290612 sha welfare reform and health
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Transcript of 290612 sha welfare reform and health
Recession, Welfare reform poverty and health
Dr John Middleton
Director of public Health
Sandwell
Reality very different
And the peculiar evil is, the less money you have , the less inclined you feel to spend it on wholesome
food. A millionnaire may enjoy breakfasting on orange juice and Ryvita biscuits; an unemployed
man doesn’t
When you are unemployed, which is to say when you are underfed, harassed,bored, and miserable
you don’t want to eat dull wholesome food……
George Orwell, The Road To Wigan pier.
• Harvey Brenner Int Journal Epidemiology • 2005, 34, 6: 1214
Recession and policy changes
Health impacts of economic downturn
• Widening health inequalities • Worse mental health –including depression, and possibly
lower levels of wellbeing• More suicides and attempted suicides; • Possibly more homicides and domestic violence• Fewer road traffic fatalities• Worse infectious disease outcomes such as tuberculosis
and HIV
Male life expectancy at birth, local authorities 2008-10
0 30 60 90 120 15070
72
74
76
78
80
82
84
86
Local authority rank - based on Index of Multiple Deprivation
Life expectancy (years)
Young people not in employment, education or training (NEET), local authorities 2008
0 30 60 90 120 1500
2
4
6
8
10
12
14
Local authority rank - based on Index of Multiple Deprivation
Not in education employment or
training%
18
Changes in real income for each 10% band ofpopulation, 1979 -1991/92, after housing costs
-17
6
16
23
29
33
39
46
62
0
6040200-20
100% (Wealthiest)
90%
80%
70%
60%
50%
40%
30%
20%
10% (Poorest)
80
Percentage
Source: Households below average income 1979-1991/92, Department of Social Security (1994)
Why ‘Child’ Poverty?
Source: The poverty site http://www.poverty.org.uk/09/index.shtml
Isn’t all poverty something we want to address?
Child poverty means family poverty
• 1 in 3 children in Sandwell live in relative poverty. This means approximately 24,000 children
• Of the 40,580 families with children dependents in Sandwell in 2008, more than 95% were in receipt of Child Tax Credit (CTC) or equivalent.
• For every 10 families in Sandwell receiving CTC, 7 were in work and 3 were out of work. The distribution of worklessness matches well-known patterns of deprivation.
Child Poverty Statistics, HMRC 2009
23
24
Life expectancy & disability free life expectancy at birth, by neighbourhood income level, England and Sandwell 1999-2003
Neighbourhoods by income deprivation (population percentiles)
Ag
e
Sandwell, Deaths by Coronary Heart Disease (CHD)
ICD10 I20 – I25 (5 year rolling average)
Directly Standardised Mortality Rate, Total Population
Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont with Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Vale
WednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburySouthSouthSouthSouthSouthSouthSouthSouthSouth
Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green and Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyng
Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath and Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hill
Soho and Soho and Soho and Soho and Soho and Soho and Soho and Soho and Soho and VictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoria
Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury NorthNorthNorthNorthNorthNorthNorthNorthNorth
West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich CentralCentralCentralCentralCentralCentralCentralCentralCentral
Friar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew tree
NewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley Heath
Princes EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces End
Great BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton Green
OldburyOldburyOldburyOldburyOldburyOldburyOldburyOldburyOldbury
St. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. Pauls
SmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwick
AbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbey
BristnallBristnallBristnallBristnallBristnallBristnallBristnallBristnallBristnall
Old WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld Warley
LangleyLangleyLangleyLangleyLangleyLangleyLangleyLangleyLangley
TividaleTividaleTividaleTividaleTividaleTividaleTividaleTividaleTividale
RowleyRowleyRowleyRowleyRowleyRowleyRowleyRowleyRowley
BlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheath
Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont with Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Vale
WednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburySouthSouthSouthSouthSouthSouthSouthSouthSouth
Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green and Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyng
Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath and Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hill
Soho and Soho and Soho and Soho and Soho and Soho and Soho and Soho and Soho and VictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoria
Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury NorthNorthNorthNorthNorthNorthNorthNorthNorth
West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich CentralCentralCentralCentralCentralCentralCentralCentralCentral
Friar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew tree
NewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley Heath
Princes EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces End
Great BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton Green
OldburyOldburyOldburyOldburyOldburyOldburyOldburyOldburyOldbury
St. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. Pauls
SmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwick
AbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbey
BristnallBristnallBristnallBristnallBristnallBristnallBristnallBristnallBristnall
Old WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld Warley
LangleyLangleyLangleyLangleyLangleyLangleyLangleyLangleyLangley
TividaleTividaleTividaleTividaleTividaleTividaleTividaleTividaleTividale
RowleyRowleyRowleyRowleyRowleyRowleyRowleyRowleyRowley
BlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheath
Sandwell, Deaths by Coronary Heart Disease (CHD) ICD10 I20 – I25 (5
year rolling average) Mortality Rate, Population Aged Under 65 Years
Directly Standardised
27
The Marmot Review
• The best evidence for what we need to do
• The biggest influences on health & wellbeing are the ‘social determinants’ of health
• The ability to influence these sits largely with the local authority
• Reducing social inequalities: UK Marmot review
• Early years education and family support: increase % spend in early years
• Evidence base: Family nurse partnership• Perry preschool study
• Triple P parenting• Surestarts and Childrens centres
Education and Skills
• Educational attainment is a predictor of health outcomes.
