Joining up interventions for better outcomes

1. Joining up interventions for better outcomes Jim McManus BHWP Summit Jan 14th 2010 Towards a neighbourhood model for health interventions in Birmingham

2. Where has this come from? • This is one part of Birmingham City Council’s Health Inequalities Strategy • It works with Partners but is focused on what the Council can do with partners • It is a part of the work of the council on • Producing a Health Inequalities Strategy • Having a senior council officer leading on health in each Department • Having a series of health interventions at local level which touch on what local authorities can do on health inequalities • Inputing into the Birmingham Health and Wellbeing Partnership

3. Model supported by Neighbourhoods Board* Children and Young Peoples Partnership* Health and Wellbeing Partnership (BHWP)Exec* Housing and Constituencies Constituency Directors Neighbourhood Managers Be Birmingham* Police Operational Commanders & Constituency Directors joint meeting Current Status * indicates fora which include NHS partners

4. The Idea • A model which is easy to use, consistent with evidence and brings together that evidence for cumulative effect • Evidence on the state of neighbourhoods and CVD • Evidence on the fear of crime and health • Evidence on citizens/tenant engagement and health • The City Council work on a neighbourhoods approach to health with partners as part of its health inequalities programme. • Easy to use and easy to understand

5. Policy Drivers and evidence • Health status is one of the key variables in Birmingham which acts on, and is acted on by, almost every other variable • It is in every agency’s corporate plan, to some extent • Life expectancy • Neighbourhood Stress • Joining up interventions can bring additional benefits • We do not do prevention well in Birmingham

6. The effect of place on health • The consensus from research evidence • There is a strong, independent and enduring effect of place on the health status of individuals, families, communities and neighbourhoods • Findings from JSNA • Wide variations in health outcomes by ward (statistical problems with analyses of neighbourhoods)

7. Evidence • Thanks to • Sir Michael Marmot • World Health Organisation • WHO Health Cities Collaborative • Medical Research Council • York Health Economics Consortium • Prof Malcolm Whitfield, Sheffield and WHO

8. Evidence: Healthy Urban Environments and Heart Disease

9. Evidence: Housing and CVD

10. Evidence: Neighbourhood Economics and CVD

11. From Neighbourhood Disadvantage to Disease

12. Leading causes of death Common Risk Factors

13. Life Style

15. Environmental pollution • 57 children per 1,000 have long term lung function problems due to this • 36 children and 30 adults per 1,000 have pollution-related asthma • 1mg/m3 drop in PM air pollution could reduce CVD deaths by over 100 • As much as 30% of acute asthma attacks and hospitalisations are atttributable to air pollution • 46% of acute bronchitis admissions are attributable to air pollution

16. Towards a Model….

17. The modelexplicitly designed to be as simple as possible so non-health specialists can implement it BIRMINGHAM NEIGHBOURHOOD HEALTH INTERVENTIONS MODEL Development of a local plan for each neighbourhood between partners with use of existing community networks 1. Complete a Basic health profile – identification of health issues salient for the neighbourhood by a) providing a basic profile and b) running health typologies through Customer Insight or whatever mechanism is favoured in each PCT/locality (for Ben it is PRIME/DR Foster) 2. WORK ON THE COMMON RISK FACTORS FOR BIG KILLERS Neighbourhood interventions for Diet, Physical Activity, Smoking, Alcohol, 3. IMPROVE LOCAL NEIGHBOURHOOD QUALITY Physical Environment, Green Space, Crime/ASB. INCREASE SOCIAL CONTACT BETWEEN NEIGHBOURS 4. INCREASE UPTAKE OF PREVENTIVE HEALTH PROGRAMMES Immunisation, Screening, This may differ from area to area depending on issues 5. Local worklessness and skills programme – deliver public health and literacy for health skills training. Develop local health trainer programmes using WNF to get people into work.

18. Just to recap….

19. Multi-Agency and BCC support Giving a clear responsibility to neighbourhoods managers to co-ordinate with health and other partners Scoping a plan for each area Finding some monies for delivery and implementation as a means of kick-starting the process and moving on from there Producing a single co-ordinated programme approach with local flavour using the model outlined above Linking this to the key health outcome issues Making it happen 1 - Process

20. Making it happen 2 - Outcomes STOP SETTING THE WRONG OUTCOMES • “We will reduce obesity”…… • We will increase the number of people on this estate who eat 5 a day • We will increase the number of people who eat healthily • We will help x people achieve normal BMI within x years

21. Making it happen 3 - Skills • THIS IS ALL PART OF THE ROLL OUT PLAN • Developing a clear model for prevention which is effective and evidence based • Using intervention mapping principles shown to ensure that interventions remain consistent with evidence • “real world” (doability and evidence) appraisal of candidate projects • Development and evidence appraisal of candidate projects (“proof of concept”) [both the prevention of undesirable outcomes and interventions which will deliver this efficaciously]

22. Why bang on about intervention mapping? • Good prevention needs a combination of • Knowledge, Evidence, Skill and Direction • Intervention mapping is a means of ensuring an intervention is consistent with the evidence and needs assessment • It has paid dividends where it has been properly implemented, not just in health but in community safety, regeneration and other areas of work • Intervention Mapping should be a key technology for rolling out any health model. This will be a key part of the roll out of training and of plans.

23. Tasking Models • Currently there are different tasking models for police, community safety and others • Be Birmingham has set up a task and finish group to ensure we have consistency across tasking models • The Neighbourhood health model is a model of “what” we will do. • Intervention Mapping will be the “how”.

25. Conclusion • Simple Model • Several Components • See things as joined up • Identify “obvious” outcomes • Healthier lifestyles, healthier area, better quality public realm etc • Develop a pathway approach • Link people into programmes • Encourage neighbourhoods to control them • Need a very small workforce (2- 3 people) to roll this out?