Working with deprived populations

Tackling health inequalities in primary care

Dr. Les Goldman, Bradford

Aim

Examine concept of health inequality and how it affects work in general practice

Objectives

Understand concept of health inequality

Understand how it applies to a local practice population

Be able to develop initiatives to tackle health inequality at practice level

Community Orientation

How?

Short presentation

Group exercise - your experience of health inequalities

Group exercise - develop a practice plan

Discussion of our plans

Reflection on what we learned

Definition

Unequal expectation of morbidity or mortality among different social groups

Reflects different exposure to risk due to Socio economic status Age Disability Ethnicity Gender

Inequality

Older people are ill more

Inequity

Inequity v inequality

Older people and people with disabilities have poorer access to health services

Higher risk of death by suicide or homicide among men

Ethnic differences in disease incidence Diabetes Infant mortality

Determinants of health

Acheson Report 1998

Spectrum of health inequalities

Outcome - morbidity, mortalityAccess to health care

HomelessDisabled

Causes of ill health Smoking, drug addictionObesity, poor nutrition

Interventions

Upstream Reduce income inequalities Improve pre-school education Government responsibility

Downstream At community or practice level Access / lifestyle / morbidity Practice / Commissioning Alliance / PCT

Task 1

Your experience of health inequalities?

Has anything upset you?

Have you wanted to change something?

Feed back

Task 2

Make plan to tackle a problem in practice (access / risk / outcome)

SMART Specific Measurable Attainable Relevat Time

bound

PDSA Plan Do Study Act Short repeated cycles of change

PDSA

•What changes are to be made?

•Next cycle?

•ObjectiveQuestions/predictionsPlan to carry out the cycle (who, what, where, when?)Plan for data collection

•Carry out the planDocument problems and unexpected observationsBegin analysis of •the data

Complete the analysis of the dataCompare data to predictionsSummarise what was learned

Factors to consider

Who will be involved In practice / outside practice In implementation

Time

Funding

References

London Health Observatory www.lho.org.uk

Dept of Health www.dh.gov.uk

Acheson Report - Independent Inquiry into Inequalities in Health 1998

Tackling Health Inequalities - a Programme for Action Dept of Health Jul 2003