290612 sha welfare reform and health

Recession, Welfare reform poverty and health

Dr John Middleton

Director of public Health

Sandwell

Reality very different

And the peculiar evil is, the less money you have , the less inclined you feel to spend it on wholesome

food. A millionnaire may enjoy breakfasting on orange juice and Ryvita biscuits; an unemployed

man doesn’t

When you are unemployed, which is to say when you are underfed, harassed,bored, and miserable

you don’t want to eat dull wholesome food……

George Orwell, The Road To Wigan pier.

• Harvey Brenner Int Journal Epidemiology • 2005, 34, 6: 1214

Recession and policy changes

Health impacts of economic downturn

• Widening health inequalities • Worse mental health –including depression, and possibly

lower levels of wellbeing• More suicides and attempted suicides; • Possibly more homicides and domestic violence• Fewer road traffic fatalities• Worse infectious disease outcomes such as tuberculosis

and HIV

Male life expectancy at birth, local authorities 2008-10

0 30 60 90 120 15070

72

74

76

78

80

82

84

86

Local authority rank - based on Index of Multiple Deprivation

Life expectancy (years)

Young people not in employment, education or training (NEET), local authorities 2008

0 30 60 90 120 1500

2

4

6

8

10

12

14

Local authority rank - based on Index of Multiple Deprivation

Not in education employment or

training%

18

Changes in real income for each 10% band ofpopulation, 1979 -1991/92, after housing costs

-17

6

16

23

29

33

39

46

62

0

6040200-20

100% (Wealthiest)

90%

80%

70%

60%

50%

40%

30%

20%

10% (Poorest)

80

Percentage

Source: Households below average income 1979-1991/92, Department of Social Security (1994)

Why ‘Child’ Poverty?

Source: The poverty site http://www.poverty.org.uk/09/index.shtml

Isn’t all poverty something we want to address?

Child poverty means family poverty

• 1 in 3 children in Sandwell live in relative poverty. This means approximately 24,000 children

• Of the 40,580 families with children dependents in Sandwell in 2008, more than 95% were in receipt of Child Tax Credit (CTC) or equivalent.

• For every 10 families in Sandwell receiving CTC, 7 were in work and 3 were out of work. The distribution of worklessness matches well-known patterns of deprivation.

Child Poverty Statistics, HMRC 2009

23

24

Life expectancy & disability free life expectancy at birth, by neighbourhood income level, England and Sandwell 1999-2003

Neighbourhoods by income deprivation (population percentiles)

Ag

e

Sandwell, Deaths by Coronary Heart Disease (CHD)

ICD10 I20 – I25 (5 year rolling average)

Directly Standardised Mortality Rate, Total Population

Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont with Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Vale

WednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburySouthSouthSouthSouthSouthSouthSouthSouthSouth

Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green and Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyng

Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath and Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hill

Soho and Soho and Soho and Soho and Soho and Soho and Soho and Soho and Soho and VictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoria

Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury NorthNorthNorthNorthNorthNorthNorthNorthNorth

West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich CentralCentralCentralCentralCentralCentralCentralCentralCentral

Friar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew tree

NewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley Heath

Princes EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces End

Great BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton Green

OldburyOldburyOldburyOldburyOldburyOldburyOldburyOldburyOldbury

St. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. Pauls

SmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwick

AbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbey

BristnallBristnallBristnallBristnallBristnallBristnallBristnallBristnallBristnall

Old WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld Warley

LangleyLangleyLangleyLangleyLangleyLangleyLangleyLangleyLangley

TividaleTividaleTividaleTividaleTividaleTividaleTividaleTividaleTividale

RowleyRowleyRowleyRowleyRowleyRowleyRowleyRowleyRowley

BlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheath

Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont Charlemont with Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Valewith Grove Vale

WednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburyWednesburySouthSouthSouthSouthSouthSouthSouthSouthSouth

Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green Greets Green and Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyngand Lyng

Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath Cradley Heath and Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hilland Old Hill

Soho and Soho and Soho and Soho and Soho and Soho and Soho and Soho and Soho and VictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoriaVictoria

Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury Wednesbury NorthNorthNorthNorthNorthNorthNorthNorthNorth

West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich West Bromwich CentralCentralCentralCentralCentralCentralCentralCentralCentral

Friar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkFriar ParkGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew treeGreat Barr with Yew tree

NewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonNewtonHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley HeathHateley Heath

Princes EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces EndPrinces End

Great BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeGreat BridgeTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton GreenTipton Green

OldburyOldburyOldburyOldburyOldburyOldburyOldburyOldburyOldbury

St. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. PaulsSt. Pauls

SmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwickSmethwick

AbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbeyAbbey

BristnallBristnallBristnallBristnallBristnallBristnallBristnallBristnallBristnall

Old WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld WarleyOld Warley

LangleyLangleyLangleyLangleyLangleyLangleyLangleyLangleyLangley

TividaleTividaleTividaleTividaleTividaleTividaleTividaleTividaleTividale

RowleyRowleyRowleyRowleyRowleyRowleyRowleyRowleyRowley

BlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheathBlackheath

Sandwell, Deaths by Coronary Heart Disease (CHD) ICD10 I20 – I25 (5

year rolling average) Mortality Rate, Population Aged Under 65 Years

Directly Standardised

27

The Marmot Review

• The best evidence for what we need to do

• The biggest influences on health & wellbeing are the ‘social determinants’ of health

• The ability to influence these sits largely with the local authority

• Reducing social inequalities: UK Marmot review

• Early years education and family support: increase % spend in early years

• Evidence base: Family nurse partnership• Perry preschool study

• Triple P parenting• Surestarts and Childrens centres

Education and Skills

• Educational attainment is a predictor of health outcomes.

