Outcome: Life Expectancy Leads: Pat Diskett & Jackie Beavington & Claire Tiffany & Deborah Lee
A Executive Summary
Life expectancy at birth (LEB) in Bristol is just below the England average i.e. 0.7 years below for males and 0.4 years below for females. Life expectancy will need
to be increased by 2.1% (1.6 years) for males and 1.4% (1.1 years) for females over the next 4 years in order to reach the national Public Service Agreement [PSA]
The national PSA target for life expectancy is 78.6 years for males in 2009-11 and 82.5 years for females in 2009-11 (see B3).
Trends: Over the last 4 years (from 2001-3 to 2005-7) Bristol has seen an improvement in male life expectancy that is greater than that for England, South West and
the Core Cities. However, the improvement rate for female life expectancy in Bristol is less good when compared with other Core Cities i.e. is higher only than
Sheffield's (see B11).
Health Inequalities: There is a 8.8 year difference in life expectancy across Bristol wards for all persons i.e. there is a 8.8 year difference between Henleaze (one of
the least deprived wards) and Southmead ward (one of the most deprived wards), due to socio-economic, educational and lifestyle factors (see B11).
Three core work programmes have been identified based on the analysis below:
1. Risk Assessment and early intervention in primary care: Local analysis suggests that the greatest gains in life expectancy will come from tackling those diseases that
cause premature mortality and which are either preventable and/or amenable to early diagnosis, prompt intervention and effective (evidence-based) treatment (to give
improved long term control of the condition and/or prolong life). Based on this analysis, and using the wider evidence–base (of effectiveness of interventions), in Bristol,
local priorities are COPD, Cancer, Cirrhosis of the liver and CVD (CHD and Stroke) - this approach is often referred to as secondary prevention
2. Primary prevention: At the same time it is important to tackle underlying risk factors (e.g. smoking, obesity and lack of physical activity, alcohol misuse etc) i.e.
3. Tackling infant mortality: Finally, there is a need to improve infant mortality, which is higher in areas of deprivation and in specific groups e.g. tackling teenage
pregnancies (which can be linked to low birth weight/prematurity), ensuring early ante-natal booking in high risk groups (especially teenagers and some BME
groups), increasing breast feeding rates and supporting smoke free homes etc.
These three work programmes are reflected in 8 of the WCC Outcome Action Plans and are matched to the Health Inequalities Action Plan. The selection of these
priority outcomes was based on the analysis above but also on an analysis of the potential to improve further (over and above what we are already doing) in order to
achieve the required outcome – improved life expectancy. All outcomes chosen were designed to be mutually supportive and complementary i.e.
1. Risk assessment in primary care: Deliverables are those described in the Cancer, CHD and Stroke/TIA templates.
2. Primary prevention: Deliverables those shown in the smoking quitters, tackling childhood obesity and alcohol misuse templates.
In addition, other deliverables include tackling adult obesity (increasing physical activity e.g. through the Active Bristol programme and the development of weight
management care pathways including in primary care - see delivery plan attached).
3. Infant mortality: The key deliverables are demonstrated through the Teenage Pregnancy Action Plan and the Childhood Obesity Action Plan (i.e. increasing breast
Other evidence-based deliverables include increasing early ante-natal booking in high risk groups, promoting smoke free homes (to improve child respiratory health)
and tackling maternal obesity (see adult obesity above).
There is a close correlation between overall life expectancy and socio-economic inequalities (especially for income) at the national level. Countries such as Japan,
Sweden, Norway, Canada, and Greece have a high life expectancy, they also have low financial inequalities. Countries such as the USA and the UK with much wider
financial inequalities have much lower life expectancies. Thus being poor in an unequal society is much worse for your health than being equally poor in an equal
society. Thus measures to reduce inequalities will also help improve life expectancy overall - please see separate Health Inequalities Action Plan.
Planned improvements in life expectancy – a cautionary note:
Life expectancy calculations are often predicated on a static population. However, as people in deprived areas become more affluent, educated and healthier (and
their life expectancy improves), they often move out to more affluent areas. In contrast, inward migrants are often drawn to deprived areas where property and rents are
cheaper. Bristol, like similar core cities elsewhere, has a changing population e.g. younger, often international migrants arriving and older people moving out; a high
student population, and changes in equality groups. Each of these populations have different lifestyle risk factors and thus changes will impact on life expectancy
Planned improvements in life expectancy need to take these factors into account. Based on evidence of effectiveness, the anticipated improvement in life expectancy
for individuals is achievable, but whether or not those individuals stay in Bristol, is not predictable, as the population is not static. Hence targeting of interventions (high
risk groups, highly mobile localities etc) is key.
