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<title>Policies and Initiatives to Tackle Health Inequalities</title></titleStmt>

<publicationStmt><distributor>BASE and Oxford Text Archive</distributor>


<availability><p>The British Academic Spoken English (BASE) corpus was developed at the

Universities of Warwick and Reading, under the directorship of Hilary Nesi

(Centre for English Language Teacher Education, Warwick) and Paul Thompson

(Department of Applied Linguistics, Reading), with funding from BALEAP,

EURALEX, the British Academy and the Arts and Humanities Research Board. The

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<p>1. The recordings and transcriptions should not be modified in any


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Researchers should acknowledge their use of the corpus using the following

form of words:

The recordings and transcriptions used in this study come from the British

Academic Spoken English (BASE) corpus, which was developed at the

Universities of Warwick and Reading under the directorship of Hilary Nesi

(Warwick) and Paul Thompson (Reading). Corpus development was assisted by

funding from the Universities of Warwick and Reading, BALEAP, EURALEX, the

British Academy and the Arts and Humanities Research Board. </p></availability>




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<item n="speechevent">Lecture</item>

<item n="acaddept">School of Health and Social Studies</item>

<item n="acaddiv">ls</item>

<item n="partlevel">UG1/PG</item>

<item n="module">Health in the Community</item>




<u who="nf0269"><kinesic desc="projector is on showing slide" iterated="n"/> so part two <pause dur="0.9"/> tackling inequalities in health <pause dur="1.1"/> and we're going to look at the national and local policy context <pause dur="0.9"/> are there any questions from the earlier two sessions before we start <pause dur="3.1"/> okay well if you do think of any then ask them to your small group tutors <pause dur="0.6"/> okay <pause dur="4.0"/> so the key question then is <pause dur="2.2"/> which policies and strategies are being employed to tackle health inequalities <pause dur="0.5"/> and how effective are they likely to be <pause dur="1.6"/> and i will say although this is <trunc>s</trunc> some of looking at some of this policy stuff is quite dry <pause dur="0.4"/> and requires quite a lot of concentration <pause dur="1.2"/> it is something that you can be examined on and that we have <trunc>ex</trunc> # # asked exam questions on in the past <pause dur="0.3"/> in the overarching <unclear>IMPSA</unclear> and qualifying papers so it's worth paying attention to <pause dur="1.9"/><kinesic desc="changes slide" iterated="n"/> okay so what i'm going to begin with is just # a very <pause dur="1.0"/> brief thumbnail sketch of the health policy framework from nineteen-forty-five this isn't something you will be examined on but it will just provide you <pause dur="0.5"/> with # a thumbnail sketch of <pause dur="0.3"/> health

policy # until up to the current date <pause dur="1.7"/> okay so from nineteen-forty-five <pause dur="0.5"/> to about nineteen-seventy-eight # we had # a health policy framework which really didn't concern itself <pause dur="0.4"/> with health inequalities really until the nineteen-seventy <pause dur="0.4"/> it wasn't an issue of political concern <pause dur="0.4"/> partly because in the # immediate post-war period <pause dur="0.4"/> health inequalities were # were at their lowest <pause dur="0.2"/> and there was much more equality in health after the <trunc>p</trunc> <pause dur="0.5"/> the war years <pause dur="0.3"/> # but inequalities in health # started to increase <pause dur="0.5"/> # <pause dur="0.2"/> with the gap health gap between those who were better off and those who were poorer <pause dur="0.5"/> # starting to increase # until it was really <pause dur="0.5"/> becoming quite wide in the nineteen-seventies <pause dur="2.2"/> and of course it was in the nineteen-seventies that the Black Report was commissioned because of this concern about this # <pause dur="0.3"/> these <trunc>ineq</trunc> these inequalities in health experience between social groups <pause dur="1.4"/> from <pause dur="0.5"/> nineteen-seventy-<pause dur="0.3"/>nine onwards # <pause dur="0.4"/> we had quite a a long <pause dur="0.2"/> almost twenty years <pause dur="0.6"/> # a long

period <pause dur="0.3"/> when <pause dur="0.2"/> there was <pause dur="0.4"/> # <pause dur="0.4"/> a really failure to acknowledge <pause dur="0.6"/> # or in in government policy to acknowledge that health inequalities existed <pause dur="0.3"/> and in fact the term health inequalities wasn't used in any policy documents or any policy speak during this <pause dur="0.5"/> period <pause dur="0.5"/> # and health <trunc>ineq</trunc> <sic corr="inequalities">equalities</sic> were referred to as health variations <pause dur="3.1"/> we had # in the early nineties the first ever national health strategy for England <pause dur="0.4"/> and there was also a health <trunc>s</trunc> # strategy put in place at that time for Scotland and Wales as well <pause dur="0.9"/> and # some of you may recall that this first health strategy was called The Health of the Nation <pause dur="1.1"/> and its overarching theme and concern was with # individual health <pause dur="0.8"/> and <pause dur="0.3"/> strategies <pause dur="0.7"/> aimed to <pause dur="0.8"/> encourage individuals to <trunc>s</trunc> to take responsibility for their own health <pause dur="0.6"/> so there was no action <pause dur="0.3"/> to tackle inequalities <pause dur="3.6"/> since nineteen-seventy-nine we've had a shift in emphasis in # the health policy framework <pause dur="1.0"/><kinesic desc="changes slide" iterated="n"/> # we've talked about the Acheson Report <pause dur="0.5"/> # the Acheson

