Agenda item

To consider a report of the Head of Scrutiny and Member Development on the Board’s Inquiry into Health Inequalities.

Following the initial meeting in November, the Director of Public Health will present a range of data contained within the Joint Strategic Needs Assessment (JSNA) to inform and support the inquiry.

A cover report will be provided and include presentation slides (to tell the story) supported by a number of data sets.  It is proposed that the presentation will focus on two specific themes, starting with Life Expectancy, specifically using premature mortality from cardio vascular disease (CVD) to illustrate the point.  It will explore some of the data sets that exist to illustrate factors that affect life expectancy, with the following data sets from the JSNA to support this:

·  CHD (coronary heart disease)

·  Active Lifestyles

·  Smoking and Tobacco

·   

The presentation will also focus on Poverty and explore the link between poverty, income and health – linking back to the life expectancy (as life expectancy is related to the level of deprivation).  This section will again examine some of the data sets that exist to illustrate the interplay between poverty, deprivation, health and ultimately life expectancy.  Four specific data sets from the JSNA will be presented  to support this.  These are:

·  Homes and Housing

·  Child Poverty

·  Deprivation

·  Incomes and Benefits

The presentation will then move to “A Tale of Two Medium Super Output Areas (MSOAs) which ties the presentation together by demonstrating the inequalities between two specific areas in the City (Gipton and Adel). 

Further to minute 39 of the meeting held on 25^th November 2011 which detailed the Board’s first session into its Inquiry on Health Inequalities, the Board undertook its second session

Following on from the Director of Public Health’s presentation on the JSNA at the meeting on 25^th November 2011, the Board considered some specific examples of the data sets which formed part of the JSNA refresh; these providing both statistical information and commentary.  Appended to the report were draft data sets in respect of the following:

• Coronary heart disease (CHD)
• Active lifestyles
• Smoking and tobacco

In the context of the Inquiry, premature mortality from CHD was

considered with the above data sets being explored as affecting life expectancy

The following people were present for this item

• Dr Ian Cameron – Joint Director of Public Health – NHS Leeds/LCC
• Lucy Jackson – Consultant in Public Health – NHS Airedale, Bradford and Leeds
• Nichola Stephens – Senior Information Manager – NHS Airedale, Bradford and Leeds

Dr Cameron provided information exploring the link between poverty, income and health and to assist the debate, the following draft data sets were also appended to the report:

• Homes and Housing
• Child Poverty
• Deprivation
• Incomes and Benefits

To highlight the health inequalities which existed within Leeds, information had been provided indicating health inequalities citywide as well as in deprived and non-deprived areas of Leeds.  Dr Cameron provided a slide presentation which brought the issues into sharp focus when considering data relating to two different areas of Leeds; Gipton South and Adel.  Details were also provided on the Leeds Observatory, a website which when completed would be the mechanism for accessing data, enabling links and searches to be made to provide both general and postcode specific profiles of a range of  health and wellbeing related data

As the issue of smoking and tobacco would be the subject of a discussion in January 2012, the Chair asked that Members wait until then to discuss any specific issues in this area

In summary, the key areas of discussion were:

• the focus of the Board and whether this should be on the key causes of premature mortality or to look wider and at areas which over the long-term could lead to improved health and less inequalities
• mortality rates and differences between men and women
• housing; the impact of poor housing on health
• the link between poverty and health and the likely negative impact of changes to the benefits system
• the introduction of the health premium with concerns this could lead to pressure being placed on health professionals to register data in a certain way
• the fluid nature of the population in some areas of Leeds and the distortion to the data caused by the large student population
• whether or not significant improvements/results could be achieved
• data quality and reporting rates among local GPs
• the range of data being collected; that winter deaths should be recorded and the importance of including details of residential properties in the city which had been adapted

Dr Cameron and his colleagues responded and provided the following information

• that to secure quick wins, it was appropriate to concentrate on heart and respiratory disease.  However it should be recognised that health inequalities were across the life course and that possibly greater benefits would be seen by focusing on longer-term building blocks/health determinants and how these are affected by Council policies/strategies
• that Leeds Metropolitan University had recently concluded a major piece of work looking at health and gender issues.  It was outlined that it was important to make best use of the research skills and expertise that existed within Leeds for the benefit of its citizens
• that encouraging data was being seen to suggest that the NHS Healthcheck was being taken up equally by women and men
• that data packs indicated the number of homes in the city which did not meet decency standards and that through the JSNA it was hoped to raise the profile of this important determinant
• that further information on the health premium would be provided in a future report
• that the areas identified as being deprived were not seen collectively; that there were differences and that understanding the dynamics of each area was vital to help ensure services were tailored accordingly
• that the inequalities within Leeds were often masked due to the size of the City.  It was recognised that historically this had led to the City missing out on a number of funding streams

The Chair welcomed Dr Cameron’s comments on the best approach to

be taken and suggested that the working group looking at this subject in greater depth, invite input from representatives of Housing, Planning, Leisure and Education.  It was also suggested that the working group meetings take place at venues in some of the City’s deprived areas, ie Inner East, Inner South and Inner West.  Consideration should also be given to inviting representatives from Leeds Metropolitan University who had carried out a study on gender and health

RESOLVED -  To note the report, the presentation and comments now made and that a series of working groups be held in January, February and March to undertake detailed scrutiny of key issues