The London Health Observatory: monitoring health and health care in
the capital, supporting practitioners and informing decision-makers
Health equity audit- canit achieve a fairer use ofresources for health?
Dr Bobbie Jacobson OBE
Director London Health Observatory
Bologna, 26 June 2012
Bologna La Rossa Contro Londra la Grigia!
Presentation Overview
• Introduction to the UK Observatories
•What do we mean by inequity?
• Measuring equity-the challenges
• Health Equity Audit and how to use it
effectively
The observatory network –what do we do now?
•We work in partnership to turn data into health intelligence tosupport decision-making on health and health care nationally andin our regions
•We are a network of regional hubs connected nationally forturning data into health intelligence ; signposting healthknowledge in innovative ways
•We monitor, forecast and assess the impacts of policy on healthin our regions
•We work with researchers, practitioners and the Department ofHealth to produce national e-tools, reports and advice to supportlocal action
•We help build analytic/public health capacity in our localworkforces
The observatory network and lead areas
LHO lead areas:
Health inequalities
Ethnicity
Smoking
The London Health Observatory: monitoring health and health care in
the capital, supporting practitioners and informing decision-makers
GENDER GEOGRAPHY SEXUALITY SOCIO-ECONOMIC GROUP
DISABILITY AGE ETHNICITY
Social-economic environment
e.g. jobs, housing, education, transport
Lifestyles/health behaviour
e.g. . diets, smoking, social networks
Access to effective health/social care
e.g. services that result in health benefits
Health outcomes
e.g. increase/reduce mortality, morbidity, ill health, disability
The Spectrum of inequity
How do we “decide”differences areinequitable?
Let’s see…..
Inequity in causes?
The example ofunemployment
Are these differencesequitable?
Si, equo
No, iniquo
Non so
The London Health Observatory: monitoring health and health care in
the capital, supporting practitioners and informing decision-makers
Inequity in outcomes:are the differences in male lifeexpectancy at birth across Londoninequitable?
Are these differencesequitable?
Si, equo
No, iniquo
Non so
Is spending on health careequitable?
The example of mental health services
Is the variation in spend inequitable?
Planned spend on direct mental health services varied from
£58 per weighted population-£220 per weighted population
Are these differences Inequitable?
Actual and expected planned mental health spendper capita (16-64 years) by borough (2005/06)
The tricky business of measuringinequity - some questions
• How will we know we have reduced inequalities?
• Do we simply “bring up the floor”? Eg improve
access to care for the homeless and migrants?
• Which dimensions of inequity to use?
• What is practical?
What is Health Equity Audit?
Health Equity Audit is a process by which:
• partners systematically review inequities in thecauses of ill health, and access to effectiveservices and their outcomes, for a definedpopulation
• ensure that further action is agreed andincorporated into policy, plans and practice.
• actions taken are reviewed to assess whetherinequities have been reduced.
Source: “Health Equity Audit Made Simple.”
Source: “Health Equity Audit Made Simple.”
The cycle of Health Equity Audit
1. Agreepriorities &partners
2. Do an equityprofile
3. Identifyeffective localaction to tackleinequalities
4. Agree localtargets withpartners
5. Securechanges ininvestment andservice delivery
6. Reviewprogress andimpacts againsttargets
The English context for HealthEquity Audit
•Introduced in 2004 during the Labour Government
•National targets set for reducing inequalities inhealth
•Made mandatory for 2-3 yrs as part of the nationalperformance assessment framework for England
•Local NHS conducted the audit and gave a selfassessment on its quality
•LHO supported & surveyed local organisations tounderstand what it was and how to do it
Audit progress – results of the LHO survey2004
Key:
1Topic(s)/theme(s) under discussion
2Topic(s)/theme(s) agreed
3Health equity profile well under way/complete
4Objectives for further action agreed at PCT Board level
5Objectives for further action agreed by partner agencies
6Planning/resource commitments identified
7Planning/resource commitments and timescales agreed
8Findings/recommendations of HEA published
9PCT Board assessment process planned/underway
Top 10 topics selected
1. Coronary heart disease
2. Smoking cessation
3. Health care access
4. Health visiting and
Children’s services
5. Diabetes
6. Neighbourhood
initiatives
7. Cancers
8. Maternal and child health
9. Sexual health
10. Black and minority issues
Dimensions of inequity covered
Key:
1 Geographical 6 Deprivation category
2Gender7 Sexual orientation
3Age 8 Disability
4Ethnicity
5Social class/socio economic group
Most common factorsinfluencing choice of topic
1.Views of local leaders
2.Ability to deliver effective change locally
3.Manageable within resources available
4.Good evidence base for a health inequalitygradient
5.Relevance to national health inequalities targets
6.Measurement and methods feasible at local level
Making a difference
What is the evidence for“Closing the auditloop”?
Per cent 5 year olds achieving ‘good developmentscore’,* Birmingham LA, West Midlands & England
*in personal, social and emotional development
and communication, language and literacy
Source: Department for Education
%
Effective implementation of HealthEquity Audit: key points
•Audit flourished in England during a period ofnational commitment to reducing inequalities
•Choice of successful audits and comparators is asmuch political & pragmatic as epidemiological
•Building engagement among relevantpeople/organisations needs “top team” commitment
• “population diagnosis” alone is not enough foreffective equity audit ; implementation of change isequally important.
Useful resources
The LHO : lead inequalities observatory: www.lho.org.uk
DH Health Equity Audit: A Guide for the NHS
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4084138
Health Equity Audit Made Simple
Health Equity Audit Made Simple: A briefing for Primary CareTrusts and Local Strategic Partnerships
Health Equity audit methods /case studies
Maternity audit and Database of case studies