Community Regeneration and

Health Improvement

Developing an outcomes focused

approachErica Wimbush

NHS Health Scotland

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?

Policy drivers

Review of HI performance management

Closing the Gap

Public service reform

Audit of community planning

Taking Stock

New PM framework

for local authorities

Review of HEAT targets

An outcomes approach to planning and performance

management

LONG-TERM OUTCOMES

MEDIUM-TERMOUTCOMES

INPUTS PROCESS OUTPUTS SHORT-TERM OUTCOMES

PLANNING

National level outcomes

Outcome-focused planning & performance reporting

REPORTING

Results for users of delivery

LONG-TERM OUTCOMES

MEDIUM-TERMOUTCOMES

INPUTS PROCESS OUTPUTS SHORT-TERM OUTCOMES

Health outcomes

Reducing inequalities in -

•Physical health

•Mental health

•Well-being

Health determinants

Indiv lifestyle

Social & Community Networks

Living & Working conditions

General socio-economic, cultural and environmental conditions

National level outcomes

Delivery of HI actions

A complex and multi-level system of cross-sectoral partnership-based

delivery

Dahlgren & Whitehead, 2004

The main determinants of health

THE SCOTTISH EXECUTIVEHealth & Well-being Directorate

THE SCOTTISH PARLIAMENTHealth & Social Care CommitteeNational

HEALTH SCOTLAND

COSLALGIS

SCVOVHS

SCCSFHA

HPSISDNESQIS

LTSSHPSU

COMMUNITIES SCOTLAND

FSASSCDCCHEX

14 NHS BOARDSRegional

The planning and delivery infrastructure for Health Improvement Outcomes

32 LOCAL AUTHORITIESCommunity health

projects

Voluntary orgs

COMMUNITY PLANNING PARTNERSHIPS

42 COMMUNITY HEALTH PARTNERSHIPS

LocalLOCAL GOVERNMENT

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 healthGöran Dahlgren and Margaret Whitehead

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 exampleLifestyle 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

Reducing health inequalitiesWhich approach?

1. Focusing only on people in poverty or the most deprived localities

2. Narrowing the health divide

3. Reducing social inequities throughout the whole population.

WHO Europe (2006) Levelling Up - Part 2

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 healthPolicy 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

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 unemploymentPolicy 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

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 lifePolicy 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

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

Social regenerationWhat can be done?

Social and community inclusion strategiesThe 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

Community Planning

What is the best approach to delivering HI outcomes?

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

A Better Community LifeCPP Vision

CPP Strategic Objectives

Getting people

into work

Education learning, skills

Health improvement

EnvironmentsCommunity

safety

Responding to demographic change

CPP Actions &Outcomes

National level

outcomes

A Better Scotland

A Better Community LifeCPP Vision

CPP Strategic Objectives

Getting people

into work

Education learning, skills

Health improvement

EnvironmentsCommunity

safety

Responding to demographic change

ROA ROA ROA/JHIPROA ROACPP

Actions &Outcomes

National level

outcomes

A Better Scotland

Wealthier SmarterHealthier Inequalities in

MortalitySustainable Safer

Workless h’holdsUnemployment,

New DealIncapacity Disability

Literacy & numeracy

School absenceFoundation skills

Smoking, Alcohol

Diet, PA, etc

Access to services

Fear of crimeCrime rates

A Better LifeCPP Vision

CPP Strategic Objectives

Responding to demographic change

CPP Actions & Outcomes

National level

priority outcomes

A Better Scotland

Reducing health inequalities

Getting people

into work

EducationLearning, skills

Social inclusion

EnvironmentsCommunity

safety

Health determinants