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“Why are we not more angry?”: Sandwell Health’s Other Economic Summit (SHOES), March 2014

Posted in Uncategorized, tagged , , , , on May 13, 2014| Leave a Comment »

  • by Miranda Eeles
  • Researcher at London School of Hygiene & Tropical Medicine

“Why are we not more angry?”

That was the question being raised by the participants of Sandwell Health’s Other Economic Summit (SHOES) which brought together academia, doctors, architects, journalists, local government and civil society to discuss issues ranging from sustainable food policy and climate change to the privatization of the NHS.

The Summit, which was held at the Balaji Temple in Tividale on Friday 28th March, is Sandwell Health’s annual event that aims to explore current themes and challenges in public health both at global and local level.

Neo-liberalism, corporate power and an assumption that development equals economic growth were identified as some of the mains reasons behind the problems facing the world today, and the increasing gap in inequalities.

“We need to change the narrative”, said Dr David McCoy, senior clinical lecturer at Queen Mary University, London and Chair of MEDACT.  “We need to demonstrate an alternative system and put forward intellectual and scientific arguments to eradicate poverty and address climate change.”

Corporations, government and the insurance industry were all put under the spotlight as speakers lamented a lack of leadership across the party spectrum.

But as in previous SHOES events, the audience also heard about the achievements at local level which illustrate how change can happen, provided the political will is there.

Urban food growing, investing in community assets and young people, creating a culture of activity and a return to a strong synergy between rural and urban environments were listed as some of the ways in which to address local needs.

This year’s Summit also was a celebration of the exemplary work done by John Middleton, Sandwell’s Director of Public Health, who retired at the end of March after 27 years in the job.

‘Dials’ and ‘levers’ were terms used to describe priorities and actions that have been employed under his leadership to bring different agencies together to improve the health and well being of the local population, including the Police, NHS Trusts, Clinical Commissioning Groups, a Youth Council and different departments of Sandwell Council.

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Sandwell public health – my life course

Posted in Uncategorized, tagged , , , , , on May 13, 2014| 1 Comment »

– by Dr John Middleton

–  Vice President, Faculty of Public Health; formerly  director of  Public Health for Sandwell, 1988-2004

When I first came to Sandwell in 1987 it was in the depths of recession. In health services there was no local mental health service, no palliative care and much general practice was single-handed out of shop fronts. Waiting lists for basic elective procedures could be up to four years. Over half the population was living in poverty. There were 120 high-rise blocks and nearly fifty thousand council houses. Less than half of all children were immunized against measles and other childhood immunisations were less than satisfactory.

There have been great advances in health and health services provision. Progress began in the early 1990s and became exponential in the early 2000s.  Even nine-month waits for operations were no longer to be accepted. They had to come down to 18 weeks. And no more than 4 hours in A&E.  Services for people with serious and enduring mental health problems were improved substantially in the early 1990s. Over many years there have been improvements in community based palliative care, with fewer people dying in hospital.

In my final annual public health report for Sandwell, ‘ Public health: a life course’, I have reflected on some improvements in outcome.  Heart disease deaths have gone down by an astonishing 2/3rds. Some of this is reflected in the long-term trends. But those trends have been influenced by the new and evidence based services, which have been implemented across the country over the years. We can point to improvements made in Sandwell, which have reduced deaths faster than the national rate and have reduced our gap in life expectancy with the national rate. Most recently, our GP based risk management system has saved more than 70 lives a year and closed the gap with the national life expectancy. Not a bad result considering heart disease deaths went up in the mid 2000s.  I believe this was a cohort effect. The group of men thrown out of work in the 80s were dying prematurely from heart disease, brought about by a lifetime without work, hope, and probably smoking, drinking and being inactive.

Teenage pregnancy has come down by 44% since 1998. This I attribute principally to rising expectations in education. From 2007, exam results went up and teenage pregnancy came down. Over a number of years, it ceased to be acceptable to attribute poor results and low expectations for our children to  ‘the deprivation’. If one teacher, or one school could make a go of educating children under difficult circumstances, they would all be expected to.  In health, there were also some excellent services built up painstakingly over a number of years, in personal social education, young people’s contraceptive services and morning after pill availability from pharmacists.

The fact that teenage pregnancy has not gone up again in the latest recession is, I think, due to the insulating effect of the Surestart programmes, which began in 1998. Surestarts gave support to parents from deprived backgrounds, Surestart plus gave additional support to teenage mothers and Surestart maternity grant gave some financial support to pregnant mums.  Most recently the Family nurse partnership has provided additional support to young mums. The policy advisory team from cabinet office that came to Sandwell in 1998 expressly set out the idea to support teenage mothers at that time, to break the cycle of babies born to teenage mothers then, becoming themselves teenage mothers 16 years on, I think we are seeing the benefits of that.

