Joining up interventions for better outcomes

Jim McManus

BHWP Summit Jan 14th 2010

Towards a neighbourhood model for health interventions in Birmingham

www.bhwp.nhs.uk

Where has this come from?

• This is one part of Birmingham City Council’s Health Inequalities Strategy

• It works with Partners but is focused on what the Council can do with partners

• It is a part of the work of the council on– Producing a Health Inequalities Strategy– Having a senior council officer leading on health in each

Department– Having a series of health interventions at local level which touch

on what local authorities can do on health inequalities– Inputing into the Birmingham Health and Wellbeing Partnership

www.bhwp.nhs.uk

Current Status

• Model supported by– Neighbourhoods Board*

– Children and Young Peoples Partnership*

– Health and Wellbeing Partnership (BHWP)Exec*

– Housing and Constituencies

– Constituency Directors

– Neighbourhood Managers

– Be Birmingham*

– Police Operational Commanders & Constituency Directors joint meeting

* indicates fora which include NHS partners

www.bhwp.nhs.uk

The Idea

• A model which is easy to use, consistent with evidence and brings together that evidence for cumulative effect– Evidence on the state of neighbourhoods and CVD– Evidence on the fear of crime and health– Evidence on citizens/tenant engagement and health

• The City Council work on a neighbourhoods approach to health with partners as part of its health inequalities programme.

• Easy to use and easy to understand

www.bhwp.nhs.uk

Policy Drivers and evidence

• Health status is one of the key variables in Birmingham which acts on, and is acted on by, almost every other variable– It is in every agency’s corporate plan, to some extent– Life expectancy– Neighbourhood Stress

• Joining up interventions can bring additional benefits

• We do not do prevention well in Birmingham

www.bhwp.nhs.uk

The effect of place on health

• The consensus from research evidence

– There is a strong, independent and enduring effect of place on the health status of individuals, families, communities and neighbourhoods

• Findings from JSNA– Wide variations in health outcomes by ward

(statistical problems with analyses of neighbourhoods)

www.bhwp.nhs.uk

Evidence

• Thanks to– Sir Michael Marmot– World Health Organisation– WHO Health Cities Collaborative– Medical Research Council– York Health Economics Consortium– Prof Malcolm Whitfield, Sheffield and WHO

www.bhwp.nhs.uk

Evidence: Healthy Urban Environments and Heart Disease

www.bhwp.nhs.uk

Evidence: Housing and CVD

www.bhwp.nhs.uk

Evidence: Neighbourhood Economics and CVD

www.bhwp.nhs.uk

From Neighbourhood Disadvantage to Disease

www.bhwp.nhs.uk

Leading causes of death

Common Risk Factors

www.bhwp.nhs.uk

Life Style

Key figures for life style Deprivation in Birmingham, West Midlands and England

Year Birmingham West Midlands England

Adults who smoke 2003/5 24.9% 24.0% 24.1%

Binge drinking adults* 2003/ 2005 17.8% 17.9% 18.0%

Healthy eating adults** 2003/ 2005 25.1% 25.1% 26.3%

Physically active adults***2007/8

16.9% 19.1% 21.3%

Obese adults**** 2003/ 2005 23.4% 26.5% 23.6%

www.bhwp.nhs.uk

www.bhwp.nhs.uk

Environmental pollution• 57 children per 1,000

have long term lung function problems due to this

• 36 children and 30 adults per 1,000 have pollution-related asthma

• 1g/m3 drop in PM air pollution could reduce CVD deaths by over 100

• As much as 30% of acute asthma attacks and hospitalisations are atttributable to air pollution

• 46% of acute bronchitis admissions are attributable to air pollution

www.bhwp.nhs.uk

Towards a Model….

www.bhwp.nhs.uk

BIRMINGHAM NEIGHBOURHOOD HEALTH INTERVENTIONS MODEL

Development of a local plan for each neighbourhood between partners with use of existing community networks

2. WORK ON THE COMMON RISK FACTORS FOR BIG KILLERS

Neighbourhood interventions for

Diet, Physical Activity, Smoking, Alcohol,

3. IMPROVE LOCAL NEIGHBOURHOOD QUALITY

Physical Environment, Green Space, Crime/ASB. INCREASE SOCIAL CONTACT BETWEEN

NEIGHBOURS

4. INCREASE UPTAKE OF PREVENTIVE HEALTH PROGRAMMES

Immunisation, Screening, This may differ from area to area depending on issues

1. Complete a Basic health profile – identification of health issues salient for the neighbourhood by a) providing a basic profile and b) running health typologies through Customer Insight or whatever mechanism is favoured in each PCT/locality (for Ben it is PRIME/DR Foster)

5. Local worklessness and skills programme – deliver public health and literacy for health skills training. Develop local health trainer programmes using WNF to get people into work.

The modelexplicitly designed to be as simple as possible so non-health specialists can implement it

www.bhwp.nhs.uk

Just to recap….

www.bhwp.nhs.uk

Making it happen 1 - Process

1. Multi-Agency and BCC support

2. Giving a clear responsibility to neighbourhoods managers to co-ordinate with health and other partners

3. Scoping a plan for each area

4. Finding some monies for delivery and implementation as a means of kick-starting the process and moving on from there

5. Producing a single co-ordinated programme approach with local flavour using the model outlined above

6. Linking this to the key health outcome issues

www.bhwp.nhs.uk

Making it happen 2 - Outcomes

STOP SETTING THE WRONG OUTCOMES

• “We will reduce obesity”……

• We will increase the number of people on this estate who eat 5 a day

• We will increase the number of people who eat healthily

• We will help x people achieve normal BMI within x years

www.bhwp.nhs.uk

Making it happen 3 - Skills• THIS IS ALL PART OF THE ROLL OUT PLAN

• Developing a clear model for prevention which is effective and evidence based

• Using intervention mapping principles shown to ensure that interventions remain consistent with evidence

• “real world” (doability and evidence) appraisal of candidate projects

• Development and evidence appraisal of candidate projects (“proof of concept”) [both the prevention of undesirable outcomes and interventions which will deliver this efficaciously]

www.bhwp.nhs.uk

Why bang on about intervention mapping?

• Good prevention needs a combination of

– Knowledge, Evidence, Skill and Direction

• Intervention mapping is a means of ensuring an intervention is consistent with the evidence and needs assessment

• It has paid dividends where it has been properly implemented, not just in health but in community safety, regeneration and other areas of work

• Intervention Mapping should be a key technology for rolling out any health model. This will be a key part of the roll out of training and of plans.

www.bhwp.nhs.uk

Tasking Models

• Currently there are different tasking models for police, community safety and others

• Be Birmingham has set up a task and finish group to ensure we have consistency across tasking models

• The Neighbourhood health model is a model of “what” we will do.

• Intervention Mapping will be the “how”.

www.bhwp.nhs.uk

www.bhwp.nhs.uk

Conclusion

• Simple Model• Several Components• See things as joined up• Identify “obvious” outcomes

– Healthier lifestyles, healthier area, better quality public realm etc

• Develop a pathway approach– Link people into programmes – Encourage neighbourhoods to control them

• Need a very small workforce (2- 3 people) to roll this out?