A strategic approach to health literacy improvement Julia Taylor, Director of Liverpool Healthy Cities Emma Page, Senior Social Marketing Executive, Liverpool PCT

Scale of the inequality challenge in North West Highest rate for: Deaths from heart disease and stroke Death rate from suicide and injuries of undetermined intent in males Alcohol related admissions Hospital admissions for depression, anxiety disorders and for schizophrenia Self-reported violence Second highest rate for: Deaths from cancer and smoking related illness Level of binge drinkers Claiming incapacity benefits for mental and behavioural disorders Reported level of feeling in poor health by the population Nine per cent (400,000 people) of the working-age population are on incapacity benefit, largely for preventable or manageable conditions

Building blocks to tackle health inequalities Health and health equity in all local policy Political commitment, Leadership & Governance Health and Equity Impact Assessment Data, Social gradient (Asset Mapping) Health Inequalities Strategy & Neighbourhood Action Plans City Wide Health Literacy programme Resilience and Mental Wellbeing

Health literacy at the heart of Healthy Cities Phase V development Healthy urban environment and design Healthy urban planning. Housing and regeneration. Healthy transport. Climate change and public health emergencies. Healthy living. Preventing non communicable diseases Local Health Systems Tobacco-free cities Alcohol and drugs Active Living Healthy food and diet Violence and injuries Healthy settings Wellbeing & happiness Caring and Supportive Environments Better outcomes for all children. Age-friendly cities. Migrants and social inclusion. Active citizenship. Health and social services Health Literacy Health Literacy Domains Health systems Educational systems Media Marketplaces, Home & Community Workplace settings Policy making arenas Health Literacy

Where we need to act Across the Life Course Health Systems Home Community (Pre natal, early years) Education & lifelong learning Workplace Information Marketplaces (media) Political- citizenship Academic support –evidence ‘what works’ & ‘how to measure’

Where we are taking action WHO Global Guide 1 & 2 Presented at UN High Level social committee Leading WHO Healthy Cities sub- network on Health Literacy Political Commitment Health Inequalities Strategy –cross cutting theme Neighbourhood integrated approach Pre-natal and Early Years –needs further development Reader Organisation Uni. of Liverpool & Libraries Schools and adult learning Work Pharmacists Primary Care Trust

118 Liverpool Your Guide to being healthy, living well and finding help in Liverpool Guide to everyday life Living a healthy lifestyle Staying well

Do we need a strategy? Learning from scoping exercise published by the Health Improvement Strategy Division of Scottish Government… –No clear or shared view of the meaning of health literacy –Ideas underpinning health literacy are complex –No appetite or requirement for health literacy strategy - pursuing separate strategy counterproductive –Focus should be on integrating health literacy into existing areas of work –Large and daunting agenda - important to focus on a limited set of priorities to begin with

Marketing (customer orientation) Skills Staff Health literacy improvement

Improving navigation of core health services

Core health services 999 / ambulance A&E GP Pharmacies Walk in centres GP-led walk-in service GP out of hours (OOH) NHS Direct TRADITIONAL MODERN

Our aim Maximise number of instances when patients receive right care, in the right place and at the right time Focus on designing a simple system that guides patients to where they need to go

Research findings Almost 3 in 5 people say they know there are services other than their GP and A&E available, but not exactly what they offer Most patients who attend A&E ‘inappropriately’ do so because they don’t know about / understand / trust alternative services

Comprehensive service users Modern service users Uninformed traditionalists Loyal traditionalists Discontented unawares 25% 26% 16% 13% 20%

Research findings No central coordination of marketing - rely on service providers to promote services which has led to unclear and confusing messages Patients don’t drive communications: one- size-fits-all approach rather than needs and benefits driven targeted approach Compounded further by lack of staff knowledge and training to ensure consistent signposting

Our strategy Establish a protocol to coordinate and manage the marketing of core health services to ensure consistency and a long-term vision Develop a long-term marketing plan that is targeted and benefits-driven Train all NHS staff to act as service navigators and ambassadors for core health services

THANK YOU any questions?