1. NDCs and Health Overview of Phase 1 Liddy Goyder, ScHARR University of Sheffield

2. The health “theme team” University of Sheffield Liddy Goyder Jean Peters Lindsay Blank Libby Ellis Sheffield Hallam University NDC team, Mike Grimsley MORI and SDRC for health data

3. Overview What are NDCs and what do they do? What are “health” issues for NDCs? “Health-related” activity in NDCs: example of healthy eating initiatives So has health improved in NDCs? Do we expect NDCs to have an impact on population health in the future?

4. The NDC Programme Launched in 1998 Ten year, community led, holistic ABI in 39 deprived English localities Five outcome areas: housing and environment,jobs, education, crime, health £50 million per partnership Compares to about £600 million from mainstream service providers Plus funding and activity through other ABIs

5. Complexity of ABI evaluation Dealing with attribution when so many previous/present initiatives Change in any ABI related to wider local/ regional/national changes Area based interventions but aimed at individuals Spillover/displacement

6. Delivery Plans 2004 Top 7 outcomes for health Health promotion: diet, exercise, health and well-being (31) Death rate/SMR and life expectancy (30) Mental health (16) Health services-access (15) Smoking (12) Teenage pregnancy (12) Self reported health (10)

7. Interventions that are likely to improve health and reduce inequalities  income and employment  educational attainment  quality of housing/physical environment  crime and fear of crime  facilitating “healthy lifestyles”  access to/quality of health services

8. Wide variation in health indicators across Partnerships Over 20 percentage point difference between Partnerships in residents with good health “Health is worse over past year” ranges from 28% in Coventry to 10% in Lambeth General health is highly correlated with deterioration in health over past year (-0.88) NDC average SF36 mental health well being score ranges from 66 to 75 in 2004

9. % NDC population consuming 5 portions of fruit and vegetables per day

10. Spending by Theme 2001-4

11. NDC Health Expenditure by Year

12. NDC Health Reports- Main Topics Improving access to health services Complementary therapies Exercise & Healthy eating Improving mental health Reducing Teenage Pregnancy Supporting Teenage Parents Drugs

13. Health Theme Evaluation Analysis of NDC business plans Mapping of health areas and selection of topics/ year Identification of case studies - –to illustrate range of approaches –variations in stages of development Multiple visits and face to face interviews with NDC programme manager, project leads etc

14. Survey and routine data sources (MORI and SDRC) Health –General health over past year and compared with a year ago –Long standing illness, disability or infirmity and whether this limits activities –SF36 mental wellbeing index derived from five questions on how respondent felt over past month Lifestyle –5 portions of fruit and vegetables –Smoking –Physical activity Services –When last saw a doctor –Ease of access –Satisfaction with doctor –When last used a local hospital –Satisfaction with hospital

15. Health Service Projects Buildings - health centres Staff - directly employed or seconded from NHS, esp PCTs Innovative delivery - the “health bus” Community involvement -”first response” Complementary therapies

16. Healthy Eating Healthy food: Limited Consumption Limited Access Limited Affordability Lack of confidence and skills in using fresh fruit and vegetables Lack of awareness / knowledge of impact on health

17. NDC Approaches to Healthy Eating Interventions Food growing Mapping provision of food sources Cooking or provision of meals Education and support groups and sessions Art and Health

18. Key Healthy Eating Projects Food Co-ops & Delivery Schemes (12) Food Growing & Allotments (10) Cook & Eat / Cooking Skills (15) Breakfast Clubs (8) Lunch Clubs (6) Breastfeeding Support (7) School Meals (6)

19. Has health improved in NDCs?

20. Are NDCs “closing the gap”?

21. Improving Health Indicators? Satisfaction with local hospitals and access to doctors have seen the most improvement from 2002 to 2004 However, ease of access to see a doctor in comparator areas improved by three times the rate in NDC areas. Mental health prescribing has increased, but not as much as national trends SMRs, SIRs and hospital admissions show no significant reductions and drug misuse admissions have increased

22. Change in general health 2002-2004 by Partnership

23. Do we expect health to improve in NDC residents? Evidence from longitudinal sample Change significantly different from comparator areas after adjustment for confounding variables Changes that we know are associated with better health: - More likely to have stopped being unemployed - More likely to have started education/training - More likely to have increased social capital (people are friendly/neighbours look out) - But no positive change in health related behaviour

24. Partnership, tenure, education, age, gender, ethnicity, household composition, household worklessness (& years resident) Social networks Trust Cohesion & Reciprocity Engagement & efficacy Use of & satisfaction with health services Self-reported health: General health Health change SF-36 MHI Lifestyle: smoking diet exercise Social capital : Security, fear of crime Health models: pathways AB C D E F G H I

27. Summary Unique source of longitudinal data on health and related factors in varied and deprived communities Need intermediate outcomes (health behaviour) to demonstrate impact Evidence that interventions associated with behaviour change but be cautious in attributing causality