Total new investment 2009/10-2012/13 = £300,000 (see delivery plan D).
Partnership arrangements (see Health inequalities Summary Sheet for wider determinants of health and partnerships).
B1 Brief description of health outcome:
To increase life expectancy at time of birth with outcome as the extra years gained. Links to improving outcomes for cancer, CHD, CVD/Stroke; reducing Health
Inequalities and tackling teenage pregnancy, smoking, obesity and alcohol harm reduction.
B2 Please state the rationale for choosing this health outcome:
National health outcome for all PCTs. However, life expectancy at birth (LEB) in Bristol is slightly less than the national average and there is a 8.8 year difference in
LEB across Bristol wards, thus there is a need to improve LEB and narrow this inequalities gap. Similarly, infant mortality rates also show an inequalities gap and
contribute to the headline LEB target, thus these also need to be improved in at risk groups.
B3 Brief description of indicator:
The national Public Service Agreement target for life expectancy is:
• 78.6 years for males in 2009-11
• 82.5 years for females in 2009-11
B4 Vital Signs
The Department of Health is using All Age All Cause Mortality (AAACM) as a proxy to measure progress against the national life expectancy targets. AAACM is a more
locally relevant measure, closely related to life expectancy and based on the same death data.
For Bristol PCT the trajectories required to meet the 2011 AAACM target are: males from 764 per 100,000 in 2006 to 685 per 100,000 in 2011 and females from 513
per 100,000 in 2006 to 502 per 100,000 in 2011.
2006 baseline 2008 2009 2010 2011
Mortality rate per 100,000 (directly age
VSB01_01 standardised) population, males, from 764 740 721 703 685
all causes at all ages
VSB01_02 Population at all ages, males 205,190 207,044 208,888 210,715
Mortality rate per 100,000 (directly age
VSB01_05 standardised) population, females, 513 522 516 509 502
from all causes at all ages
VSB01_06 Population at all ages, females 204,631 205,541 206,471 207,424
Projected 2010 AAACM figures for Bristol are based on current trends using single year observed AAACM rates for 1997 to 2006.
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B5 Causation Analysis and Evidence Base
Analysis shows that the greatest gains will come from tackling those common diseases (and related risk factors) that cause premature mortality and which have an
evidence base that they are preventable, amenable to early intervention and/or treating them prolongs survival. Diseases that fulfil these criteria include CHD,
CVD/stroke, lung cancer, cirrhosis of the liver, and chronic obstructive airways disease. Key risk factors relating to these diseases also need to be addressed, to bring
about sustainable improvements. These include: smoking, obesity/lack of physical activity and alcohol/substance misuse. Given Bristol's history (employment in the
tobacco industry) and recent trends (increase in obesity and alcohol misuse) a focus on primary prevention and early intervention/treatment for key diseases and
targeted groups is key. Clearly if a condition kills early in life (such as in the first year or for someone in their twenties) then these deaths make a much greater impact
on life expectancy data than would the death of a seventy year old, albeit numbers are much smaller. Infant mortality is considered a key contributor to life expectancy
and significant gains can also be made through actions to reduce infant mortality - although benefits might take longer to be realised.
Another major consideration when planning to improve overall life expectancy is to be aware that of the link between overall life expectancy and socio-economic
inequalities (especially for income) found at the national level. Countries such as Japan, Sweden, Norway, Canada, and Greece have high life expectancies, they also
have low financial inequalities. Countries such as the USA and the UK with much wider financial inequalities have much lower life expectancies. Thus being poor in an
unequal society is much worse for your health than being equally poor in an equal society. Thus reducing inequalities will also improve life expectancies overall - please
see separate health inequalities briefing sheet.
Health Inequalities Intervention Tool for Bristol with the comparator area as the local authority average: Life Expectancy years gained if the Most Deprived Quintile
(MDQ) of Bristol UA had the same mortality rate as the local authority average for each cause of death.