Report was used to inform # the new health strategy <pause dur="0.5"/> which we currently have in place <pause dur="0.5"/> and this strategy is called Saving Lives Our Healthier Nation <pause dur="5.0"/> Saving Lives Our Healthier Nation represents the government's health strategy <pause dur="0.9"/> and this strategy aims to <pause dur="0.2"/> improve the health of everyone <pause dur="1.1"/> but particularly to improve the health of the worst off <pause dur="0.5"/> so it does acknowledge that # <pause dur="0.3"/> there are groups <pause dur="0.2"/> # who are experience health inequality <pause dur="0.3"/> and this is <trunc>near</trunc> this is where efforts need to be put <pause dur="0.3"/> to improve the health <pause dur="0.4"/> # of those who are in the <pause dur="0.2"/> the <pause dur="0.2"/> the in the poorest health <pause dur="1.7"/> and this # health strategy seeks to tackle the four main killers and you'll if you refer back to <gap reason="name" extent="2 words"/>'s lecture on lifespan <pause dur="0.5"/> he looked at # <pause dur="0.7"/> the incidence # <pause dur="0.5"/> and the patterns for <pause dur="0.4"/> # <trunc>th</trunc> <pause dur="0.2"/> these four main killers <pause dur="2.7"/> so we currently have a health policy framework which # aims to reduce coronary heart disease accidents <pause dur="0.4"/> mental health and cancer et cetera <pause dur="1.9"/><kinesic desc="changes slide" iterated="n"/> so <pause dur="0.4"/> it's important to recognize # <pause dur="1.6"/> what Saving

Lives Our Healthier Nation aims to do because it does provide direction <pause dur="0.4"/> for health work <pause dur="0.4"/> so it does acknowledge the existence of health inequalities again this as i said this is a substantial change <pause dur="0.9"/> # <pause dur="0.5"/> it accepts the evidence that health is determined by social and economic factors <pause dur="1.3"/> and it states that health inequalities need to be tackled <pause dur="1.0"/> and it sees the way forward as people communities and government working together in partnership <pause dur="2.3"/> if it can be criticized <pause dur="0.3"/> # or certainly when it was published the criticisms were that no funding no specific funding was attached to reducing health inequalities <pause dur="2.6"/> it actually itself <pause dur="0.8"/> as a policy document doesn't address poor living standards or inadequacy of <pause dur="0.4"/> of benefits <pause dur="0.8"/> but having said that these are addressed in # in in other government documents and we'll be looking and these and other government policies we'll be looking at some of the social <pause dur="0.5"/> policies that aim to address issues such as poor living standards <pause dur="1.4"/><kinesic desc="changes slide" iterated="n"/> and it didn't when it

was published <pause dur="0.4"/> identify any national targets <pause dur="0.2"/> # to reduce inequalities <pause dur="0.3"/> but <trunc>s</trunc> these targets # since have been identified <pause dur="0.5"/> and since February <pause dur="0.3"/> two-thousand-and-one we've had <pause dur="0.5"/> two <pause dur="0.2"/> health inequalities targets to work towards <pause dur="1.8"/> and these are <pause dur="0.2"/> targets relating to infant mortality and life expectancy <pause dur="0.6"/> the first target is to reduce by at least ten per cent by the year two-thousand-and-ten <pause dur="0.6"/> the gap in infant deaths between manual groups and the population as a whole <pause dur="1.3"/> and for life expectancy to reduce by again by at least ten per cent <pause dur="0.6"/> # by two-thousand-and-ten the gap in life expectancy between the fifth of health authorities with the lowest life expectancy at birth <pause dur="0.3"/> and the population as a whole <pause dur="1.4"/> so we now have got some targets to work towards <pause dur="2.5"/><kinesic desc="changes slide" iterated="n"/> the government <pause dur="1.8"/> works to <pause dur="0.2"/> # <trunc>s</trunc> <pause dur="0.3"/> reduce <pause dur="0.2"/> health inequalities or sees itself as reduc<pause dur="0.4"/>ing health inequalities by a number of overarching strategies <pause dur="1.0"/> and these three strategies which are White Papers <pause dur="0.2"/> # <pause dur="0.3"/> i'm not sure if the N-H-S

plan was a White Paper but <pause dur="0.4"/> these three documents <pause dur="0.3"/> all refer to in some shape or form <pause dur="0.4"/> # the existence of health inequalities and the way in which health inequalities <pause dur="0.2"/> # should be tackled <pause dur="0.7"/> we've talked about # <pause dur="0.2"/> the N-H-S plan <pause dur="0.3"/> # in the first week that we were here <pause dur="3.1"/><kinesic desc="changes slide" iterated="n"/> but then <pause dur="0.3"/> it delivers these plans if you like <pause dur="0.2"/> through a number of mechanisms <pause dur="0.8"/> through Primary Care Trusts and N-H-S Trusts <pause dur="0.3"/> where you'll all be working <pause dur="1.0"/> # <pause dur="0.2"/> through health improvement and modernization programmes <pause dur="0.2"/> which i'll be talking a little bit about <pause dur="0.6"/> and through national programmes and initiatives and again i'm going to talk about those in a minute <pause dur="1.9"/><kinesic desc="changes slide" iterated="n"/> but Primary Care Trusts # <pause dur="0.3"/> has anyone not heard of a Primary Care Trust you may do if you <pause dur="0.5"/> # <pause dur="1.6"/> if you <trunc>do</trunc> if you haven't lived here very long or if you've studied in another country and just come here to do medicine has anybody </u><u who="sf0270" trans="overlap"> <gap reason="inaudible" extent="2 secs"/> </u><pause dur="1.4"/> <u who="nf0269" trans="pause"> Primary <sic corr="Care">hair</sic> <trunc>ca</trunc> Trusts # <pause dur="0.2"/> G-Ps are all part of a Primary <sic corr="Care Trusts">hair crust</sic> in Ireland what are they do you have health boards </u><pause dur="0.9"/> <u who="sf0270" trans="pause">

