Health inequalities

1. Health inequalities Linda de Caestecker Director of Public Health NHS Greater Glasgow and Clyde

2. ‘Who were the women who, day by day, trod the very stones on which my feet now stood?... Child-burdened women who were left without money, without the means or opportunity or physical power to earn it, who had stolen in order to save their lives and that of their children.’… if such women become ‘sodden by drink, undermined by drug taking…what hope is there of cure by imprisonment?’ Lytton, C. (1908) Prisons and Prisoners: Some Personal Experiences. London: Virago.

3. With Health in Mind – quote from Georgina Brown, “In my vision the perspective of primary care should shift away from the traditional paternalistic view of people living in deprivation to one in which patients are encouraged to value their own lives and develop their potential…. The aim would be for all patients to have a purpose each day. Without a 'Purpose,' life is meaningless and people will remain static and poor.”

5. Top 10 Tips for Better Health Chief Medical Officers Top Ten Tips • Don’t smoke, if you can stop, if you can’t cut down • Follow a balanced diet with plenty of fruit and vegetables • Keep physically active • Manage stress by, for example, talking things through and making time to relax • If you drink alcohol, do so in moderation Alternative Tips – Townsend Centre • Don’t be poor. If you are poor, try not to be poor for too long • Don’t live in a deprived area. If you do, move • Don’t be disabled or have a disabled child • Don’t work in a stressful low paid manual job • Don’t live in damp, low quality housing or be homeless

6. Tackling poverty in GlasgowFive core messages • Dignity has to be at the heart of any framework • People struggling against poverty need to be seen as part of the solution • More effective coordination of anti-poverty work • Public sector spending must be targeted on tackling poverty and inequality • Welfare reform necessitates action now

7. Income maximisationHealthier Wealthier Children To build action on child poverty and financial inclusion services into mainstream child and families • Dedicated Financial Inclusion workers • Information and awareness raising for Midwives and Health Visitors • Almost half of advice cases gained financially • Average client gain: £3404 • Range: £2,259 - £5,636

8. Learning for health staff • Midwives, health visitors and other health staff can play a significant contributory role towards addressing child poverty and can integrate into their daily practice. • Limitations of signposting and the importance of routine enquiry which can reduce stigma and increase uptake • The importance of positive staff attitudes to ensure engagement.

9. Good parenting can limit effects of poverty • Only 19% of children who had lived in persistent poverty and experienced the lowest level of parenting had good achievement ….whereas • 58% of children who had lived in persistent poverty but with high parenting scores had substantially higher achievement • 73% of children who had not experienced poverty and had high parenting scores had the highest achievements (Kiernan and Mensah 2011)

10. Inadequate housing, homelessness, and family poverty are structural issues but are no less amenable to intervention than the health conditions they engender. The way they differ is in the type of intervention required. …Advocacy is structural therapeutics. Roberts I. Deaths of children in house fires.BMJ1995; 311: 1381-2