south birmingham board health inequalities session 23 mar
DESCRIPTION
An NHS Board development session on health inequalities focusing on South BirminghamTRANSCRIPT
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23rd March 2011NHS South Birmingham Board Seminar
Jim McManusJoint Director of Public Health, Birmingham City Council
Health Inequalities – some challenging issues
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National Audit Office 2010not on course!
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Leading causes of death
Common Risk Factors
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Don’t wait for change or direction…move now
Life Expectancy by WardStill there whatever the back office system
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Nothing new under the sun?
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Age Structure
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Population Change 2000-2007
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Population Change 2000-2007
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Age Structure 2
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Life Expectancy
Males - PSA Target 77.56 Years by 20100.6 years under trajectory in 2005-07, 0.7 years under trajectory in 2006-08
Birmingham BEN HOB SOUTH
1995-1997 72.1 73.5 71.2 73.7
2005-2007 75.6 76.01 73.65 76.32
2006-2008 75.9 76.3 74.2 76.6
Females – PSA Target 81.70 Years by 20100.18 years under trajectory in 2005-2007, 0.1 years under trajectory in 2006-2008
Birmingham BEN HOB SOUTH
1995-1997 78.0 78.5 77.6 78.8
2005-2007 80.8 80.44 80.13 81.62
2006-2008 81.0 80.6 80.6 81.8
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Male life expectancy - 3 years rolling average
70.00
71.00
72.00
73.00
74.00
75.00
76.00
77.00
78.00
79.00
80.00
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
2008-2010
2009-2011
Years
Ye
ars
of
ag
e
Birmingham England PSA trajectory*
Projection
PS
A t
arg
et b
asel
ine
year
Lat
est
Tar
get
yea
r
Data source: England and Birmingham MLE - ONSEngland MLE Projection - Government Actuary's DepartmentTrajectories - PHIT
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Female life expectancy - 3 years rolling average
75.00
76.00
77.00
78.00
79.00
80.00
81.00
82.00
83.00
84.00
85.00
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
2004-2006
2005-2007
2006-2008
2007-2009
2008-2010
2009-2011
Years
Ye
ars
of
ag
e
Birmingham England PSA trajectory*
Projection
Bas
elin
e ye
ar
Lat
est
Tar
get
yea
r
Data source: England and Birmingham MLE - ONSEngland MLE Projection - Government Actuary's DepartmentTrajectories - PHIT
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Male AAACM by IMD Quintile in Birmingham 1995 - 2008
Three year rolling average
0.00
200.00
400.00
600.00
800.00
1000.00
1200.00
1400.00
1995
/ 19
97
1996
/ 19
98
1997
/ 19
99
1998
/ 20
00
1999
/ 20
01
2000
/ 20
02
2001
/ 20
03
2002
/ 20
04
2003
/ 20
05
2004
/ 20
06
2005
/ 20
07
2006
/ 20
08
Years
DS
R
Affluent Less Affluent Average Less Deprived Deprived
Data source: ONS death registrationsPHIT calculation
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Female AAACM by IMD Quintile in Birmingham 1995 - 2008
Three year rolling average
0.00
100.00
200.00
300.00
400.00
500.00
600.00
700.00
800.00
900.00
1995
/ 19
97
1996
/ 19
98
1997
/ 19
99
1998
/ 20
00
1999
/ 20
01
2000
/ 20
02
2001
/ 20
03
2002
/ 20
04
2003
/ 20
05
2004
/ 20
06
2005
/ 20
07
2006
/ 20
08
Years
DS
R
Affluent Less Affluent Average Less Deprived Deprived
Data source: ONS death registrationsPHIT calculation
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Birmingham by Cadbury Neighbourhood Classifications
Understanding these as drivers and intervening variables
Transit or Escalator– move to more deprived areas
Isolate – move to equally or more deprived areas
Gentrifier -
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CVD Mortality and Cost
• There is an opportunity across City to avoid £12.8 million (annual) worth of admissions to hospital through moderately ambitious preventive interventions chosen well
• Doing case finding would give us the potential to reduce CVD risk and we can then model this against life expectancy
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Admissions avoided with 3-4% reduction in risk factors
Admissions avoided with 5-6% reduction in risk factors
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Children Key Points
• From topic to geography• Geographical clusters with longitudinal affect-
cumulative challenges • Focus on outcomes and not outputs- Brighter
futures Logic model• Focus on Inequalities- reduction in rates
between geographical areas and target groups • Engaging with children and young people on
the results
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Childrens Composite Scores
See detailed Map and Sheet
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Pupil Census-Somali Speakers
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Pupil Census-Pashto/Pakto Speakers
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Pupil Census-Polish Speakers
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Income Deprivation Affecting ChildrenIndex 2007
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Child and Adolescent Mental Health Services Tier 3
Social Gradient for Accessing CAMHS Tier 3 services by CWI Decile 2008BCH
0.00%
0.20%
0.40%
0.60%
0.80%
1.00%
1.20%
1.40%
1.60%
1 2 3 4 5 6 7 8 9 10
Child Wellbeing Index Decile (Where 1 is Most Deprived)
Add Trendline
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Economic well being: Children's centres registrations
Social Gradient for Childrens centres registration by CWI Quintile2008/9
BCC: Children data
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
1 2 3 4 5
Child Wellbeing Index Quintile(Where 1 is Most Deprived)
Add Trendline
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Rates of Chlamydia infection
Rates of Positive Chlamydia tests by Birmingham ward 2006Source: HPU 2008
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
16.00%
18.00%
Os
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Sp
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Bil
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Birmingham Average
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Hospital admissionsfor accidents
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Stay Safe: Impact of deprivation
Social Gradient for Children in Need by CWI Quintile2009
Source: Birmingham City Council
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
50.00
1 2 3 4 5
Child Wellbeing Index Quintile(Where 1 is Most Deprived)
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The space for emotional intelligence
The Challenge for most of usand the opportunity!
• We are doing tertiary prevention first because of where we are epidemiologically
• Understand REALLY which levers pull short, medium and long term
Short Term – primary care
Medium to Long Term – LA and other players
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Our Burdens of Disease
Primary Secondary Tertiary
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Domains of Public Health
Health Improvement
Health Protection
Service Public Health
Where does this go and when will it stop being entirely NHS focused?
Diverse accountabilities
What about the PH role in Commissioning?
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Principles
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Evidence: Housing and CVD
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Evidence: Neighbourhood Economics and CVD
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From Neighbourhood Disadvantage to Disease
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Life StyleKey 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%
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Population Change 2000-2007
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CVD Mortality and Cost
• There is an opportunity across City to avoid £12.8 million (annual) worth of admissions to hospital through moderately ambitious preventive interventions chosen well
• Doing case finding would give us the potential to reduce CVD risk and we can then model this against life expectancy
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Admissions avoided with 3-4% reduction in risk factors
Admissions avoided with 5-6% reduction in risk factors
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