1. Health inequalities,
Marmot and English
health policy
Socialist Health Association, Manchester,
July 25th 2011
John Middleton
Director of Public Health
for Sandwell

2. Socialist health association – inequalities
in health meeting
Introduction- welcome to
Sandwell
History of public health
Spearhead inequalities
• Reducing social inequalities:
UK Marmot review
• Implementing effective
interventions
• Current UK health policy
context

3. About Sandwell
• Located in the
Black Country
• High levels of
deprivation
• Inequalities in
health
• Multi-cultural
community
• Six distinct towns

4. Six Towns in the West
Midland
Known as Sandwell

5. Welcome to Sandwell

6. Welcome to Sandwell

7. Neptune forge 1930

8. Neptune health park, 1999

9. An history of English history of
public health

17. The Changing landscape for public health in England, John Middleton Warrington, March
2nd 2011
30% of the life expectancy gain since
the formation of the NHS is due to
effective medical interventions
Bunker ,Frazier and Mostellar, Milbank
Quarterly, 1994
Through the work of the DH National
Support Team for health inequalities we
now have effective tools to use to
reduce inequalities by case finding and
treating people at highest risk of
cardiovascular disease and other
conditions

19. it's not who
your doctor
is, it's who
you vote for,
that most
affects your
health

25. Sandwell, Deaths
Sandwell, Deaths by Coronary
by Coronary Heart Disease (CHD)
Heart Disease (CHD) ICD10
ICD10
I20 – I25 (5 year rolling
I20 – I25 (5 year rolling
average) Mortality Rate,
average)
Population Aged Under 65
Directly Standardised Mortality
Years
Rate, Total Population
Directly Standardised
Wednesbury
Wednesbury Wednesbury
Wednesbury
North
North Friar Park
Friar Park North
North Friar Park
Friar Park
Great Barr with Yew tree
Great Barr with Yew tree Great Barr with Yew tree
Great Barr with Yew tree
Charlemont
Charlemont Charlemont
Charlemont
Wednesbury
Wednesbury Wednesbury
Wednesbury
Princes End
Princes End with Grove Vale
with Grove Vale Princes End
Princes End with Grove Vale
with Grove Vale
South
South South
South
Hateley Heath
Hateley Heath Newton
Newton Hateley Heath
Hateley Heath Newton
Newton
Great Bridge
Great Bridge Great Bridge
Great Bridge
Tipton Green
Tipton Green Tipton Green
Tipton Green
West Bromwich
West Bromwich West Bromwich
West Bromwich
Greets Green Central
Greets Green Central Greets Green Central
Greets Green Central
and Lyng
and Lyng and Lyng
and Lyng
Oldbury
Oldbury Oldbury
Oldbury
Tividale
Tividale Tividale
Tividale
St. Pauls
St. Pauls St. Pauls
St. Pauls
Soho and
Soho and Soho and
Soho and
Rowley
Rowley Smethwick Victoria
Smethwick Victoria Rowley
Rowley Smethwick Victoria
Smethwick Victoria
Langley
Langley Langley
Langley
Bristnall
Bristnall Bristnall
Bristnall
Blackheath
Blackheath Blackheath
Blackheath
Abbey
Abbey Abbey
Abbey
Cradley Heath
Cradley Heath Cradley Heath
Cradley Heath
Old Warley
Old Warley Old Warley
Old Warley
and Old Hill
and Old Hill and Old Hill
and Old Hill

29. The economic
Town Profiles
climate and health

30. Fear of job loss Economic Downturn Early retirement
Jobs at risks (Jobcentre
Plus)
Increasing numbers in higher /
Precarious Work further education Higher education
Unemployment enrolment numbers (HESA)
Reduced income % low
pay jobs & household income
Potentially measured by:
Fuel Poverty per head (ONS)
Unemployment numbers
Housing tenure Health Consequences Unemployment rate (unemployed / economically active population))
social rented housing Influenced by demography of those JSA claimants (updated monthly)
needs register (HSSA) affected ( EoE forecasting model – EEDA) Economically inactive (not in employment or unemployed)
Incapacity benefit claimants (sub divided by type)
Measured Increase Increase Increase Decrease Decrease Other
by smoking alcohol overweigh physical psychological
t & activity well-being
obesity
Mortalit Smoking Alcohol Suicide & Land
y attributa attributa injury transport
ble ble undetermined accident
mortality mortality mortality
rate rate
Morbidit Smoking Alcohol % Prescribing
y prevalenc consumpti recorded data of anti-
e over 16 on obese depressants
yr adults 16 (ADQ)
+
Healthca COPD Alcohol Admissions All
re admission related for self-harm admissions
utilisat s admission Adults in All 1st OPD
ion Acute MI s contact with attendance
Key Questions: admission mental health s
1.What is the likely impact of the economic downturn upon health services
s at an individualAll A&E
and population level ?
(literature search) admissions
2.What can be done to mitigate the impact of an economic downturn on health? (literature search)
3.Is the economic downturn impacting upon healthcare service use within the East of England? (data analysis
– contemporary)

31. Health and wealth
Health and recession

34. Reality very different

39. Health and wealth
Poverty and health

40. • Harvey Brenner Int Journal
Epidemiology 2005, 34, 6: 1214

44. Shaw et al.
Critical public health
2001,11:289-304

45. Shaw et al
Critical public health,
2001;11:289-303

46. Spearhead
authorities
in England
distance from
target for
reducing
inequalities

47. Changes in real income for each 10% band of
population, 1979 -1991/92, after housing costs
Percentage
10% (Poorest) -17
20% 0
30% 6
40% 16
50% 23
60% 29
70% 33
80% 39
90% 46
100% (Wealthiest) 62
-20 0 20 40 60 80
Source: Households below average income 1979-1991/92, Department of Social Security (1994)

49. Households below average
income survey

52. Health and wealth
Health access and
inequality

54. Health and wealth
Environmental justice

61. Inequalities in health:
evidence (Acheson)
• Income inequalities
• Early years education
• Tobacco control
• Workplace health
interventions
• Food and nutrition
• Transport and access
• Health inequalities impact
assessment