The graph shows that the greatest possible gain for life expectancy and tackling male inequalities is for CHD with a gain of 0.6 years, suicide with 0.4 years and stroke
with 0.3 years. The next greatest possible gains for men are for lung cancer, other cancers, ill-defined conditions, and cirrhosis of the liver (all about 0.2 years). For
women the greatest gains for life expectancy and tackling inequalities are similar to the male ones, except that chronic obstructive airways disease is more prominent
and ill-defined conditions none existent. NB: Note that suicide data should be treated with caution as numbers are generally small and thus rates fluctuate annually.
Evidence from the literature, Cochrane Reviews and NICE suggests, in relation to the above, that Bristol PCT can achieve most benefits for its local population through:
a) identification of at risk patients in primary care, ensuring primary prevention, early intervention and prompt treatment (see CVD, Cancer and Stroke/TIA outcomes)
and through b) primary prevention of those diseases e.g. smoking cessation, obesity reduction/increased levels of physical activity, alcohol harm reduction (see
relevant outcomes). The DH has also identified key interventions for improving infant mortality that will also contribute to overall improvements in LEB. In the Bristol
context tackling teenage pregnancy [TP] (see TP outcome briefing paper) is key. However others, such as increasing breast feeding, reducing smoking in pregnancy,
ensuring early ante-natal booking in deprived groups also will make a difference - some of these are dealt with through the LAA and a separate Maternity and Newborn
action plan is under development (through the Maternity Services review group).
B6 Summary of Strategy:
As defined above, the greatest gains in life expectancy will come, in the short to medium term, from tackling those common diseases (and their related risk factors) that
cause premature mortality and which have an evidence base that they are preventable and/or treating them prolongs survival. Diseases that fulfil these criteria include
CHD, stroke, lung cancer, cirrhosis of the liver, and chronic obstructive airways disease. Reducing inequalities will also have a positive impact on improving Life
Expectancy thus this strategy should be read in conjunction with that for Health Inequalities. This strategy therefore is derived from a) analysis of need (see JSNA) b)
opportunities for health improvements (see analysis B5 above) and c) analysis of what is already in place, leading to the choice of 8 outcomes that feed into both this
and the Health Inequalities Strategy/Outcome.
B7 Demonstrate the links to the Strategic Plan and Joint Strategic Needs Assessment (JSNA):
The Joint Strategic Needs Assessment identified a number of trends (including difficulties in closing the inequalities and life expectancy gaps across the city), related
risk factors (e.g. obesity, smoking etc) and underlying wider determinants of health (e.g. education, housing/homelessness etc). Tackling these is therefore a priority
and is reflected in the PCT's Strategic Plan, the Local Area Agreement and the Bristol City Council Corporate plan.
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B7 Data from national data set (available to assessment panel):
B8 Data sources:
National Statistics via Compendium of Clinical and Health Indicators / Clinical and Health Outcomes Knowledge Base (www.nchod.nhs.uk or nww.nchod.nhs.uk).
Health Inequalities Intervention Tool (London health Observatory at http://www.lho.org.uk/NHII/interventions.aspx?la=00HB&comp=1&IMMValue=24&IMFValue=24
B9 Is the national data robust? How have we come to this conclusion?
Yes, but there is at least a 12 month time lag in annual data becoming available. 2005-2007 data was released February 2009.
B10 Please state current performance against target outcome:
Male life expectancy in Bristol is currently 77 years, representing an increase of 1.2 years (1.6%) over the 3 year period from 2002-4 to 2005-7. Female life expectancy
in Bristol is currently 81.4 years, representing an increase of 0.8 years (1%) over the 3 year period from 2002-4 to 2005-7. Life expectancy will need to be increased by
1.6 years (2.1%) and 1.1 years (1.4%) over the next 4 years for males and females respectively in order to reach the national PSA targets. Currently males in Bristol
have a life expectancy 0.7 years lower than England, females 0.4 years below the England average.
B11 Do we know the current rate of improvement? If so, please provide details:
In Bristol in the last year (2004-6 to 2005-7) male life expectancy increased by 0.1 years and female life expectancy by 0.2 years. Male life expectancy has risen
steadily in Bristol from 75.3 in 2001-3 to 77 in 2005-7. The average annual percentage increase over this 4 year period was 0.6%. Female life expectancy has risen in
Bristol from 80.5 in 2001-3 to 81.4 in 2005-7. The average annual percentage increase over this 3 year period was 0.3%. (Source: National Centre for Health Outcomes
Life expectancy is an artificial construct. It does not take into account migration, changes in health behaviours or health services, or unusual demography, all of which
might alter the expected pattern of mortality. Bristol as elsewhere has a changing population - changing migration patterns, a high student population, and changes in
equality groups. Each of these populations have different lifestyle risk factors.
