residents’ charter for health and wellbeing · residents’ charter for health and wellbeing -...

Residents’ Charter for Health and Wellbeing

Wingrove, NewcastleOctober 2015

Funded by: Wingrove WardNewcastle City Council

Supported by HealthWORKS Newcastle

Wingrove

Introduction

Residents’ Charter for Health and Wellbeing - Wingrove 2

The Wingrove Community Health and Wellbeing Project

The aim of this project was to engage and involve local people and community projects in a Healthy Life Simulation event with support received from Wingrove Ward Health and Wellbeing fund, to:

• raise awareness about issues affecting health in Wingrove ward in a different way

• contribute towards improving health literacy, and support local people to think about what difference they as individuals can make to address health inequalities

• using the information and ideas generated from the event, to work with local people to produce a Wingrove Charter for Health and Wellbeing and present it to local decision makers.

• There is also a small pot of funding set aside (£2,000) for local people to start to implement the ideas they come up with to address health inequalities so they can see, and lead on, immediate local actions arising from the work.

The Healthy Life Simulation Event

In order to identify local solutions to the important issue of health inequality and ageing we decided to run a Healthy Life Simulation event.Sixteen local people resident in the Wingrove Ward were recruited by Healthworks Newcastle via various methods; attending ward meetings, linking into existing project events and activities, engaging with schools, faith groups plus a local café. • Twelve people took part in the event with 4 apologies on the day.• The one day simulation event was successfully held at the Nunsmoor Centre on

14 October 2015.• The findings from the event are presented here as the “Wingrove Residents’

Charter for Health & Wellbeing”• The simulation process and the activities residents undertook are also described

as they provide the evidence base for recommendations.• The outputs will be used by the residents of Wingrove to shape and influence

how local services are designed and delivered. Residents aim to have a direct influence on health and wellbeing budget spend.


Wingrove ward area

0 125 250 375 50062.5Meters

1:4,500Scale

© Crown Copyright and database right [2015]. Ordnance Survey [100019569].

February 2016

Title:Wingrove Ward

Drg. No.15018-0009/0025/002

Wingrove Ward

Notes: Produced By RBHighways and Local [email protected]

Peter GrayHead of Highways and Local Services

Communities DirectorateStratford House

Newington Road EastNewcastle upon Tyne

NE2 1PXTel: 0191 2328520 Fax 0191 2783805

@A1 .

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STEM CERT I F I CAT ION SY

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We are very grateful to the following for providing their invaluable support which made this event possible and to the people of Wingrove who enthusiastically gave their time, ideas and input.

• Angelou Centre• Cooperative Communities team• CHAT Trust• Community First Elswick • Greening Wingrove• First Step• JET• HealthWORKS Newcastle

• Moorside School• Newcastle University• Nunsmoor Centre• Robert Stewart Memorial Church• Spice FM • Spital Tongues Community Centre• Time Exchange• Wingrove Ward Councillors

Acknowledgements


Background

Healthy Life Simulation • The Healthy Life Simulation was commissioned by Newcastle

University as a novel way of addressing the problems of inequality and ageing.

• It was developed by a team of experienced simulation designers and has been run successfully with academics, health professionals, Newcastle City councillors as well as with young people.

• In partnership with Healthworks, the simulation has proven its utility as a mechanism for local communities to understand and debate the complex issues of health inequality.

• Importantly, it enables players to develop community driven solutions for improving local health and wellbeing.

• As a result of residents engaging with the simulation in another west end ward; a Peoples’ Charter was presented to Chi Onwurah MP, local actions to improve health have been implemented and the group received a Public Health Excellence award at the House of Commons 3 March 2015.

HealthWORKS NewcastleHealthWORKS Newcastle is a registered charity working to improve health literacy and reduce health inequalities. Professor Sir Michael Marmot from the Institute of Health Equity at University College in London became patron of HealthWORKS in February 2014.Adopting an asset based approach; building the capacity of individuals to identify and act on issues that impact on their own, and others, health and wellbeing, HealthWORKS offers: • appropriate and user-friendly community activities, responding to

locally identified needs• support for those wanting to make positive change in their lifestyle

and reduce the risk of serious health issues in the future• help for those living with long-term illness such as diabetes and heart

disease to manage their conditions• services that are safe, welcoming, secure and well-managed,

addressing access and equity issues• active participation in local health related networks and partnerships.


