Framework for Community Health and Care Partnerships to review and evaluate action on inequalities:

1
Framework for Community Health (and Care)
Partnerships to review and evaluate action on
inequalities application to Equally Well test
sites

• Pauline Craig
• Bruce Whyte
• Public Health Programme Managers
• Glasgow Centre for Population Health

2
Development of the framework

• Analysis of Greater Glasgow and Clyde NHS CH/CP
  strengths and areas for development in addressing
  health inequalities through development plans and
  three service plans
• Analysis used Whitehead and Dahlgrens 10
  principles for policy action on social inequities
  in health (Levelling Up)
• Search for indicators relevant to CH/CP actions
  for evaluation and review
• Issues of variation across CH/CPs in addressing
  inequalities and their capacity for indicator
  analysis and tracking generic framework produced
  for CH/CPs to use to identify own indicators

3
Inequalities framework

• Final framework based on CH/CP actions to address
  inequalities together with knowledge from over 30
  years of inequalities research
• Key concepts
• Aim to reduce inequalities (vs population health
  improvement)
• Know your population complexity of gender,
  ethnicity, deprivation
• Individual health improvement plus action on
  social circumstances
• Three interlinked but distinct approaches to
  addressing inequalities and consequently to
  measuring progress

4

Framework for reviewing action on inequalities


Stated aims for reducing inequalities
Three approaches
What


Reducing the gap between groups
Targeting the worst off
Reducing inequalities across the population

Identification of need and baseline position
Why
Additional research
Data about individuals
Data about the population
How
Interventions
Evidence informed services for individuals
Action on social and economic circumstances
Outcome measurement and review Three
approaches
Progress
Reducing the gap between groups
Reducing inequalities across the population
Targeting the worst off
5
Application in practice

• Primary care mental health team (SE Glasgow)
  exploring their roles in addressing inequalities
  in mental health
• Childrens services (East Glasgow)
• Diabetes (GGC)
• Parenting framework evaluation (Glasgow City)
• Tools for CH/CPs for Shifting the Balance (QIS)
• Capacity building in health promotion
• Three Equally Well test sites (SE Glasgow,
• East Lothian and Fife)

6
Equally Well test sites project

• Collaboration between GCPH and the Scottish
  Governments Analytical Services Division and
  Health Department
• Aim to pilot a method to link indicators of
  progress on health inequalities more closely with
  local actions using the framework
• Links with national work on long-term
  inequalities indicators that can be produced at
  local level
• Seek indicators to generalise beyond EW

7
Process

• Framework used to articulate proposed actions on
  inequalities in a way that allows us to identify
  potential relevant indicators
• Link these indicators and actions to the
  outcomes-mapping and logic models were using
  Steve Montagues results chain
• Indicators could potentially be put into practice
  by the test site teams for evaluation and longer
  term monitoring of progress (beyond the scope of
  the project)

8
Outcome Improve school readiness
Stated aims for reducing
inequalities Reduce gap in readiness for
school for 5year olds between targeted areas and
CHP
Reducing the gap between groups Reducing the gap
between targeted areas and CHP. Aim to bring the
measures for the targeted groups up to the CHP
average
Targeting the worst off Three targeted areas
agreed using SIMD
Reducing inequalities across the
population Inequalities sensitive early years
practice
9
Identification of need and baseline position
Data about individuals Educational data for
nurseries and P1 could give the difference
between nursery and P1 entry assessments.
Data about the population Community Profiles,
also additional relevant data on factors
influencing levels of school readiness eg
domestic abuse
Additional research On interventions eg music
and movement (although benefit might be
involvement of parent and child together),
parenting and inequalities
10
Interventions
Evidence informed service for individuals Map
interventions with education and Curriculum for
Excellence. Early reading skills. Examples Music
and movement sense of rhythm to enhance child
development and engage parents and children
together. Forest schools.
Action on social and economic circumstances Paren
ts levels of involvement with the children aim
to enhance interaction between parents and
children to develop trust and resilience
11
Outcome measurement and review Three approaches
Targeting the worst off Nurseries and schools in
targeted areas School readiness scores should
be available
Reducing inequalities across the
population Shifting mainstream resources towards
greater need
Reducing gaps between groups Compare between
targeted areas and CHP
12
Progress

• Time required to think differently about
  inequalities test sites dilemma of demonstration
  of action vs enabling change
• Our results chain theoretical would work better
  linked to actual practice
• Report by end of the year

13
Learning from application

• The framework has filled a theory-practice gap
  for understanding inequalities, reflecting on
  where interventions might be targeted and
  measuring progress
• Applicable to a variety of settings and topics
  relevance of indicators
• Facilitated discussion of the complexity helped
  to pin down the what, why, how and areas for
  development in addressing inequalities
• Established the starting point for evaluation and
  monitoring of progress.