Community Regeneration and Health Improvement Developing an outcomes focused approach

1. Community Regeneration and Health Improvement Developing an outcomes focused approach Erica Wimbush NHS Health Scotland

2. Outline • Policy drivers • An outcomes approach to planning and performance management • The potential role of community regeneration in delivering health improvement outcomes – what can be done? • Community Planning Partnerships – what is the best approach?

3. Closing the Gap Audit of community planning Public service reform Review of HI performance management Review of HEAT targets Taking Stock New PM framework for local authorities Policy drivers

4. An outcomes approach to planning and performance management

5. PLANNING National level outcomes INPUTS PROCESS OUTPUTS SHORT-TERM OUTCOMES MEDIUM-TERM OUTCOMES LONG-TERM OUTCOMES REPORTING Results for users of delivery Outcome-focused planning & performance reporting

6. National level outcomes INPUTS PROCESS OUTPUTS SHORT-TERM OUTCOMES LONG-TERM OUTCOMES MEDIUM-TERM OUTCOMES Delivery of HI actions Health determinants Indiv lifestyle Social & Community Networks Living & Working conditions General socio-economic, cultural and environmental conditions • Health outcomes • Reducing inequalities in - • Physical health • Mental health • Well-being A complex and multi-level system of cross-sectoral partnership-based delivery

7. The main determinants of health Dahlgren & Whitehead, 2004

8. THE SCOTTISH PARLIAMENT Health & Social Care Committee LOCAL GOVERNMENT Local COMMUNITY PLANNING PARTNERSHIPS THE SCOTTISH EXECUTIVE Health & Well-being Directorate Community health projects Voluntary orgs 32 LOCAL AUTHORITIES 42 COMMUNITY HEALTH PARTNERSHIPS The planning and delivery infrastructure for Health Improvement Outcomes National SCDC CHEX SCC SFHA SCVOVHS LTS SHPSU COSLA LGIS COMMUNITIES SCOTLAND HPS ISD NES QIS FSAS HEALTH SCOTLAND Regional 14 NHS BOARDS

9. The potential role of community regeneration in delivering HI outcomes What can be done? WHO Europe, 2006 Levelling up (Part 2): a discussion paper on European strategies for tackling social inequities in health Göran Dahlgren and Margaret Whitehead

10. Influencing health determinantsWhat can be done? • Promoting positive health factors– for example Economic security, adequate housing and food security Control over life outcomes, good family and social relationships • Strengthening protective factors– for example Immunization against infectious diseases; Protection from hazards/community safety; Social support, sense of purpose and direction in life; Healthy diet • Risk factors/conditions – for example Lifestyle related risk factors – smoking, excessive drinking and eating; Social or economic risk factors - poverty, low income, unemployment, isolation; Environmental health hazards, such as air pollution, road traffic. WHO Europe (2006) Levelling Up - Part 2

11. Reducing health inequalitiesWhich approach? • Focusing only on people in poverty or the most deprived localities • Narrowing the health divide • Reducing social inequities throughout the whole population. WHO Europe (2006) Levelling Up - Part 2

12. Economic regenerationWhat can be done? Economic growth strategies – Health is Wealth • Potential health benefits of economic growth • Population health as a determinant of economic growth; high social and business costs of poor health Policy options for reducing health inequalities • Economic growth recognised as a resource for human development, esp for disadv groups/areas • Successful growth reduces poverty and income inequalities, improves living conditions, access to education and healthcare • Use human development measures of growth - health adjusted measures of GNP, Millennium Dev Goals WHO Europe (2006) Levelling Up - Part 2

13. Getting people into work What can be done? Work environment and unemployment • Positive social aspects of work environment • Health hazards of work – work-related ill-health, stress and physical safety still a significant factor in burden of disease • Negative health impacts of unemployment Policy options for reducing health inequalities • Health & safety legislation • Actions that remove physical hazards in the workplace and improve psychosocial conditions • Actions to improve the employability of those out of work • Rehabilitation of those off sick or on incapacity benefit • Develop the workplace as a setting for health promotion. WHO Europe (2006) Levelling Up - Part 2

14. Education, learning, skillsWhat can be done? Education and health • Improved health literacy • Impacts on job opportunities, income level, occupational stresses/hazards • A route out of poverty for disadvantaged groups and a channel for social mobility • Empowerment – enabling and encouraging participation in the community; more control over life Policy options for reducing health inequalities • Reduce barriers to gaining access to education and life-long learning for disadvantaged groups • Comprehensive support programmes for children in less privileged families, to promote preschool development, prevent school drop-out, and support the school-work transition • Reduce social segregation within the school system • Health Promoting Schools WHO Europe (2006) Levelling Up - Part 2

15. Environmental regenerationWhat can be done? Environment and health • Housing quality, overcrowding, homelessness, thermal efficiency, child safety • Security/safety – mental health & injuries from crime, violence and disorder • Transport/roads – mobility/access to services, road deaths and injuries • Access to green space – mental health and physical activity benefits

16. Social regenerationWhat can be done? Social and community inclusion strategies The extent and quality of social networks, participation and relationships have • Individual level health impacts • Population level health impacts Policy options for reducing health inequalities • Bolstering individual social and emotional support • Promoting horizontal integration and interaction • Promoting vertical social interactions and bonds WHO Europe (2006) Levelling Up - Part 2

17. Community PlanningWhat is the best approach to delivering HI outcomes?

18. Community planningWhat are the priorities? • Responding to demographic change • Economic growth, job opportunities • Education, lifelong learning, employability/skills • Environment – transport, housing, neighbourhoods • Social justice, inclusion, equity • Community safety and security • Health improvement

19. Getting people into work Education learning, skills Environments Community safety Health improvement CPP Vision A Better Community Life Responding to demographic change CPP Strategic Objectives CPP Actions & Outcomes National level outcomes A Better Scotland

20. CPP Vision A Better Community Life Responding to demographic change CPP Strategic Objectives Getting people into work Education learning, skills Environments Community safety Health improvement CPP Actions & Outcomes ROA ROA ROA ROA ROA/JHIP Workless h’holds Unemployment, New Deal Incapacity Disability Literacy & numeracy School absence Foundation skills Access to services Fear of crime Crime rates Smoking, Alcohol Diet, PA, etc National level outcomes Wealthier Smarter Sustainable Safer Healthier Inequalities in Mortality A Better Scotland

21. Getting people into work Education Learning, skills Environments Community safety Social inclusion CPP Actions & Outcomes CPP Vision A Better Life Responding to demographic change CPP Strategic Objectives National level priority outcomes Health determinants Reducing health inequalities A Better Scotland