Wingrove Ward Players

On 14 October 2015, twelve residents of Wingrove came together to play the Healthy Life Simulation in order to develop strategies for the local community to improve their health and wellbeing.Councillor Irim Ali joined the simulation and worked alongside local people in debating how to further enhance the community and improve local health outcomes.

Name Locality Name LocalityAlison Pride Sidney Grove (NE4) Rina Wahyuni Baxterwood Grove (NE4)

Angela Oxberry Spital Tongues (NE2) Samitra Singh Wingrove Road (NE4)

Di Barnes Spital Tongues (NE2) Stella Simbo Sidney Grove (NE4)

Gerry Hunwick Dilston Road (NE4) Umi Latifah Tamworth Road(NE4)

Jill Dales Sidney Grove (NE4) Yustira Mayasari Croydon Road (NE4)

Linda Robson Wingrove Road (NE4) Yessi Erismadona Brighton Grove (NE4)

Victoria Powell Co-operative Communities NCC


Health inequalities and ageing

Health inequality The North East of England, like many other areas, has significant variation in how well people age depending on where they live. Newcastle University research showed that the number of healthy years 55 year olds can expect to live will vary by 11 years if they live just a few stops apart on the Metro line. The actual figure for Wingrove is 67.8 years, representing a difference of 7 years from Ponteland South.

Unsolved problemConsiderable effort has been made in understanding the problem but developing solutions has proven challenging.

Health inequalities are influenced by a wide range of factors including access to education, employment and good housing as well as individuals’ circumstances and behaviours. Local people are uniquely placed to offer potential solutions.

The challenge The consequences of not addressing this gap in healthy life expectancy (HLE) are unacceptable levels of human suffering and premature loss of life in disadvantaged groups. In addition, increasing HLE in people from disadvantaged groups would bring economic gains to individuals and the community as well as reducing direct costs to the NHS and social care.


The Healthy Life Simulation

The Healthy Life Simulation, commissioned by Newcastle University, was developed as a novel and interactive toolkit to address the problems of health inequalities and ageing. It enables players to develop the skills and knowledge to debate this complex issue and to identify potential solutions based on local knowledge and experience.

How the simulation worked• Scenario - the gap in healthy life expectancy (HLE) between the least and most deprived

areas of a fictional city was exposed in a vividly filmed news report• Mission - players were challenged by the leader of the Council to form a Task Force to

analyse the cause of the health divide and devise an action plan of interventions to close the gap for 55 year olds by 50% in 10 years within a strict budget

• Teamwork - local people from the Wingrove ward formed 2 teams ( Blue & Green Team) who spent the day analysing, prioritising, discussing and preparing a plan to close the gap

• Priority diseases - players had to analyse the differences between areas with high and low deprivation, prioritise diseases from data that showed the share each disease contributed to the gap in HLE

• Risk factors - teams also had to prioritise risk factors associated with the diseases that could be modified by intervention.

Intervention strategy • Intervention - teams then had to select two interventions

directed at distinct levels of the major determinants of healthy life:

- Individual behaviours - Community & social networks - Health services - Population & general environment• Modelling - the interventions were assessed in an

evidenced-based Multi Criteria Decision Analysis (MCDA) model that estimated cost and effectiveness over 10 years

• Presentation - at the end of the session, teams presented their findings to the group.


Wingrove Residents’ Charter for Health and wellbeing

• Engaging with the simulation showed that local people from Wingrove can under-stand complex health information and are uniquely positioned to offer ideas and potential solutions to local issues that influence their health and wellbeing

• The following slides outline our experience and recommendations based on our knowledge and aspirations. Ideas generated by the simulation are presented at the end.


