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Health Inequalities Intervention Tool for Scotland (HITS). Faculty of Public Health in Scotland, Annual Conference 2011 Rory Mitchell Public Health Observatory Division NHS Health Scotland. What do we do about health inequalities in Scotland?. Overview. Background & aims

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Health inequalities intervention tool for scotland hits
Health Inequalities Intervention Tool for Scotland (HITS)

Faculty of Public Health in Scotland, Annual Conference 2011

Rory Mitchell

Public Health Observatory Division

NHS Health Scotland



Overview
Overview

Background & aims

What are the health inequalities intervention tools?

Data issues

Demonstration

Preliminary findings

Discussion (wider context of tackling health inequalities)

Conclusions


Health inequalities intervention tools
Health Inequalities Intervention Tools

Spreadsheet based models, underpinned by current data and effectiveness evidence

Tools available at local and national level, for use by policy makers and local planners to inform decision making

Modelling of the impact of selected interventions on population health and health inequalities

Modelling of costs required to achieve particular outcomes


Health inequalities intervention tools1
Health Inequalities Intervention Tools

Interventions:

Alcohol brief interventions (ABIs)

Counterweight (BMI reduction intervention)

NHS smoking cessation services

Outcomes:

Deaths (number prevented, life expectancy)

Hospital admissions (number prevented, rate)

Risk factor (prevalence, population mean)

[population & most deprived quintile (MDQ)]





Alcohol brief interventions tool demo
Alcohol Brief Interventions Tool Demo

Investment of an additional £1 million at Scotland level


Health inequalities intervention tool for scotland hits

= Modelling £1M investment

above estimated 2010/11

baseline


Alcohol brief interventions tool demo1
Alcohol Brief Interventions Tool Demo

Investment of an additional £1 million at Scotland level

Investment of an additional £1 million at Scotland level, and targeting of all interventions to the most deprived two quintiles


Health inequalities intervention tool for scotland hits

Same budget, but perfectly

targeted to more deprived

groups


Preliminary findings
Preliminary findings

All 3 interventions can have an impact on health inequalities

Accurate targeting is critical

Modelled impact is dependent on input data and assumptions

….but the magnitude of impact is fairly robust

For all interventions the predicted impact is modest



Tackling health inequalities what is likely to work

Likely to be more effective*:

Structural changes in the environment

Legislative and regulatory controls

Fiscal policies

Income support

Reducing price barriers

Improving accessibility of services

Prioritising disadvantaged groups

Offering intensive support

Starting young

Likely to be less effective*:

Information based campaigns

Written materials

Campaigns reliant on people taking the initiative to opt in

Campaigns/messages designed for the whole population

Whole school health education approaches

Approaches which involve significant price or other barriers

Programmes that raise housing costs

Tackling health inequalities: what is likely to work?

*Edited, from MacIntyre, S. What are inequalities in health and what causes them? Briefing Paper for Ministerial Taskforce on Inequalities. Scottish Government; 2008.


Conclusions
Conclusions

HITS outputs provide practical tools to inform decision making

The 3 interventions modelled can have a measurable impact on health inequalities

However, the impact of downstream individual interventions is likely to be small…and highly dependent on targeting

Upstream universal interventions are likely to have a larger role to play in tackling health inequalities in Scotland


What s next
What’s next?

Outputs scheduled for publication in early 2012

Feedback very welcome!


Health inequalities intervention tool for scotland hits

AcknowledgementsScotPHO colleagues: Diane Stockton, Gerry McCartney, Colin Fischbacher, Jamie ReidHITS Steering Grouprory.mitchell@nhs.netwww.scotpho.org.uk