let's talk research annual conference - 24th-25th september 2014 (prof. margaret whitehead)
TRANSCRIPT
Let’s Talk Research Annual Conference, 25th
September 2014, Bolton
Professor Margaret Whitehead
University of Liverpool
Chair: Inquiry into Health Equity for the North
Addressing health inequalities: why a research
priority for the North West?
• Professor Margaret Whitehead (Chair), W.H. Duncan Chair of Public Health, Department of Public Health and Policy,
University of Liverpool • Professor Clare Bambra, Professor of
Public Health Geography, Department of Geography, Durham University
• Ben Barr, Senior Lecturer, Department of Public Health and Policy, University of
Liverpool • Jessica Bowles, Head of Policy,
Manchester City Council • Richard Caulfield, Chief Executive,
Voluntary Sector North West • Professor Tim Doran, Professor of Health
Policy, Department of Health Sciences,
University of York • Dominic Harrison, Director of Public
Health, Blackburn with Darwen Council • Anna Lynch, Director of Public Health,
Durham County Council • Neil McInroy, Chief Executive, Centre for
Local Economic Strategies • Steven Pleasant, Chief Executive,
Tameside Metropolitan Borough Council • Julia Weldon, Director of Public Health,
Hull City Council
Inquiry Panel
• Differences in poverty, power and
resources needed for health
• Differences in exposure to health-
damaging factors
• Differences in opportunities to enjoy
positive health factors and protective
conditions that help maintain health,
especially conditions that give children
the best possible start in life
Causes – socioeconomic
• Greater prevalence of poverty
• Higher unemployment
• Adverse working conditions
• Poorer housing
• Higher unsecured debts
• All have adverse effects on health and
increase health inequalities
The SEVERITY of these causes is greater in North
Narrowing of the school readiness gap between children in most and least disadvantaged areas, England, 2008 to 2011
Source: Department for Education. Early years foundation profile results 2008-2013
• Austerity measures and poverty-generating
welfare reforms hit disadvantaged areas and the
North the hardest
• Demands for greater devolution to do things
more effectively and equitably
• Transfer of public health to local authorities
Why now? Threats and opportunities
DUE NORTH: LA cuts increase with increasing
deprivation of area (IMD score)
Source: Taylor-Robinson et al, 2012
Trend in child poverty and inequalities in infant
mortality
Source: Taylor-Robinson et al for Due North, 2014
Trend in child poverty and inequalities in infant mortality Trends in malnutrition and use of and food banks
Source: Taylor-Robinson et al, 2013
1. What can agencies in the North do to help
reduce health inequalities within the north and
between the north and the rest of England?
2. What does central government need to do to
reduce these inequalities?
Lessons for the whole country, not just the North
Two types of recommendations
• Rec. 1: Tackle poverty and economic development
• Rec. 2: Promote healthy development in early
childhood
• Rec. 3: Share power over resources and increase
influence of the public over decisions
• Rec. 4: Strengthen the role of the health sector in
promoting health equity
Four high-level recommendations for reducing the
North-South Divide and
the Divide between rich and poor areas
RESEARCH AND DEVELOPMENT NEEDED:
Northern agencies should:
• Collect and collate the evidence on the consequences of central government economic and welfare policies, particularly the impact on the most disadvantages communities in the region – use it to ameliorate and lobby
Central government needs to:
• Assess the impact of changes in national policies on health inequalities in general and regional inequalities in particular
•Extend the ONS ‘Measuring national wellbeing programme’ to better monitor progress and influence policy on inequalities
Rec 1: Tackle poverty and economic inequality
RESEARCH AND DEVELOPMENT NEEDED:
Northern agencies:
• Collect better data in children in the early years so that we can
track changes over time, monitor inequalities in child development
and evaluate services for their early effects on early disadvantage
Central government needs to:
• Commit to carrying out a cumulative impact assessment of any
future welfare changes, with a focus on the impact on people living
in vulnerable situations, especially children
Rec 2: Promote healthy development in early
childhood
RESEARCH AND DEVELOPMENT NEEDED:
Northern agencies:
• Develop community-led systems for health equity auditing and accountability
• Ensure the public reporting of actions and progress on health inequalities
• Make intelligence and data on health, equity and social determinants more accessible within the public domain
• Develop indicators of progress with local communities
Central government should:
•Invest in and expand role of Healthwatch to monitor progress and advocate for action on health inequalities
Rec 3: Share power over resources and
increase influence of public over decisions
R & D NEEDED
CCGs and other NHS agencies:
• Collect better data, improve monitoring and increase awareness of the health impacts of poverty for staff working in the health services
• Assess the adequacy of welfare benefits for supporting health
• Work more effectively with LA Directors of Public Health and PE to address the risk conditions that drive health and social care system demand
Public Health England:
Conduct a cumulative assessment of the impact of welfare reform and cuts to public services, in particular focusing on the impact on children and people with disabilities
Rec 4: Strengthen the role of the health
sector in promoting health equity
Evaluate policies and interventions for their
impact on health inequalities
Identify if any have differential impact on
different social groups – which would improve
the health of the worst-off the fastest?
BURNING RESEARCH NEED FOR ALL
Ben Barr, Margaret Whitehead and Clare Bambra. The
impact of NHS resource allocation policy on health
inequalities in England 2001-11: longitudinal
ecological study. BMJ 2014; 348: g3231
Investigated: Policy of increasing NHS funding to a
greater extent in deprived areas of England compared
with more affluent areas “to contribute to the
reduction of avoidable health inequalities”
An example from the North West: Evakuating
a Natural Policy Experiment
Trends in male mortality amenable to health care
and NOT amenable, by deprivation of area
NOT AMENABLE AMENABLE
Source: Barr et al. BMJ 2014; 348: g3231