yeah the health board </u><u who="nf0269" trans="overlap"> yeah </u><u who="sf0270" trans="overlap"> <gap reason="inaudible" extent="1 sec"/> </u><pause dur="0.4"/> <u who="nf0269" trans="pause"> yeah Primary Care Trusts okay <pause dur="0.4"/> they were they have replaced Primary Care Groups so they are relatively new so if you haven't heard them <pause dur="0.8"/> # <pause dur="0.4"/> i'm <trunc>n</trunc> i'm not too surprised <pause dur="0.5"/> they're part of the new framework for delivering the new N-H-S so they're key they're key to government's way of delivering health <pause dur="1.0"/> they've evolved from Primary Care Groups so you may still and some Primary Care Groups still exist so you may <trunc>peop</trunc> hear people talking about Primary Care Groups <pause dur="0.9"/> # but it's hoped that by two-thousand-and-four all groups will have transformed themselves into Primary <trunc>c</trunc> Care Trusts <pause dur="0.3"/> which are much much <pause dur="0.2"/> bigger on the whole <pause dur="1.9"/> and they're seen as pivotal <pause dur="0.6"/> in terms of improving health and tackling health inequalities <pause dur="1.2"/> and that by two-thousand-and-four <trunc>pi</trunc> Primary Care Trusts will be <trunc>res</trunc> responsible for at least seventy-five per cent of the N-H-S budget <pause dur="0.5"/> so <pause dur="0.4"/> # <pause dur="0.5"/> you

know they'll huge <pause dur="0.4"/> <trunc>hu</trunc> they'll hold huge budgets so for example for Coventry <pause dur="0.4"/> there's just one Primary Care Trust now there were three Primary Care Groups <pause dur="0.4"/> and there's and they've reorganized into one Primary Care Trust i think in Warwickshire <pause dur="0.5"/> there are three <pause dur="0.3"/> trusts is that right <pause dur="0.7"/><kinesic desc="nod heads" iterated="n" n="ss"/> how many <trunc>tu</trunc> tutors are nodding yeah there are three trusts which are <pause dur="0.5"/> north south and Rugby <pause dur="0.9"/> is that right yeah <pause dur="0.4"/> okay <pause dur="0.8"/> # and some of you may have had speakers from the trusts has anybody had speakers from the trusts yet </u><pause dur="0.7"/> <u who="su0272" trans="pause"> <gap reason="inaudible" extent="1 sec"/></u><pause dur="0.5"/> <u who="nf0269" trans="pause"> yeah <pause dur="0.4"/> yeah <pause dur="0.3"/> good <pause dur="0.4"/> good <pause dur="1.3"/> so Primary Care Trusts are free-<pause dur="1.4"/>standing N-H-S bodies accountable to their strategic health authority <pause dur="1.7"/> and Primary Care Trusts <pause dur="0.2"/> # <pause dur="0.6"/> are responsible for commissioning care for their local population <pause dur="0.8"/> so they're able to commission care from hospital trusts <pause dur="0.4"/> so they will be commissioning # <pause dur="0.6"/> care from secondary care <pause dur="0.8"/> and from other organizations as well so they can can commission flexibly <pause dur="0.7"/> # and innovatively so they can commission aspects of care from <pause dur="0.3"/> # local

authorities from voluntary <pause dur="0.3"/> and other statutory agencies <pause dur="2.5"/> and they also provide <pause dur="0.2"/> primary and they can also <pause dur="0.4"/> commission other primary care but they also provide primary care themselves <pause dur="0.9"/> and the primary care boards are made up of all the local stakeholders <pause dur="0.2"/> in that locality <pause dur="0.5"/> so there # there are elected family doctors <pause dur="0.7"/> there are elected nurses community nurses <pause dur="0.2"/> # midwives professions allied to medicine <pause dur="0.3"/> social services for example you might have a <trunc>so</trunc> some social workers on there <pause dur="0.4"/> and also # <pause dur="0.6"/> representatives of the wider community <pause dur="0.6"/> and it's the <trunc>b</trunc> the boards <pause dur="0.2"/> that decide the priorities for the trust <pause dur="0.4"/> and ensure that # <pause dur="0.3"/> services are commissioned to meet the needs of the local population <pause dur="1.6"/> the trusts unlike Primary Care <pause dur="0.2"/> Groups they have a much stronger <pause dur="0.3"/> public health role <pause dur="0.5"/> and the public health duties that were once until recently were held by <pause dur="0.5"/> # the health authorities have now been passed on to the Primary Care Trusts <pause dur="0.4"/> so <pause dur="1.3"/> public health <pause dur="0.7"/> is now the <trunc>r</trunc> the role of the Primary Care

Trusts <pause dur="0.5"/> # <pause dur="0.5"/> so they're responsible for example for publishing # the annual public health reports <pause dur="0.8"/> # <pause dur="0.4"/> and for monitoring public health in localities <pause dur="1.0"/> # and they're <pause dur="0.2"/> also responsible trusts are responsible for <pause dur="0.5"/> to <pause dur="0.5"/> # facilitate better access to services <pause dur="0.4"/> and to provide <pause dur="0.2"/> better integrated services <pause dur="0.5"/> so these are the roles that have been allocated by government to Primary Care Trusts <pause dur="2.5"/> so the trusts will be <trunc>af</trunc> # # <trunc>affe</trunc> <pause dur="0.4"/> the trusts will determine who comes to you in hospital <pause dur="0.3"/> and a <trunc>ki</trunc> and the kinds of services that you're required to <trunc>pr</trunc> # <pause dur="0.5"/> to # provide <pause dur="0.4"/> # and if you're a doctor in a community trust a community based doctor you will you may be # part of the board or you may become part of the board <pause dur="0.6"/> that's if there isn't <trunc>s</trunc> any substantial # reorganization of the health service by the time you qualify <pause dur="1.7"/><kinesic desc="changes slide" iterated="n"/> so <pause dur="0.3"/> Primary Care Trusts then have the potential to respond to local health needs <pause dur="0.5"/> because they're # <pause dur="0.2"/> they're responsible for a local

