Reducing Inequalities Alliance - call to action

Bradford District and Craven Health and Care Partnership

Reducing Inequalities our call to action for Bradford District and Craven

Foreword Living a healthy and happy life is something we all should experience. There are many people working hard in services, organisations, and teams across our district to reduce inequalities. Yet we know that we must do more. We owe it to all our communities to get this right.

Our Call to Action for Bradford District and Craven describes the types of inequalities that exist locally and how you can get involved to be part of the solution.

In Bradford District and Craven, people living in deprived areas have a 20-year difference in healthy life expectancy from those living in affluent areas. We know that children living in the most deprived areas of our district are four times more likely to die than those living in other areas. These are shocking statistics, and ones which we all agree are unacceptable.

We are proud of the diversity, cultures and traditions of people living and working in our district. Overall, we are a young district, full of potential, and we firmly believe that quality care, stable jobs, fair pay, good housing, and education should be available for everyone living in Bradford District and Craven.

This is why we need to work across many partnerships, collaborate and be relentless in our focus on reducing inequalities. We need to take an asset-based approach, building on the skills, energy and innovation within our workforce and communities. This will help create a fairer place to live for everyone and one that matches the aspirations and ambitions of our communities.

To achieve this, we must work together. This document - which is our collective Call to Action - will help you understand how you can take action to reduce inequalities and ultimately close the life expectancy gap.

We know there is a lot of good work already happening in the district to reduce inequalities and it is this work that the Reducing Inequalities Alliance wants to spotlight, learn from and build on. This document contains ways to do that and how you can get involved.

We look forward to connecting with colleagues and partners as we work ambitiously to make our district and communities the best it can be. Let’s start that journey today, let’s do this together and let’s build a fairer Bradford District and Craven for everyone.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together Population health approach

Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Mel Pickup Place Lead for Bradford District and Craven Health and Care Partnership Sam Keighley Reducing Inequalities Alliance Executive Lead for Bradford District and Craven Health and Care Partnership

Appendix - key sources

Section 1:

Our collective call to action

Our call to action shows how you can make tackling inequalities part of your everyday business. This document provides you with the evidence to understand why - through the Bradford District and Craven Health and Care Partnership - we have set up the Reducing Inequalities Alliance.

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

It is aimed at staff working across our statutory and voluntary community and social enterprise (VCSE) sectors and for those working within our partnership that aim to improve local health and wellbeing.

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health

Get involved in our work to create a fairer, equal, and inclusive Bradford District and Craven.

Our health behaviours Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

CLICK HERE

Appendix - key sources

Section 1 Our collective call to action This animated film tells the story of the stark inequalities we see across our district. To support happy and healthy lives, partners across Bradford District and Craven are working to create a fairer district for all.

As part of this effort, we have created the Reducing Inequalities Alliance. The alliance aims to support and coordinate action to reduce inequalities in Bradford District and Craven. This demonstrates our vision to make Bradford District and Craven a fairer place to live.

Section 5 describes how you can take action to reduce inequalities by developing your own inequalities plan or getting involved with one of our programmes and partner organisations.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 2 Why we need to take action to reduce inequalities Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society.

We are committed to reducing inequalities and improving the health and wellbeing of our population.

Good health is vital for prosperity, allowing people to find good and stable employment while also playing an active role in their communities.

There are important reasons in Bradford District and Craven why we need to take collective action now.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 2 Differences in life expectancy

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Firstly, there are significant inequalities in the health of our population, as demonstrated by differences in life expectancy. Life expectancy varies by 11 years between different wards, from those in those most economically challenged wards Ingleton and those in affluent areas (from 77 to 88 64.9 70.2 years for women, and from 72 to 83 years for men).

However, what is more important is the variation in quality of life (or healthy life expectancy). Healthy life expectancy is the average number of years a person is expected to live in good health. This varies greatly between different communities and between different groups of people.

Differences in Life Expectancy COVID-19

Settle

Equality Diversity and belonging

64.0 70.4 Social and financial

Section 3:

Why we need to work together

Skipton

Ilkley

61.5 62.4

Population health approach

70.7 71.4

Different types of inequalities Key measures of inequality

Keighley

56.9 55.3

For example, women living in parts of central Bradford can expect 49 years of healthy life expectancy compared to 72 years in Wharfedale (a 23-year difference). There are also other parts of Bradford and central Keighley where this inequality is stark. For men, the difference in healthy life expectancy varies from 51 to 71 years (a 20-year gap).

