Community Regeneration and Health Improvement Developing an outcomes focused approach Erica 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-TERM OUTCOMES INPUTSPROCESS OUTPUTS SHORT-TERM OUTCOMES PLANNING National level outcomes Outcome-focused planning & performance reporting REPORTING Results for users of delivery

LONG-TERM OUTCOMES MEDIUM-TERM OUTCOMES INPUTSPROCESS 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 EXECUTIVE Health & Well-being Directorate THE SCOTTISH PARLIAMENT Health & Social Care Committee National HEALTH SCOTLAND COSLA LGIS SCVO VHS SCC SFHA HPS ISD NES QIS LTS SHPSU COMMUNITIES SCOTLAND FSASSCDC CHEX 14 NHS BOARDS Regional The planning and delivery infrastructure for Health Improvement Outcomes 32 LOCAL AUTHORITIES Community health projects Voluntary orgs COMMUNITY PLANNING PARTNERSHIPS 42 COMMUNITY HEALTH PARTNERSHIPS Local LOCAL 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 health Göran Dahlgren and Margaret Whitehead

Influencing health determinants What 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 example Lifestyle 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 inequalities Which 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 regeneration What 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 health Policy 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 unemployment Policy 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, skills What 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 life Policy 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 regeneration What 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 regeneration What can be done? Social and community inclusion strategies The 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 planning What 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 Life CPP Vision CPP Strategic Objectives Getting people into work Education learning, skills Health improvement Environments Community safety Responding to demographic change CPP Actions & Outcomes National level outcomes A Better Scotland

A Better Community Life CPP Vision CPP Strategic Objectives Getting people into work Education learning, skills Health improvement Environments Community safety Responding to demographic change ROA ROA/JHIP ROA CPP Actions & Outcomes National level outcomes A Better Scotland Wealthier Smarter Healthier Inequalities in Mortality SustainableSafer Workless h’holds Unemployment, New Deal Incapacity Disability Literacy & numeracy School absence Foundation skills Smoking, Alcohol Diet, PA, etc Access to services Fear of crime Crime rates

A Better Life CPP 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 Education Learning, skills Social inclusion Environments Community safety Health determinants