Fairer and healthier: interventions that should work in a small country

1. Fairer and healthier: interventions that should work in a small country Welsh Public Health Conference October 2014

2. Fairer and Healthier • Scots Health Policy, & Referendum Debate • Focus on Health Inequalities • …and what we need to do about them • Changing ‘What’s the matter with you?’ to become ‘What matters to you?’ – co-production • Co-production – of a climate for Social Justice, Scotland & Wales?

3. What do we mean by health inequalities? Health inequalities are: • Unfair differences in health within the population across social classes and between different population groups These unfair differences: • Are not random, or by chance, but largely socially determined • Not inevitable.

4. Are health inequalities narrowing in Scotland? Trends in RELATIVE all-cause mortality inequality (1981-2001 using Carstairs index (all ages); 1996 onwards using SIMD (<75yand 15-44y); men and women combined)

5. Emergence of the ‘Scottish Effect’ Source: Hanlon P, Lawder RS, Buchanan D, et al. Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a 'Scottish Effect'. Journal of Public Health. 2005; 27:199-204.

6. Upstream Downstream Wider environmental influences Economic & work Physical Educ & learning Social & cultural Services Individual experiences Economic & work Physical Educ & learning Social & cultural Services Fundamental causes Global forces, political priorities, societal values leading to: Unequal distribution of income, power and wealth Effects Inequalities in the distribution of health and wellbeing INEQUALITIES HEALTH INEQUALITIES Health inequalities: theory of causation

7. Guiding principles for effective interventions Guiding principles

8. Examples of effective interventions

9. Intervention evidence – what works, and what doesn’t? • Least likely to reduce health inequalities - Interventions such as information based campaigns, written materials, messages for the whole population, programmes requiring individual agency. • Most likely to be effective in reducing health inequalities - Interventions such as structural changes in the environment, fiscal policy, welfare support, improving accessibility of services, intensive input for disadvantaged groups. Prof. Dame Sally Macintyre for Equally Well, 2008

10. Key Points on Health Inequalities There are no proven strategies. Some policies and strategies offer a better opportunity than others; some won’t work. Actions at several levels simultaneously are most likely to work. Community-driven action is essential but not sufficient Health and wellbeing is personal, but influences are numerous ‘What’s the matter with you?’ becomes ‘What matters to you?’

12. “Government’s Programme for Scotland 2011-12” sets-out a vision for a Scotland … “where people collaborate; creating a new social partnership, with Scots empowered to take responsibility for improving their own lives. This requires the creation of a renewed sense of community and personal responsibility, maximising the opportunities presented by our greatest asset - our people.”

13. Men’s Group Tea Dances Community Family events Chancers – local womens group Pop-up farm/beach & cafe 1583 Participants + 61 Volunteers Fruit & Veg Stall Lunch Club Cooking Cinema 905 Participants + 35 Volunteers Bingo Dads group Cinema Gardening Friends of Lorne Primary 874 Participants + 64 Volunteers Inter-gen Sessions Possil 30mths Archery Whitfield 26mths Biking Make my Neighbourhood Beautiful N. Motherwell 28mths Gardening Youth Activities Leith 31mths Community Gardening NW Kilmarnock 32mths Cinema DJ Workshops Community Gardening Bingo 916 Participants + 133 Volunteers 380 Participants + 19 Volunteers Archery Silly Soccer Befriending Larkfield 33mths Community information Women’s Group Litter Picks TOTAL ENGAGEMENT @ 31 JULY 2014 8921 participants 569 volunteers Self defence 1284 Participants + 96 Volunteers Women’s Group Tenants group Archery Community Cafe Family swim 1027 Participants + 17 Volunteers Arts Youth Cafe Chess Kelly’s Cafe Arts & Crafts Darts Bingo Muirhouse 27mths Photography Open Cafe Athletics Group Cinema Photography Culture on Every Corner Guitar Group Gallatown 28mths 541 Participants + 12 Volunteers Gorbals 26mths Music @ Barn Alloa 30mths Community Football Big Breakfast Club Gardening 433 Participants + 37 Volunteers Soggy Sports Sewing Group ‘Man Up’ Roots & Boots Women’s Football Pop-up Museum Cinema Creative writing Internet cafe & Community information Drumming Street Dance Women’s Circuit Training Bike club 978 Participants + 95 Volunteers Women’s Group Young Parents Craft Group Community Gardening Bowmar Group

14. It’s working… • 66% never taken part in community activities pre-involvement • 95% felt they had a lot of contact with local people (other than family) post-involvement (52% pre) • 64% indicated feeling more confident dealing with people • 63% indicated feeling healthier • 83% indicated they had strong skills post-involvement (47% pre) • 89% indicated they thought their community was a good place to live post-involvement (66% pre) • 52% indicated feeling more able to cope with life and delivering…

15. …potentially significant transformation 56employed 120expressing desire to work 43 secured university/college place/traineeship 218 attained skills/competency based/qualification/award 84attained food hygiene qualification 34reduced alcohol consumption 34reduced tobacco consumption 20reduced drugs consumption 27 reduced some form of daily medication Increasing self-efficacy (and resilience?) 101re-engaged with formal decision-making structures 155previously isolated but now engaging 569 volunteering and helping others in their community 8,921 social connections between people that might otherwise not have met

16. So…what’s different about Link Up? • It starts by asking what’s good about a community & what local people can contribute • It’s not about enforcing external agendas • Workers have significant autonomy to develop and ‘flex’ their approach in line with the local context • Workers are developing a culture of seeking ways round local barriers (personal and institutional) • Ideas are rapidly turned into action • Workers value and respect participants

17. Fairer and Healthier • Scots Health Policy, & and Referendum Debate • Focus on Health Inequalities • …and what we need to do about them • Changing ‘What’s the matter with you?’ to become ‘What matters to you?’ – co-production • Co-production – of a climate for Social Justice, Scotland & Wales?

18. Upstream Downstream Wider environmental influences Economic & work Physical Educ & learning Social & cultural Services Individual experiences Economic & work Physical Educ & learning Social & cultural Services Fundamental causes Global forces, political priorities, societal values leading to: Unequal distribution of income, power and wealth Effects Inequalities in the distribution of health and wellbeing INEQUALITIES HEALTH INEQUALITIES Health inequalities: theory of causation

19. Fairer and healthier: interventions that should work in a small country Dr Andrew Fraser Director of Public Health Science andrew.fraser2@nhs.net www.healthscotland.com