1. Angela Donkin UCL Institute of Health Equity Setting the Context JSNA workshop for Southampton

3. England Southampton LABassettBitterne LE male78.378.480.675.3 LE female82.382.484.079.9 While inequalities are stark, Southampton LA has lower than average inequalities compared to the rest of England, yet higher than average inequalities compared to the South East region. Life expectancy in Southampton

4. Policy Objectives: The Social Determinants of Health 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 a 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

5. A. Giving every child the best start in life Children achieving a good level of development at age five, local authorities 2011

6. Southampton – Development at age 5 England AveSouthampton LA England Best Good devt %55.753.969.3 School Ready at Age 5 will be measured as part of the Public Health Outcomes Framework, and likely to be based on scores on the Early Years Foundation Stage Profile.

7. A. Give every child the best start in life Negative early years experiences and poor development are highly predictive of negative later life outcomes in health but also crime, low educational attainment, future benefit dependency, teenage pregnancy etc. Existing outcomes frameworks give good indication of what children should be expected to be able to do, focus on school ready for age 5, use these - but need to start early. Need more focus on parenting and quality of home learning environment – we are developing new framework for children’s centres. Use midwives, health visitors and GPs to give messages and support from conception

8. A. Give every child the best start in life. Socio-emotional difficulties at age 3 and 5: Millennium Cohort Study Age 3Age 5 Kelly et al, 2010 Fully adjusted = for parenting activities and psychosocial markers

9. B. Enable all children, young people and adults to maximise their capabilities and have control over their lives. Continued priority to reducing inequalities in education outcomes Prioritise inequalities in life skills (whole child approach, full service schools, workforce) Increase access and use of quality lifelong learning (16-25 yr old support, work based learning, non-vocational courses)

10. Prioritise active labour market programmes Quality of jobs improved (equality legislation, well being, stress and mental health at work) Security and flexibility of employment (retirement and people with poor health and caring responsibilities) C. Create fair employment and good work for all

11. Southampton NEET – not in employment, education or training 10.2% of Southampton’s 16-19 year olds are NEET, compared to 6.3% across the UK. Significantly higher. Recession has hit hard on young people. Will impact on mental health, drug and alcohol dependency and suicides. Also has long term detrimental effect on labour market outcomes. Tackle youth unemployment, and ensure sufficient resources in mental health and drug/alcohol support

12. D. Ensure a healthy standard of living for all Lack of money, and particularly debt increase stress. They lead to an increase in mental health conditions, and to family conflict, and post natal depression – all bad for the parent and the child. Fear of loss of income/employment is also a stressor. Also need an absolute level of income to meet daily needs. Increase in number reporting fuel, and food poverty.

13. D: Ensure a healthy standard of living for all

14. E. Create and develop healthy and sustainable places and communities Combining policies to mitigate climate change and health (active travel, green space, food environment, energy efficiency) Integrate planning, transport, housing environmental and health systems Regeneration based on reducing social isolation and remove barriers to action

15. F. Strengthen the role and impact of ill health prevention Smoking, obesity, lack of physical activity and unhealthy nutrition all follow the SE gradient: Increase and improve the scale of medical drug treatment programmes Focus public health interventions (e.g. alcohol reduction or smoking cessation) on reducing the social gradient Improve programmes to address the causes of obesity across the social gradient. Focus on interventions related to the SDH.

16. Thank you a.donkin@ucl.ac.uk http://www.instituteofhealthequity.org