Health and wellbeing in Brighton and Hove

Alistair Hill –Consultant in Public Health

Determinants of health and wellbeing

Dahlgren and Whitehead, 1991

Marmot Review 2010: Reducing inequalities is a matter of fairness and social justice

•The cost of health inequalities in England•1.3 - 2.5 million life years every year•Economic:

•productivity losses of £31-33B•reduced tax revenue and welfare payments of £20-32B•increased treatment costs > £5B.

•Beyond economic growth – to wellbeing•Action required

•Across all social determinants•From preconception to the grave – the lifecourse

Social deprivation in Brighton and Hove

ENGLAND SOUTH EAST BRIGHTON & HOVE

Most deprived quintile in England

Least deprived quintile in England

MID SUSSEX

What is the life expectancy gap in Brighton and Hove?

• Life expectancy gap is 7.0 years for females and 10.1 for males

Life expectancy 78.6 years

Life expectancy 75.4 years

Life expectancy 77.4 yearsLife expectancy

80.9 years

A journey on the No. 1

Life expectancy gap between the most affluent and most deprived is 7 years in women and 10 years in men

“... the ability of a community to adapt to pressures and transform itself in ... ways that fundamentally transform the basis of the community.” Australian Social Inclusion Board, June 2009

Community resilience in Brighton and HoveThe WARM concept of community resilience

WARM assets and vulnerabilities: Life satisfaction

Satisfaction with living in Brighton and Hove is high, especially for older people.

Many LGBT community members move to the city because it is LGBT-friendly

Limited BME perspective in this model.

Strong correlation between satisfaction and affluence, although even in some deprived wards satisfaction is high

Satisfaction is not translated into a sense of belonging.

(Proxy of “satisfaction with living here” used)

WARM assets and vulnerabilities: Education

Falling school exclusions. Resilience training (SEAL) embedded in curriculum but not evaluated, good primary school performance.

Underperformance in GCSE results

Highly educated working age adults and older people.

Imported educated workforce placing pressure on longer term residents.

Highly educated LGBT with high levels of peer support in Education Institutions.

Bullying of certain groups may reduce attendance.

Scope to improve resilience through vertical integration

WARM assets and vulnerabilities:Health

Strong correlation between health and affluence.

Similar pattern of health assets and vulnerabilities across young people, adults and older people.

Population is generally more fit, relatively good diet, lower levels of obesity.

Relatively high rates of alcohol and substance use.

High rates of sexual health and mental health issues.

Opportunities for cross-generation / vertical integration initiatives.

WARM assets and vulnerabilities: Material wellbeing

Low exposure to debt.

Higher number of income supportand incapacity benefit claimants

Single parent families, older people and carers struggle.

Need to maximise benefit uptake – in context of welfare reforms

WARM assets and vulnerabilities: Strong and stable families

Lower rate of lone parent and carer claimants

Many elderly live alone and are potentially socially isolated.

High levels of mental health problems, substance misuse and domestic violence – including among LGBT communities.

WARM assets and vulnerabilities: Belonging

• Lower sense of belonging and participation in decision making, overall average levels of volunteering.

• Higher participation of children in group activities.

• Older people most involved in decision making.

• LGBT volunteering high however lower feelings of local area inclusiveness.

WARM assets and vulnerabilities: Local economy

Small size and short travel times (foot/public transport).

Creative businesses, business start ups and business density.

Geographical differences.

WARM assets and vulnerabilities: Public Services

By virtue of size most public services are nearby.

Higher levels of public satisfaction with public transport services.

Vulnerable residents and older people more likely to feel that services respond to their need.

However relatively low level of public satisfaction with public services with regard to City Council, GP, local hospital and dental services.

WARM assets and vulnerabilities: Crime and anti-social behaviour

Low fear of crime and average burglary offences.

Initiatives tackling antisocial behaviour rates (including alcohol).

However overall crime, anti-social behaviour, violent crime are relatively high.

Crime matches deprivation profile.

Crime falling less than it is elsewhere in Sussex.

Evidence of hate crime against LGBT community.

WARM assets and vulnerabilities: Infrastructure

Peripheral wards have more infrastructure resilience (except Moolescomb and Bevendean)

Housing is a powerful vulnerability.

High levels of satisfaction with parks, green spaces and seafront.

– Demand increasing (population growth)

– Impact of austerity measures

– The end of increases in public sector spending

• “the Government has run out of money” George Osborne 26/2/12

• “Austerity is the new normal” Alan Milburn

– Contribution of carers and community &voluntary sector

– Outcomes that are important to users and communities

– Services must recognise impact of assets and resilience

– More integration between services

– New health commissioning structures (tbc)

Future challenges...and opportunities for health and wellbeing