• Higher educational attainment is associated with healthier behaviour.
• There is a gradient in limiting illness by level of educational attainment.
• There is a gradient in mortality by educational attainment.
Children achieving a good level of development at age five, local authorities 2011
0 30 60 90 120 15040
45
50
55
60
65
70
75
80
Local authority rank - based on Index of Multiple Deprivation
Good level of development
at age 5%
• Reducing social inequalities: UK Marmot
review
• Maximise the capabilities and control young and adults
people have over their lives : reduce the social gradient of skills and
qualifications
• Reducing social inequalities: UK Marmot review
• Create fair employment and good quality work for all and improve quality of work across social gradients
Work is good
More than just a source of cash Psychological and social
benefits Structures people’s days Not working affects life expectancy Should be rewarding and
fulfilling (Marie Jahoda)
• Reducing social inequalities: UK Marmot review
• Ensure healthy standard of living for all reducing the social gradient through progressive taxation and other fiscal policies
Sandwell welfare rights services
37
How unemployment influences healthMaterial and psychosocial effects, can lead to: • an inability to afford to live a healthy life• distress, anxiety, depression and a
worsening of physical health• a loss of self identity and self esteem • an increase in smoking and alcohol
consumption and decrease in physical activity.
Employment and Life Expectancy
• Those experiencing unemployment are likely to have higher mortality rates over their next decade, than those working.• Mortality rates are higher in manual compared to professional professions.
• Reducing social inequalities: UK Marmot review
• Healthy and sustainable physical environments-
Green Space
Greener living environments: lower health inequalities, England
Source: Mitchell & Popham, Lancet 2008
Deaths from circulatory disease
Income group 4 is most deprived
Green Space
Healthy towns-Sandwell Healthy Urban Development Unit
Outcomes• Healthy urban development
approach• Working with town planners and
transport engineers – to influence policy and design
• Emphasis on environment and open spaces- create safer places where people
• Encouraged to walking and cycling
• Health impact assessment on all developments
• Spin off for comments on health care impacts eg new nursing homes
Housing and Health
Achievements so farService Investment Estimated annual
savings to NHS
Health Homes Advocate £30,000 £44,800
HUB £7,000
Handy Person Service £100,000 £132,000
Affordable warmth £250,000 £105,000
Home improvement agency £25,000 £56,000
• Reducing social inequalities: UK Marmot review
• Strengthen the role and effect of prevention of ill health priority for investment to reduce social gradients-
Breakdown of life expectancy gap by disease for males and females,
Sandwell (DH Health Inequalities Tool)
CHD Mortality 2000-2005
54
Male life Expectancy at birth, Sandwell and England
74.4
74.4 74.274.3
74.9
76.977.3
77.7 77.978.3
72.0
73.0
74.0
75.0
76.0
77.0
78.0
79.0
2003-05 2004-06 2005-07 2006-08 2007-09
3 year periods
Lif
e E
xpec
tan
cy (
Yea
rs)
Sandwell
England
Gap:
2.9
years
Gap:
3.5
years
Gap:
3.6 years
Gap:3.4
yearsGap:
2.5
years
55
Three dividends for a healthier future
The health dividend
Domestic burglary Sandwell 2001-2005 Full implementation
drug intervention project doubling numbers of drug users in treatment
1300 fewer domestic burglaries 33% fall
Three dividends for a healthier future
The inclusion dividend
The Future?
Easy to use Patient Graphic interface
Wireless or wired devices, POTS and IP Communications
Software based product – operates on a variety of devices in expanding applications
Standard protocols – easy customization
Tablet PC CareCompanion II Handheld devices
i- House, demonstration house West Bromwich 2008
Three dividends for a healthier future
The green dividend
Good corporate citizen award 38 apprenticesRationalisation of offcies : 6 leases surrendered 890 tonnes of CO2 reduction £200k saved
Citizen Wage?
Time to resurrect the concept Recognises work not covered by the conventional economic system
Advantages to employers and industry
67
Everyone’s business!
• Consider health impact of our activity
• Read the Public Health Report
• Read the Marmot Review summary
• Visit Sandwell Trends
www.sandwelltrends.co.uk
• THANKYOU
• John Middleton• Director of Public Health for Sandwell • [email protected]
• Vice President, UK Faculty of Public Health