CHD Equity Profiles

1. CHD Equity Profiles The North West Experience Bob Harbin, East Lancashire Public Health Network (Bob.harbin@hrvpct.nhs.uk)

2. Outline • Background • CHD Equity Profiles • Methods • Findings • Conclusions

3. Background to CHD Equity Profiles • NSF for CHD – requirement for DPH to produce a CHD Equity Profile by April 2001 • Cover inequalities in heart health, access to preventative and treatment services • Comment on the needs of individuals and groups, particularly those for whom special consideration is warranted. • Complement HIAs and directly inform the HImP • The profile would link to local equity targets. • It should be produced in a public document, for example the DPH Annual Report. • It should be produced in collaboration with the local authority and in consultation with the local community. • It should be reviewed and updated every three years.

4. CHD Equity Profiles in the North West • Previous work on Equity in the NW. • April, 2001- letter from the RDPH reminding DPHs of the requirements of the NSF to produce an Equity Profile. Also identified possible region-wide work on equity target setting. • By August, 2001 all districts had submitted an Equity Profile to the Regional CHD Project Manager. • Fifteen profiles from sixteen districts (HAZ – 2 shared). • DoH requested sight of profiles.

5. Aims of the work • To conduct a content analysis of the Equity Profiles produced in the NW and describe the approaches adopted • To investigate the ways in which the Equity Profiles have been or may be used within districts • To make recommendations regarding the future production of equity profiles

6. Methods • Literature review and discussions • Content analysis of profiles using a structured framework • Telephone interviews with key informants in districts

7. Authorship Status Title Length Target audience Definition of equity Deprivation indicators used Mortality data used Morbidity data used Prevention data used Treatment data used Lifestyle data used Local projects/initiatives Data gaps identified Geographical area of analysis Vulnerable groups Trend data Recommendations/Targets General approach Local use of profile Content Analysis Framework

8. Interview respondents Consultant in Public Health Medicine (7) Acting Director of Public Health and Health Policy Deputy Director of Development and Public Health Public Health Specialist (2) Specialist Registrar Epidemiologist and Head of Health Partnerships Head of Performance Management Health Economist Public Health Information analyst Public Health Information Scientist Public Health R&D Strategy Manger

9. Findings • Fifteen profiles – all standalone, all but one internally printed. • Length 7-80p – mean 40p • Nine termed “profiles”, Five “audits” • Majority (13) submitted by HAs (1 HAZ, 1 PCT) • Most produced by a team • Named author(s) in 10 • Aims – NSF (10), Focus on access to (tertiary) services (3), To develop process of producing Equity Profiles (2) • Target audience- majority not explicit • Definition/discussion of equity – Whitehead (1990) definition (5), discussion of equity (3)

10. Findings

11. Overall Approach Adopted Profiles could be grouped into three main types depending on the particular focus.( However these were not mutually exclusive) • Epidemiological/descriptive (6) • NSF based approaches – closely linked to the areas identified in the NSF and structures (4) • Exploring particular techniques (e.g. GIS/Spatial analysis) and approaches to developing Equity Profiles (3)

12. Main type of recommendations included • Absence of equity targets, though many had recommendations • Improved information/monitoring for equity (e.g. CHD registers in primary care). • Developing methodologies and repeating equity profile (e.g. using particular techniques/approaches) • Further investigations and specific research (e.g. identifying reasons for low service utilisation) • Some identified action areas • Organisational issues for developing this work (e.g. PCT role in equity)

13. Production • Local context vital • Usually team – Public Health with Information/Prescribing • Often significant resource involvement • Role of DPH variable • Sometimes training task

14. Factors shaping profiles • Policy guidance vague (e.g. NSF) and need for further guidance expressed • Some based profile directly on the NSF chapters • Some used other studies, previous work or had shared profiles from Regional Office • Joint work between districts (especially in HAZs) • Pragmatism – data gaps (primary care and morbidity) & tight timescales. • Broad Equity Audits & Disease Specific Equity Profiles

15. Dissemination and use of profiles • Shared with HA and PCG/T boards with LIT and Cardiac Boards, HImP groups • Largely positive reactions but frustrations with changing organisational structures • Some attempts at wider sharing (e.g. with summaries for a wider readership) • Some planned to include the work in the DPH annual report but others had already set the topic or were uncertain of future DPH report status

16. Perceived Value of Equity Profiles Contextual influences on decision making process Lomas (2000) • Information • Institutional structures for decision making • Values

17. Perceived Value of Equity Profiles Information • Descriptive, portraying inequities (old and new) • Single source • To share with partners (e.g. Local Authorities) • As a baseline/monitoring tool • Revisit former work (e.g. Revascularisation)

18. Perceived Value of Equity Profiles Institutional structures for decision making • Linking to LIT and other strategic groups • Used within a process • Acting as a catalyst to strategy • Tool for partnerships • How to “hand on” to new structures?

19. Perceived Value of Equity Profiles Values • Promoting equity as a concept • Balancing the more medical aspects of the NSF • To prevent equity getting sidelined or dropping down the agenda • What Public Health should be doing

20. Development of future profiles • Future organisational structures/roles? • Desire for comparability of profiles – greater standardisation • But desire to have local flexibility! • Data set and Framework • Support for target setting • Broad Equity Audits / Disease specific Equity Profiles

21. NSF requirements revisited • Cover inequalities in heart health, access to preventative and treatment services • Comment on the needs of individuals and groups, particularly those for whom special consideration is warranted. • Complement HIAs and directly inform the HImP • The profile would link to local equity targets. • It should be produced in a public document, for example the DPH Annual Report. • It should be produced in collaboration with the local authority and in consultation with the local community. • It should be reviewed and updated every three years.

22. Conclusions • First set of CHD Equity Profiles produced at a time of organisational uncertainty. • Range of approaches • Local context a key influence • Significant omissions • Perceived value but frustration with process and co-ordination • Identified need for guidance and support with particular aspects of profiles. • Opportunity to learn from production of first set of profiles