geographical area <pause dur="0.8"/> # so the potential is they could be quite responsive <pause dur="1.2"/> they're required to work in partnership one of their strengths are that they're required to work in partnership <pause dur="0.2"/> with other organizations like social services <pause dur="4.4"/> they can commission very flexibly <pause dur="1.5"/> and they can target <pause dur="0.6"/> # prevention <pause dur="0.3"/> and care and work towards equity in access to care <pause dur="1.3"/> but what they can't do <pause dur="0.2"/> is reduce poverty or income inequalities because it requires <pause dur="0.4"/> # <pause dur="1.5"/> wider social policy <pause dur="0.2"/> to do that <pause dur="2.9"/><kinesic desc="changes slide" iterated="n"/> the second mechanism i identified were HIMPs which is the Health Improvement and Modernization Programme <pause dur="0.3"/> has anyone when they've been out in the community localities had a <trunc>sp</trunc> a HIMP <pause dur="0.7"/> <trunc>lec</trunc> speaker yet <pause dur="1.7"/> no it may well be you have have you yeah <pause dur="0.7"/> may well be that some of you will have <pause dur="0.4"/> # <pause dur="0.5"/> someone from the trust <pause dur="0.2"/> coming to talk about <pause dur="0.5"/> the HIMP plan <pause dur="0.2"/> the Health Improvement and <trunc>moder</trunc> Modernization Programme <pause dur="0.3"/> for your particular locality <pause dur="1.3"/> so as i said earlier they've become the responsibility of the

trust <pause dur="0.8"/> and they set out the local strategic plan <pause dur="0.3"/> for improving health <pause dur="0.3"/> and importantly for tackling health inequalities <pause dur="5.4"/> okay so the HIMP will set out # the plan and it will look at <pause dur="0.4"/> # with <trunc>oth</trunc> other organizations how it can # <pause dur="1.3"/> work to tackle the broader determinants of illness with other local <pause dur="0.2"/> # <pause dur="0.2"/> with other local groups and minimize the impact of hill ill health through providing <pause dur="0.3"/> integrated services <pause dur="2.1"/><kinesic desc="changes slide" iterated="n"/> so let's turn to look at national programmes rolling out policy <pause dur="1.1"/> well it's clear if we're going to reduce health inequalities that we need to have <pause dur="0.4"/> the kinds of policy in place <pause dur="0.3"/> at national level <pause dur="0.4"/> that # will <pause dur="0.6"/> both improve <pause dur="0.2"/> # <pause dur="0.2"/> cash in kind <pause dur="0.3"/> and improve cash in income <pause dur="0.2"/> because we've seen that those <pause dur="0.3"/> those are the main ways that we're going to reduce health inequalities <pause dur="7.2"/><event desc="drinks" iterated="n"/> the government has put in place since nineteen-ninety-seven <pause dur="0.6"/> a number <pause dur="0.9"/> of programmes that aim to improve cash in kind <pause dur="0.5"/> and these are initiatives like <pause dur="0.3"/> which i'm sure you've all heard of even if you don't know what they

are <pause dur="0.3"/> things like Health Action Zones Education Action Zones <pause dur="0.3"/> Sure Start and regeneration programmes <pause dur="0.9"/> as well as having # some cash in income programmes again <pause dur="1.1"/> # regeneration programmes Welfare to Work programmes <pause dur="0.4"/> and changes to benefits and pensions <pause dur="0.3"/> # are likely <pause dur="0.2"/> or are aimed to increase cash in income <pause dur="0.5"/> and i'm just going to look at some of these not all of them now so that you have at least <pause dur="0.3"/> some understanding of of what they're about <pause dur="2.1"/><kinesic desc="changes slide" iterated="n"/> so the first one i'm going to look at is # a cash in kind programme which is Health Action Zones <pause dur="3.2"/> Health Action Zones were launched # <pause dur="1.5"/> and first of all drawn attention to when the N-H-S plan was # <pause dur="0.7"/> launched <pause dur="1.1"/> they're seen by the government as blazing the trail for modernizing the N-H-S <pause dur="2.0"/> and Health Action Zones are an area based approach for improving health and reducing health <trunc>equali</trunc> health inequalities <pause dur="0.8"/> so it's a local area based approach <pause dur="3.5"/> the key objectives of Health Action Zones are <trunc>t</trunc> <pause dur="0.3"/> that the zone will <pause dur="0.3"/> identify and address

local needs <pause dur="2.6"/> increase the effectiveness and responsiveness of local services <pause dur="0.5"/> and develop partnerships with other agencies <pause dur="1.9"/> and <pause dur="0.4"/> these <pause dur="0.3"/> # these programmes or initiatives are coordinated usually by the National Health Service <pause dur="0.7"/> now the government has made substantial amounts of money available for Health Action Zones <pause dur="0.8"/> # and the latest figures suggest that about two-hundred-and-seventy-four-million pounds <pause dur="0.4"/> have been made available for Health Action Zones <pause dur="1.1"/> and this two-hundred-and-seventy-four-million pounds <pause dur="0.4"/> is going to twenty-six Health Action Zones that have been established <pause dur="1.0"/> and they cover about thirteen-million people and will run for about seven years <pause dur="3.0"/> we haven't got any Health Action Zones in Coventry or Warwickshire <pause dur="0.3"/> # i don't know if any bids were made but people <pause dur="0.4"/> # <pause dur="0.5"/> groups <pause dur="0.2"/> local groups had to put together bids so it would have been local health authorities <pause dur="0.5"/> # bidding with with partners in education social services et cetera <pause dur="0.6"/> # <pause dur="0.2"/> to put a