Evidence from the Healthy Life Simulation


Systematic approach

• We used a systematic approach to understanding the complex issues of health inequalities and ageing

• We started understanding the nature of the Healthy Life Expectancy (HLE) gap by comparing a high income community with one with high levels of deprivation (Pillar 1)

• We considered seven key diseases that contribute to the gap and can be modified by intervention (Pillar 2)

• We reviewed the modifiable risk factors that are associated with the key diseases (Pillar 3)

• We considered changes individuals can make to reduce risk and disease profile (Pillar 4)

• We debated ways to enhance and improve the health of communities with high levels of deprivation (Pillar 5 )

• We discussed how best to influence how health services are delivered to socially deprived groups (Pillar 6)

• We thought about changes in the overall environment that would improve health & wellbeing (Pillar 7).

We worked in two teams - Blue & Green Team


Pillar 1:

The importance of community and knowing what is happening within it “We have recognised the diversity and transient nature of the population in our ward and the social isolation that may result. We also recognise positives like ‘Greening Wingrove’ which we can build on.”

“Peer support is all important in sharing information and encouraging people to go and access services.”“The population in a deprived ward may have the same access to health services but that doesn’t mean individuals use services in the same way.” “For example, people may only use emergency dental services rather than routine dental prevention – peer support and encouragement is vital for people to make maximum use of available health services.” “One bill that you don’t pay can just get worse and worse so people need to get help in a crisis.”“Sometimes things are so close but you don’t know they are there because you are so buried in your problems – you need leaflets going through doors as well as face-to-face support.““Everyone needs to know the gathering points in the community.”“Loneliness is very hard especially if you live alone and can’t access things, so neighbours become more important.” “Work is very important – as well as income, it provides a sense of purpose, social connectedness and makes people feel valued.” “Helping other people is important – to feel you have a role and a value.”

Often people’s health gets put on the backburner when they have so much else to cope with.

One thing leads to another and things can snowball. You don’t necessarily want people to know you’re struggling.

Good neighbours are a hugely important thing – sharing knowledge and just touching base is very important.

People need to know about things in order to access them !


Pillar 2:

We are informed about the diseases that affect us mostWe investigated seven diseases that contribute to the HLE gap at 55 between income groups:Type 2 diabetes, heart disease, stroke, Chronic obstructive pulmonary disease (COPD), lung cancer, liver disease, mental illnessMental illness“ Everything comes down to people’s mental health”• Mental ill health affects your ability to cope with other areas of health, your relationships with other

people, your ability to function socially • Social isolation and deprivation are key factors in causing mental ill health• Education also has an important part to play – it equips you to deal with life’s difficulties“ I strongly believe that our ability to deal with whatever life throws at us is heavily influenced by our mental wellbeing” Diabetes type 2 • This can be reversed in some cases• Also linked with heart disease and stroke“The things you can do to make an impact are not that difficult - like swapping from white rice to brown”• You need to change habits and incorporate those into your life• Smoking /lung cancer/COPD are really bad but rates are declining whereas diabetes is going up and up • What we are seeing is just “the tip of the iceberg”

With long-term illness, It’s not just the people who are ill who are affected, the family is having to deal with it too.

Blue Team Green Team

Mental illness Mental illness

Type 2 diabetes Type 2 diabetes

Top 2 picks in the simulation


Pillar 3:

The risks that we are exposed to k factors associated with the key diseases that make up the gap and that can be modified by intervention were debated and prioritised for action.

“The amount of money people have to live on is hugely influential, especially on mental health”

“I don’t feel the Government always spends money in ways that benefit our communities.”

The amount of money people have to live on is hugely influential, especially on mental health.


Deprivation Deprivation

Social isolation, obesity Obesity


• Diet and physical activity are also important because they affect so many other conditions, including mental health, obesity, diabetes

• Health literacy is all important – people need the skills to understand health messages and important things like taking medication for chronic illness (many people don’t do this )

• Smoking still has a massive impact even though rates are declining• Social isolation is strongly linked to mental ill health


Pillar 4:

Changes we can make as individualsKey discussion points:

“I can’t get away from thinking that learning is all important … we need to deliver it in creative ways… which aren’t just sitting in the classroom.”


