1. Addressing inequalities in Health and Wellbeing Outcomes Bradford Professor Chris Bentley HINSTAssociatesHINSTAssociates

2. After Ronald Labonte Well being and Health Physiological risks High blood pressure High cholesterol Stress hormones Anxiety/depression Behavioural risks Smoking Poor diet Lack of activity Substance abuse Psycho-social risks: Isolation Lack of social support Poor social networks Low self-esteem High self-blame Low perceived power Loss of meaning/purpose of life Risk conditions – e.g.: Poverty Low social status Poor educational attainment Unemployment Dangerous environments Discrimination Steep power hierarchy Gaps/weaknesses in services and support Health Seeking Behaviour

3. Enable all children, young people & adults to maximise their capabilities & control their lives. Create and develop healthy and environment- ally sustainable places & communities. Ensure healthy standard of living for all. Create fair employm ent & decent work for all. Give every child the best start in life. Strengthen the role and impact of ill- health prevention. Healthcare Public Health Marmot ‘Plus’ policy Objectives

4. 2005201020152020 Health Inequalities Different Gestation Times for Interventions A B C For example intervening to reduce risk of mortality in people with established disease such as CVD, cancer, diabetes For example intervening through lifestyle and behavioural change such as stopping smoking, reducing alcohol related harm and weight management to reduce mortality in the medium term For example intervening to modify the social determinants of health such as worklessness, poor housing, poverty and poor education attainment to impact on mortality in the long term

5. Partnership, Vision and Strategy, Leadership and Engagement Population Level Interventions Intervention Through Communities Intervention Through Services Systematic and scaled interventions through services Systematic community engagement Service engagement with the community Producing Percentage Change at Population LevelC. Bentley 2007

7. Haringey: Slope Index of Inequality (Males)

8. Haringey Index of Multiple Deprivation (IMD) % of residents from each English quintile

9. Bradford and Airedale – national deprivation quintiles

10. Bradford and Airedale: Slope Index of Inequality (Males)

11. Bradford and Airedale: Slope Index of Inequality (Females)

12. Bradford and Airedale – national deprivation quintiles

13. Bradford Cause of Excess Death (not infants) most deprived 20% versus the rest

14. Improving Male Life Expectancy in Birmingham

15. Coronary Heart Disease Cold Damp Housing

16. Have the problem Aware of problem Eligible for treatment Optimal therapy Compliance with therapy Benefit from evidence based interventions across populations (not to scale) A B C D

17. Components of Population Level Strategy A.Awareness and understanding B.Presentation and Assessment C.Quality of Service D.Support for Self Management Have the problem Aware of problem Eligible for intervention Optimal intervention Compliance with plan A B C D

18. Health and Wellbeing Boards should provide an excellent platform for more systematic engagement with communities, families and individuals currently not connecting appropriately with health services

19. C + D. Quality of Care

20. A High Performance PCT

21. A +B. ‘Missing thousands’

22. Have the problem Aware of problem Eligible for intervention Optimal intervention Compliance with plan Benefit from evidence based interventions across populations (not to scale) A B C D Chris Bentley 2012