proposal forward for funding <pause dur="0.9"/> twenty-six <pause dur="0.4"/> proposals have been <pause dur="0.2"/> # <pause dur="0.5"/> successful and there's some and and i don't think there's any <pause dur="0.3"/> any more <pause dur="0.5"/> # <pause dur="0.2"/> Health Action Zones going to be funded <pause dur="0.8"/> but Leicester has one is that right <pause dur="1.2"/> but you can see that substantial <pause dur="0.4"/> amounts of money have been put into them <pause dur="1.1"/> # they're currently being evaluated but it's early days <pause dur="0.5"/> the evidence so far suggests that innovative projects have been put into place <pause dur="0.6"/> # but there has been <pause dur="0.3"/> # a flexible and <trunc>i</trunc> <trunc>innova</trunc> innovative # commissioning of services <pause dur="0.2"/> and developments of services <pause dur="0.7"/> but there's no evidence yet # on whether they have brought about any health improvements within those local areas <pause dur="3.2"/> although they were seen as blazing the trail for modernizing the N-H-S <pause dur="0.3"/> they seem to have when you <pause dur="0.4"/> # hear government ministers talking about health policy they seem to be <pause dur="0.4"/> less on the agenda than they were <pause dur="0.7"/> # sort of two years ago <pause dur="1.1"/><kinesic desc="changes slide" iterated="n"/> but if we look at <pause dur="0.2"/> the strengths of Health Action Zones <pause dur="0.4"/> # <pause dur="0.6"/> and the strengths and weaknesses really of

any area based approach to tackling health inequalities <pause dur="0.5"/> and because they're they're the same <pause dur="0.5"/> # <pause dur="0.5"/> then the strengths are that <pause dur="0.5"/> they could potentially seek to address locality based needs <pause dur="1.8"/> they can build <pause dur="0.5"/> or could have the potential to build local solutions and there's some evidence that that's being done <pause dur="1.9"/> and that they can strengthen and provide <pause dur="0.2"/> money for <pause dur="0.2"/> existing and new partnerships <pause dur="2.5"/> working together <pause dur="0.6"/> to improve health in local areas and you can see the substantial among <pause dur="0.3"/> amounts of money <pause dur="0.4"/> gone into these projects <pause dur="1.2"/> but the weaknesses if you like are that they can only ever reach <pause dur="0.2"/> a small number <pause dur="0.2"/> of of <pause dur="0.2"/> people whom whose whose health is poor <pause dur="0.6"/> you can see they were only actually covering although it was two-hundred-and-fifty-four-million <pause dur="0.3"/> they were only actually covering thirteen-million people <pause dur="1.9"/> # <pause dur="0.9"/> and they're not necessarily in areas with the greatest needs so we know that there are for example <pause dur="0.3"/> there are areas of Birmingham for example and other areas of the

country <pause dur="0.5"/> # which have <pause dur="0.2"/> very very high levels of disadvantage and very very <pause dur="0.3"/> and very very large numbers of people in very poor health that don't have <pause dur="0.3"/> Health Action Zones <pause dur="2.4"/> so they're not necessarily in areas with the greatest need <pause dur="2.1"/> historically there's little or no evidence that area based approaches have ever been effective <pause dur="0.6"/> area based approaches were tried in # i think the sixties and early seventies <pause dur="0.4"/> when # the government put money into community development in health schemes <pause dur="0.5"/> but the evidence from that was that # over time <pause dur="0.5"/> # <pause dur="0.8"/> # they've been shown to not produce any <pause dur="0.4"/> any lasting effects in terms of health improvement in local areas <pause dur="2.2"/> and of course <pause dur="0.5"/> it's difficult to see how they can really impact on the root causes <pause dur="0.3"/> of health inequality such as poverty and poor living standards <pause dur="4.2"/><kinesic desc="changes slide" iterated="n"/> the second programme i'm going to talk about is Sure Start because <pause dur="0.4"/> # <pause dur="1.4"/> Sure Starts are operating in several of the areas that you're <pause dur="1.2"/> you're <pause dur="0.2"/> you're based in <pause dur="0.2"/> # <pause dur="0.3"/> Nuneaton has got a Sure

Start programme and also # <pause dur="0.6"/> Wood Wood End got one <pause dur="0.3"/> yeah <pause dur="0.4"/> # anywhere else anywhere in South Warwickshire <pause dur="2.7"/> no <pause dur="1.7"/> but if you listen to the news <pause dur="0.3"/> read the local newspapers you'll <trunc>of</trunc> often <pause dur="0.3"/> hear <pause dur="0.3"/> references to Sure Start schemes <pause dur="1.5"/> Sure Start is a programme a government funded programme <pause dur="0.5"/> # which is aimed at <trunc>impr</trunc> improving children's life chances <pause dur="0.8"/> so it's aimed at families with young children <pause dur="1.6"/> and is a response to the Acheson Report that we need to target <pause dur="0.2"/> parents and young children <pause dur="1.8"/> it's a cross-departmental strategy involving the Department of Health and the Department of Education <pause dur="1.2"/> and it aims to improve children's health <pause dur="0.5"/> to reduce inequalities in children's health <pause dur="0.6"/> to raise educational standards <pause dur="0.3"/> to promote opportunities in local areas <pause dur="0.3"/> and to encourage good parenting <pause dur="5.0"/><kinesic desc="changes slide" iterated="n"/> the government again has set set aside <pause dur="0.3"/> huge amounts of money for Sure Start programmes <pause dur="0.5"/> # it's set aside <trunc>f</trunc> <pause dur="0.3"/> # <pause dur="0.4"/> five-hundred-million <pause dur="0.3"/> to deliver it <pause dur="1.1"/> # and <trunc>i</trunc> it's # <pause dur="0.5"/> it's projected that

