jim mcmanus, joint director of public health birmingham city council and nhs
TRANSCRIPT
Jim McManus, Joint Director of Public Health
Birmingham City Council and NHS
The response to the JSNA took everyone by surprise.....
1. Introduction to context of Marmot2. Relevance to Health & Social Care
Integration3. Relevance to JSNA4. Examples of use in Practice5. Over to you
The elements which make for a healthy society are multi-faceted
Our frameworks and systems are not JSNA has an almost impossible task Everyone knows what they want the Health
and Wellbeing Strategy to do...nobody wants to do it
Need to plan across the lifecourse
Forward Comrades!
The JSNA has solved all our problems!
Activities Framework
1. Adopt the Outcomes Starting well Developing well Living well Working well Ageing well
2. Add an objective “dying well”
3.Cut our JSNA and Strategy across the Lifespan
4. Use as “golden thread” (still under construction)
For Health Inequalities Action
For JSNA For Health and
Wellbeing Strategy For Integration As a lifecourse
approach to human ecology
LGBT MENTAL HEALTH PREVENTION
Lifecourse approach using Marmot
Early development Mental health
problems onset Tasks for each
lifestage Community and Public
Sector tasks Interdependencies
Use of Marmot Framework across lifecourse
Tasks for adult social care and older adult social care elucidated
Incorporation into third sector contracts with third sector
Preventive workstream
Life course
Prenatal
Pre-school School Training
Employment Retirement
Family building
PreventionEarly Years Skills
DevelopmentEmployment and Work
Accumulation of positive and negative effects on health and
wellbeing
Healthy Standard of Living
Sustainable communities and places
Life course stages
Areas of action
The Conceptual Framework
Reduce health inequalities and improve health and well-being for all.
Create an enabling society that maximises individual and
community potential.
Ensure social justice, health and sustainability are at heart of
policies.
A. Give every child the
best start in life.
C. Create fair
employment and good work for all.
B. Enable all children, young people and adults to maximise
their capabilities and have control over
their lives.
D. Ensure healthy
standard of living for all.
E. Create and develop
healthy and sustainable places and communities.
F. Strengthen the role
and impact of ill health prevention.
Equality and health equity in all policies.
Effective evidence-based delivery systems.
Policy objectives
Policy mechanisms
0
10
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30
40
50
60
70
80
90
100
22 26 30 34 38 42 46 50 54 58 62 66 70 74 78 82 86 90 94 98 102 106 110 114 118
months
Ave
rag
e p
osi
tio
n in
dis
trib
uti
on
High Q at 22m
Low Q at 22m
Source: Feinstein, L. (2003) ‘Inequality in the Early Cognitive Development of British Children in the 1970 Cohort’, Economica (70) 277, 73-97
Socio Economic StatusHigh SES Low SES
Avera
ge p
erc
enti
le s
core
Waldfogel & Washbrook 2008
Life expectancy and disability free life expectancy at birth, persons by neighbourhood income level, England, 1999-2003
45
50
55
60
65
70
75
80
85
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
Neighbourhood Income DeprivationSource: ONS (Population Percentiles)
Age
Life expectancy
DFLE
Pension age increase2026-46Poly. (DFLE)
Poly. (Life expectancy)
Reducing health inequalities is a matter of fairness and social justice – inequality is avoidable.
Action is needed to tackle the social gradient in health – Proportionate universalism
Action on health inequalities requires action across all the social determinants of health avoiding lifestyle drift
Reducing health inequalities is vital for the economy – cost of inaction
A move beyond economic growth to well-being of society: sustainability and the fair distribution of health
Each year, if all had the mortality rate of 1) those with university education: Prevent 202,000 people aged 30+
dying prematurely (40 % of deaths); 2.5 million life years gained;2) those in most affluent 10% of areas: 2.8 million extra years of life free from
limiting illness or disability
Estimates calculated for Marmot Review based on ONS data
1) Give every child the best start in life.
Priority objectives
1. Reduce inequalities in the early development of physical and emotional health, and cognitive, linguistic, and social skills.
2. Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient.
3. Build the resilience and well-being of young children across the social gradient.
Focus Group respondent – Single Parent in Manchester:
“I’m not mentally ok because I’m doing too much, but then how am I helping my children?”
2) Enable all children, young people and adults to maximise their capabilities and have control over
their lives.
Priority objectives
1. Reduce the social gradient in skills and qualifications.2. Ensure that schools, families and communities work in
partnership to reduce the gradient in health, well-being and resilience of children and young people.
3. Improve the access and use of quality lifelong learning across the social gradient.
Focus Group Respondent ,Birmingham
“If there is no education, there are no jobs these days, so it really is worrying. If your children don’t get a good education then what’s going to happen to them”
Life expectancy (Years of Life) Health expectancy (quality of years) Wellbeing. (when developed) Readiness for School Young People not in education or
unemployment. Increase in proportion of households
with an income sufficient for healthy living.
An overview Principles
JSNA (Birmingham, Lincolnshire, E Mids, Mcr)
Health Inequalities Strategy (London,
Tracking Progress (LHO, Wales)
Sustainable Community Strategy (Birmingham)
Health and Wellbeing Strategy (Bham)
Pragmatism What works for you Bridging framework Analysis tool Outcomes tracker Strategic Tool A way to getting to
lifecourse commissioning
Marmot gives us the best possible statement of evidence on the challenges of health inequalities
Evidence appraisal leads to outcomes and Policy Objectives
Marmot as Bridging Framework
Activities Framework
1. Adopt the Outcomes Starting well Developing well Living well Working well Ageing well
2. Add an objective “dying well”
3.Cut our JSNA and Strategy across the Lifespan
4. Use as “golden thread” (still under construction)
For Health Inequalities Action
For JSNA For Health and
Wellbeing Strategy For Integration As a lifecourse
approach to human ecology
Adoption of Framework by HWBB and LSP The JSNA is constructed according to
outcomes Prioritisation being developed according to
Marmot Outcomes Health and Wellbeing Strategy using
Marmot Marmot Group – Joint NHS and LA Group on
the “what of health inequalities work”
Start Well Develop Well Age Well
Adults & Communities
High priority parents in touch with A & C
Transition Older Peoples’ offer from prevention to very high need
Homes & Neighbourhoods
Overcrowding and infant mortality
Decent Homes Standard
Access, Trips, Falls, Extreme Weather, Adaptability,
Development
Back to work packagesDigital inclusion
Back to work packages for parentsDigital Inclusion
Volunteering and work packagesDigital Inclusion
NHS Infant MortalityConception
Frail Elderly
JSNA refresh in draft HWBS in drafting process Commissioning for older people Prevention programme LGBT Health Strategy Faith Community Strategy Joint Health Inequalities Plan Vision for Public Health Reorganisation
Thank [email protected]