Equally Well strategy

The Joint Health and Wellbeing Strategy to tackle health inequalities is North Tyneside’s high level strategic plan for improving the health and wellbeing of our population. It builds on the previous strategy and existing work to reduce inequalities in the Borough and initially outlines the approach for the next four years. All partners acknowledge that major change will take time to achieve and there is a longer-term commitment to reducing inequalities and narrowing the gap

The North Tyneside Health and Wellbeing Board is responsible for the strategy, which has been developed by its representative partners and will shape and inform plans for commissioning and providing services that address the wider determinants of health and reduce inequalities.

This document will support board members as system leaders to work together on the shared vision and embed the priorities and principles of working across a range of organisations, including their own.

The strategy is underpinned by three key pieces of work:

1. Impact of COVID-19 pandemic on health and socio-economic inequalities in North Tyneside, October 2021
2. Summary of the evidence base to tackle health inequalities, October 2021
3. Joint Strategic Needs Assessment (JSNA), October 2021

Engagement with our Voluntary, Community and Social Enterprise sector (VCSE), residents, young people, elected members and health and care professionals has also been carried out to identify work that is already happening and current challenges. This engagement will continue to be important in the subsequent development of a detailed implementation plan for the strategy

What do we mean by health inequalities, what are their causes and why do they matter?

Health inequalities are the unfair and avoidable differences in health across the population and between different groups within society

These unfair differences are:

• Not random, or by chance, but largely socially determined and
• Not inevitable

The issue of health inequalities is not new, but the moral imperative for addressing them has been reinforced by the COVID-19 pandemic, which exposed pre-existing inequalities and amplified them. Our ‘Impact report of COVID-19 on health and socio-economic inequalities in North Tyneside’ (October 2021) details the assessment of the impact of the pandemic across the borough.

There are also economic reasons for action.

The high burden of disease in deprived areas generates higher use of health and social care services, higher unemployment and lower productivity.

An individual’s ‘health’ is shaped by a complex interaction between many factors. These include access and quality of health and care services, individual behaviours, the places and communities in which people live and wider determinants such as education, employment, housing and access to green space.

Digital exclusion also emerged as a key factor in creating inequalities during the pandemic. Digital access can connect people to education and training, enable them to access better jobs, increase their social interaction and support access to healthcare and statutory services, as well as providing access to cheaper products and services online.

Health outcomes are therefore not simply about access to health care or individual health choices. Poor health outcomes are more common in groups and communities that experience multiple hardships. The lower an individual’s socio-economic position, the worse their health. Disadvantage can start before birth and the effects are cumulative across the life course. Health inequalities exist at every stage and can also endure from one generation to the next, if not addressed. There is a social gradient in health that runs from top to bottom of the socio-economic spectrum.

Health inequalities exist between population groups as illustrated in the figure below. It is important to note that these are overlapping dimensions, with people often falling into various combinations of these categories.

In summary, health inequalities arise because of the conditions in which we are born, grow, live, work and age. These conditions influence our opportunities for good health and how we think, feel and act; and this shapes our mental health, physical health and wellbeing. Action on health inequalities requires improving the lives of those with the worst health outcomes, fastest

Protected characteristics

Age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation

Inclusive health and vulnerable groups

For example, Gypsy, Roma, Travellers and Boater communities, people experiencing homelessness, offenders/former offenders and sex workers

Socio-economic deprived population

Includes impact of wider determinants, for example: education, low-income, occupation, unemployment and housing

Geography

For example, population composition, built and natural environment, levels of social connectedness, and features of specific geographies such as urban, rural and coastal

National policy context

The case for acting on health inequalities is recognised in recent announcements from across government, and in the NHS’s Long-Term Plan. The Office for Health Improvement and Disparities (OHID) has also been established to co-ordinate an ambitious programme across central and local government, the NHS and wider society, drawing on expert advice, analysis and evidence, to drive improvements in the public’s health and tackle inequalities.

The national focus on health inequalities provides an opportunity to harness the collective efforts of society. However, to bring about sustainable change, effective action at both national and local level is required.

The NHS Long-Term Plan and Government’s Health and Care White Paper take a concerted and systematic approach to reducing health inequalities. Some of the commitments in the NHS Long-Term Plan relating to inequalities include:

• Basing five-year funding allocations to local areas, using a more accurate assessment of health inequalities and unmet need
• Setting out specific, measurable goals for narrowing inequalities, including those relating to poverty
• Development of detailed and measurable plans for how every local area in England will contribute to narrowing the health inequalities gap over the next 5 to 10 years

Place-based approaches are a fundamental part of the national drive to tackle inequalities. Utilising the leadership, expertise and levers that are available to affect place and recognising the importance of addressing the wider determinants, i.e. those conditions into which people are born, live and work, across the life course.

Evidence Base: doing what works to narrow the gap

The approach within this strategy is based on the up-to-date evidence of how best to effectively reduce inequalities and is informed by the considerable work led by Sir Michael Marmot and the Institute of Health Equity.

The evidence is clear that a life course approach is needed to address the wider determinants of health. A life course approach considers the critical stages, transitions and settings where large differences can be made in promoting or restoring health and wellbeing.

Life stages

Proportionate universalism

“The implications of the social gradient in health are profound. It is tempting to focus limited resources on those in most need. But we are all in need – all of us beneath the very best-off

To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. We call this proportionate universalism. Greater intensity of action is likely to be needed for those with greater social and economic disadvantage but focusing solely on the most disadvantaged will not reduce the health gradient, and will only tackle a small part of the problem.”

Source: Fair Society, Healthy Lives. Institute of Health Equity, 2010

In the 2010 Marmot Review, Fair Society Healthy Lives, six priorities that cover stages of life, healthy standard of living, communities and places and ill health prevention are the evidence-based recommended areas of focus in tackling inequalities:

1. Give every child the best start in life
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives
3. Create fair employment and good work for all
4. Ensure a healthy standard of living for all
5. Create and develop healthy and sustainable places and communities
6. Strengthen the role and impact of health prevention

Given that there is the existence of a social gradient in health, if we want people to have equal health outcomes and we want to bring the level of health in our deprived areas up to the level of good health enjoyed by people living in our most affluent areas, the Marmot Review also identified that approaches that use proportionate universalism are required. This means designing interventions, services and solutions that are universally available, but with an intensity that is directly proportionate to the level of social disadvantage.