Health
Interlinkages
It is estimated that around 40% of the recent increase in life expectancy has been driven by improvements in health-care. However, the greater part of the improvement (around 60%) is thought to have been due to socio-economic and environmental factors. These factors include employment, income, education, housing, community safety and ‘lifestyle’ etc.
Responsibility for improving the general socio-economic and environmental condition of the East Midlands rests with a range of regional and local organisations. As a general rule, health improves as socio-economic conditions improve, so targeted interventions to improve the socio-economic and environmental status of deprived communities will tend to improve the health of those communities, and to narrow the health inequalities gap. If maximum health benefit is to be achieved, then effective co-ordination of activity via robust regional and local partnerships is required. The cross-cutting nature of ‘health’ means that all of the ‘component regional strategies’ highlighted above have an impact on health and wellbeing.
Sometimes, economic development may bring adverse health consequences such as pollution, noise and increased traffic. It is therefore important that negative as well as positive health impacts are taken into account, via ’Health Impact Assessment’, when assessing economic and infrastructure developments at both local and regional level.
National Policy Context
Provision of safe and effective healthcare has always been, and remains, a priority for government. However, publication in 2002 of the first ‘Wanless’ report (‘Securing our Future Health: Taking a Long-Term View’) prompted a renewed government interest in environmental, socio-economic and lifestyle factors as the major drivers of health and health inequality. Since 2002, national policy on improving both health and healthcare has been set out in a number of policy documents, including:
The Second Wanless Report
Tackling Health Inequalities: A Programme for Action;
Choosing Health;
Our Health, Our Care, Our Say;
Health Reforms in England, A Stronger Local Voice;
Social Cohesion Strategy;
Health Challenge England;
Commissioning a patient-led NHS;
Local Area Agreements;
NHS National Operating Framework;
Review of Government Offices;
World Class Commissioning.
Underlying all of current government health policy is the fundamental need to reduce the substantial inequalities in health which exist between individuals, communities, socio-economic and ethnic groups.
Key Challenges
In very many respects the East Midlands experience of health reflects that of England as a whole. Life expectancy is close to the English average, and is improving at a similar rate. The number of premature deaths from the major killers (cardiovascular disease and cancers) is falling.
A cause for concern, however, is that whilst health overall is improving, the East Midlands has levels of obesity which are well above the England average, with implications for future rates of diabetes and cardiovascular disease. It also has the highest per capita death rate from accidents of all the English regions.
Of greater concern is the health inequality that lies hidden behind the overall picture. Major inequalities in health exist between different areas of the Region, and within local areas. For example, in 2003-2005 a baby born in Rushcliffe (an example of an affluent LA) would expect to live, on average, around 5 years longer than a baby born in neighbouring Nottingham UA.
Within each local area, the inequalities are even more stark. In Nottingham, for example, life expectancy at ward level ranges between 69 and 80 years.
Of greatest concern is the fact that there is little evidence that the inequalities gap is narrowing. Indeed, whilst life expectancy has increased in both Rushcliffe and Nottingham, it increased at a slower rate in Nottingham, so that the gap between them in 2003-05 is bigger than it was in 1997-1999
People living in more deprived areas suffer worse health than those living in less deprived areas. If the health of the population of the East Midlands could be brought up to the level of the current ‘best’ 10% of local areas, it is estimated that up to 17,000 deaths per year might be avoided.
Behavioural change is theme running through the IRS, and is of particular relevance to improving health. A large proportion of the health inequalities gap is due to behavioural differences between those living in deprived and less deprived communities. In particular, smoking prevalence is generally much higher in more deprived areas, as is the proportion of calorie intake consumed in the form of fats and other ’energy dense’ foods. The reasons for these behavioural differences are complex.
Smoking is the main avoidable cause of premature death in England. Rising levels of obesity also present a major challenge to future health. Whilst it may not be possible to improve the socio-economic status of communities overnight, effective interventions to reduce smoking prevalence and to reduce obesity (by improving diet and increasing exercise) offer perhaps the two most obviously effective ways in which the health inequality gap might be narrowed
Current Position on Regional Policy
The regional public health strategy Investment for Health was published in April 2003. It highlighted the key challenges for improving the health of the East Midlands population, and set out a series of priority areas, action on which would have the greatest positive impact on the health and well-being of the region.
A review of ‘Investment for Health’ is at an advanced stage, and publication of the revised strategy is imminent. Whilst some of the detail is yet to be agreed, there is already broad agreement across the regional partners that the primary focus of the new strategy should be the reduction of health inequalities. This focus is consistent with, and will make a significant contribution to, delivery of the IRS Vision and IRS Priority 1.
Delivery of the revised strategy will require that:
- effective leadership, governance and partnership arrangements are in place at regional, sub-regional and local levels.
- the individuals, organisations and partnerships charged with delivery of the strategy are clear about their priorities, plans and outcomes. The strategy will set out a limited number of strategic goals to help ensure this clarity of delivery and outcome.
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Case Studies
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Braunstone Sport Action Zone aims to place sport at the heart of regeneration by encouraging participation in a wide range of sporting activities through mentoring. The project began in January 2004 and exceeded its targets in the first 6 months with 50% increase in residents involved in physical activity. Participants report health benefits ranging from reduced blood pressure and weight loss to changes in diet and giving up smoking; there is also evidence of reduced dependency on medication.
Impact provides alternative forms of healthcare, which are usually only available in the private sector to residents of inner city Radford and Hyson Green, Nottingham, at no cost to the patient. Patient satisfaction levels are high. The results of the NDC and Nottingham City PCT evaluation indicate considerable improvements in patients’ health and well being, as well as a subsequent reduction in their utilisation of NHS healthcare.
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Links to the relevant sections of the State of the Region Report for 2008
Links to the relevant sections of the East Midlands Integrated Toolkit (EMIT)
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Last updated: 29th July 2008