Agenda item

Professor Kate Pickett will present to the Board recent findings on health inequalities, to be published shortly by the British Academy under the title “If You Could Do One Thing”. Professor Maynard will discuss his work on the role of evidence and evaluation in reducing inequality.

Board Members received a report and PowerPoint presentation from Professor Kate Pickett and Professor Alan Maynard on current findings of health inequalities. Slides from the PowerPoint were attached to the agenda, which was subsequently republished following the meeting.

During Professor Maynard’s presentation he told the Board;

·        There must be greater evidence in policy making. In his view most policy had been an unevidenced experiment on people, and investment in certain areas would always have a knock on effect in depriving other sections of society.

·        He felt it was un-ethical and against the public benefit if rigorous examination using evidence and evaluation of practice in Health and Social Care was not always used.

·        There was a need for collation and pooling of data across all sectors of public life, not just in the health service but also in education and in justice services for example.

·        South Somerset for example had merged all data for individuals and attached costs in regards to their needs. They had also added in details such as Long Term Conditions to the data. He felt this could be done by the Council and that York would be behind the pace if this was not done.

·        Great data collation could enable greater demand management and allow for Government ministers to not “fly free” when presenting policy.

During Professor Pickett’s presentation she told the Board that there was now a 25 year difference in life expectancy between the richest and poorest in the  richest and poorest boroughs of London. She also reported that it was estimated that 40% of all health problems were socially determined.

She shared with the Board the 9 key local policy changes that were recommended in the British Academy report on Health Inequalities. These responses were;

·        Living Wage:There was a need to implement a living wage, for example Local Authorities could use their procurement powers to stimulate this across the public sector.

·        Giving Children the Best Start in Life: Resources should be focused as early as possible in a child’s life.

·        20 mph Speed Limits in all Residential Areas: 20 mph speed limits imposed on 30 mph zones would be easy to enact at a local level. This might reduce the number of fatalities, in particular child fatalities.

·        Tackle Worklessness: To overcome worklessness, more focus should be made on a person’s individual health situation rather than getting them a job as quickly as possible.

·        Use of Participatory Budgets: Using participatory budgets in mental health provision to make decisions. The process of participation in intervention does make an impact on the individual.

·        Improve Further and Adult Education: Further and Adult Education could reduce health inequalities and could lower mortality rates.

·        Better Focus on Ethnicity:  Ethnicity had been substantially neglected in discussions about health inequalities.

·        Friendly Environments for Older People: It was necessary to create Older Friendly Environments, as place matters in greater social integration.

·        Rigorous Evaluation and Use of Evidence: This had been discussed already in the presentation by Professor Alan Maynard.

Discussion between took place on the two presentations. The following points were raised;

·        That often when looking for examples of good international practice there was a tendency to look towards the United States, which had a poorer health and social care system in comparison.

·        That there was always research available for service providers and commissioners to use, but there always seemed to be reluctance to access this.

·        That there were people who had a job but were in poverty.

·        Income inequity was a driver in health inequality, and although York had high levels of growth there was a worsening picture of income inequality in the city.

·        There was a necessity to look at the whole family when examining mental and emotional health. In some cases, it might be better for one parent to not work.

·        Unless a community was ‘healthy, learning and safe’ it would fall behind more prosperous communities.

Board Members asked what work would be done to push the momentum raised by Professor Pickett’s report. They added that data sharing required more work and that all partners needed to have the courage to evaluate their practices.The Board were told that a Health Inequalities Board had been established which would look at having a wider discussion with partners in the city. It was noted that an update would be given on this at the next Board meeting.

Resolved:  (i)      That the report and presentations be noted.

(ii)      That an update on the work of the Health Inequalities Board be given at the next meeting.

Reason:    In order to inform future work of the Health and Wellbeing Board.