There are strong correlations in Bristol between deprivation and life expectancy. Life expectancy varies across wards and deprivation quintiles (graphs below). Life
expectancy in Bristol is correlated with smoking patterns and chronic obstructive pulmonary disease mortality rates within wards.
Figure 1: Life expectancy trends in Bristol
Trend in Life Expectancy at Birth, Bristol compared to South West and England
84 Fig 1. Male life expectancy
in Bristol been getting closer
to the England average,
however the rise has slowed
down recently. Female life
Life expectancy at Birth
expectancy in Bristol is also
lower than the England
average but is staying in line
with the rise in England. The
South West has the highest
female life expectancy and
second highest male life
72 England - Male South West - Male
expectancy in England.
Bristol - Male England - Female
South West - Female Bristol - Female
1991- 1992- 1993- 1994- 1995- 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005-
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Figure 2: Recent life expectancy improvements for men showing comparisons for Bristol
Life expectancy males: Average annual percentage change 2001-3 to 2005-7 Bristol, South West, England
and core city comparison
0.58% 0.58% 0.56%
0.47% 0.47% 0.46%
0.5% 0.43% 0.41%
Figs 2 and 3. Over the last 3
years (from 2001-3 to 2005-7)
Bristol has seen an
improvement in male life
expectancy greater than
England, South West and half
the core cities. The
improvement rates for female
Figure 3: Recent life expectancy improvements for women showing comparisons for Bristol
life expectancy are lower than
Life expectancy females: Average annual percentage change 2001-3 to 2005-7 Bristol, South West, England males in all cities. In Bristol the
and core city comparison rate of improvement is higher
only than Sheffield's.
0.4% 0.34% 0.34% 0.35% 0.35% 0.34%
Ward level life expectancy at birth: Bristol 2003 - 2007
80 3 11/10/2011
Figure 4: Life expectancy variation by electoral ward within Bristol
Fig 4. There is a 8.8 year
Ward level life expectancy at birth: Bristol 2003 - 2007
difference between the
highest and lowest life
expectancy at birth (LEB)
85 for all persons across
wards in Bristol.
life expectancy (years)
Henleaze has the
highest, and Southmead
the lowest LEB.
Note: To calculate life
expectancy at ward level
a minimum of five years
of mortality and
65 population data are
St George West
St George East
Source: Bristol PCT using South East Public Health Observatory calculation methodology
Figure 5: Trends in the Bristol life expectancy inequalities gap
Bristol - Life Expectancy at Birth
Differences between the least deprived and most deprived areas Fig 5. The life expectancy
gap between the least
86.0 deprived quintile and the
most deprived quintile is
Note: Calculated using
82.0 South East Public Health
80.0 August 2008. Source:
Office for National
78.0 Statistics (ONS) Mortality
files for Bristol; GP
1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010-
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Least deprived quintile Most deprived quintile
B12 Include benchmarking data where available:
Figure 6: Male and female life expectancies for Bristol compared to other Core Cities
Bristol life expectancy at birth 2005-7 compared to core cities
Fig 6. Bristol has the
84.0 second highest life
expectancy for men
80.5 (after Sheffield) and the
80.0 second highest life
expectancy for women
life expectancy (years)
78.0 77.2 77.0 76.9 (after Leeds) when
75.7 75.6 compared with other
74.6 Core Cities
B13 Is there an LAA or SHA stretch target? If so, please provide details:
B14 Are there any links to other WCC health outcomes? If so, please provide details:
Health inequalities, CVD, cancer, alcohol misuse, smoking, TIAs, childhood obesity and teenage pregnancy.
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C Delivery Plan Actions & Indicators
Please state the main actions to be undertaken in order to improve health outcomes:
Life Expectancy at Birth: Strategy and Action Plans
Improving life expectancy overall (through stabilising and then closing the inequalities gap), requires both a multi-sectoral population-based approach and carefully
targeted interventions, reflecting the need to reduce inequalities and achieve a long term sustainable improvement in life expectancy for all sectors of the population.
The problem is multi-causal and therefore needs a multi-sectoral and targeted approach. Thus a number of PCT/BCC policies and strategies will contribute to this
The overarching Inequalities Framework and the PCT Strategic Framework bring together a number of strategies, priority outcomes and action plans that will
contribute to this outcome (SA = Strategic Ambition).
