plan to cover the timeframe from 2010 to 2020. A key consideration in the adoption of the plan was the way in which the Single Outcome Agreement would align with it and be the instrument with which we would measure performance. The Community Planning Partnership commissioned work to establish a Golden Thread showing the links between the SOA and partners plans and strategies. The partners also agreed that they wished to focus on the 15 national outcomes and make links with the life stages work that has been ongoing. The national outcomes of particular relevance to this report are: we live longer, healthier lives we have tackled the significant inequalities in Scottish society. 3.2 Locality Plan In November 2008, the Fauldhouse and the Breich Valley Local Area Committee approved the Fauldhouse and the Breich Valley Locality Plan for 2008 – 2011. The plan outlines three main priorities for the ward: employability, health and development challenges. The priorities were based on a statistical analysis of the ward aligned to the Single Outcome Agreement challenges, previous locality planning work and community engagement experiences and on-the-ground experiences of workers. The Locality Plan is currently being implemented by Community Planning partners. Annual updates of the plan have and will continue to be tabled at the Local Area Committee. The health priority is focused around substance misuse, poor diets and a lack of exercise. Poor diets and a lack of exercise are contributing to the poor health and low life expectancy in the area. This issue is magnified by the lack of availability of fresh fruit and vegetables for residents. Activities within the plan aim to address these issues locally. 3 3.3 Life Stage Programme The overall aim of the West Lothian Life Stage Outcome Planning Programme is to enable the Community Planning Partnership to plan and deliver more effective interventions to tackle social inequalities and build successful communities across West Lothian. This provides a significant opportunity to do things differently, demonstrating a new, innovative way of developing Community Planning outcomes, achieving more flexibility in target setting and resource allocation to help us better achieve the outcomes we have set. There are 3 main objectives for the Life Stages programme: Reducing inequalities by targeting services at those most at risk Shifting resources ‘upstream’ and reinforcing a prevention approach Ensuing maximum impact from expenditure The Early Years Life Stage’s target population is children under the age of 5 (and in particular those aged 0 – 3) who are living with a parent or carer with a substance misuse problem. The long term outcomes for this population are: children are ready to start nursery and school & parents and carers are responsive to their children’s developmental needs The School Age Life Stage’s target population is children and young people at risk of failing to achieve their potential owing to serious adverse circumstances. The long term outcome for this population is: everyone’s life chances are maximised (by improving their educational attainment) to become successful learners, confidant individuals, responsible citizens and effective contributors The Young People in Transition Life Stage’s target population is young people between the ages of 14 to 25 in need of additional support to achieve positive transitions. The long term outcomes for this population is: our young people are successful learners, confident individuals, effective citizens and have a positive destination. The Adults of Working Age Life Stage’s target population is adults aged 25 – 40 on a health related benefit and women returning to the job market. The long term outcome for this population is: every adult has the confidence, skills and ability to secure and sustain employment. The Older People’s Life Stage’s target population is people over working age who are most at risk of poor health outcomes and low quality of life, particularly during times of transition. The long term outcome for this population is: older people live longer, healthier, more independent and fulfilling lives within a safe and supportive community. Each long term outcome is underpinned by a number of SMART short term and medium term outcomes established though a process of logic modeling and based on local evidence and intelligence.