2. Equality and Health Inequalities
Setting the Scene: Equality Board – Roadshow
Maqsood Ahmad

3. NHS Commitment
NHS England has legal and ethical obligations to reduce health inequalities and advance equality, with due regard to the elimination of discrimination, the promotion of equality of opportunity and the fostering of good relations between those who have a protected characteristic and those who do not share it, in accordance with the public sector Equality Duty of the Equality Act 2010

4. Equality and Health Inequalities

5. Equality and Health Inequalities: lens
Men with learning disabilities die 13 years sooner than the general population; women 20 years sooner. 22% were under 50 when they died (Source: CIPOLD, 2013, DH Ministerial working group 2012
Gypsy and traveler communities have lowest life expectancy of any ethnic group in UK. Experience high infant mortality rates, high rates of mental illness, suicides, substance misuse, diabetes, heart disease and premature death. (Source: Parry et al, DH 2004 and IPSOS Mori East of England 2009)
Rough sleepers, average age of death is 30 years earlier than average population (47 years for men & 43 years for women) (Source: Crisis, 2012)
Women in Manchester live an average of 79 years (90 years in Kensington & Chelsea – a gap of 11 years)
Men in Blackpool live an average of 74 years (Kensington and Chelsea it is an average of 85 years - a gap of 11 years). (Source: NHS England AGM: 2013)

6. Equality and Health Inequalities
It is estimated that people with schizophrenia can expect to live 10 years less than those without schizophrenia (Newman and Bland, 1991)
Black African Caribbean men are 30 per cent more likely to die from prostate cancer than white men (BME Cancer Communities, 2013)
Two-thirds of refugees & asylum seekers suffer from anxiety or depression (Inclusion Health Board, 2009)
People with serious mental illness have rates of cardiovascular disease rates 2–3 times higher than the general population (Brown et al., 2000, Osby et al.,2000)
Suicide rates are higher for men - 4,231 suicides among men in 2010 (17.0 per 100,000 population). In women there were 1,377 suicides in 2010 (5.3 per 100,000 population). Highest in those aged 45–74 (ONS, 2010).

7. Equality and Health Inequalities
Gay and bisexual men are over four times more likely than heterosexual men to attempt suicide. (Sheffield in the Pink 2009)
Both men and women who identify as Black are more likely to be an inpatient of mental health services and more likely to be subject to the Mental Health Act (Count Me In ).
The ONS Opinions Survey 2010 found a third of disabled people experience difficulties related to their impairment in accessing public services, including health services (ONS, 2010).
Muslims, Sikhs and Caribbean Christians have worst health than white Christians eg: self assessed health, limiting longstanding illness, diabetes and waist/hip ratios (Karlsen and Nazroo, 2009)

8. Health Inequalities' and discrimination
The greater the gap between the rich and the poor, the greater differences are observed in health.
When discussing inequality it is important to reflect on groups of people who experience discrimination, and although are also highly represented within lower socio-economic groups, also encounter additional social injuries. Examples:
People from BME,
Refugees and asylum seekers,
Homeless
Older people and
People with disabilities, including mental health problems and learning disabilities.

9. Cost of health Inequality
£70 billion estimated annual cost to England of failure to address Health Inequalities
(Source: Institute of Health Equity )
Up to 2.5m extra years of life could be enjoyed by those who die prematurely as a result of health inequalities…
…and an additional 2.8m extra years of life free from limiting illness or disability (Marmot et al 2010)

10. Memorandum of Understanding – signed in May 2017
It is clear that the Voluntary, Community and Social Enterprise (VCSE) sector has a crucial role to play in consultation, design and delivery related to health and social care in Greater Manchester. This is acknowledged by the Greater Manchester Health and Social Care Partnership, who are responsible for delivering the strategy.
In recognition of this, in May 2017 representatives of the Greater Manchester Health and Social Care Partnership formally signed a Memorandum of Understanding (MoU) with the Greater Manchester Voluntary, Community and Social Enterprise (VCSE) sector.
The MoU sets out a way for the VCSE sector in Greater Manchester (GM) to be better engaged and linked in with the Health and Social Care devolution agenda in GM both at a strategic level and within each of the 10 local authority areas.
Memorandum of Understanding – signed in May 2017

11. The Health and Social Care VCSE Engagement Project
GMCVO, on behalf of the Greater Manchester VCSE Devolution Reference Group, is leading on a project to implement some of the principles included in the MoU. This work is funded by the Greater Manchester Health and Social Care Partnership and includes;
Enabling dialogue between public sector and peers in the VCSE sector via various events, workshops and roundtables
Sharing information about all things related to health and social care
Enabling VCSE representation on high level Greater Manchester Health and Social Care (GM HSC) boards, committees and working groups
Developing a new approach to Equalities
Identifying issues and priority work areas as soon as they arise, and mobilising the VCSE sector to respond
Supporting work in localities related to Health and Social Care
Commissioning small projects to explore issues in further detail

12. Advancing Equalities – work so far:
Nov 2017: Co-design process started with VCSE ‘Assembly’ event open to all VCSE organisation with equalities focus
Dec 2017: Co-design meeting between VCSE orgs, people with lived experience and public sector health and social care colleagues to begin to shape the ‘Approach to Equalities’
Feb 2018: follow up event feeding back to VCSE ‘Assembly’
Mar - Apr 2018: Write up of report and recommendations
May - June 2018: Equalities Co-ordinator recruited
June present: Shadow Equality Board meeting to explore setting up of GM Equalities body and planning for how people from across sectors can be recruited/supported to get involved in this group
Nov - April 2019: roadshows being held, open recruitment to and launch of GM Equalities body
This work forms part of MoU between GM Health & Social Care Partnership and the VCSE sector – recognising there is huge issue around Health Inequalities and within the context of devolution an opportunity to look at the work differently and do things in a joined-up, co-designed and co-produced way