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

20

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 you!Jim.mcmanus@birmingham.gov.uk