Inequalities in Health: Is social capital the missing link

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Inequalities in HealthIs social capital the
missing link?

• Chris Drinkwater

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Inequalities in Health

• Between 1995-97 2004-06
• Life expectancy for all improved
• Relative gap got wider by
• - 2 for males
• - 11 for females
• From Tackling Health Inequalities 2007
• Status Report. DH. February 2008

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Better Health, Fairer Health

• Mental health, happiness and well-being (p7)
• The NE will have the most favourable measures of
  mental health and happiness in the country.
• We will establish a Regional Advisory Group for
  Mental health, Happiness and Well-being.
• Available at www.go-ne.gov.uk.

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What will be done?

• Physical activity support for mental health
  sufferers.
• Access to bereavement counselling.
• Parenting support.
• LSPs to develop policies for maximising social
  capital through Community Strategies
• Develop appropriate measures for an annual
  progress report on social capital
• Available at www.go-ne.gov.uk.

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Medical or Social Model
Evidence
Medical model
Social model
Physical Capital
Social
Hospital
Individuals Communities
GP PBC
DTCs
HLNs
Individual responsibility behaviour change
Patient centredness

Demand
DTC Diagnostic Treatment Centre
HLN Healthy Living Network
PBC Practice Based Commissioning
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Health TrainersChoosing Health 2004

• advice from on high to support from next door
• Drawn from local communities
• Understanding of local concerns and experiences
• A common sense resource
• Accredited by the NHS

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Health TrainersChoosing Health 2004

• advice from on high to support from next door
• Drawn from local communities
• Understanding of local concerns and experiences
• A common sense resource
• Accredited by the NHS

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Health Trainers 2008

• 1,200 across the country (16 in Newcastle).
• NHS or commissioned voluntary sector service.
• Recruited from local communities or re-badged.
• 11 referral or social network approach.
• Outcome monitoring focused on smoking cessation,
  obesity and alcohol reduction.

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PSA 18Promote Better Health and Wellbeing

• Reduce inequality in mortality rates between
  England average and spearhead areas.
• Reduce smoking prevalence
• Increase proportion of people supported to live
  independently
• Increase access to psychological therapies

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PSA 21Cohesive, empowered active communities

• Increase of people who feel they can influence
  decisions in their locality
• Increase of people from different backgrounds
  who get on well together
• Increase of people who feel they belong to
  their neighbourhoods
• A thriving voluntary and community sector

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Powerlessness

• Living in poverty
• Low in hierarchy
• High demand psychological and physical
• Low control perceived and actual
• Chronic stress
• Lack of social support
• Lack of resources

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Individual Community Empowerment
Empower individual
Treat Illness
Reduce Risk Factors
Sense of Community participation
in Decision-making Community actions Increased
empathy
Empower community local action Stronger
networks Resource access equity Community
competence
Wallerstein,N. Powerlessnes,Empowerment and
Health. American Journal of Health Promotion
1992, Vol 6. No.3. P 197-205
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NICECommunity Engagement Guidance

• For policy makers, commissioners, providers,
• community organisations.
• Health promotion activities.
• Activities addressing wider determinants
• Area-based initiatives
• February 2008 www.nice.org.uk/guidance

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Prerequisites for community engagement

• Policy development
• Long term investment
• Organisation and cultural change
• Levels of engagement power
• Mutual trust and respect
• February 2008 www.nice.org.uk/guidance

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Newcastle NDC baseline mental health survey

• Men aged 46-55
• Living alone 49
• Economically inactive 58
• High levels of anxiety and depression
• Associated high levels of smoking, alcohol
  consumption and obesity.

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WEFA Outcomes

• Supportive social network
• More physically active
• Better nutrition
• Decreased alcohol/smoking
• Improved mental health
• Better diabetic control
• Health talks prostate problems