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Tackling Health Inequalities in North & West Belfast Goretti Horgan Where this work came from… • The need for this secondary analysis was identified as a result of work carried out within Investing for Health Improvement Planning workshops in N&W Belfast. • Two Wellnet partners – NI Anti Poverty Network and National Energy Action NI – took the lead. • A reference support group was formed to develop the brief and commission the work. Partners • NI Anti Poverty • University of Ulster Network • Health Promotion • National Energy Agency Action NI • Save the Children • DSD Housing • North & West • HEART Healthy Investing for Health Living Centre • North & West Health • EH & SSB Action Zone • Queens University, Belfast Inequalities the overarching theme: The secondary research has focused on a number of the key determinants of health and wellbeing namely: • Poverty incl. child poverty • Low income (employment & unemployment) • Fuel poverty ……with consideration given to the impact they have on Health and Social Exclusion The overarching purpose of the work was to …. • Strategically address inequalities by directly influencing the focus and planning of health planners and policy makers • To provide strong indicators and guidance for planners and decision makers, as well as community and programme providers on the type of effective work which will make a positive difference to the long term health of individuals, families and communities’ • To enable service providers to develop and deliver programmes The message many politicians may not want to hear… Since socio-economic inequality is the main cause of health inequalities, policy and practice towards reducing inequalities in health must address the broader inequality in society. What works to reduce health inequalities? Little evidence – from WHO, EU, UK or Ireland – of effective interventions (not aimed at reducing broader inequalities in society) that work to reduce inequalities in health. Poverty & ill-health in N&W Belfast High levels of deprivation and ill-health BUT Interaction of layers of disadvantage… Social distress seen in high levels of mental ill-health, especially depression and anxiety Impact of stress on physical health Low income Stress + + Caring Smoking responsibilities + Smoking more Impact of stress on diabetes and heart disease more than its impact on other health-related behaviours Reducing impact of child poverty Much good practice e.g. • SureStart • Healthy Living Centres, • Working in schools - to teach children relaxation techniques; self-esteem; how to talk about feelings; problem solving; healthy eating; anger management; physical activity Impact of the conflict • Over a third of all deaths in five postal districts – all in N&W Belfast • Same areas among poorest in NI • Psychological damage continues • Segregation + FEAR Tackling the Impact of the Conflict • High levels of mental ill-health due to combination of financial strain, caring responsibilities and conflict • HLCs, community groups, women’s groups providing complementary therapies to relieve stress • Signposting to counselling and statutory services • Short term funding only Why such low levels of economic activity? • Stress + anxiety of making ends meet • Mental ill-health in wake of conflict • High levels of fear across N&W Belfast • Low educational qualifications • Low quality of available jobs • Lack of childcare/caring services • Poor public transport Key messages from research • Community provision of health and health-related services must be additional and complementary to statutory services, not substitutes for services which are being cut. • Funding for community-based preventative work, whether carried out by statutory or community organisations, should be ring-fenced and protected. • Long-term funding strategies need to be developed urgently for community-based services. Particular where cumulative disadvantage facing communities in N&W Belfast need to be included in regional funding allocations. • A targeted advertising initiative and pension credit take-up campaign is needed to address the misunderstanding of the basis of pension credits as compared to other tax credits The interactions between: • Poverty • Conflict • Disability and ill-health • A low wage economy and employability Requires greater attention by policy makers and needs more research.
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