Agenda item

The Board received a presentation from the Director of Public Health South Tees on Addressing Inequalities.

 

The presentation provided the definition of Health Inequalities:

 

●     Health Inequalities are unfair and avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which we are born, grow, live, work and age.

●     Health Inequalities result in poor health being experienced from a younger age, at a higher intensity for a greater proportion of life and ultimately in premature death.

●     The factors influencing health inequality and the dimensions of inequality are complex

 

The Board heard of the overlapping dimensions of health inequalities:

 

Socioeconomic groups and Deprivation

 

●     Unemployed, low income, deprived areas

 

Protected characteristics in the Equality Duty

 

●     Age, sex, religion, sexual orientation, disability, pregnancy and meternity

 

Inclusion health and vulnerable groups

 

●     Homeless people, Gypsy, Roma and Travellers, sex workers, vulnerable migrants and people who leave prison

 

 

 

 

Geography

 

●     Urban and rural

 

The North East Context

 

The North East is a great place to live and work with many positive assets conducive to good health and wellbeing. However there are stark differences for those living in the most deprived areas compared to the more affluent areas.

 

Inequalities within boroughs e.g within Middleborough smoking in pregnancy varies at ward level between 1 and 35% following significant recent improvements in pathways and support the gap persists.  Patterns of inequality can be locked in at an early age and follow in individual throughout their life impacting on longer term life expectancy. Under 15s admissions for injury varies between 119-247/100,000 compared with 110/100000 for England - context 30% of children living in poverty.

 

It was advised that key contributors to the gap in length and quality of life included deaths caused by heart disease, stroke, and cancers which made up half of the gap in life expectancy between the most and least deprived quantiles in England.

 

The Director of Public Health stated that the COVID-19 infection and illness does not affect all population groups equally:

 

●     Mortality - People aged 80 or older with COVID-19 were seventy times more likely to die than those under 40. Being male, living in a deprived area and being a member of Black, Asian and Minority Ethnic (BAME) groups are factors independently associated with a higher risk of dying from COVID-19. As were conditions such as diabetes and obesity which are also unevenly spread.

●     Transmission - people in lower paid work are more likely to be unable to work from home (care work, hospitality, cleaning and transport) and/or to be socially distanced in their work, those from lower incomes groups are more likely to live in overcrowded housing and may have limited access to outdoor space
Indirect harm - the burden of lockdown measures falls hardest on those with poor living conditions, educational impacts unevenly spread with many facing barriers in accessing education remotely due to issues such as access to technology and home environments conducive to learning and financial impact of furlough, job loss and insecurity.

 

People with inequalities also faced:

 

●     Increased vulnerability - poorer general health

●     Increased susceptibility - impact of stress on immune systems

●     Increased exposure - job roles and contacts

●     Increased transmission - housing and shared spaces

 

The impacts of Covid-19 were explained to the Board by the Director of Public Health:

 

Direct effects

 

●     Infection of Covid-19 causing direct health issues including morbidity, death and longer term health, social and economic impacts for those affected.

 

Indirect effects on Health and Social Care

 

●     Re-centering of Health and Social Care services to react to Covid means that non Covid services have not been available or people haven't perceived them to be available leading to morbidity and mortality from non Covid health and social issues

 

Indirect effects from impact of Covid response on Health and Society

 

●     Social distancing, shielding of vulnerable individuals and other measures can impact on health such as mental wellbeing and society such as children's education.

 

Direct and indirect of Covid on economy

 

●     Covid will effect the economy through both the disease itself and the indirect results of the response.  This likely to increase poverty and hardship.

 

The Board heard that Covid-19: Health and the Economy are not separate choices but interlinked.  The burden of poor healthy life expectancy and poor population health is greatest on the health and social care system, placing increased demands on the system and resulting in a system over-focussed on the treatment of ill health at the expense of prevention. The patterns of health and care service utilisation and health seeking behaviours across Tees Valley demonstrate a reliance on urgent and emergency care pathways demonstrated by higher levels of A&E attendances, higher utilisation of the NHS 111, emergency and elective admissions. The impact this has on diagnosis, treatment, recovery and mortality of cancers, respiratory, cardiovascular diseases and other mental health conditions is very well documented in the joint strategic needs assessments, DPH annual reports, PHE finger tips and other sources of population health intelligence. The relationship between poor health, over reliance on hospitals and impact on resources available for prevention has been described as the vicious 'cycle of missed opportunity'.

 

The following recommendations were made to the Board:

 

●     Adopt a Social Value Charter across Anchor Organisations

●     Apply Inequalities Impact Assessment to key policies across partners

●     Develop whole systems monitoring and strengthen accountability for inequalities across the system

●     Add to Existing Workstreams:

●     Commit to aligning priorities and activity across partners working together on early years (service level) - BSiL Workstream

●     Expansion and system wide adoption of approaches which take financial crisis as a call for help replacing sanctions with coordinated multi-agency support (civic-service) - MH Workstream

 

The Board was informed of the Social Value Charter for Anchor Organisations:

 

●     Employ Local - Training and employment can create a resilient and innovative local economy. Link to Foundation for Jobs & 50 Futures

●     Buy Local -  Develop dense local supply chains of businesses likely to support local employment and retain wealth locally

●     Think Local - Play an active part in local communities - partnerships with VCS; volunteering opportunities, sharing skills

●     A great place to live  - Commit to protecting the environment, minimising waste and energy consumption and using other resources efficiently

●     Good employers - Value the welfare of staff and those within supply chains

 

AGREED that the recommendations, as presented, were approved.