Working for Health Equity: The Role of Health Professionals
5th Feb 2014
Matilda Allen – [email protected] Institute of Health Equity
Today…
• Health Inequalities and Social Determinants of Health – brief background
• Working for Health Equity report– Workforce education and training– Working with individuals and communities– Working in partnership– Workforce as advocates
• NHS Organisations and health at work
Key themesReducing health inequalities is a matter of fairness and social justiceAction is needed to tackle the social gradient in health – proportionate universalismAction on health inequalities requires action across all the social determinants of health
Reducing health inequalities is vital for the economy – cost of inaction
Beyond economic growth to well-being of society: sustainability and the fair distribution of health
A. Give every child the best start in lifeB. Enable all children, young people and adults to maximise
their capabilities and have control over their lives.C. Create fair employment and good work for allD. Ensure a healthy standard of living for allE. Create and develop healthy and sustainable places and
communitiesF. Strengthen the role and impact of ill-health prevention
6 Policy Objectives
1. Workforce Education and Training
2. Working with Individuals and Communities
3. NHS Organisations4. Working in Partnership5. Workforce as Advocates6. The Health System – Challenges
and Opportunities
Statements for Action and Commitments• Statements for action – short,
practical and accessible guides for particular professionals
• Commitments to action – in all areas of the report
Institute of Health EquityAcademy of Medical Royal CollegesRoyal College of MidwivesRoyal College of PhysiciansBarts and the London NHS TrustBritish Dietetic AssociationRoyal College of Paediatrics and Child HealthRoyal College of General PractitionersRoyal College of Speech and Language TherapistsChartered Society of PhysiotherapyDental Schools Council
Royal College of Obstetricians and GynaecologistsBritish Association of Occupational Therapists and College of Occupational TherapistsRoyal College of PsychiatristsRoyal College of NursingAllied Health Professionals FederationMedsinBritish Association for Music TherapyBritish Medical AssociationNHS AllianceSocial Work and Health Inequalities NetworkRoyal College of PsychiatristsCollege of ParamedicsSociety and College of Radiographers
Why we did this• NHS workforce has an underutilised role in SDH
and wider inequalities
• NHS has 1m employees and reach to wider families, from across the social gradient
• And sees 1m people every 36 hours and nearly whole population every year
The health system
• Legal duties to reduce health inequalities, for the first time
• Public Health in Local Authorities• Health and Well Being Boards in LAs• Platform for joining up health services, social care
services and health-related services at local level
Workforce Education and Training
• Knowledge: greater focus on SDH in UG and PG.• Skills: communication, partnership and advocacy• Placements: More training placements in
disadvantaged areas and in a range of sectors e.g. charities, social services
• Continuing Professional Development• Access
Working with Individuals and Communities
• Relationships : including collaboration and communication with communities
• Gathering information : social history, used for referral, greater understanding, and at aggregate level.
• Providing information : referral and social prescribing
Royal Free London Case Study(taken from Adrian Tookman presentation at the ‘working for health equity’ launch)
• Presented to board – – High levels of deprivation– High levels of smoking, drinking and obesity– Ethnic differences – Bangladeshi, Jewish/Armenian,
Eastern European and other East Asian all over 20% more likely to be non-elective admission
• In order to make changes, need to start with quick wins and provide a bundle of changes
• Need senior sign up/sponsorship and front line engagement
Royal Free Cont.1. SUPPORTING HEALTHIER LIVES
– Well at the Free– Comprehensive Stop Smoking Service
2. BETTER HEALTH FOR ALL– Homelessness Pathway– A&E assault-related violence data sharing– Domestic Violence Screening: Pilots in key areas: Gynaecology, Maternity and
Sexual Health.3. CREATING A HEALTHIER WORKFORCE
– Fit at the Free4. TAKING A POPULATION PERSPECTIVE
– Trust strategy– Reducing Readmissions
More information available in Adrian Tookman’s presentation on IHE website - http://www.instituteofhealthequity.org/presentations/presentation-slides
Working in Partnership
• Within health sector: consistent, broad and focussed on SDH
• With external bodies: e.g. joint commissioning, data sharing and joint delivery. Design and assessment are essential.
