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Health Inequality

Tackling Health Inequalities

There are wide inequalities in life expectancy at birth for both males and females in Bedford Borough. The Borough is in the 20% of local authorities in England with the greatest inequalities. The difference in life expectancy between the least and most deprived is 11.3 years for males. The Joint Strategic Needs Assessment has identified that Bedford Borough has higher rates for overall premature death, heart disease and stroke, lung disease and liver disease amongst minority men.

Since 2009 ACCM (UK) has been working with the Clinical Commissioning Group and other organisations in Bedford to improve communities in NHS Health Checks take-up and to tackle health inequalities. It has become evident that communities, majority of them from Black Minority Ethnic, reside in some of the most deprived wards i.e. Queens Park, Cauldwell, Kempston, Hapur, and Castle, where serious health inequalities exist. We have been working with communities to provide health and wellbeing activities, information, ESOL courses for non-English speakers to enable them to communicate, as there are serious health issues affecting these communities. They often don't visit their doctors or attend health checks because they are too busy running family businesses or are unable to use statutory services for cultural, religious language problems.

Health & Wellbeing sessions

Public Health Research and Local Authority studies show that a third of minority children suffer mental health problems. From our work this is due to most mothers suffering from depression or mental health problems due to controlling home environment for religious or cultural reasons. Some of the mothers of Asian and African origin were married when aged under 15 years old, or were brought over from overseas for marriage and have no knowledge of English systems, services and many do not speak English leading to isolation. ACCM (UK) runs ESOL with the aim of empowering and enabling mothers to speak English to improve use and access to statutory services and help their children.

Our main aim and objective is to reduce health inequalities in Bedford and ensure illegal harmful traditional practices against children and women are eliminated around the world. Bedfordshire has six Wards ranked in the top 10% by the Index of Multiples.

Deprivation as most deprived and majority of black minority ethnic (BME) and other vulnerable communities reside in these wards. ACCM (UK) reaches out to these hard to reach communities to tackle health, social and economic inequalities to improve their health and wellbeing and status buy running events, one to one consultation, providing information to improve their access and use of statutory services; referring or signposting them to relevant services if we cannot help. We also undertake follow up sessions with groups and individuals to ensure that they have been supported or that their needs have been met. We mainly target young and older people and women from migrant communities who are disillusioned with life and feel no one cares about their plight or problems. (7 training sessions undertaken since January 2010 and five booked between September and December 2010 and three for February 2011). We act as advocates and provide interpreting services if required. We have just completed work with NHS Bedfordshire and Horizon Community Health Commissioning Ltd on running NHS Free Health Checks with ACCM (UK) organising clinics within the community and ensuring that communities do attend through fliers distribution door to door and ensuring that community group coordinators, religious and community leaders to be involved and mobile their communities for this event. Migrant communities come with their traditions some of which are illegal in the UK.

ACCM (UK) works with communities who practice these harmful traditional practices (forced marriage, female genital mutilation, and honour-based violence) by organising and running training and workshops to raise awareness on the social, health, human rights and legal implication of these practices. We develop and distribute relevant information or use the official Government provided information available in different formats, for professionals and communities on these sensitive issues.

Tackling domestic violence - a hidden problem amongst migrant and vulnerable communities as they are hard to reach or difficult to engage with. We run Positive Parenting events with specialist providers or signpost victims to relevant services.
- Providing training and awareness raising to statutory and voluntary agency professionals to understand the reasons, (such as cultural, language or fear barriers) why BME and other vulnerable communities do not access or use statutory services such as parks, leisure centres or seek health advice for health and social benefit.

Developing networks to support a new strand of work with children and young people from all backgrounds, supporting the Every Child Matters 5 Outcomes (Stay Safe, Be Healthy, Enjoy and Achieve, Make a positive contribution and Achieve economic wellbeing) and Children's Plan Objectives. This is an area we strongly want to develop, as there is no work targeting children and young people in Bedfordshire.

Work to promote community cohesion and diversity to enable asylum and migrant communities to integrate and adapt in host community through such activities as Citizenship.
We have been supporting small groups by providing capacity building and empowering group leaders with information and support to enable them to support their groups and communities better
Work with existing community groups supporting and developing the unemployed, especially minority women, who never have social or economic life outside the home, into volunteering, training and careers. This helps to empower women, reduce domestic abuse, isolation, and improve their lives at home and in the community.
ACCM (UK) acknowledges that to reach out and achieve our aims we have to developed strong partnership and links with other agencies locally, nationally and internationally. Multi Agency working enables us to reach out, support more beneficiaries through joint working, share of resources and good practice and learn from each other for the benefit of our beneficiaries.

ACCM (UK) in its own capacity and in partnership with other NGOs or individuals lobby Local Authorities and Central Governments to improve access to services, develop and promote relevant services and laws to improve access and use of statutory services to reduce health inequalities. The Trustees and the Directors are members of various local, Government Forums, national and international Forums that enable us to lobby, share information, good practice, get involved in consultations and provide advice to policy makers.

Promoting and getting involved in education and research programmes in any field related to our work. The recent research by the Government on improving maternal health for women in the UK and Overseas and Comic Relief's research on elimination of female genital mutilation 2010 is an offshoot of our previous activity.

