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NDCs and Health Overview of Phase 1

Explore the impact of Area-Based Interventions (ABIs) on health in 39 deprived English localities, focusing on key health themes, interventions, funding, and evaluation methods.

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NDCs and Health Overview of Phase 1

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  1. NDCs and HealthOverview of Phase 1 Liddy Goyder, ScHARR University of Sheffield

  2. The health “theme team” University of Sheffield • Liddy Goyder • Jean Peters • Lindsay Blank • Libby Ellis Sheffield Hallam University • NDC team, Mike Grimsley MORI and SDRC for health data

  3. Overview • What are NDCs and what do they do? • What are “health” issues for NDCs? • “Health-related” activity in NDCs: example of healthy eating initiatives • So has health improved in NDCs? • Do we expect NDCs to have an impact on population health in the future?

  4. The NDC Programme • Launched in 1998 • Ten year, community led, holistic ABI in 39 deprived English localities • Five outcome areas: housing and environment,jobs, education, crime, health • £50 million per partnership • Compares to about £600 million from mainstream service providers • Plus funding and activity through other ABIs

  5. Complexity of ABI evaluation • Dealing with attribution when so many previous/present initiatives • Change in any ABI related to wider local/ regional/national changes • Area based interventions but aimed at individuals • Spillover/displacement

  6. Delivery Plans 2004Top 7 outcomes for health • Health promotion: diet, exercise, health and well-being (31) • Death rate/SMR and life expectancy (30) • Mental health (16) • Health services-access (15) • Smoking (12) • Teenage pregnancy (12) • Self reported health (10)

  7. Interventions that are likely to improve health and reduce inequalities  income and employment  educational attainment  quality of housing/physical environment  crime and fear of crime  facilitating “healthy lifestyles”  access to/quality of health services

  8. Wide variation in health indicators across Partnerships • Over 20 percentage point difference between Partnerships in residents with good health • “Health is worse over past year” ranges from 28% in Coventry to 10% in Lambeth • General health is highly correlated with deterioration in health over past year (-0.88) • NDC average SF36 mental health well being score ranges from 66 to 75 in 2004

  9. % NDC population consuming 5 portions of fruit and vegetables per day

  10. Spending by Theme 2001-4

  11. NDC Health Expenditure by Year

  12. NDC Health Reports- Main Topics • Improving access to health services • Complementary therapies • Exercise & Healthy eating • Improving mental health • Reducing Teenage Pregnancy • Supporting Teenage Parents • Drugs

  13. Health Theme Evaluation • Analysis of NDC business plans • Mapping of health areas and selection of topics/ year • Identification of case studies - • to illustrate range of approaches • variations in stages of development • Multiple visits and face to face interviews with NDC programme manager, project leads etc

  14. Survey and routine data sources (MORI and SDRC) • Health • General health over past year and compared with a year ago • Long standing illness, disability or infirmity and whether this limits activities • SF36 mental wellbeing index derived from five questions on how respondent felt over past month • Lifestyle • 5 portions of fruit and vegetables • Smoking • Physical activity • Services • When last saw a doctor • Ease of access • Satisfaction with doctor • When last used a local hospital • Satisfaction with hospital

  15. Health Service Projects • Buildings - health centres • Staff - directly employed or seconded from NHS, esp PCTs • Innovative delivery - the “health bus” • Community involvement -”first response” • Complementary therapies

  16. Healthy Eating • Healthy food: • Limited Consumption • Limited Access • Limited Affordability • Lack of confidence and skills in using fresh fruit and vegetables • Lack of awareness / knowledge of impact on health

  17. NDC Approaches to Healthy Eating Interventions • Food growing • Mapping provision of food sources • Cooking or provision of meals • Education and support groups and sessions • Art and Health

  18. Key Healthy Eating Projects • Food Co-ops & Delivery Schemes (12) • Food Growing & Allotments (10) • Cook & Eat / Cooking Skills (15) • Breakfast Clubs (8) • Lunch Clubs (6) • Breastfeeding Support (7) • School Meals (6)

  19. Has health improved in NDCs?

  20. Are NDCs “closing the gap”?

  21. Improving Health Indicators? • Satisfaction with local hospitals and access to doctors have seen the most improvement from 2002 to 2004 • However, ease of access to see a doctor in comparator areas improved by three times the rate in NDC areas. • Mental health prescribing has increased, but not as much as national trends • SMRs, SIRs and hospital admissions show no significant reductions and drug misuse admissions have increased

  22. Change in general health 2002-2004 by Partnership

  23. Do we expect health to improve in NDC residents? • Evidence from longitudinal sample • Change significantly different from comparator areas after adjustment for confounding variables • Changes that we know are associated with better health: - More likely to have stopped being unemployed - More likely to have started education/training - More likely to have increased social capital (people are friendly/neighbours look out) - But no positive change in health related behaviour

  24. Health models: pathways Use of & satisfaction with health services G Social capital: Social networks I F Trust Self-reported health: General health Health change SF-36 MHI Cohesion & Reciprocity Lifestyle: smoking diet exercise H E C Engagement& efficacy Security, fear of crime B A D Partnership, tenure, education, age, gender, ethnicity, household composition, household worklessness (& years resident)

  25. Summary • Unique source of longitudinal data on health and related factors in varied and deprived communities • Need intermediate outcomes (health behaviour) to demonstrate impact • Evidence that interventions associated with behaviour change but be cautious in attributing causality

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