Which Tips for Health Really Matter

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• Which Tips for Health Really Matter?
• Don't smoke. If you can, stop. If you can't, cut
  down.
• Follow a balanced diet with plenty of fruit and
  vegetables.
• Keep physically active.
• Manage stress by, for example, talking things
  through and making time to relax.
• If you drink alcohol, do so in moderation.
• Cover up in the sun, and protect children from
  sunburn.
• Practice safer sex.
• Take up cancer screening opportunities.
• Be safe on the roads follow the Highway Code.
• Learn the First Aid ABC airways, breathing,
  circulation.
• Foreward to Acheson Report

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• or
• Don't be poor. If you can, stop. If you can't,
  try not to be poor for long.
• Don't have poor parents.
• Own a car.
• Don't work in a stressful, low paid manual job.
• Don't live in damp, low quality housing.
• Be able to afford to go on a holiday and
  sunbathe.
• Practice not losing your job and don't become
  unemployed.
• Take up all benefits you are entitled to, if you
  are unemployed, retired or sick or disabled.
• Don't live next to a busy major road or near a
  polluting factory.
• Learn how to fill in the complex housing
  benefit/shelter application forms before you
  become homeless and destitute.
• See Donaldson, L. (1999). Ten Tips For Better
  Health. On-line at http//www.official-documents.c
  o.uk/document/cm43/4386/4386-tp.htm.
• Gordon, D. (1999). An Alternative Ten Tips for
  Staying Healthy. Personal Communication, October
  10, 1999.

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Community Development Approaches to Tackling
Health Inequalities

• What are health inequalities?
• What causes them?
• How can we reduce them?
• Can community development approaches reduce
  health inequalities?
• Do you think your work reduces health
  inequalities?
• Future work for CDHN.
• Barbary Cook, Director, 2nd March 2007

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Community Development Approaches to Tackling
Health Inequalities

• Tackling health Inequalities is Really, Really,
  Really difficult.
• People are still trying to work out whats the
  best way to do it.
• In community development and health we have to
  ask ourselves if were doing it in the most
  effective way we can.

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Community Development Approaches to Tackling
Health Inequalities

• What are health inequalities?
• People with no formal educational qualifications
  are half as likely as those with third level
  education to have excellent/very good health.
• People who are unemployed are a third less likely
  than those in employment to have a high general
  mental health score.
• People with the lowest income are half as likely
  as those with the highest income to be very
  satisfied with their health or have a very good
  quality of life.
• People who rent in the public sector are nearly
  half as likely as those who own their own home to
  have a very good quality of life.
• Balanda,K.,Wilde, J. (2003) Inequalities in
  Perceived Health A Report on the All-Ireland
  Social Capital and Health Survey. Dublin
  Institute of Public Health in Ireland.

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Community Development Approaches to Tackling
Health Inequalities

• What are health inequalities?
• Differences in health status/outcomes between two
  groups of people.
• Often between the lowest and highest
  socio-economic groups.
• Can be between genders, between different
  ethnicities etc.
• When you talk about tackling a health inequality
  you have to think about who you are working with
  and what other groups health status/outcomes you
  are comparing your group to.
• Thats the gap youre trying to close.

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Community Development Approaches to Tackling
Health Inequalities

• Differences in lifestyle behaviour such as
  diet,exercise,tobacco use have been presented as
  the prime determinants of health. However
  according to WHO, 2003 these risk factors only
  account for a small proportion of variation in
  heart disease and cancers.
• The evidence that the social determinants of
  health are more important than biomedical and
  lifestyle factors is clear.
• According to WHO, 2003 despite this evidence
  people are told by the government, media and
  policy makers that lifestyle factors are both a
  threat and a salvation to their health.
• Anna Cootes, Kings Fund on WHO, The Solid Facts
  (2003)

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Community Development Approaches to Tackling
Health Inequalities

• How do the wider determinants cause health
  inequalities?
• Material (poverty, income distribution) or
  psycho-social (understand your status relative to
  other people) or a combination?
• Influences at macro-social (e.g. public policy),
  meso-social (e.g. work environment) or individual
  level?
• A life-course or longitudinal approach (e.g.
  critical early life experience or cumulative
  effects over time)
• Cultural context (differences within and between
  countries)?
• Determinants of Social Disadvantage, presentation
  by Prof. Cecily Kelleher, Health Research Board
  Unit for Health Status and Health Gain,
  1999-2004, Combat Poverty Agency conference on
  the social determinants of health

