ndcs and health overview of phase 1
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NDCs and Health Overview of Phase 1. Liddy Goyder, ScHARR University of Sheffield. The health “theme team”. University of Sheffield Liddy Goyder Jean Peters Lindsay Blank Libby Ellis Sheffield Hallam University NDC team, Mike Grimsley MORI and SDRC for health data. Overview. - PowerPoint PPT PresentationTRANSCRIPT
NDCs and Health Overview of Phase 1
Liddy Goyder, ScHARR University of Sheffield
The health “theme team”University of Sheffield• Liddy Goyder• Jean Peters• Lindsay Blank• Libby EllisSheffield Hallam University• NDC team, Mike GrimsleyMORI and SDRC for health data
Overview
• What are NDCs and what do they do?• What are “health” issues for NDCs?• “Health-related” activity in NDCs:
example of healthy eating initiatives • So has health improved in NDCs?• Do we expect NDCs to have an impact
on population health in the future?
The NDC Programme
• Launched in 1998• Ten year, community led, holistic ABI in 39
deprived English localities• Five outcome areas: housing and
environment,jobs, education, crime, health• £50 million per partnership• Compares to about £600 million from
mainstream service providers • Plus funding and activity through other ABIs
Complexity of ABI evaluation
• Dealing with attribution when so many previous/present initiatives
• Change in any ABI related to wider local/ regional/national changes
• Area based interventions but aimed at individuals
• Spillover/displacement
Delivery Plans 2004Top 7 outcomes for health
• Health promotion: diet, exercise, health and well-being (31)
• Death rate/SMR and life expectancy (30)
• Mental health (16)
• Health services-access (15)
• Smoking (12)
• Teenage pregnancy (12)
• Self reported health (10)
Interventions that are likely to improve health and reduce
inequalities income and employment educational attainment quality of housing/physical environment crime and fear of crime
facilitating “healthy lifestyles” access to/quality of health services
Wide variation in health indicators across Partnerships
• Over 20 percentage point difference between Partnerships in residents with good health
• “Health is worse over past year” ranges from 28% in Coventry to 10% in Lambeth
• General health is highly correlated with deterioration in health over past year (-0.88)
• NDC average SF36 mental health well being score ranges from 66 to 75 in 2004
% NDC population consuming 5 portions of fruit and vegetables
per day
NDC Area
Ply
mouth
Mid
dle
sbro
ugh
Hart
lepool
Derb
yH
ull
Know
sle
yB
risto
lO
ldham
Doncaste
rM
ancheste
rS
underland
Sheffie
ldLuto
nS
alford
Nottin
gham
Liv
erp
ool
Sandw
ell
Bra
dfo
rdC
oventr
yS
outh
am
pto
nN
ew
castle
Fulh
am
Rochdale
Kin
gs N
ort
on
Wolv
erh
am
pto
nN
orw
ich
Brighto
nB
irm
ingham
Lew
isham
Leic
este
rW
als
all
New
ham
Tow
er
Ham
lets
Islin
gto
nH
ackney
Haringey
Bre
nt
Lam
beth
South
wark
% e
atin
g 5
fru
it o
r ve
g d
aily
40
35
30
25
20
15
10
5
0
Spending by Theme 2001-4
104
87
68
47
45
45
66
0 20 40 60 80 100 120
Housing & PE
CommunityDevelopment
Education
Worklessness
Health
Community Safety
Average
Total NDC Expenditure (£000,000)
NDC Health Expenditure by Year
30
12
3
33
21
8
0 10 20 30 40 50 60
2003/04
2002/03
2001/02
Total NDC Health Expenditure (£ 000,000)
Average Theme Expenditure
Health Expenditure
NDC Health Reports- Main Topics
• Improving access to health services• Complementary therapies• Exercise & Healthy eating• Improving mental health• Reducing Teenage Pregnancy• Supporting Teenage Parents• Drugs
Health Theme Evaluation
• Analysis of NDC business plans• Mapping of health areas and selection
of topics/ year• Identification of case studies -
– to illustrate range of approaches – variations in stages of development
• Multiple visits and face to face interviews with NDC programme manager, project leads etc
Survey and routine data sources (MORI and SDRC)
• Health– General health over past year and compared with a year ago– Long standing illness, disability or infirmity and whether this limits
activities– SF36 mental wellbeing index derived from five questions on how
respondent felt over past month
• Lifestyle– 5 portions of fruit and vegetables– Smoking– Physical activity
• Services– When last saw a doctor– Ease of access– Satisfaction with doctor– When last used a local hospital– Satisfaction with hospital
Health Service Projects
• Buildings - health centres• Staff - directly employed or seconded
from NHS, esp PCTs• Innovative delivery - the “health bus”• Community involvement -”first
response”• Complementary therapies
Healthy Eating
•Healthy food:•Limited Consumption•Limited Access•Limited Affordability
•Lack of confidence and skills in using fresh fruit and vegetables
•Lack of awareness / knowledge of impact on health
NDC Approaches to Healthy Eating Interventions
• Food growing• Mapping provision of food sources• Cooking or provision of meals• Education and support groups and
sessions• Art and Health
Key Healthy Eating Projects
•Food Co-ops & Delivery Schemes (12)
•Food Growing & Allotments (10)•Cook & Eat / Cooking Skills (15)•Breakfast Clubs (8)•Lunch Clubs (6)•Breastfeeding Support (7)•School Meals (6)
Has health improved in NDCs?