• Higher educational attainment is associated with healthier behaviour.

• There is a gradient in limiting illness by level of educational attainment.

• There is a gradient in mortality by educational attainment.

Children achieving a good level of development at age five, local authorities 2011

0 30 60 90 120 15040

45

50

55

60

65

70

75

80

Local authority rank - based on Index of Multiple Deprivation

Good level of development

at age 5%

• Reducing social inequalities: UK Marmot

review

• Maximise the capabilities and control young and adults

people have over their lives : reduce the social gradient of skills and

qualifications

• Reducing social inequalities: UK Marmot review

• Create fair employment and good quality work for all and improve quality of work across social gradients

Work is good

More than just a source of cash Psychological and social

benefits Structures people’s days Not working affects life expectancy Should be rewarding and

fulfilling (Marie Jahoda)

• Reducing social inequalities: UK Marmot review

• Ensure healthy standard of living for all reducing the social gradient through progressive taxation and other fiscal policies

Sandwell welfare rights services

37

How unemployment influences healthMaterial and psychosocial effects, can lead to: • an inability to afford to live a healthy life• distress, anxiety, depression and a

worsening of physical health• a loss of self identity and self esteem • an increase in smoking and alcohol

consumption and decrease in physical activity.

Employment and Life Expectancy

• Those experiencing unemployment are likely to have higher mortality rates over their next decade, than those working.• Mortality rates are higher in manual compared to professional professions.

• Reducing social inequalities: UK Marmot review

• Healthy and sustainable physical environments-

Green Space

Greener living environments: lower health inequalities, England

Source: Mitchell & Popham, Lancet 2008

Deaths from circulatory disease

Income group 4 is most deprived

Green Space

Healthy towns-Sandwell Healthy Urban Development Unit

Outcomes• Healthy urban development

approach• Working with town planners and

transport engineers – to influence policy and design

• Emphasis on environment and open spaces- create safer places where people

• Encouraged to walking and cycling

• Health impact assessment on all developments

• Spin off for comments on health care impacts eg new nursing homes

Housing and Health

Achievements so farService Investment Estimated annual

savings to NHS

Health Homes Advocate £30,000 £44,800

HUB £7,000

Handy Person Service £100,000 £132,000

Affordable warmth £250,000 £105,000

Home improvement agency £25,000 £56,000

• Reducing social inequalities: UK Marmot review

• Strengthen the role and effect of prevention of ill health priority for investment to reduce social gradients-

Breakdown of life expectancy gap by disease for males and females,

Sandwell (DH Health Inequalities Tool)

CHD Mortality 2000-2005

54

Male life Expectancy at birth, Sandwell and England

74.4

74.4 74.274.3

74.9

76.977.3

77.7 77.978.3

72.0

73.0

74.0

75.0

76.0

77.0

78.0

79.0

2003-05 2004-06 2005-07 2006-08 2007-09

3 year periods

Lif

e E

xpec

tan

cy (

Yea

rs)

Sandwell

England

Gap:

2.9

years

Gap:

3.5

years

Gap:

3.6 years

Gap:3.4

yearsGap:

2.5

years

55

Three dividends for a healthier future

The health dividend

Domestic burglary Sandwell 2001-2005 Full implementation

drug intervention project doubling numbers of drug users in treatment

1300 fewer domestic burglaries 33% fall

Three dividends for a healthier future

The inclusion dividend

The Future?

Easy to use Patient Graphic interface

Wireless or wired devices, POTS and IP Communications

Software based product – operates on a variety of devices in expanding applications

Standard protocols – easy customization

Tablet PC CareCompanion II Handheld devices

i- House, demonstration house West Bromwich 2008

Three dividends for a healthier future

The green dividend

Good corporate citizen award 38 apprenticesRationalisation of offcies : 6 leases surrendered 890 tonnes of CO2 reduction £200k saved

Citizen Wage?

Time to resurrect the concept Recognises work not covered by the conventional economic system

Advantages to employers and industry

67

Everyone’s business!

• Consider health impact of our activity

• Read the Public Health Report

• Read the Marmot Review summary

• Visit Sandwell Trends

www.sandwelltrends.co.uk

• THANKYOU

• John Middleton• Director of Public Health for Sandwell • John.middleton@sandwell-pct.nhs.uk

• Vice President, UK Faculty of Public Health

• vpPolicy@fph.org.uk