1. Health Inequalities: Performance and recovery Deborah Harkins Head of Joint Health Unit

2. Overview Lancashire County Council Commitment Current action and plans to reduce health inequalities –Increase life expectancy –Address the social determinants of health

3. Role of LCC - Corporate Strategy Improve life expectancy Promote positive choices for C&YP and adults Improve emotional health & wellbeing of C&YP and adults Promote independence Maximise the contribution of all LCC policies and services Promote a healthy environment within schools, workplaces and communities

4. Increase life expectancy: Prevent avoidable deaths

5. Prevent avoidable deaths All age all cause mortality (indicator of life expectancy) –Target to narrow the gap between places in Lancashire and England –Overall gap is not narrowing –Preston, Pendle, Hyndburn, Rossendale and Burnley unlikely to meet target Focus of CAA red flag

6. All Age All Cause Mortality

7. Prevent avoidable deaths Analysis to establish main causes of avoidable death in Lancashire: –Infant mortality –Cardio vascular disease (heart disease and stroke) –Cancer –Accidents –Seasonal excess deaths

8. Infant mortality Use Children’s Centres to: –Increase breastfeeding –Reduce smoking in pregnancy –Promote healthy weight in pregnancy –Improve access to maternity care and screening –increase uptake of immunisation –Pan Lancashire safer sleeping policy and promotion of baby safe messages

9. Cardio vascular disease (heart disease and stroke) –Maximise uptake of NHS Health Check Through front line staff In employees –Contribute to review of Save a Million Years of Life programme

10. Cancer –Cancer Awareness among front line staff (including social care) –Prevention and early detection programme –Developing a Lancashire Cancer Inequalities Strategy (to be completed June 2010)

11. Accidents Transport –20 mph speed limit pilots (Morecambe West End; Larches, Preston; South West Burnley) –Social marketing –16 collision reduction studies in areas of highest risk –30 road safety schemes to change the road environment –Road safety education for children and young people Older people –Development of a county wide falls prevention, treatment and rehabilitation service between PCTs and LCC

12. Seasonal excess deaths –All district councils run energy efficiency schemes –Development of Lancashire fuel poverty referral project (climate change BTI) –Promote warm front –Integrate seasonal protection into care planning –Maximise uptake of vaccination

13. Address the social determinants of health

14. Evidence Marmot Review of Health Inequalities –Importance of social determinants of health –Proportionate universalism –No single solution – combined impact of complementary interventions JSNA analysis of inequalities in health and its determinants in Lancashire Identified 10 goals of a programme of action: Fair and Healthy Lancashire

15. Priorities – determinants of health Med-long term impactShort-med term impact Reduce unemployment/ worklessness Increase income/ reduce child poverty Strengthen communities Life long learning/ skills development Reduce alcohol harm Increase social support Minimum unit price for alcohol Extend 20 mph in residential areas Reduce fuel poverty Maximise the use of local authority regulatory powers Short to Medium term impacts provide the scope of the Health Inequalities Big Ticket Issue (Healthy Streets)

16. Unemployment and worklessness Big Ticket issue focusing on high growth sectors of the economy Health and the economy integrated into Mid Lancs MAA Health and worklessness commission established Development of a single health related worklessness system, to include: –Health related worklessness pathway –Public sector as an exemplar –Healthy workplaces and working practices –Mental health

17. Increase income and reduce child poverty Children’s Trust developing a child poverty strategy Economy Big Ticket Issue focus on high growth sectors Equity audit of income maximisation initiatives

18. Alcohol Modernising alcohol treatment services Enforcement of illegal sales through trading standards Provide alternative treatment venues linked to the night time economy Develop enforcement and licensing interventions within healthy streets programme Promote consistent use of proof of age scheme Alcohol brief intervention training within local government, fire and rescue service Ensure consistency of marketing and educational alcohol harm reduction to the community/ retailers /parents and young people

19. Strengthen communities Workshop with People and Communities Partnership to identify actions to build social capital Action plan under development focusing on: –Social participation –Social networks and social support –Reciprocity and trust –Civic participation Theme of next Fairness for All – social capital

20. Health Impact Assessment (HIA) Mental wellbeing impact assessments of all LAA themes Training to local government staff to develop HIA skills and capacity HIA of Central Lancashire Local Development Framework HIA of Transport Strategy HIA of mid Lancashire MAA HIA of licensing policies

21. Conclusions Need the concerted efforts of all partners to make a difference Cumulative impact of several complementary programmes will have an impact LCC has a significant contribution to make