Inequalities and wellbeing

1. Inequalities and wellbeing Public Services working Together

2. Social Inequalities in health Source: Norwegian Ministry of health Care Services, 2007

3. Where you are born, who your parents are and your earliest life opportunities impact on all your life course Pre-birth Early years School age Young adults Health Personal development Educational attainment Infant health Early development Achievement at end primary Developing positive behaviours Staying engaged at 16-18 Opportunities to access university High test scores High social class Low social class Age months

4. The income gap between the richest and the poorest is growing not shrinking Relative household income richest 10% median income poorest 10% In 2006 the most affluent 10% are earning relatively much more per week than in 1961 – the poorest 10% relatively the same Source: FES, IFSanalyses

5. Living in poverty affects every part of peoples’ lives For example, children living in poverty are less likely to do well at school 60 And women who grew up in poverty are less likely to earn at / above the average wage as adults 50 40 30 (percentages) Pupils with 5 GCSE grades A* to C 20 0.45 0.4 10 0.35 0.3 0.25 0 no qualifications Comparative hourly earnings with those with 0.2 0-10 11-20 21-30 31 and 0.15 over 0.1 0.05 Pupils eligible for free school meals (percentages) 0 CSE/other O-levels A-levels Higher other Degree or above Highest level of qualification 1958 cohort 1970 cohort

6. Poor health is both a cause and a consequence of poverty More people born in to Social Class V die in early middle age than those with fathers in Social Class I Cumulative death rates 26 to 54 years by father’s social class men and women born in March 1946 1.00 0.99 0.98 0.97 Proportion alive Key Social Class I Social Class V 0.96 0.95 0.94 0.93 26 30 34 38 42 44 48 54 Kuh et al, 2003 Age in years

7. In 2008 there is 40 years difference in apparent health year between Rutland and Manchester Manchester has an apparent health year of 1984 Rutland has an apparent health year of 2023

8. Major burden of disease Major burden of disease – – leading 10 selected leading 10 selected risk factors in developed countries risk factors in developed countries (% cause of disease burdens measured in Disease Adjusted Life Ye (% cause of disease burdens measured in Disease Adjusted Life Years) Tobacco Tobacco High blood pressure High blood pressure Alcohol Alcohol Cholesterol Cholesterol Overweight Overweight Behavioural Fruit & Veg intake Fruit & Veg intake factors Physical inactivity Physical inactivity explain the Illicit drugs Illicit drugs majority of years lost Unsafe sex Unsafe sex Iron deficiency Iron deficiency 0 0 2 2 4 4 6 6 8 8 10 10 12 12 14 14 Peoples lifestyles & related risks are the causes of a growing burden of disease

9. Some groups live lives that are riskier to their health People in social class V are three to four times more likely to have two of three lifestyle risks (smoking, harmful levels of alcohol consumption and poor diet) compared to those in social class I For females, 20% of people have two of For males, 30% of people have two of three three behaviours in social class V behaviours in social class V compared to compared to <5% in social class I <10% in social class I Percentage of women Percentage of men 0 10 20 30 40 0 10 20 30 40 I I II II IIIn IIIn Social class Social class IIIm IIIm IV IV V V Key Key = Three behaviours = Two or more behaviours = Three behaviours = Two or more behaviours

10. Problems are interrelated NEETs are disproportionately likely to misuse drugs & alcohol Teenage pregnancy Substance misuse NEET Truancy & Behaviour Youth crime 71%of young women who are NEET for 6 months & between 16-18 are parents by 21 3 in 5 excluded young people report having offended Persistent truants are nearly 10 times more likely to be NEET at16 and 4 times more likely to be NEET at 18 Young people with emotional &behavioural difficulties are 4 times more likely to use illicit drugs

11. From mid life onwards smoking has a greater impact on life expectancy than socioeconomic status does

12. Proportion of single handed practices: QOF: % points available In deprived areas, patients do not get the best quality of care % satisfied - average across 5 domains from patient survey: • Scoring on the QOF (a measure of the quality of primary care) is higher in more affluent PCTs • There are proportionally more single handed practices in deprived PCTs • Patient satisfaction is higher in affluent PCTs

13. Targeted interventions do work - Sheffield achieved a 7% greater reduction in CVD death rates in its most deprived communities (23% v 16%) Sheffield Initiative to Reduce CHD (CIRC) • Identify GP practices with high CHD mortality • Targeted support with specialist nurses to assist them in developing at risk registers and promoting statin prescribing • Differential increase in statin prescribing • in less privileged areas

14. Meet… Charles Helen Mario Rebecca Sergej Tatjana Mark Maggie Antonio Victoria Anatoly Margareta

15. Children’s health has been affected by a several external global factors Children are travelling more and exposed to diseases ((skin cancer) Huge medical advances in life saving treatments-more lives saved Fast food popular with children – growing consumption and rising rate of obesity Technology has transformed communication Sex, Drugs, Alcohol no longer have the stigma that they once did when people grew up with strongly involved grandparents of the war / Victorian era. Genetic disorders – diagnosed and treated better (foetal transfusion) TV is major source of entertainment

16. We say we know we need to eat more fruit & vegetables – more so than others Q What do you think ‘eating a healthy diet’ involves? Germany 77% UK 70% Netherlands 61% Ireland 59% Sweden 59% EU 25 58% Spain 49% France 44% Italy 35% Source: Eurobarometer 64.3 2005. Base c1,000 interviews in each country

17. ….For childhood obesity, we reckon its up to the state Who is at fault for obesity 80 Who is responsible for addressing it? 60 40 76 69 48 20 40 31 30 22 12 0 Parents Food and drink The individual The state manufacturers Source: Henley Centre (2005) Note: HCHLV is soon to release up to datedata. Early cuts of which show broadly similar trends

18. Baby Born to affluent parents – will live 10-15 years longer than friends below Aged 10 Enjoying a good life, lots of opportunity, good education, etc Aged 20 Enter at university with good marks. Plays sport and eats a healthy diet Aged 45 Fit and healthy with a good job Aged 10 Growing up in a disadvantaged environment, as are many kids in Europe Aged 20 Left school with no qualifications, casual labourer, drinks, smokes and takes drugs Aged 45 Weighs 18 stone/114 kg, has high cholesterol, early stage type 2 diabetic How do we achieve more equal life chancesWhose responsibility is it? Charles, Rebecca, Sergej, Helen Aged 60 Retired early to spend time with grand-children and travel Mark, Maggie, Anatoly, Victoria Aged 60 Died from massive stroke Baby One of many low income teenage conceptions. Will live 10-15 years less than their friends above. Adapted from: D. Harrison (2007)

19. As public service leaders we can change people’s life chances and help shape the communities in which we live The challenges are to….. • Raise community aspirations for change • Identify the positive assets and build upon them • Create and share common cultures across public services • Work through commissioning and place shaping • Build upon JSNA • Lead together • Identify and share our strengths

20. Vision

21. Visible leaders with mandate Strategic vision with clear outcomes Success through partnership Excellent business organisations Empowered communities Seek out & act on public expectations Excellent knowledge management Clinically driven Manage the system