1. Health Inequalities Intervention Tool for Scotland (HITS) Faculty of Public Health in Scotland, Annual Conference 2011 Rory Mitchell Public Health Observatory Division NHS Health Scotland

2. What do we do about health inequalities in Scotland?

3. Overview Background & aims What are the health inequalities intervention tools? Data issues Demonstration Preliminary findings Discussion (wider context of tackling health inequalities) Conclusions

4. Health Inequalities Intervention Tools Spreadsheet based models, underpinned by current data and effectiveness evidence Tools available at local and national level, for use by policy makers and local planners to inform decision making Modelling of the impact of selected interventions on population health and health inequalities Modelling of costs required to achieve particular outcomes

5. Health Inequalities Intervention Tools Interventions:  Alcohol brief interventions (ABIs)  Counterweight (BMI reduction intervention)  NHS smoking cessation services Outcomes:  Deaths (number prevented, life expectancy)  Hospital admissions (number prevented, rate)  Risk factor (prevalence, population mean) [population & most deprived quintile (MDQ)]

6. Data

7. Demo

8. Draft!

11. Alcohol Brief Interventions Tool Demo 1.Investment of an additional £1 million at Scotland level

12. = Modelling £1M investment above estimated 2010/11 baseline

16. Alcohol Brief Interventions Tool Demo 1.Investment of an additional £1 million at Scotland level 2.Investment of an additional £1 million at Scotland level, and targeting of all interventions to the most deprived two quintiles

17. Same budget, but perfectly targeted to more deprived groups

19. Preliminary findings All 3 interventions can have an impact on health inequalities Accurate targeting is critical Modelled impact is dependent on input data and assumptions ….but the magnitude of impact is fairly robust For all interventions the predicted impact is modest

20. Tackling health inequalities: the scale of the challenge

21. Tackling health inequalities: what is likely to work? Likely to be more effective*: Structural changes in the environment Legislative and regulatory controls Fiscal policies Income support Reducing price barriers Improving accessibility of services Prioritising disadvantaged groups Offering intensive support Starting young Likely to be less effective*: Information based campaigns Written materials Campaigns reliant on people taking the initiative to opt in Campaigns/messages designed for the whole population Whole school health education approaches Approaches which involve significant price or other barriers Programmes that raise housing costs *Edited, from MacIntyre, S. What are inequalities in health and what causes them? Briefing Paper for Ministerial Taskforce on Inequalities. Scottish Government; 2008.

22. Conclusions HITS outputs provide practical tools to inform decision making The 3 interventions modelled can have a measurable impact on health inequalities However, the impact of downstream individual interventions is likely to be small…and highly dependent on targeting Upstream universal interventions are likely to have a larger role to play in tackling health inequalities in Scotland

23. What’s next? Outputs scheduled for publication in early 2012 Feedback very welcome!

24. Acknowledgements ScotPHO colleagues: Diane Stockton, Gerry McCartney, Colin Fischbacher, Jamie Reid HITS Steering Group rory.mitchell@nhs.net www.scotpho.org.uk