No Actions Delivery Indicators/Data Collection Evidence Base
Specify the units of activity and exactly what When will What data/indicators will be collected/used to Why will the action be carried out?
outcome this will lead to. the action demonstrate success?
1 Risk Assessment in primary care, early interventions and treatment
1.1 Cardio Vascular Disease (CVD) See briefing papers for indicators of Evidence base indicates that risk assessment and early
Mortality (see Health Outcome briefing success. detection with effective management and systematic review
papers: CVD Mortality and TIA in primary care are key. QOF evidence suggests that not all
Management). high risk individuals are identified and even if identified are
not necessarily receiving optimum treatment. It is likely that
there will be an inequality with the more disadvantaged
being less likely to receive treatment.
1.2 Cancer (see Health Outcome briefing See cancer mortality outcome briefing Please see cancer strategy and Smoke Free Bristol
paper: Cancer Mortality). paper indicators of success. strategy.
1.3 Chronic Obstructive Pulmonary All patients with COPD to receive influenza Respiratory Service design group is currently reviewing the
Disease (COPD) Mortality. vaccine and community-based pulmonary care pathway.
1.4 Cirrhosis of the liver (see Health See alcohol outcome paper. Alcohol harm reduction strategy screening in primary care
Outcome briefing paper: Alcohol and A&E and Maternity services, using standardised
misuse). assessment packager and stepped care approach to
alcohol treatment includes inpatient care.
1.5 Suicide. National target for suicide prevention is to See Bristol Suicide Prevention Strategy and Action Plan
reduce the death rate from suicide and 2008-11 also see the Domestic Abuse Strategy and HV
undetermined injury by at least a fifth by targeted risk assessment for post natal depression
2010 (from a baseline rate of 9.2 deaths per (Edinburgh Post Natal depression scale) but problems with
100,000 population in 1995/6/7 to 7.4 deaths recording as some will be recorded on GP systems but
per 100,000 in 2009/10/11). others on HV paper records.
1.6 Prevention of harm from substance National Substance misuse target: See DPH Annual Report for 2007 and Harm Reduction
misuse. Numbers of drug misusers retained in Strategy (Safer Bristol Partnership).
2 Primary prevention
2.1 Stopping smoking (see Health PCT SA 31: Contribute to a reduction in See smoking outcomes paper .
Outcome briefing paper: Smoking smoking levels by meeting the challenging
Quitters). annual targets for '4-week quitters'. To
achieve a quit rate of 870/100,000
population in the neighbourhood renewal
2.2 COPD. See smoking quitter briefing papers
indicators of success.
2.3 Prevention of obesity.
2.3.1 Prevention of childhood obesity (see See Childhood Obesity briefing papers
Health Outcome briefing paper: indicators of success.
2.3.2 Prevention of adult obesity. PCT SA targets 19, 20, 29 and 30 relating Link to Weight Management Strategy, Food & health
to weight management, physical activity and Strategy and Physical Activity Strategy Link to infant
healthy food. mortality.
2.4 Prevention of harm from alcohol See alcohol briefing papers indicators of See Alcohol Harm reduction strategy.
misuse (see Health Outcome briefing success.
paper: Alcohol misuse).
2.5 Mental health. National target for suicide prevention is to See Bristol Suicide Prevention Strategy and Action Plan
reduce the death rate from suicide and 2008-11 also see the Domestic Abuse Strategy.
undetermined injury by at least a fifth by
2010 (from a baseline rate of 9.2 deaths per
100,000 population in 1995/6/7 to 7.4 deaths
per 100,000 in 2009/10/11).
3 Infant Mortality
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Modelling for the Department of Health has identified interventions that will contribute to improving infant mortality and reducing the inequalities gap. As applied
to Bristol, these are reflected in points 3.1 to 3.6 below. In addition, two other key areas are:
Meeting the child poverty target to halve the number of children in relative low-income households between 1998–99 and 2010–11, by increasing the income
in the routine and manual occupational group by an average of 18%.
Reducing housing overcrowding in the routine and manual occupational group through the effect on reducing SUDI (sudden unexpected death in infancy).
These are best addressed in partnership – please see the health inequalities template.
3.1 Reduction in teenage pregnancy (see See teenage pregnancy outcome briefing See also Teenage Pregnancy Strategy.
Health Outcome briefing paper: paper indicators of success.