Lifelong Exercise weight learning managementWelfare & benefits Welfare & benefits advice advice


• Even small lifestyle changes can have a rapid and large impact – more so than interventions that require policy change

• Learning should include skills for healthy living, food, cooking, exercise, growing veg • Accessing advice ensures people have all the welfare benefits to which they are entitled, which has a

potential impact on their standard of living and mental health

“lifting people out of poverty and giving them more disposable income makes them more likely to interact with society, buy different foods and decrease social isolation”• Benefits advice needs to be targeted, based on referrals and people need to be aware it exists – use

leaflets, word-of-mouth, local drop-ins and one-to-one contact is essential• Weight management & exercise schemes should incorporate technology like pedometers/Fitbits which

could be motivational and could change behaviour• Weight/exercise groups should be promoted by Community Health Trainers and linked with voluntary

groups – they can provide opportunities for volunteers • Consider using community groups and resources as well as commercial organisations to increase the

uptake of activities.


Pillar 5:

Enhancing our community

There are good green spaces in Wingrove - “green gyms” could add benefits of more free exercise opportunities

Need to encourage over 50s to engage in leisure that increase activity levels &

social interactions

Housing Control of alcohol/fast food outlets


Reduce alcohol Controls on fast availability food outlets Improve housing Housing

Top 2 interventions targeted at the level of the community

• Poor housing is a major factor in causing ill health• In Wingrove there are over 1500 privately rented

properties with over 500 registered landlords• Many properties are not well looked after or

energy efficient and people have no choice but to live in them

• We need to engage with landlords and tenants to improve standards

• Transient community results in housing challenges• Tenants need timely advice, support and advocacy• People need more information about bins and

recycling• Wingrove has a diverse ethnic population in which

many different languages are spoken

• Many fast food outlets exist resulting in potential over consumption of unhealthy food, plus considerable amount of litter arising from them

• Residents would like to see a cap set on numbers of takeaways and locations. Improvements to food with healthier options should be offered in takeaways

• Concern over availability of low cost alcohol and resulting antisocial behaviour

• More support / confidence to challenge applications / make effective representations

• Ensure adequate support services are available for those seeking to overcome dependencies


Pillar 6:

We want to influence how our health services are delivered


Community Health Community Health Trainers Trainers

Health Literacy Social Prescribing

Top 2 interventions using health services

Community Health Trainers • Employed and recruited from local communities who are felt more approachable than some other health

professionals.• Increase awareness of organisations such as Healthworks and community partnerships.• Identify target population and ensure they deliver specifically on local priorities. • Support people to help themselves - empowering people promotes good mental health. • Offer lifestyle advice and one-to-one support.Social Prescribing “Seems to be the missing link we’ve been working towards“• Promotes participation in social events, creative events, gyms and physical activity.• Strengthen links between GPs and Community Health Trainers.• Need to ensure there is sufficient capacity in the voluntary sector to meet demand.Health Literacy • Health related education is vital.• People need to recognise symptoms and seek appropriate help early. • Need confidence to find information and services to then act on and make decisions about

our own / others health.


Pillar 7:

Changes in our environment

“Make healthy food the norm not an option”


Job creation Job creation schemes schemesImprove processed Improve processed food food

Top 2 interventions at population level

Job Opportunities • People over 55 still need to work• Work impacts on people’s sense of value and

self esteem• It provides income, education and social

interaction and raises aspirations for whole families

• Work reduces isolation, deprivation and mental ill health

• We need to persuade Government and local council to invest in local jobs

• Apprenticeships for older workers - e.g. work with organisations such as Elders Council

Improve Processed Food• There is an evidence base for impact of unhealthy food• People will continue to eat processed food so quality

should be improved• This will target low income groups who consume more • Labelling so people can see fat, sugar, salt content is

important• Some change could be achieved at a local level by

working with local retailers • Maintain education about ingredients• Raise awareness of good aspects of some convenience

food, for example, frozen vegetables


Other important issues we discussed

• More discussion needed around sugar tax and whether it would disproportionally hurt the people who are socially disadvantaged

• Although we know the value of home-cooked family meals and the need to budget, we also have to acknowledge that society has changed and convenience food is part of life. We need to find ways to make them more healthy.