by the end of two-thousand-and-four there'll be five-hundred Sure Start programmes <pause dur="1.2"/> and it's estimated that these programmes will cover or encompass one-third of all children in poverty <pause dur="2.7"/> all programmes are multiagency <pause dur="0.2"/> # agencies working together such as education social services <pause dur="0.5"/> # together with health services and often <pause dur="0.2"/> # many voluntary organizations within local areas <pause dur="2.9"/><kinesic desc="changes slide" iterated="n"/> if we're looking at what the strengths of Sure Start might be <pause dur="0.7"/> they're that they're # <pause dur="0.2"/> can be non-stigmatizing because Sure Start programmes aim to deliver <pause dur="0.4"/> the Sure Start programme to <pause dur="0.3"/> universally within an area <pause dur="0.3"/> so all families with children under <pause dur="0.2"/> under five <pause dur="0.5"/> will be # offered the Sure Start programme so it doesn't stigmatize people by only offering it <pause dur="0.3"/> to selected groups and it has been shown <pause dur="0.4"/> that # <pause dur="0.2"/> <trunc>o</trunc> offering services universally <pause dur="0.5"/> # <pause dur="0.6"/> to young families reduces stigma and therefore ensures better uptake of services <pause dur="0.3"/> to those groups who most need care <pause dur="1.2"/> it's multifaceted <pause dur="0.4"/>

<trunc>inte</trunc> it's <pause dur="0.3"/> different agencies working together <pause dur="0.5"/> again like # <trunc>h</trunc> <pause dur="0.2"/> # <pause dur="0.3"/> the Health Action Zones <pause dur="0.5"/> # they're locally driven programmes and they're programmes that # are designed to address local needs specifically <pause dur="2.0"/> Sure Start programmes are required to acknowledge # <pause dur="0.5"/> # <pause dur="0.2"/> the the the fact that # <pause dur="0.8"/> different groups have different needs <pause dur="0.3"/> and they're required to deliver <pause dur="0.3"/> culturally appropriate services <pause dur="2.6"/> and that they <pause dur="1.0"/> will increase support to families with young children living in those particular areas <pause dur="1.3"/> the weaknesses of Sure Start are the same as i've i've referred to in relation to # Health Action Zones <pause dur="0.5"/> # because it's an area based approach it's got the same inherent problems <pause dur="4.0"/> although <pause dur="0.2"/> there's a there's now there's going to be about five-hundred programmes they're still only likely to reach a small proportion of of children who are poor <pause dur="0.5"/> there's two-thirds of poor children who are not being # <pause dur="0.5"/> # covered by Sure Start programmes who would benefit

from more intensive <pause dur="0.2"/> support in their early lives <pause dur="1.9"/> like HAZs there are no <pause dur="0.2"/> there's no <trunc>learn</trunc> long term in funding for Sure Start <pause dur="0.8"/> # <pause dur="0.4"/> local # Sure Start programmes have got to if they want to continue <pause dur="0.5"/> # they've got to look at finding alternative funding to carry on the initiative <pause dur="0.7"/> and also they're not <trunc>tag</trunc> tackling the root cause of <trunc>prob</trunc> <pause dur="0.4"/> of poverty <pause dur="0.3"/> which are things which are <trunc>l</trunc> related to # <pause dur="0.5"/> overall social policies in the area of things like <pause dur="0.4"/> # employment wages policies et cetera <pause dur="4.2"/><kinesic desc="changes slide" iterated="n"/> okay <pause dur="0.6"/> so we've looked at HAZs and Sure Start <pause dur="0.2"/> which are <pause dur="0.2"/> # very much health service # <pause dur="0.3"/> <trunc>i</trunc> initiatives <pause dur="0.5"/> we also need to look at the <trunc>w</trunc> the broader policies that the government's put into place <pause dur="0.4"/> it's at it's at this point i wish we'd still got the camera on you because <shift feature="voice" new="laugh"/>several <shift feature="voice" new="normal"/>of you are starting to look sleepy again <pause dur="1.6"/> okay <pause dur="0.3"/> remember you might get an exam question on this <pause dur="1.4"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> what time are we <pause dur="0.4"/> only another fifteen minutes <pause dur="0.8"/> okay <pause dur="1.8"/> let's look then at what the government's got in place in terms of

regeneration programmes <pause dur="10.3"/> the government is seeking to through <pause dur="0.3"/> # <pause dur="0.5"/> regeneration programmes to regenerate local areas to put more life and money <pause dur="0.5"/> and economic activity <pause dur="0.3"/> into local areas to boost the # you know the <pause dur="0.4"/> # <pause dur="1.3"/> economic climate within areas <pause dur="0.3"/> in the hope <pause dur="0.2"/> that by regenerating very poor areas there will be <pause dur="0.3"/> economic spin-offs for those who are are the poorest <pause dur="1.6"/><kinesic desc="changes slide" iterated="n"/> we've got things like New Deal for communities <pause dur="0.2"/> # this is a a government programme <pause dur="0.4"/> that targets money to most deprived areas and i think Wood End's got # and Henley in the north of Coventry have got a New Deal programme <pause dur="1.1"/> # <pause dur="0.8"/> so it it targets money on the most deprived areas <pause dur="0.4"/> and has it aims to <pause dur="0.3"/> # <pause dur="0.7"/> to build initiatives within local areas which <pause dur="0.4"/> reduce social exclusion and improve health so it has a very <pause dur="0.6"/> clear health focus <pause dur="0.4"/> and in fact next week when we're in we've got a <trunc>s</trunc> got a speaker i think haven't we from New Deal <pause dur="0.8"/> # who will be talking about <pause dur="0.3"/> # <pause dur="1.1"/> the New Deal programme in Coventry </u><pause dur="0.5"/> <u who="nf0271" trans="pause"> yeah </u><u who="nf0269" trans="latching">