3.2 Improve breastfeeding rates (see See childhood obesity briefing paper
Health Outcome briefing paper: indicators of success.
3.3 Increase the proportion of smoke free PCT SA 20: By March 09 all 8 month See Strategic Framework.
homes. checks on children carried out by Health
Visitors are to routinely include a discussion
of the benefits of a smokefree home. To be
recorded in 85% of the Child Health
Records. The same target to be at 90% by
3.4 Improve rates of early ante-natal Targets yet to be set. Inequalities identified through the Maternity services health
booking. equity audit - a particular problem locally in specific groups/
communities (e.g. Somali women).
3.5 Reduce rates of smoking in PCT SA stretch target 46. Reduce smoking Integral to the Smoking Quitters target.
pregnancy. rates during pregnancy to a level which is
half those of women in that age group in the
general population of the South West.
3.6 Sudden infant death. Primary prevention advice routinely given Evidence suggests that reductions in sudden unexpected
by the health visiting team during routine death in infancy (SUDI) can be achieved by persuading
visits/contacts i.e. to all families. All sudden those (especially in the routine and manual occupational
infant deaths are subject to Child Death group) to avoid sharing a bed with their baby or putting their
reviews and PCT is represented on the baby to sleep prone (on its front) - would be recorded on HV
Panel. notes (some paper and some electronic - thus not easily
D Total Investment
D1 Please provide details of the total new investment between 2009/10-2012/13:
D2 Please include comments if funding is subject to Operational Planning Process (OPP) approval:
Most costs are already included in either the other WCC outcomes, Darzi and OPP bids.
E Partnership Arrangements
E1 Which organisations will help us deliver this plan? If key posts are part of another organisation please provide details:
See Assurance Framework (attached) and Health Inequalities Outcome - which gives partnership arrangements.
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Life Expectancy at Birth: Strategy and Action Plans
A number of factors contribute to inequalities in life expectancy (JSNA). The JSNA suggests a need for a stronger focus on primary
prevention, addressing underlying determinants of health and associated risk factors (smoking, obesity, physical activity levels,
environment, housing etc). At the same time there is a need to improve access to quality services and clear care pathways
(specifically targeting cancer, CVD/CHD, COPD) alongside improved management of a range of long term conditions i.e. service
development and redesign will be needed in some areas. It also involves tackling inequalities in infant mortality and working in
partnership (e.g. practice based commissioners, local authority, NHS partners and providers including the voluntary and community
sector) to address the wider determinants of health and tackle health inequalities.
Improving life expectancy overall (through stabilising and then closing the inequalities gap), requires both a multi-sectoral
population-based approach and carefully targeted interventions, reflecting the need to reduce inequalities and achieve a long term
sustainable improvement in life expectancy for all sectors of the population. The problem is multi-causal and therefore needs a
multi-sectoral and targeted approach. Thus a number of PCT/BCC policies and strategies will contribute to this outcome.
The overarching Inequalities Framework and the PCT Strategic Framework bring together a number of strategies, priority outcomes
and action plans that will contribute to this outcome. Here we have identified a number of linked strategies and action plans that will
be reviewed annually to assess their contribution towards this Outcome.