• There is a dilemma around paying people to lose weight or stop smoking

• The team thought it would be better to incentivise healthy behaviour - perhaps on a point system rather than money where points could be used to buy things like fruit and vegetables or join activities.


Healthy Life Simulation Results

Demonstrating that: local residents can understand complex health information, spend budget responsibly and know what interventions work well in their communities

Blue TeamNarrowed gap by 5 yearswith 44% improvement

at a cost of £329,200 (over budget but negotiated some cost reductions due to

conditions in the ward)

Green TeamNarrowed gap by 4 yearswith 41% improvement

at a cost of £213,700(under budget by £48,737)


Recommendations for our ward

• Build on our existing community-led approaches to providing education, information and advice on healthy life styles

• Analyse and identify the areas of greatest need within our diverse ward and target and prioritise resources in order to meet those needs

• Maximise the use of our community resources to promote healthy living through physical activity schemes and learning programmes on health and food in particular

• Promote and develop local opportunities for older residents to engage in occupations (paid or voluntary) that provide purpose, a sense of self worth and social connectedness

• Ensure our residents are fully informed about benefit entitlements and available support services.


Specific Recommendations

• Engage with private landlords in order to establish good quality housing for properties in Wingrove. • Improve advice, support and advocacy for tenants from diverse communities• Engage with city council with regard to the licensing and control of takeaway and alcohol outlets• Develop links with GPs to promote social prescribing• Maximise the use of our open spaces to promote physical activity, for example, use of back lanes for

cycling / walking measured miles• Promote an “awareness campaign” with leaflets, banner stands, online and face-to-face contact to

ensure everyone knows what activities and support is available• Explore running local delivery services of fresh fruit and vegetables, to help less mobile older

population and those socially isolated.

We recognise that the evidence base for some of our ideas needs developing; we would gather research data during the process of implementation for future proposed activities


Opinion Survey

Results

• At the start all but one participant was aware of the gap in Healthy Life Expectancy (HLE) at 55 years of age• Both before and after engaging with the simulation, all players wanted to close the gap• Reducing human suffering and making society more fair remained the most important reasons for wanting to close the gap though there were

also concerns about costs• Awareness of COPD, heart disease, type 2 diabetes, mental illness was high at start• Awareness of the importance of mental ill health and diabetes increased as a result of playing and concerns over COPD and smoking remained• Overall 64% thought it was harder or much harder for people on the lowest incomes to make healthy life style choices after playing (55% at start)• Education regarding heathy life style choices and targeting more resources to deprived areas were the most favoured approaches before and

after play • Introducing more laws and taxes to control how people behave was not favoured. Nor was paying rewards to people who adopt healthy

behaviours• Around 70% of players said family was most important influence on their health behaviours. Next was ‘self research’; that is the use of media

and the internet for individual research.

Players were asked to complete a survey that canvassed opinions about the gap in HLE at the start of the simulation and then to repeat it at the end. This provided a measure of opinions and attitudes and any shifts in response to engaging with the simulation.

For information about this work contact: HealthWORKS Newcastle, Adelaide Terrace, Benwell, Newcastle upon Tyne, NE4 8BE Tel: 0191 272 4244Registered Charity no: 1040370 ‘Better Health: Fairer Health’ www.hwn.org.uk PATRON: Professor Sir Michael Marmot

Funded by Newcastle City Council - Health and Wellbeing Fund.

With thanks to Newcastle University

Designed and printed by NPS. 4 Whitehouse Road Industrial Estate, Whitehouse Road, Newcastle upon Tyne NE15 6LN Tel: 0191 238 6008 Email: [email protected] www.callnps.co.uk

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