<shift feature="voice" new="laugh"/><gap reason="name" extent="1 word"/>'s <trunc>c</trunc> <gap reason="name" extent="1 word"/>'s looking worried here we have haven't we <gap reason="name" extent="1 word"/> <shift feature="voice" new="normal"/></u><u who="nf0271" trans="overlap"> <gap reason="inaudible" extent="1 sec"/> </u><u who="nf0269" trans="overlap"> <shift feature="voice" new="laugh"/>yes <vocal desc="laugh" iterated="n"/><shift feature="voice" new="normal"/><pause dur="0.5"/> yeah we hope to have a New Deal speaker <pause dur="0.3"/> as also we hope to have a Sure Start speaker who will be talking about <pause dur="0.3"/> how <trunc>sir</trunc> Sure Start is being being implemented again in one of the local areas in Coventry and Warwickshire <pause dur="1.5"/> so <pause dur="0.6"/><kinesic desc="changes slide" iterated="n"/> regeneration programmes are aiming to tackle the local infrastructure <pause dur="0.4"/> improve <trunc>en</trunc> employment <pause dur="0.5"/> there's large amounts of money <pause dur="0.3"/> # being invested in them <pause dur="4.8"/> and they're covering # about thirty-nine neighbourhoods that are typically of between one and four-thousand households <pause dur="1.5"/> so these money are these these <pause dur="0.2"/> programmes are trying to tackle some of the root causes <pause dur="0.3"/> of poverty within local areas <pause dur="1.2"/> but again they've got # <pause dur="0.3"/> they are <pause dur="0.3"/> putting money <pause dur="0.3"/> cash into areas <pause dur="0.4"/> and trying to improve employment opportunities et cetera <pause dur="0.4"/> but they have got many of the same problems that i've described in relation to HAZ and to Sure Start <pause dur="1.0"/> in that they're short term

funded <pause dur="0.6"/> # # <pause dur="0.3"/> et cetera <pause dur="2.2"/><kinesic desc="changes slide" iterated="n"/> now you also need to just bear in mind that there are things like Welfare to Work programmes that the government has in place <pause dur="0.3"/> confusingly one of them is also called New <pause dur="0.2"/> New Deal <pause dur="0.8"/> but it's different to New Deal for communities <pause dur="2.0"/> New Deal # <pause dur="0.2"/> is a Welfare to Work programme <pause dur="0.6"/> which is designed to get specific <pause dur="0.2"/> groups of the population <pause dur="0.6"/> # back into employment <pause dur="1.0"/> so it combines <pause dur="0.5"/> training and employer <trunc>incenti</trunc> <pause dur="0.2"/> incentives <pause dur="0.4"/> # <pause dur="0.5"/> # <pause dur="0.3"/> together with making it very difficult for some groups <pause dur="0.4"/> # <pause dur="0.4"/> together in one programme so it aims <pause dur="0.2"/> # New Deal is particularly aiming at getting lone parents back into employment <pause dur="0.5"/> it's aimed at getting people off welfare <pause dur="0.3"/> back into the work programme so off welfare benefits <pause dur="1.0"/> it's aimed at lone parents young adults # eighteen to twenty-four <pause dur="0.6"/> adults who are twenty-five-plus who are long term unemployed <pause dur="0.5"/> and also looking at trying to get people with disabilities back into work <pause dur="1.7"/> for some groups <pause dur="0.4"/> there where i've said coercion what i mean is <pause dur="0.2"/>

there are some groups # if they <trunc>h</trunc> who if they do not <pause dur="0.5"/> # move into a New Deal programme or move into <pause dur="0.4"/> sort # a training programme then there are <pause dur="0.3"/> # it will affect their benefit <pause dur="3.8"/> so there's little opportunities for some groups to # not to <trunc>g</trunc> to take part in this scheme <pause dur="1.1"/> one of the problems with these kinds of programmes is they're only going to be effective if there are <pause dur="0.4"/> well paid <pause dur="0.5"/> jobs for people to move into <pause dur="0.4"/> so for example <pause dur="0.3"/> # <pause dur="0.2"/> if if <pause dur="0.2"/> these particular groups lone parents et cetera <pause dur="0.4"/> # are to move into <trunc>e</trunc> <pause dur="0.2"/> employment then <pause dur="0.3"/> # they need to <trunc>wo</trunc> to move into employment <pause dur="0.3"/> which has # <pause dur="0.6"/> a healthy wage in terms of a wage that provides them <pause dur="0.4"/> with access to a healthy living style <pause dur="0.3"/> we're not going to reduce <trunc>in</trunc> <pause dur="0.2"/> # inequalities if <pause dur="0.3"/> health inequalities if the people are just moving from benefits to work <pause dur="0.4"/> # without having an income <pause dur="0.2"/> that provides them access to a healthy lifestyle <pause dur="0.6"/> # <pause dur="1.5"/> and <pause dur="0.4"/> the evidence we have at the moment is <pause dur="0.2"/> that # <pause dur="0.4"/> the New Deal programme isn't <trunc>move</trunc> necessarily moving

