NHS South Birmingham Board tackles health inequalities
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1) Jim McManus from Birmingham City Council presented on health inequalities and challenging issues facing the NHS and public health. 2) Life expectancy has been rising but remains below targets, with significant gaps between the most and least deprived areas of the city. 3) Preventive interventions could help avoid millions in costs from cardiovascular disease hospital admissions each year if risk factors are reduced.
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NHS South Birmingham Board tackles health inequalities
- 1. 23rd March 2011 NHS South Birmingham Board Seminar Jim McManus Joint Director of Public Health, Birmingham City Council Health Inequalities – some challenging issues
- 2. National Audit Office 2010 not on course!
- 3. Leading causes of death Common Risk Factors
- 4. Don’t wait for change or direction…move now Life Expectancy by Ward Still there whatever the back office system
- 11. Life Expectancy Males - PSA Target 77.56 Years by 2010 0.6 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 2010 0.18 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
- 12. 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 Yearsofage Birmingham England PSA trajectory* Projection PSAtargetbaselineyear Latest Targetyear Data source: England and Birmingham MLE- ONS England MLEProjection - Government Actuary's Department Trajectories - PHIT
- 13. 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 Yearsofage Birmingham England PSA trajectory* Projection Baselineyear Latest Targetyear Data source: England and Birmingham MLE- ONS England MLEProjection - Government Actuary's Department Trajectories - PHIT
- 14. 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 /1997 1996 /1998 1997 /1999 1998 /2000 1999 /2001 2000 /2002 2001 /2003 2002 /2004 2003 /2005 2004 /2006 2005 /2007 2006 /2008 Years DSR Affluent Less Affluent Average Less Deprived Deprived Data source: ONS death registrations PHIT calculation
- 15. 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 / 1997 1996 / 1998 1997 / 1999 1998 / 2000 1999 / 2001 2000 / 2002 2001 / 2003 2002 / 2004 2003 / 2005 2004 / 2006 2005 / 2007 2006 / 2008 Years DSR Affluent Less Affluent Average Less Deprived Deprived Data source: ONS death registrations PHIT calculation
- 18. 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 -
- 20. 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
- 21. Admissions avoided with 3-4% reduction in risk factors Admissions avoided with 5-6% reduction in risk factors
- 22. 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
- 23. Childrens Composite Scores See detailed Map and Sheet
- 28. Child and Adolescent Mental Health Services Tier 3 Social Gradient for Accessing CAMHS Tier 3 services by CWI Decile 2008 BCH 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
- 29. Economic well being: Children's centres registrations Social Gradient for Childrens centres registration by CWI Quintile 2008/9 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
- 30. Rates of Chlamydia infection Rates of Positive Chlamydia tests by Birmingham ward 2006 Source: HPU 2008 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% 16.00% 18.00% Oscott Nechells Aston ShardEnd Kingsbury PerryBarr Longbridge Weoley Soho SuttonFo-urOaks Handsworth Kingstanding SuttonVesey HodgeHill Moseley Erdington Brandwood King'sNorton Ladywood Sandwell Bournville Sheldon Northfield StocklandGreen SuttonNewHall Edgbaston WashwoodHeath Sparkhill BartleyGreen HallGreen SmallHeath FoxHollies Quinton SellyOak Acock'sGreen Harborne Sparkbrook Billesley Yardley Birmingham Average
- 32. Stay Safe: Impact of deprivation Social Gradient for Children in Need by CWI Quintile 2009 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)
- 33. The space for emotional intelligence The Challenge for most of us and 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
- 34. Our Burdens of Disease Primary Secondary Tertiary
- 35. 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?
- 36. Principles
- 37. Evidence: Housing and CVD
- 39. From Neighbourhood Disadvantage to Disease
- 40. Life Style Key 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%
- 42. 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
- 43. Admissions avoided with 3-4% reduction in risk factors Admissions avoided with 5-6% reduction in risk factors
Notes de l'éditeur
- I am going to talk about our experience of trying to address issues as they arose In most emergencies issues arise you do not plan for In this flu pandemic, we had neither a slow rising tide nor a flash flood experience but a mix of different issues in different parts of the country and the city I think what comes out of this is the need to seek to predict what systems of the City’s life will be most affected given what we now know, and then seek to make those resilient My guesses are most cities will see schools, nurseries and social care very affected In delivering this I am focusing on Local Authority services because this is a local authority seminar. I will, inevitably, do injustice to NHS family colleagues because of this. Setting up out of hours flu centres, for example, was a valuable experience for us. And the work of BADGER in developing clinical good practice in assessment and response is just one important piece of work from Birmingham I won;’t be able to do justice to. I will also inecvitably underestimate the role of the Birmingham Resilience Team and the multi-agency Birmingham Resilience Group. These have been hugely important and positive experiences.