32
32
21
19
33
30
22
19
0 5 10 15 20 25 30 35
Long standing illness (NDC)
Long standing illness(Comparator)
Health worse than 12 monthsago (NDC)
Health worse than 12 monthsago (Comparator)
2002
2004
Are NDCs “closing the gap”?
77
15
8479
40
78
15
84 84
38
86
15
90
81
26
0
10
20
30
40
50
60
70
80
90
100
Health good/fairlygood
Health better Satisfied with doctor Satisfied with localhospital
Residents whosmoke
2002 2004 National
Improving Health Indicators?
• Satisfaction with local hospitals and access to doctors have seen the most improvement from 2002 to 2004
• However, ease of access to see a doctor in comparator areas improved by three times the rate in NDC areas.
• Mental health prescribing has increased, but not as much as national trends
• SMRs, SIRs and hospital admissions show no significant reductions and drug misuse admissions have increased
Change in general health 2002-2004 by Partnership
-8
-6
-4
-2
0
2
4
6
8
10
Lam
beth
Wal
sall
Bre
ntK
now
sley
Live
rpoo
lP
lym
outh
New
ham
Cov
entr
yF
ulha
mB
irmin
gha
Brig
hton
Wol
verh
amD
onca
ster
New
cast
leN
ottin
gham
Mid
dles
bro
Leic
este
rH
artle
pool
Old
ham
Hul
lD
erby
Bris
tol
Bra
dfor
dR
ochd
ale
Nor
wic
hH
ackn
eyS
andw
ell
Birm
ingh
aLu
ton
Sou
tham
ptM
anch
este
rT
ower
She
ffie
ldS
outh
war
kIs
lingt
onH
arin
gey
Lew
isha
mS
alfo
rdS
unde
rland
NDC NDC average Comparator
Do we expect health to improve in NDC residents?
• Evidence from longitudinal sample• Change significantly different from comparator
areas after adjustment for confounding variables• Changes that we know are associated with better
health:
- More likely to have stopped being unemployed
- More likely to have started education/training
- More likely to have increased social capital (people are friendly/neighbours look out)
- But no positive change in health related behaviour
Partnership, tenure, education, age, gender, ethnicity, household composition, household worklessness (& years resident)
Socialnetworks
Trust
Cohesion & Reciprocity
Engagement &efficacy
Use of &satisfaction with
healthservices
Self-reportedhealth:
General healthHealth change
SF-36 MHI
Lifestyle:smoking
dietexercise
Social capital:
Security,fear of crime
Health models: pathways
AB
C
D
E
F
G
H
I
20611482334514191969 20611482334514191969N =
Change wave 1 to 2: Diet quality
Large increase
Small increase
No change
Small decrease
Large decrease
Gen
eral
hea
lth s
core
: M
ean
& 9
5% C
I2.3
2.2
2.1
2.0
2002 General H
2004 General H
20271453328313931930 20271453328313931930N =
Change wave 1 to 2: Diet quality
Large increase
Small increase
No change
Small decrease
Large decrease
Menta
l health s
core
: M
ean &
95%
CI
72
71
70
69
68
67
66
2002 Mental H
2004 Mental H
Summary
• Unique source of longitudinal data on health and related factors in varied and deprived communities
• Need intermediate outcomes (health behaviour) to demonstrate impact
• Evidence that interventions associated with behaviour change but be cautious in attributing causality