people into well paid jobs that people <pause dur="0.4"/> are moving into jobs <pause dur="0.3"/> that have poverty level incomes or minimum wages <pause dur="2.4"/><kinesic desc="changes slide" iterated="n"/> finally <pause dur="0.6"/> # <pause dur="0.2"/> we need to look at benefits and pensions and the <pause dur="0.3"/> benefits and pensions programme that the government has in place <pause dur="0.6"/> it's important because the majority of the poorest fifth of the population are dependent on welfare benefits <pause dur="1.6"/> so for example ten-million people claim income support <pause dur="0.2"/> in England <pause dur="2.2"/> the evidence that we have is <pause dur="0.2"/> that # <pause dur="1.2"/> welfare benefits particularly income support fall short of the level <pause dur="0.4"/> independent experts # say is needed <pause dur="0.2"/> to be a modern <pause dur="0.5"/> minimum <pause dur="3.1"/> so that would be the modern minimum if you like for # <trunc>t</trunc> to <pause dur="0.2"/> # support <pause dur="0.5"/> good health <pause dur="0.2"/> in these groups <pause dur="3.1"/> there is evidence that the current government has increased benefits # <pause dur="0.7"/> # for younger children <pause dur="0.2"/> # # and for families and there've been # above inflation increases in things like <pause dur="0.5"/> # <pause dur="1.0"/> # child benefit <pause dur="0.4"/> and other initiatives # have been put in place like <pause dur="0.2"/> the childcare tax credit and the working family tax

credits <pause dur="0.5"/> # which aim to provide additional <pause dur="0.5"/> # <pause dur="0.8"/> resources through <pause dur="0.3"/> through income <trunc>t</trunc> the income tax system <pause dur="0.4"/> to those families who are the poorest and they're particularly aimed <pause dur="0.4"/> at providing <pause dur="0.2"/> # people with additional income <pause dur="0.3"/> that will enable them to be slightly better off in work than they were on welfare benefits <pause dur="1.3"/> and that # <pause dur="0.3"/> these are likely to to narrow some of the discrepancies between social groups but not eradicate them <pause dur="2.6"/> the government has aimed to # <pause dur="0.5"/> lift # about <trunc>f</trunc> <pause dur="1.1"/> # <pause dur="0.2"/> four-point-five-million children <pause dur="0.4"/> out of poverty <pause dur="0.2"/> in the next ten years or i think it claimed it had <pause dur="0.3"/> lifted four-point-five-million over the last Parliament but the latest figures suggested <pause dur="0.5"/> that they'd only actually # lifted about half a million children <pause dur="0.3"/> out of poverty through their welfare and tax benefits <pause dur="2.0"/> okay <pause dur="0.3"/> if we look at <pause dur="0.3"/> # older adults # 'cause again these are we saw that about twenty-five per cent <pause dur="0.5"/> of <pause dur="0.5"/> # <pause dur="0.2"/> pensioner couples live in poverty so there's high rates of poverty <pause dur="0.4"/> amongst older adults <pause dur="0.4"/> we have

seen <pause dur="0.2"/> some increases in benefits to these small <pause dur="0.3"/> to these groups but they're small <pause dur="0.5"/> # and they've resulted in in single pensioner households for example being about eight pounds better off so we haven't seen <pause dur="0.3"/> substantial increases in in welfare benefits and pensions <pause dur="0.2"/> we've seen shifts at the margins <pause dur="1.7"/><kinesic desc="changes slide" iterated="n"/> so let's sum up then <pause dur="0.2"/> okay <pause dur="0.2"/> we've looked at # <pause dur="1.6"/> the evidence on # how health inequalities can be tackled <pause dur="0.5"/> it suggests it can only really be tackled effectively through national programmes <pause dur="1.3"/> we have got a government that <pause dur="0.3"/> is who has acknowledged that <pause dur="0.3"/> health inequalities exist <pause dur="0.5"/> and that health inequalities need to be tackled and has <pause dur="0.4"/> # <pause dur="0.2"/> indicated that it has # <pause dur="1.0"/> # <pause dur="2.7"/> it sees it as part of its work to tackle them <pause dur="0.6"/> we've got evidence of of some <pause dur="0.2"/> income in cash <pause dur="0.7"/> initiatives and some <pause dur="0.2"/> # cash in kind <pause dur="0.9"/> initiatives <pause dur="0.7"/> # <pause dur="0.5"/> but also the evidence is suggesting that <pause dur="0.4"/> # benefits increases are are <trunc>insignifi</trunc> <pause dur="0.4"/> insufficient to lift people out of poverty <pause dur="0.3"/> or to significantly improve people's material

conditions <pause dur="1.9"/> what we're going to talk about # <pause dur="0.8"/><kinesic desc="changes slide" iterated="n"/> oops wrong one <pause dur="1.2"/><kinesic desc="changes slide" iterated="n"/> this afternoon <pause dur="0.6"/> is we're going to talk about <pause dur="1.1"/> we've looked at how the government <pause dur="0.5"/> is setting about <pause dur="0.2"/> tackling health inequalities <pause dur="1.4"/> we're going to look at <pause dur="0.8"/> what it means for you at the level of health care practice both generally and specifically as a doctor <pause dur="2.2"/><kinesic desc="changes slide" iterated="n"/> that reminder is that # <pause dur="0.2"/> your <trunc>for</trunc> your first formative assignment's due in on Friday <pause dur="0.2"/> the first <pause dur="1.0"/> if you need any help than see your small <trunc>gue</trunc> group tutor today or you can just e-mail me if <event desc="noise from students" iterated="y" dur="4" n="ss"/> if you don't do that <pause dur="0.4"/> if you are struggling just a minute <pause dur="2.4"/> if you are struggling <pause dur="0.5"/> or you need <pause dur="0.6"/> additional support because of a learning need such as dyslexia <pause dur="0.4"/> then see us early enough it's very difficult <pause dur="0.2"/> particularly when it comes to the summer term if you're only seeing us a few <trunc>w</trunc> <pause dur="0.3"/> a few <pause dur="0.5"/> days before your assignment's due in <pause dur="0.3"/> so see us early enough so we can provide you with some real support <pause dur="1.3"/> okay you've got about five minutes before we do some small group work