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What do we understand by Health Inequalities?

Health inequalities are unjust disparities in health outcomes between individuals or groups. They arise from differences in social and economic conditions that influence people's behaviours and lifestyle choices, their risk of illness and actions taken to deal with illness when it occurs 1. Inequalities in these social determinants of health are not inevitable, and are therefore considered avoidable and unfair. The different life chances of life expectancy at birth, illustrated in Figure 1, is an example of inequity or unfairness – an inequality that cannot be accounted for by a difference in need.

Inequalities may be found between many types of community or population groups. For example, there are disparities by gender, age, sexuality and ethnicity. Figure 2 summarises the many dimensions in which inequalities in health can be found.

Types of Health Inequalities

Throughout the health system, inequalities exist from determinants to outcomes, and include inequalities in:

1 Socio-economic and environmental factors, including: income, employment, housing, occupation and education. Eg. The proportion of babies born each year who have a low birth weight varies according to the social class of the father. In 2008, 8% of babies born to fathers of manual social backgrounds had a low birth weight compared with 6.5% for babies of fathers from a non-manual background.

2 Lifestyle and health related behaviours, such as smoking, diet and levels of physical activity. Eg. In 2006-2008, the estimated smoking prevalence between English local authorities ranged from 10.2% in Chiltern, in the South East, to 35.2% in Blackpool, in the North West.

3 Access to services, such as health care. Eg. The Maternity Survey (2006) found that women from Black and Minority Ethnic groups in England accessed antenatal care later than White women (8.6 weeks compared to 7.7 weeks)

4 Health outcomes, such as the differences in life expectancy, or rates of death or disease. Eg. People in more disadvantaged areas not only die sooner, they will also spend more of their lives with a disability. In England, the health expectancy (disability-free life expectancy) for people living in the poorest neighbourhoods is 17 years lower than for people living in the richest neighbourhoods.

5 National archives Publications.

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Tackling health inequalities 10 years on - 2009

Tackling health inequalities

National Archives , Tackling Health

Report is a 'wake-up call'
Bedford has one of the largest health inequality gaps in the country – a new damning report has revealed (17 January 2013).

The report called Inequalities in Bedford Borough, carried out by the director of public health Muriel Scott, has shown that people living in the most deprived areas of Bedford have a lower life expectancy than people living in the rest of the town.

The research was carried out between people living in the 20 per cent most deprived areas of the town and the less deprived areas, ahead of the authority taking on responsibility for health.

It revealed that Bedford is among the worst 20 per cent of local authorities for health inequalities, with women living in the most deprived areas living nine years less, and men 11 years less than the other 80 per cent of the town.

The Labour group of Bedford Borough Council has slammed the results branding them 'shocking' and a 'wake-up call'.

The party has said it is alarmed at the inequalities the results have shown for children, with fewer than four in every ten children from deprived areas in Bedford achieving a good level of physical development at five years old.

And it believes that the Government's recent decision to cap maternity pay, child benefit and tax credits at one per cent will only make the problem worse.

The issue was due to be discussed by Bedford Borough Council last night (Wednesday).

The Labour group will now be campaigning heavily to provide children living in deprived area with more help and support in an attempt to close the gap.

Labour spokesman for health Councillor Colleen Atkins said: "This report on children's health inequalities is extremely worrying.

"It is known that children from low-income families can suffer disproportionately with health and development.

"It is simply beyond belief that the Government has made a callous decision that will hit expectant mothers and young children with a cut in their income.

"Some families will be hit extremely hard, especially with food inflation running at nearly five per cent.

"Everyone recognises that tough decisions need to be made to reduce the deficit, but targeting children in poverty while giving tax cuts to millionaires speaks volumes about the Government's values".

The report has found that the significant contributors to the life expectancy gap are circulatory diseases, cancers and respiratory diseases.

The data that has been compiled suggests that inequalities among the 20 per cent most deprived and the 80 per cent least deprived is for low birth weight, babies living with a smoker, child obesity, teenage pregnancy, education attainment at Key Stage 4, unemployment and smoking prevalence.

A spokesman for Bedford Borough Council said: "Currently, Primary Care Trusts are responsible for public health in Bedford Borough.

"Bedford Borough Council looks forward to taking on responsibility for public health from April 2013, and being able to impact positively on public health issues, and in particular the clear health inequalities between different communities within the borough.

"Bedford Borough Council has an excellent record of targeting resources to frontline services and on the basis of need, and we look forward to doing so using the data and evidence gathered when we take on the responsibility for Public Health from April 2013."

The report was presented to Bedford Borough Council by NHS Bedfordshire. It gives an overview of health and health inequalities across Bedford Borough, which highlights both improvements and challenges.

It also found that in general the health of people in Bedford Borough is good, and similar to the average in England.

The spokesman added: "We are committed to improving the health of these residents and we are working in partnership with a range of organisations, including the NHS and the voluntary sector, to provide evidence based interventions and services, based on an accurate assessment of the needs of our community."

The council now plans to put together an action plan to work towards the recommendations in the report.

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