1. Plenary 1 Chair: Professor Gareth Williams Health Impact Assessment: Making the Difference

2. 7th International Health Impact Assessment Conference Health Impact Assessment: Making the Difference Supported by:

3. Chris Tudor-Smith Head of Public Health Improvement Division, Welsh Assembly Government Health Impact Assessment: Making the Difference

4. Tackling inequalities in health in Wales Chris Tudor-Smith Public Health Improvement Division Office of the Chief Medical Officer

5. The presentation will cover... The situation in Wales The policy context From policy to action Sustainable Health Action Research Programme Concluding remarks ‘So what do I need to know about health inequalities then Humphrey?’ ‘Well Minister…’

6. ‘Headline’ indicator: all deaths by quintile of deprivation, Wales, 1993-97 European age-standardised mortality rate per 100,000 population Source: NAfW (2001) Expert Group on Indicators of Health Inequality

7. Coronary heart disease mortality (age under 65) by quintile of deprivation, Wales, 1996 European age-standardised mortality rate per 100,000 population Source: NAfW (2001) Expert Group on Indicators of Health Inequality

8. Adult mental health status by quintile of deprivation, Wales, 1998 SF36 Mental Component Summary score Source: NAfW (2001) Expert Group on Indicators of Health Inequality

9. Adults smoking by quintile of deprivation, Wales, 1996 Source: NAfW (2001) Expert Group on Indicators of Health Inequality

10. Teenage conceptions by quintile of deprivation, Wales, 1992-1997 Conceptions to girls under 18 per 1,000 girls aged 15-17 Source: NAfW (2001) Expert Group on Indicators of Health Inequality

11. The policy context in Wales ‘Better Health Better Wales’ - late 1990’s policy document dealing with public health in Wales –health inequalities acknowledged and described Townsend review ‘Targeting Poor Health’ –NHS resource allocation favouring those most in need ‘Review of Health and Social Care in Wales’ (Wanless Report) –notes inequalities and action being taken in other policy areas Topic specific strategies with a focus on health inequalities –e.g. Food and Well Being identifies priority groups (low income, ethnic minorities…) Health targets and inequality indicators –e.g. to improve CHD mortality in all groups and at the same time aim for a more rapid improvement in the most deprived groups.

12. Tackling health inequalities in Wales – working at different levels Government socio-economic policy e.g. –responsibility with UK government e.g. fiscal policies –Wales: A Vibrant Economy Collaboration and partnership between communities and agencies e.g. –SHARP –Health Impact Assessment –Communities First –Development of food cooperatives Individual behaviour change e.g. –Inequalities in Health Fund (focus on risk factors for CHD) –Health Challenge Wales –Programmes tackling smoking, nutrition, physical activity…

13. Sustainable Health Action Research Programme (SHARP) Roots in Better Health Better Wales – attempt to develop learning and add to evidence base on partnership-driven and community-based action research approaches to tackling broad social determinants of health Focused on communities with the highest incidence of ill-health and premature death, social exclusion and poor life chances Project level and overarching evaluation (Cropper S., Carlisle S., Beech R., Little R – Centre for Health Planning & Management, Keele University) Seven projects funded for six year period, ending spring 2006

14. ‘Barefoot’TrianglePembsHolwayBeWEHLHYPPR2R

15. SHARP funded projects (1) HYYP Project An evaluation of community involvement in Powys to meet the health needs of young people in rural areas ‘Right 2 Respect’ Project A project to identify and begin to address issues of particular concern to girls and young women (11 to 25 years) in Wrexham BeWEHL Project An initiative in Newport to examine the contribution of women’s learning to community health development Triangle Project A programme to support local health alliances in Cardiff, Merthyr and Powys in tackling health inequalities

16. SHARP funded projects (2) Healthy Living Approach Project An evaluation of the Healthy Living approach to improving the health and wellbeing of communities in Pembrokeshire Holway Project House Community development and regeneration in the Holway community in Flintshire ‘Barefoot’ Health Workers Project A project to support the health improvement of Somali, Yemeni and Bangladeshi communities in the Butetown/Grangetown area of Cardiff

17. Assets & Legacies ‘Barefoot’: Expertise in working with minority ethnic groups; community researchers skilled in working with agencies and local people. Triangle: framework for establishing sustainable community health partnerships; model of participatory action research as tool for community health engagement – ‘local health champions’; locally sustainable projects. Pembrokeshire SHARP: Community research training programme and handbook - transferable inquiry into local priorities; Community Action Plans. Holway House: community transformation - residents working in partnership with external organisations. Source: Cropper (2005)

18. Assets & Legacies BeWEHL: improvements in women’s mental and ‘social’ health (increased confidence/self-esteem, wider networks); transferable approach to developing women’s capacity to engage in lifelong learning. HYPP: civic participation by young people, better relationships between different generations; Youth Council and OASIS roll-out. Right 2 Respect: impact on Wrexham CBC Youth Services; ONC in a/r for single gender youth work; outdoor worker; sustainable spin-off projects. Source: Cropper (2005)

19. Policies tackling health inequalities – a synthesis Successful policies will need to be broadly based including : –lifecourse approach –multisectoral interventions –health impact assessment –focus on the distribution of social determinants –tailoring where appropriate Policies on health inequalities and social justice/inclusion should be inextricably linked Local capacity building is required to deliver policies Importance of (applied) research, particularly monitoring impact of policies and developing evidence base of effective interventions Commitment

20. 7th International Health Impact Assessment Conference Health Impact Assessment: Making the Difference Supported by: