Health Inequalities Intervention Tool for Scotland (HITS)

Health Inequalities Intervention Tool for Scotland (HITS)

Faculty of Public Health in Scotland, Annual Conference 2011

Rory Mitchell

Public Health Observatory DivisionNHS Health Scotland

What do we do about health inequalities in Scotland?

Overview

• Background & aims• What are the health inequalities intervention tools?• Data issues

• Demonstration

• Preliminary findings• Discussion (wider context of tackling health inequalities)• Conclusions

Health Inequalities Intervention Tools• Spreadsheet based models, underpinned by current data

and effectiveness evidence

• Tools available at local and national level, for use by policy makers and local planners to inform decision making

• Modelling of the impact of selected interventions on population health and health inequalities

• Modelling of costs required to achieve particular outcomes

Health Inequalities Intervention ToolsInterventions:

Alcohol brief interventions (ABIs)Counterweight (BMI reduction intervention)NHS smoking cessation services

Outcomes:Deaths (number prevented, life expectancy)Hospital admissions (number prevented, rate)Risk factor (prevalence, population mean)

[population & most deprived quintile (MDQ)]

Data

Demo

Parameter to modelNote: for current draft version, please select "Scotland" Cost per intervention (£)

Outcome gap comparatorBaseline throughput SIMD DistributionCost per intervention (£) choose parameter to model

Population size

Number eligible for intervention Females

Total cost Total CostThroughput number ThroughputRecruitment rate required Recruitment rate requiredNo. of 'successful' interventions No. of 'successful' interventionsCost per successful intervention Cost per successful intervention

Males FemalesHarmful / hazardous drinking

Males Females Females

Life expectancy (years)

No of alcohol-related


No of alcohol admissions in

Life expectancy in MDQ (years)Life expectancy gap (years)

Alcohol-related hospital admissions prevented in MDQ% change in alcohol-related admission rate gap

New prevalence of harmful / hazardous drinking (not calculable )

Health Inequalities Outcomes Males

New life expectancy (years)Gain in life expectancy (years)Alcohol-related hospital admissions prevented

Health Inequalities Tool for Scotland (HITS): Alcohol Brief Interventions

Population Health Outcomes Males

% change in life expectancy gap

New life expectancy in MDQ (years)New life expectancy gap (years)

Baseline data

MalesIntervention Impact

User input 3: model dataUser input 1: population

User input 2: current activity

Draft!



Population size


















Baseline data




Baseline throughput

Cost per intervention (£) £25

User input 1: population

88,138User input 2: current activity

Scotland




Population size


















Baseline data





Population size

Number eligible for interventionTotal costThroughput numberRecruitment rate requiredNo. of 'successful' interventionsCost per successful intervention

Males Females

Harmful / hazardous drinking (%) 28.7% 19.4%

Males Females

Life expectancy (years) 75.32 80.04

No of alcohol-related admissions 27,907 11,370

Males Females

No of alcohol admissions in MDQ 11,821 4,816

Life expectancy in MDQ (years) 69.40 76.39Life expectancy gap (years) 11.00 7.19

5,143,680

Baseline data

1,005,198£2,203,45088,1388.8%57,290£38

Alcohol Brief Interventions Tool Demo

1. Investment of an additional £1 million at Scotland level



Population size


















Baseline data





Parameter to model Investment


Outcome gap comparator Least deprived quintile (Scot)

SIMD Distribution Baseline distribution

Budget (£) 3,203,450

User input 3: model data

= Modelling £1M investment above estimated 2010/11

baseline



Population size


















Baseline data





Total Cost £3,203,450Throughput 128,138Recruitment rate required 14.0%No. of 'successful' interventions 83,290Cost per successful intervention £38

Intervention Impact



Population size


















Baseline data





Females

40.00332

0.007Deaths preventedGain in life expectancy (years)

10

Alcohol-related hospital admissions prevented 117




Population size


















Baseline data





Females

12-0.28%

Deaths prevented in MDQ 176.397.19-0.05%

3

Alcohol-related hospital admissions prevented in MDQ 51% change in alcohol-related admission rate gap -0.42%


69.41

% change in life expectancy gap10.99-0.09%


Alcohol Brief Interventions Tool Demo

1. Investment of an additional £1 million at Scotland level

2. Investment of an additional £1 million at Scotland level, and targeting of all interventions to the most deprived two quintiles



Population size


















Baseline data





Same budget, but perfectly targeted to more deprived

groups

Parameter to model Investment


Outcome gap comparator Least deprived quintile (Scot)

SIMD Distribution Perfect targeting to Q1&2

Budget (£) 3,203,450

User input 3: model data



Population size


















Baseline data





Females

76-0.90%

Deaths prevented in MDQ 676.417.17-0.30%

21

Alcohol-related hospital admissions prevented in MDQ 331% change in alcohol-related admission rate gap -1.47%


69.46

% change in life expectancy gap10.94-0.58%


Preliminary findings

• All 3 interventions can have an impact on health inequalities

• Accurate targeting is critical

• Modelled impact is dependent on input data and assumptions

….but the magnitude of impact is fairly robust

• For all interventions the predicted impact is modest

Tackling health inequalities: the scale of the challenge

Tackling health inequalities: what is likely to work?

Likely to be more effective*:

• Structural changes in the environment

• Legislative and regulatory controls • Fiscal policies • Income support • Reducing price barriers • Improving accessibility of services• Prioritising disadvantaged groups • Offering intensive support • Starting young

Likely to be less effective*:

• Information based campaigns • Written materials • Campaigns reliant on people

taking the initiative to opt in• Campaigns/messages designed

for the whole population• Whole school health education

approaches • Approaches which involve

significant price or other barriers• Programmes that raise housing

costs

*Edited, from MacIntyre, S. What are inequalities in health and what causes them? Briefing Paper for Ministerial Taskforce on Inequalities. Scottish Government; 2008.

Conclusions

• HITS outputs provide practical tools to inform decision making

• The 3 interventions modelled can have a measurable impact on health inequalities

• However, the impact of downstream individual interventions is likely to be small…and highly dependent on targeting

• Upstream universal interventions are likely to have a larger role to play in tackling health inequalities in Scotland

What’s next?

• Outputs scheduled for publication in early 2012

• Feedback very welcome!

Acknowledgements

ScotPHO colleagues: Diane Stockton, Gerry McCartney, Colin Fischbacher, Jamie Reid

HITS Steering Group

[email protected]

Date post:	01-Feb-2016
Category:	Documents
Upload:	duante
View:	48 times
Download:	0 times

Health Inequalities Intervention Tool for Scotland (HITS)

Documents