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Health Impact Assessment: Making the Difference. Plenary 1 Chair: Professor Gareth Williams. 7th International Health Impact Assessment Conference. Health Impact Assessment: Making the Difference. Supported by:. Health Impact Assessment: Making the Difference. Chris Tudor-Smith

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Health Impact Assessment: Making the Difference

Plenary 1

Chair: Professor Gareth Williams


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7th International Health Impact Assessment Conference

Health Impact Assessment:

Making the Difference

Supported by:


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Health Impact Assessment: Making the Difference

Chris Tudor-Smith

Head of Public Health Improvement Division, Welsh Assembly Government


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Tackling inequalities in health in Wales

Chris Tudor-Smith

Public Health Improvement Division

Office of the Chief Medical Officer


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The presentation will cover...

  • The situation in Wales

  • The policy context

  • From policy to action

  • Sustainable Health Action Research Programme

  • Concluding remarks

‘So what do I need to know about health inequalities then Humphrey?’

‘Well Minister…’


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‘Headline’ indicator: all deaths by quintile of deprivation, Wales, 1993-97

European age-standardised mortality rate per 100,000 population

Source: NAfW (2001) Expert Group on Indicators of Health Inequality


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Coronary heart disease mortality (age under 65) by quintile of deprivation, Wales, 1996

European age-standardised mortality rate per 100,000 population

Source: NAfW (2001) Expert Group on Indicators of Health Inequality


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Adult mental health status by quintile of deprivation, Wales, 1998

SF36 Mental Component Summary score

Source: NAfW (2001) Expert Group on Indicators of Health Inequality


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Adults smoking by quintile of deprivation, Wales, 1996 Wales, 1998

Source: NAfW (2001) Expert Group on Indicators of Health Inequality


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Teenage conceptions by quintile of deprivation, Wales, 1992-1997

Conceptions to girls under 18 per 1,000 girls aged 15-17

Source: NAfW (2001) Expert Group on Indicators of Health Inequality


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The policy context in Wales 1992-1997

  • ‘Better Health Better Wales’ - late 1990’s policy document dealing with public health in Wales

    • health inequalities acknowledged and described

  • Townsend review ‘Targeting Poor Health’

    • NHS resource allocation favouring those most in need

  • ‘Review of Health and Social Care in Wales’ (Wanless Report)

    • notes inequalities and action being taken in other policy areas

  • Topic specific strategies with a focus on health inequalities

    • e.g. Food and Well Being identifies priority groups (low income, ethnic minorities…)

  • Health targets and inequality indicators

    • e.g. to improve CHD mortality in all groups and at the same time aim for a more rapid improvement in the most deprived groups.


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Tackling health inequalities in Wales – working at different levels

  • Government socio-economic policy e.g.

    • responsibility with UK government e.g. fiscal policies

    • Wales: A Vibrant Economy

  • Collaboration and partnership between communities and agencies e.g.

    • SHARP

    • Health Impact Assessment

    • Communities First

    • Development of food cooperatives

  • Individual behaviour change e.g.

    • Inequalities in Health Fund (focus on risk factors for CHD)

    • Health Challenge Wales

    • Programmes tackling smoking, nutrition, physical activity…


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Sustainable Health Action Research Programme (SHARP) different levels

  • Roots in Better Health Better Wales – attempt to develop learning and add to evidence base on partnership-driven and community-based action research approaches to tackling broad social determinants of health

  • Focused on communities with the highest incidence of ill-health and premature death, social exclusion and poor life chances

  • Project level and overarching evaluation (Cropper S., Carlisle S., Beech R., Little R – Centre for Health Planning & Management, Keele University)

  • Seven projects funded for six year period, ending spring 2006


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‘Barefoot’ different levels

Triangle

Pembs

Holway

BeWEHL

HYPP

R2R


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SHARP funded projects (1) different levels

  • HYYP ProjectAn evaluation of community involvement in Powys to meet the health needs of young people in rural areas

  • ‘Right 2 Respect’ ProjectA project to identify and begin to address issues of particular concern to girls and young women (11 to 25 years) in Wrexham

  • BeWEHL ProjectAn initiative in Newport to examine the contribution of women’s learning to community health development

  • Triangle ProjectA programme to support local health alliances in Cardiff, Merthyr and Powys in tackling health inequalities


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SHARP funded projects (2) different levels

  • Healthy Living Approach ProjectAn evaluation of the Healthy Living approach to improving the health and wellbeing of communities in Pembrokeshire

  • Holway Project HouseCommunity development and regeneration in the Holway community in Flintshire

  • ‘Barefoot’ Health Workers ProjectA project to support the health improvement of Somali, Yemeni and Bangladeshi communities in the Butetown/Grangetown area of Cardiff


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Assets & Legacies different levels

  • ‘Barefoot’: Expertise in working with minority ethnic groups; community researchers skilled in working with agencies and local people.

  • Triangle: framework for establishing sustainable community health partnerships; model of participatory action research as tool for community health engagement – ‘local health champions’; locally sustainable projects.

  • Pembrokeshire SHARP: Community research training programme and handbook - transferable inquiry into local priorities; Community Action Plans.

  • Holway House: community transformation - residents working in partnership with external organisations.

Source: Cropper (2005)


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Assets & Legacies different levels

  • BeWEHL: improvements in women’s mental and ‘social’ health (increased confidence/self-esteem, wider networks); transferable approach to developing women’s capacity to engage in lifelong learning.

  • HYPP: civic participation by young people, better relationships between different generations; Youth Council and OASIS roll-out.

  • Right 2 Respect: impact on Wrexham CBC Youth Services; ONC in a/r for single gender youth work; outdoor worker; sustainable spin-off projects.

Source: Cropper (2005)


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Policies tackling health inequalities – a synthesis different levels

  • Successful policies will need to be broadly based including :

    • lifecourse approach

    • multisectoral interventions

    • health impact assessment

    • focus on the distribution of social determinants

    • tailoring where appropriate

  • Policies on health inequalities and social justice/inclusion should be inextricably linked

  • Local capacity building is required to deliver policies

  • Importance of (applied) research, particularly monitoring impact of policies and developing evidence base of effective interventions

  • Commitment


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7th International Health Impact Assessment Conference different levels

Health Impact Assessment:

Making the Difference

Supported by:


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