• CCGs: should tackle HI through role as commissioner, in partnership (e.g. HWBBs), and as local employer and advocate
Living in cold homes: effect on adolescents% children with four or more negative outcomes*
Overcrowded
Poor state of repair
Inadequately heated
All children
0 5 10 15 20 25 30
4
4
4
9
11
9
9
16
283-5 years1-2 years0 yearsAll children
*i)A long-standing illness or disability, ii) to go without regular physical exercise, iii) in trouble for smoking, drinking or taking drugs, iv) bullied in or out of school, v) expelled or suspended from school, vi) does not see friends and does not attend organised activities, vii) has been in trouble with the police, viii)below average in key academic subjects, ix) family cannot afford an annual holiday, and, x) family in income poverty. Source: Barnes et al 2008
% children with four or more negative outcomes*
Number of previous5 years child has lived in theseconditions
Case Study - AWARM
Local area partnerships that link health, housing and fuel poverty.
Designed to reach most vulnerable.
Model identified key systems and processes needed to access vulnerable poor, streamline referral and delivery systems.
Over 1000 referrals made by frontline professionals. 1,359 professionals trained.
Gain in quality-adjusted life years was estimated to range from 1.67 to 31.6, depending on model used.
Workforce as advocates
• For individuals• For changes to local policies• For changes to the health profession• For national policy change
Projected relative AHC income poverty rates under current policies and without the coalition government’s tax and benefits reforms: UK
IFS 2010
Neighbourhoods affordable to Housing Benefit Recipients in 2011 and 2016
NHS Organisations Health professionals should utilise their roles as managers and employers to ensure that:• Staff have good quality work that increases control,
respects and rewards effort, and provides services such as occupational health.
• Their purchasing power is used to the advantage of the local population, using employment and commissioning to improve health and reduce inequalities in the local area.
• Health inequalities strategies are given status at all levels of the organisation, so the culture of the institution is one of equality and fairness.
Impact of working conditions on health
• Income• Physical hazards• Psychosocial working environment• Job security• Long or irregular hours or shift work
All are distributed along a social gradient.
Stress at work• Two models
– Demand-control model: high job strain is characterised by high job demands and low job control
– Effort/reward imbalance: efforts at work are not adequately rewarded by pay, esteem, job security or opportunities for career advancement
• Socially isolated – (no supportive co-workers or supervisors)
The association of civil service grade with job control, Whitehall II study, 1985–88
High Low
Job control
Employment Grade
Chandola et al. BMJ 2006
• Stress at work is associated with a 50% excess risk of coronary heart disease
Kivimäki M, Virtanen M, Elovainio M, Kouvonen A, Väänänen A, Vahtera J. Work stress in the etiology of coronary heart disease—a meta-analysis. Scand J Work Environ Health 2006;32(6 special issue):431–442.
RCP audit: implementing public health guidance for the workplace73% of all hospital trusts participated
Some findings:- 24% of trusts do not monitor the mental wellbeing of staff- Only 31% of trusts monitor long term sickness absence by age- Trusts had difficulty estimating how many contracted or outsourced
staff they had.- Outsourced staff, and those working irregular or night shifts, have less
access to health promoting initiatives or healthy conditions of work- Many trusts do not measure who participates in programmes by
characteristic (e.g. gender, age, ethnicity, job grade, etc.)- 38% of trusts do not allow staff to attend smoking cessation services
during working hours without loss of pay.
Case study: Barts and the London NHS Trust
Developed a public health approach with 3 themes:
1. Making every contact count for patient health2. Staff health and wellbeing3. Community employment and procurement
On-going IHE work• Support to implement the commitments made by royal
colleges and BMA and others
• Set up an education working group
• Will set up a CCG working group
• And explore incentives and system drivers
Thank you for listening!
Lots of information on our website:www.instituteofhealthequity.org