Linked Strategies/Actions Responsible/Lead Frequency of review by Date of next review by Indicators/Data Collection Investment
responsible group oversight group (PD/JB +
What is going to be done to improve health outcomes? Lead group (PCT/PH named lead) 2008/09 What data/indicators will be collected/used to What investment is required? Utilise
Include evidence base and data - numbers/%/trajectory demonstrate success? programme budgeting
Inequalities Framework Bristol Partnership (VH) Annual review Annual review - Dec As per current monitoring arrangements
Local Area Agreement H&W_B delivery group and Quarterly reports and Annual review - May As per current monitoring arrangements
LAA performance management annual review (May)
challenge group (JB)
Smoke Free Bristol Strategy Bristol Partnership (WP) Annual review Annual review - Sep As per current monitoring arrangements
Weight Management strategy Bristol Partnership (NF) Annual review Annual review - June As per current monitoring arrangements
Food and Health Strategy Bristol Partnership (NF) Annual review Annual review - June As per current monitoring arrangements
Physical Activity Strategy Bristol Partnership (NF) Annual review Annual review - June As per current monitoring arrangements
Active Bristol Bristol Partnership (NF) Annual review Annual review - June As per current monitoring arrangements
Bristol Suicide Prevention Strategy PCT-led Steering group (CG) Annual Audit (Feb) Annual review - March As per current monitoring arrangements
Harm Reduction Strategy Safer Bristol Partnership (BC) Annual review Annual review - March As per current monitoring arrangements
Alcohol Harm reduction strategy Safer Bristol Partnership (BC) Annual review (Sep) Annual review - Oct As per current monitoring arrangements
Older People Strategy Bristol Partnership (JB) Annual review Annual review - Sep As per current monitoring arrangements
PCT Strategic Ambitions PCT (PD) Annual review Annual review - April As per current monitoring arrangements
The Cancer Reform Strategy PCT (AR) Cancer ReformAction Plan under review June 2008; See work of BHSP Cancer Service Design Group
Sustainable Communities Strategy Bristol Partnership (HA) Annual review Annual review - June As per current monitoring arrangements
Local Development Framework Bristol Partnership (HA) Annual review Annual review - June As per current monitoring arrangements
Children and Young People's Strategy CYP (NF) Annual review Annual review - May As per current monitoring arrangements
Carer's Strategy ACC (RL) Annual review Annual review - June As per current monitoring arrangements
Parks and Green Space Strategy BCC (JB) Annual review Annual review - June As per current monitoring arrangements
Community Cohesion Strategy Safer Bristol Partnership (CG) Annual review Annual review - June As per current monitoring arrangements
Domestic Abuse Strategy Safer Bristol Partnership (JB) Quarterly Annual review - June As per current monitoring arrangements
Health Trainers Programme PH Directorate (JB) Annual review Annual review - June As per current monitoring arrangements Increase capacity
Other Outcomes (CHD/CVD/Cancer) PH Directorate (VH/AR) Annual review Annual review - June As per current monitoring arrangements
BCC Corporate Plan PH Directorate
Data Development equalities groups (DH/CG) Ethnicity project, prison HNA Disablility, mental health Under development
Minimum Data Set/JSNA (JT/ Mainstreaming Data refresh Data refresh Annual updated report Mainstreaming required
Equality Impact Assessments of all strategies Scoping/proofing Monitoring system Summary report and action taken Capacity/monitoring systems
Rolling Programme Health Equity Audits (HN) Scoping 2-3 audits 2-3 audits Audit reports and action taken Increase PH consultant and analyst
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Route Map (M)
Relative contributions of the three work streams - Males
Using this model:
10 years Benefits Age
accrual groups 0-1 Reducing male infant mortality for Bristol by 1/3rd over 5 years will contribute a
Infant years 0.1 year improvement in LEB for males (i.e. more than 0.2 years over 10
50 Primary prevention is key to ensure medium to long term (sustainable) benefits
5 years years and if not addressed will lead to increased pressures on scarce NHS
Primary prevention = resources as the burden of ill health in the population grows.
? 0.7- 1.4 years
3 years 50-80+
Some of the necessary gains in the first three years (2008-2010 inclusive) can
Secondary prevention (Risk assessment
be achieved by secondary prevention, although primary prevention (stop
and management in primary care) = ? 0.7
smoking, tackling obesity and alcohol misuse, etc) are still clearly important,
although maximum benefits for some of the key lifestyle changes become
more apparent after 5 years.
Need to improve LEB for males by 1.7 years by 2010
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Route Map (F)
Relative contributions of the three work streams - Females
10 years Benefits
groups Reducing female infant mortality for Bristol by 1/3rd over 5 years can
mortality 0.2 years contribute a 0.1 year increase in LEB for females (i.e. more than 0.2 years over
5 years 50
Primary prevention is key to ensure medium to long term (sustainable)
Primary prevention = = benefits and if not addressed will lead to increased pressures on scarce NHS
0.7? 0.9 - 1.8 years
years resources as the burden of ill health in the population grows.
Some of the necessary gains in the first three years (2008-2010 inclusive) can
Secondary prevention (Risk assessment be achieved by secondary prevention, although primary prevention (stop
and management in primary care) = ? 0.9 smoking, tackling obesity and alcohol misuse, etc) are still clearly important,
years LEB although maximum benefits for some of the key lifestyle changes become
more apparent after 5 years.
Need to improve LEB for females by 1.3 years by 2010
62b3c52b-a69e-42e4-8eec-d404ded0da32.xls 9 11/10/2011