Section 4:

Local Inequalities

Bingley

Wider determinants of health

67.4 68.9

Our health behaviours Health and care services

Shipley

62.0 64.3

These marked inequalities also occur for specific groups of people. For example, those with a severe learning disability have over 25 years less life expectancy than the general population.

Bradford City

52.0 50.6

Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Figure 1 above shows the variation in healthy life expectancy across the local authority wards within Bradford District and Craven. Data source: Office of National Statistics, 2009-2013

Appendix - key sources

Section 2 COVID-19 Secondly, we need to respond to social and health inequalities that were exposed by the COVID-19 pandemic.

During the pandemic, we saw a higher death rate from COVID-19 for those with existing long term health conditions and disabilities, carers, those on low incomes, minority ethnic communities and in some key worker groups. Young people were far less likely to die from COVID-19 but there was significant disruption to their education, training and social development, with evidence showing how this has impacted on their emotional health and wellbeing.

During the COVID-19 pandemic, we saw how different organisations worked together with urgency and creativity to respond to the threat of the infection and multiple lockdowns. For example, voluntary sector organisations collaborated with local authority and NHS teams to ensure public health messaging was received by all members of the community. There was an expansion of community networks, venues and providers of health information and localised services for testing, vaccination, and support.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 2 Equality, diversity and belonging Thirdly, tackling inequalities requires us to address structural failures in society. We want to ensure that equity, diversity, and belonging is a core focus. In recent years, we have seen the raised profile of #BlackLivesMatters and #Metoo movements, sparking worldwide debate on equalities and a number of calls to action. We have a strong message on equality and tolerance from young people, as expressed via the Schools Pandemic Recovery Manifesto. Integral to reducing inequalities is a new approach to inclusive leadership across our services and partnerships to facilitate cultural change.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 2 Social and financial Finally, although the social and moral imperative to reduce inequalities seems clear, there is also a strong financial argument. Before COVID-19, health inequalities were estimated to cost the NHS an extra £4.8 billion a year, and society around £31 billion in lost productivity, reduced taxes, higher welfare benefits and responding to social issues. Health is a major determinant of our economic prosperity.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 3 Why we need to work together to reduce inequalities Almost every aspect of our lives affects our health and wellbeing. This includes environmental quality, our community, schools, jobs and lifestyle, as well as the quality of the healthcare we receive. Different organisations across Bradford District and Craven have direct responsibly for, and are able to influence, these determinants of health.

However, people do not experience these factors in isolation. Each person faces their own unique combination of influences on their health. Therefore, we need to take a collective approach to tackling inequalities which recognises the interconnectedness between the determinants of health.

We recognise that each organisation has its own role and responsibilities in reducing inequalities. At the same time, we know that there are shared issues that cross organisational boundaries that we can only resolve by working together. By taking an alliance this approach we hope to achieve greater progress against our shared priorities and outcomes.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 3 Population health approach

Section 1:

Our collective call to action

Section 2:

Why we need to take action

The four pillars of population health

Differences in Life Expectancy COVID-19

1

3

The wider determinants of health

Our health behaviours and lifestyles

2

4

An integrated health and care system

The places and communities we live in

The four pillars of population health (Figure 2) provide a useful framework for understanding how different factors contribute to health and wellbeing – across the wider determinants of health, our health behaviours and lifestyles, our healthcare system and from within our communities. It helps to demonstrate the actions already being taken many organisations in Bradford District and Craven contribute to improving healthy lives.

Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Figure 2 – The Four Pillars of Population Health.

Taken from The King’s Fund A vision for population health

Health and care services Communities

The êåŠßĉĥĀȊFĥêŊŠÃĞĉŚĉêŒȊĉĥȊ ĬĤĤŠĥĉŚĉêŒȊDz F dzȊňŋĬĀŋÃĤĤêȊis an example of an initiative has incorporated the four pillars of population health into its design and delivery. RIC was created to test a range of projects on behalf of the system, to gain a better understanding of ‘what works’ in tackling health inequalities for our population. It is co-ordinating the delivery of 21 projects in central Bradford with cohorts from all life stages and involves over 50 partners. Interventions range from local VCSE anchor organisations working to support local groups and volunteer development, to creating a new community-based team which integrates physical and mental health professionals to provide proactive care.

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 3 Different types of inequalities

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Health inequalities are unfair and avoidable differences in health across the population, and between different groups within society. A useful way of looking at inequalities is the four different ways in which they reveal themselves. Differences in health between those with protected characteristics (or vulnerabilities) and the rest of society. Differences in socio-economic status (e.g. by wealth, employment and housing status), and differences between different geographical areas (Figure 3).

