LTP Priority: Place based approaches for reducing health inequalities
Type of Interventions: Place based approaches for reducing health inequalities
Major driver of health inequalities in your area of work
Despite overall increases in life expectancy, the differences in health outcomes between the most and least deprived communities continues to grow. There is a 19 year-gap in healthy life expectancy (years lived in good health) between the most and least deprived areas of England. People living in the most deprived areas spend nearly a third of their lives in poor health, compared with only about a sixth for those in the least deprived areas. These health inequalities are unfair and avoidable.
They cut people’s lives short; lead to avoidable years living with impaired health and wellbeing; and cost the NHS, local authorities and our national and local economies billions of pounds. This variation is generating additional need and demand for health care services including an estimated £4.8 billionn of additional expenditure on ambulatory care alone.
Population, people in deprived areas (urban and rural), people from protected groups and inclusion health groups.
Place based approaches for reducing health inequalities
Effectively tackling differences in health outcomes starts with a recognition of the complex drivers of health inequalities.
This model highlights the interplay between physiological, behavioural and wider determinants of health. It describes how our ability to be healthy is underpinned by the wider socio-economic and environmental circumstances that play out at a local level – or place.
This means that treatment alone cannot tackle health inequalities, rather local systems working together with strong leadership, joint planning, ambition and scale, have an important role to play in tackling the complex web which leads to health inequalities.
To support local areas to develop a system wide response to health inequalities, Public Health England, alongside the Local Government Association and the Association of Directors of Public Health has produced a new resource, Place-Based Approaches for Reducing Health Inequalities. Core to the place-based approach is the Population Intervention Triangle (PIT) which provides a lens through which action to address health inequalities can be identified, organised and implemented. It offers a practical framework for acting on health inequalities which organises action around key assets across place to enable population level reductions in inequalities.
Detailed guidance on this model can be found here along with tools for each part of this model. These resources can support local areas to identify the strengths of their current approach to health inequalities and any opportunities to enhance them. For example, the place-based planning tool (the centre circle) includes the following prompts for assessing practice:
- Leadership in Place: fully committed to HI goals?
- Joint Needs Assessment: bottom-up and top-down?
- Joint priority setting: balanced across partners?
- Scoping whole system: civic, service and community interventions considered?
- Intervention selection: realistic about system and scale?
- Target setting: locally relevant and meaningful?
- Business planning: health economic case for change?
- Information governance: systematic intelligence sharing?
- Programme management: who is accountable?
10. Evaluation: built in from the start?
Guidance for Commissioners
Place Based Approaches provides a suite of resources that local leads can choose from to support their work in addressing health inequalities.
Access to the Place Based Approaches (PBA) materials
Materials available now through the gov.uk website. Published 29 July 2019, By Public Health England. Support in use of the Toolkit is being piloted over the next few months.