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Community Development Approaches to Tackling
Health Inequalities

• Labour Govt targets on health inequalities
• Education welfare to work environment housing
  and urban renewal better transport
• What has been done?
• Minimum wage and tax credits
• Community based interventions
• 500 Sure start programmes 1.3 billion
• New Deal 1.9 million
• 26 Health Action Zone programmes 449 million
• Healthy living centres 300 million
• Local Strategic Partnerships 2 billion
• Anna Cootes, Kings Fund

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Community Development Approaches to Tackling
Health Inequalities

• Swedish Health Policy has six main actions.
• Swedish Public health policy - these health goals
  are not very sophisticated, however the targets
  are formulated in terms of the determinants of
  health and there is a consensus on their
  importance
• Increase social capital, decrease inequality and
  discrimination
• Improve conditions for children and young people,
  better support for families
• Promote healthy lifestyles, support the
  vulnerable
• Provide good public health at all levels
• Promote good working conditions
• Improve the physical environment
• Presentation, Anna Cootes, Kings Fund

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Community Development Approaches to Tackling
Health Inequalities

• The result
• Sweden has low mortality rates,
• high life expectancy,
• and favourable health indicators across all
  groups
• Reducing Inequalities in Health a European
  Perspective (2002) Burgstrom et al

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Community Development Approaches to Tackling
Health Inequalities

• Even though there is acceptance of the impact of
  wider determinants on health interventions still
  mostly revolve around individuals and lifestyles
  - Investing for Health etc focusing on smoking
  cessation, fitness, nutrition etc.
• Why? - Asthana and Halliday say its because
  stronger evidence base for these interventions
• Favour randomised controlled trials research
  funding flows down existing policy priorities
  medical epidemiology prefers linear causal
  relationships rather than possibly non-linear
  interplay of wider determinants political will.
• Response need to strengthen the evidence base
  for community-development wider determinants
  interventions (poverty, education, focus on
  lowest socio-economic group, neighbourhood
  renewal).

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Community Development Approaches to Tackling
Health Inequalities

• Rob Phipps, DHSSPS, Presentation to Belfast
  Healthy Cities Equity in Health course, i.e. from
  statutory point of view
• Interventions that target socio-economic
  disadvantage
• Policies that promote educational achievement of
  children from lower socio-economic families
• Taxation policies that reduce income inequalities
• Benefit uptake schemes, transfer of extended
  benefits to particular groups.

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Community Development Approaches to Tackling
Health Inequalities

• But what if everything depends on macro-level
  interventions?

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Community Development Approaches to Tackling
Health Inequalities

• What can community development offer health
  inequality interventions?
• Community-based
• Empowerment people who are experincing the
  inequality define the problem and design the
  solution
• Responsive
• Practical can tackle the real problems people
  are experiencing
• Can reach most disadvantaged groups
• Can design solutions that are complex and deal
  with lots of different issues at the same time

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Community Development Approaches to Tackling
Health Inequalities

• Rob Phipps, DHSSPS, presentation to Belfast
  Healthy Cities Equity in Health course
• Correlates or causes
• Partnership empowerment community-based
  stakeholder involvement targeted integrated
  pragmatic realistic informed (theoretically
  sound)
• So community development has good process
  ingredients
• Phipps asked are these variables necessary or
  sufficient we would say necessary but not
  sufficient

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Community Development Approaches to Tackling
Health Inequalities

• What do our interventions look like at the
  moment?
• Turn to the person beside you and briefly
  describe one of the projects youre working on.
• Try and describe what health inequality it is
  tackling and how.
• Feedback on flipcharts common ingredients

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Community Development Approaches to Tackling
Health Inequalities

• What do our interventions look like at the
  moment?
• Do we intervene to tackle the symptoms or the
  causes of health inequalities in our community?

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Community Development Approaches to Tackling
Health Inequalities

• Community development that moves from the
  individual to the system
• Interventions based around service provision and
  health improvement pathways for individuals
• Interventions are responsive, understand the
  impact of the wider determinants of health on
  that individual (education, poverty etc.),
  complex and people clearly benefit
• However, even though we build the wider
  determinants into the intervention we still
  intervene to the individual
• What would it look like to intervene against the
  wider determinants themselves? - Advocacy that
  moves beyond individual pathways to political
  problems?

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Community Development Approaches to Tackling
Health Inequalities

• Future work for CDHN.
• Strengthen the evidence base for
  community-development wider determinants
  interventions
• Develop advocacy work on wider determinants
• What else?
• Thanks!