There has been an outstanding achievement in improving  Sandwell homes to Decent homes standard. In our local research which we plan to publish,  we have found much larger health effects in reducing cold related deaths and hospital admissions than have previously been reported.

There has also been the excellent achievement of Sandwell probation service in having the lowest reoffender rate in the country.  The health component of crime reduction this has been considerable- in tackling drug and alcohol related crime, responding to domestic violence, providing appropriate care for mentally disordered offenders and supporting community development programmes to combat violent extremism.  The recovery agenda for drugs and alcohol related offences has been a substantial contributor to reducing reoffending.

On a downside, there is much for my successor Jyoti Atri, to pick up on and deal with. Tuberculosis rates remain stubbornly and unacceptably high.  It is normal to be overweight in Sandwell.  Infant death rates have not reduced in the last 15 years. The West Midlands has the highest perinatal and infant deaths in the country and they have not come down as fast as they have elsewhere. The West Midlands has the highest rates of child poverty and the highest rates of obesity in the country both known risks in terms of infant health outcomes. We  also need to review our antenatal policies, particularly with regard to growth monitoring in utero. I have recommended that Sandwell should commission an expert review of infant deaths, preferably with other councils in the West Midlands conurbation. The review would look at how we should prevent deaths, and what might be needed in improving care in pregnancy and childbirth.

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Act now to tell ONS how important data is for public health work

Posted in Uncategorized, tagged , , , , , on October 28, 2013| 1 Comment »

by Ralph Smith, Deputy Head of Public Health Information, Public Health, Sandwell Metropolitan Borough Council

The future of some vital public health-related information hangs in the balance as a result of the ONS Consultation on Statistical Products 2013.  The bland title of the consultation belies the rich and varied statistical products it covers.  They are divided into four areas, with the last two representing the bulk of the products in question:

•    Output from national surveys, such as the general lifestyle survey
•    Regional and local outputs
•    Health statistics and analysis, life events
•    Health inequalities analysis

Respondents are asked to state what the impact would be of discontinuing the product and encouraged to expand on the consequences if an impact is anticipated.

There are some critical products on the list and I encourage public health professionals to take part in protecting them.  Increasingly, policy documents are emphasising the importance of robust data sources and analysis, so it is an unfortunate time for ONS to be proposing cuts.

We are all going through a period where the provision of local public health analysis is under pressure due to a shortage of skilled staff, increased demand in a Local Authority environment and problematic relationships with the NHS over access to data.  At the same time we are reliant on national organisations, such as ONS and Public Health England, to provide nationwide data produced through economies of scale.

The consultation document often refers to alternative sources of data to the one they are suggesting they may cut.  But what happens if that alternative source dries up too?

One proposed product to discontinue is the monthly reporting of death registrations.  The monitoring of excess winter mortality relies on such data sources, both nationally and locally.  Indeed Local Authority Public Health has its own supply of mortality data, via the primary care mortality database.  What the national monthly data provides are vital comparators to help make informed analytical decisions in areas such as health and housing.

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Figure 1: monthly death and mean monthly temperature, Winter 2012/13 for Sandwell

Winters may be getting warmer on average, but cold snaps are happening later in the season.  Thus, austere conditions that influence a household’s ability to heat their home means that such health and housing topics are still very much on the agenda.
In the health inequalities section of the consultation, many of the products are vital to public health.  They act as either a national benchmark to monitor progress, or provide small area analysis for local authority public health to reduce inequalities within their boundaries.  Life expectancy and healthy life expectancy analyses were first commissioned from the Marmot secretariat.  This small area intelligence was used to draw attention to the spread of health inequalities within an area, helping to target scarce resources.  A refreshed update of these data is under threat.

ImageFigure 2: Life expectancy and disability-free life expectancy at birth, by neighbourhood income level, England and Sandwell 1999- 2003

There are several products that take a closer look at health outcomes by protected equality groups such as occupation, deprivation and gender. Often there are no alternatives to such analyses.

Discontinuing the products outlined in this consultation does not only affect the professional public health world.  The idea of using freely available datasets and presenting them simply and clearly is increasingly popular with the media, charities and the voluntary sector.  The Guardian Datablog frequently uses ONS data to drive home a story.

Coupled with novel ways of presenting information, this brand of data journalism creates debate on current social issues.  And it’s not only the broadsheets that use this method.  The free paper the Metro frequently uses public domain national data to producer infographics such as the one below.

ONS are not looking to discontinue all the products listed in the consultation.  However they are looking for users to help them prioritise statistical products, some of which have to be cut to help contribute to annual savings of around £9 million.  I encourage you to take part in the consultation and emphasise how important  the majority of the products are in influencing policy and informing interventions.

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