Let’s Talk Research Annual Conference, 25th

September 2014, Bolton

Professor Margaret Whitehead

University of Liverpool

Chair: Inquiry into Health Equity for the North

Addressing health inequalities: why a research

priority for the North West?

• Professor Margaret Whitehead (Chair), W.H. Duncan Chair of Public Health, Department of Public Health and Policy,

University of Liverpool • Professor Clare Bambra, Professor of

Public Health Geography, Department of Geography, Durham University

• Ben Barr, Senior Lecturer, Department of Public Health and Policy, University of

Liverpool • Jessica Bowles, Head of Policy,

Manchester City Council • Richard Caulfield, Chief Executive,

Voluntary Sector North West • Professor Tim Doran, Professor of Health

Policy, Department of Health Sciences,

University of York • Dominic Harrison, Director of Public

Health, Blackburn with Darwen Council • Anna Lynch, Director of Public Health,

Durham County Council • Neil McInroy, Chief Executive, Centre for

Local Economic Strategies • Steven Pleasant, Chief Executive,

Tameside Metropolitan Borough Council • Julia Weldon, Director of Public Health,

Hull City Council

Inquiry Panel

Life Expectancy: the North-South health Divide

Source: HSCIC, 2014

Kensington and Chelsea, London

Kensington and Fairfield, Liverpool

20 minutes on Merseyrail

10 fewer years of life expectancy

Source: Barr for Due North, 2014

• Differences in poverty, power and

resources needed for health

• Differences in exposure to health-

damaging factors

• Differences in opportunities to enjoy

positive health factors and protective

conditions that help maintain health,

especially conditions that give children

the best possible start in life

Causes – socioeconomic

• Greater prevalence of poverty

• Higher unemployment

• Adverse working conditions

• Poorer housing

• Higher unsecured debts

• All have adverse effects on health and

increase health inequalities

The SEVERITY of these causes is greater in North

Employment rates: the North compared with the rest

of England

Source: Due North 2014

% of those out of work in poverty: North vs.

rest of England

% of workers who are in poverty: North vs. rest of

England

% Households in fuel poverty

Source: Data produced by ChiMat, based on the latest available data

Worse child health in North

Narrowing of the school readiness gap between children in most and least disadvantaged areas, England, 2008 to 2011

Source: Department for Education. Early years foundation profile results 2008-2013

GCSE success by child poverty rate in wards in Liverpool

Source: Taylor-Robinson, 2013

• Austerity measures and poverty-generating

welfare reforms hit disadvantaged areas and the

North the hardest

• Demands for greater devolution to do things

more effectively and equitably

• Transfer of public health to local authorities

Why now? Threats and opportunities

DUE NORTH: LA cuts increase with increasing

deprivation of area (IMD score)

Source: Taylor-Robinson et al, 2012

Trend in child poverty and inequalities in infant

mortality

Source: Taylor-Robinson et al for Due North, 2014

Trend in child poverty and inequalities in infant mortality Trends in malnutrition and use of and food banks

Source: Taylor-Robinson et al, 2013

DUE NORTH: actions to tackle root causes

1. What can agencies in the North do to help

reduce health inequalities within the north and

between the north and the rest of England?

2. What does central government need to do to

reduce these inequalities?

Lessons for the whole country, not just the North

Two types of recommendations

• Rec. 1: Tackle poverty and economic development

• Rec. 2: Promote healthy development in early

childhood

• Rec. 3: Share power over resources and increase

influence of the public over decisions

• Rec. 4: Strengthen the role of the health sector in

promoting health equity

Four high-level recommendations for reducing the

North-South Divide and

the Divide between rich and poor areas

Preventing poverty

RESEARCH AND DEVELOPMENT NEEDED:

Northern agencies should:

• Collect and collate the evidence on the consequences of central government economic and welfare policies, particularly the impact on the most disadvantages communities in the region – use it to ameliorate and lobby

Central government needs to:

• Assess the impact of changes in national policies on health inequalities in general and regional inequalities in particular

•Extend the ONS ‘Measuring national wellbeing programme’ to better monitor progress and influence policy on inequalities

Rec 1: Tackle poverty and economic inequality

Early childhood

RESEARCH AND DEVELOPMENT NEEDED:

Northern agencies:

• Collect better data in children in the early years so that we can

track changes over time, monitor inequalities in child development

and evaluate services for their early effects on early disadvantage

Central government needs to:

• Commit to carrying out a cumulative impact assessment of any

future welfare changes, with a focus on the impact on people living

in vulnerable situations, especially children

Rec 2: Promote healthy development in early

childhood

Resources matched to need?

A fairer deal

RESEARCH AND DEVELOPMENT NEEDED:

Northern agencies:

• Develop community-led systems for health equity auditing and accountability

• Ensure the public reporting of actions and progress on health inequalities

• Make intelligence and data on health, equity and social determinants more accessible within the public domain

• Develop indicators of progress with local communities

Central government should:

•Invest in and expand role of Healthwatch to monitor progress and advocate for action on health inequalities

Rec 3: Share power over resources and

increase influence of public over decisions

R & D NEEDED

CCGs and other NHS agencies:

• Collect better data, improve monitoring and increase awareness of the health impacts of poverty for staff working in the health services

• Assess the adequacy of welfare benefits for supporting health

• Work more effectively with LA Directors of Public Health and PE to address the risk conditions that drive health and social care system demand

Public Health England:

Conduct a cumulative assessment of the impact of welfare reform and cuts to public services, in particular focusing on the impact on children and people with disabilities

Rec 4: Strengthen the role of the health

sector in promoting health equity

Evaluate policies and interventions for their

impact on health inequalities

Identify if any have differential impact on

different social groups – which would improve

the health of the worst-off the fastest?

BURNING RESEARCH NEED FOR ALL

Ben Barr, Margaret Whitehead and Clare Bambra. The

impact of NHS resource allocation policy on health

inequalities in England 2001-11: longitudinal

ecological study. BMJ 2014; 348: g3231

Investigated: Policy of increasing NHS funding to a

greater extent in deprived areas of England compared

with more affluent areas “to contribute to the

reduction of avoidable health inequalities”

An example from the North West: Evakuating

a Natural Policy Experiment

NHS allocation per head in deprived and

affluent areas

Source: Barr et al. BMJ, 2014

Trends in male mortality amenable to health care

and NOT amenable, by deprivation of area

NOT AMENABLE AMENABLE

Source: Barr et al. BMJ 2014; 348: g3231