Health Inequalities: evidence for action. Welsh Collaboration for Health and theEnvironment 24th April 2013 Dr Mike Grady. Principal Adviser Institute of Community development and health improvementEquity UCL

The CSDH – closing the gap in a generation The Marmot Review – Fair Society Healthy Lives Review of the Social Determinants of Health and the Health Divide in the WHO European Region

Life expectancy in countries in the WHO European Region, 2010 (or latest available) Source: WHO Health for all database, 2012

Life course PrenatalPre-schoolSchoolTrainingEmploymentRetirement Family building Prevention Early YearsSkills DevelopmentEmployment and Work Accumulation of positive and negative effects on health and wellbeing Healthy Standard of Living Sustainable communities and places Life course stages Areas of action 5

Children achieving a good level of development at age five, local authorities 2011: England Source: LHO (2012)

Attainment gap from early years to higher education: free school meal (FSM) vs non- FSM:England Source: DCSF 2009

Living in cold homes: effect on adolescents % children with four or more negative outcomes* *i)A long-standing illness or disability, ii) to go without regular physical exercise, iii) in trouble for smoking, drinking or taking drugs, iv) bullied in or out of school, v) expelled or suspended from school, vi) does not see friends and does not attend organised activities, vii) has been in trouble with the police, viii)below average in key academic subjects, ix) family cannot afford an annual holiday, and, x) family in income poverty. Source: Barnes et al 2008 % children with four or more negative outcomes* Number of previous 5 years child has lived in these conditions

A.Give every child the best start in life B.Enable all children, young people and adults to maximise their capabilities and have control over their lives C.Create fair employment and good work for all D.Ensure healthy standard of living for all E.Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill health prevention Strategic Drivers. Fair Society: Healthy Lives: 6 key Policy Objectives

Summary of review outcomes Health inequalities are not inevitable or immutable Health inequalities result from social inequalities - ‘causes of the causes’ – the social determinants Address the social gradient in health through ‘proportionate universalism’ Life course approach Intergenerational focus Address processes of exclusion Develop strategies based on assets, resilience, capabilties and strengths. Human Rights framework

People and Places Critical linkage of health, wellbeing and resilience. Evidence of linkage of low level stress, depression and exclusion are barriers to participation. “ You can see the deprivation, all you have to do is look outside. Its in your face every day, litter everywhere, rats and rubbish. It’s a dump……it feels like people around you have no meaning to life. I keep my curtains closed at times….It doesn’t give you a purpose to do anything” (Focus group participant) Many communities are characterised by lack of mutual trust, isolation and under developed social cohesion. “ It is a deprived area,there are no jobs, people are stressed out family and partner relationships and all things like that are going wrong” (June)

Green spaces that I can use Lack of interesting activities in winter Poor local job prospects Poor street lighting and uneven pathways Recycling facilities Soaring fuel bills and poor insulation Affordable transport Spending time with my neighbours What enhances my wellbeing and health What is detrimental to my wellbeing and health Affordable healthy food

Health,Wellbeing and resilience Evidence participation and improving life skills ameliorates impact of health inequalities through developing social support networks. (Bynner and Parsons 2006) Learning and skill development impact positively and fosters community action. “ I have learned..I use my counselling skills with my family. I listen more and I know my daughter will say I am really proud of what you are doing,Mum “ (Jane) Social networks create the conditions in which people thrive “ I would say that people in the group have more confidence. At one poInt they would have been sat at home doing nothing,now they are out and are involved. Once you get there it ‘s amazing to see how far you can go.” (Joyce)

Producing Percentage Change at Population LevelC. Bentley 2007 Build healthy public policy Create supportive environments Strengthen community action Develop personal skills Reorient (health) services Ottawa Charter Population Level Interventions Intervention Through Services Intervention Through Communities

Local Ward Forum ‘The Mayor asks You to Decide’ Neighbourhood Forum Neighbourhood Agreement locally appropriate services Neighbourhood Plans Co-commissioning & Co-development Addresses Local Issues and Priorities through: Local Champions Local Choice Local Results Wellbeing of an Area Part of the local statutory development plan Forms the basis for determining planning applications Enables community to grant planning permission it wishes to see Agreement between communities and service providers Council ‘offer’ to residents supporting them as key drivers of improvement within their communities 1. LOCAL DECISION MAKING 2. THE BUILT ENVIRONMENT 3. SERVICE ACCELERATION

Per cent 5 year olds achieving ‘good development score’,* Birmingham LA, West Midlands & England *in personal, social and emotional development and communication, language and literacy Source: Department for Education %

Creating conditions in which individuals and communities have control over their health and lives and participate fully in society