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Protected characteristics

Socio-economic deprived population

Age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, sexual orientation

Includes the impact of wider determinants, for example: education, low-income, occupation, unemployment and housing

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health

Inclusion health and vulnerable groups

Geography

For example: Gypsy, Roma, Travellers and Boater communities, people experiencing homelessness, offenders/former offenders and sex workers

For example, population composition, built and natural environment, levels of social connectedness, and features of specific geographies such as urban, rural and coastal

Our health behaviours Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Figure 3 - Domains of health inequality (adapted from Health inequalities: place-based approaches to reduce inequalities - GOV.UK (www.gov.uk)

Section 3 Key measures of inequality

Section 1:

Our collective call to action

Section 2:

It is important to have a shared set of outcomes and measures that describe how we want to reduce inequalities. The measures below are drawn from key areas of inequality across Bradford District and Craven. They are referenced in our key local strategies and the report Fair Society, Healthy Lives (the Marmot Review of the social determinants of health and social inequality). By pulling these measures together we can see that to tackle inequalities we need a truly collaborative approach.

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Wider determinants of health • Level of development at reception School attainment • Education/employment/training 16-17 years • Low income households (living wage) • Employment rates in deprived areas • Mortality attributable to air pollution • Housing quality • Digital connectivity Integrated health and care • Premature mortality (infant mortality, cancer, CVD, respiratory, serious mental illness) • GP appointments per head • Children & young people access to mental health & learning disability services • Inclusive leadership & workforce development

Healthy Life Expectancy

Communities • Mental wellbeing (happiness) • Health equity embedded in community projects • Community cohesion and safety perception • Strength and diversity of local partnerships • Reducing racism and discrimination • Health literacy • Transport to health and support services

Section 3:

Why we need to work together Population health approach

Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health

Behaviours and lifestyles • Smoking rates • Obesity rates • Physical activity • Alcohol related admissions • Access to green spaces

Our health behaviours Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Figure 4 – Key measures for reducing inequalities. [*These are not an exclusive set of inequalities measures but are drawn from key areas of local inequalities, Bradford District strategy, Bradford and Craven Health and Care partnership and Marmot indicators]

Section 4 Local inequalities

Section 1:

Our collective call to action

Section 2:

The wider determinants of health are estimated to account for a large proportion of our health and well-being (40%). The environment (10%), our health behaviours (30%) and the quality and access to healthcare (20%) are also crucial (Figure 5).

These four areas should not be viewed in isolation. For example, the school environment (as a single setting) is able to influence the educational quality and future prosperity of a child, local air quality via policies on school drop off and engine idling, behaviour via a whole school approach to tackling obesity, and healthcare via health education and integrated vaccination, sexual health and wellbeing hubs.

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

The wider determinants of health

Population health approach Different types of inequalities

40% Wider factors

Key measures of inequality

Education

Family Support

Income

Job status

10% Environment

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Housing

Air quality and green spaces

Health and care services

30% Behaviours

Communities

Tobacco use

Alcohol use

Diet and exercise

Sexual activity

Section 5:

Our alliance approach - getting involved

Our workplan

20% Health

How can you get involved?

Access and quality of care

Figure 5 – The contribution of different factors to health and well being

The following sections provides examples of key measures of inequality from each area of population health.

Appendix - key sources

Section 4 Wider determinants of health

Section 1:

Our collective call to action

Section 2:

Why we need to take action

The wider determinants of health are the social, economic and environmental conditions in which people live that all impact on health. They include income, education, access to green space and healthy food, the work people do and the homes they live in. Living in relative or absolute poverty is the single most important factor as this can cause or lead to multiple disadvantages.

Many approaches to policy and service design seek to influence individual behaviour rather than addressing the conditions that drive these behaviours. Attributing poor health to bad choices is too simplistic. It does not recognise the importance of the built and social environment (e.g. poverty, education, housing conditions) in influencing individual behaviour and choices.

Poverty impacts people in a number of ways. Living in poverty or on low incomes leads to increased levels of stress and anxiety, enormous demands on mental resources, and conditions in which the cycle of poverty may perpetuate. Poverty leads lower-than-average life expectancy. It needs to be tackled at root cause and early in life.

Prevention is far better than the cure when it comes to improving life chances and reducing inequalities.

For example, preventing family poverty reduces the risk of children not attending and leaving their studies early, and helps improve parental mental health and parenting behaviours.

Poverty influences the quality of housing and the ability to heat one’s home (for general health and for effective learning for school children). An adequate standard of living is essential to be able to afford a healthy diet and to afford to access training and employment. In 2020, 38% of children in Bradford district lived in low-income families.

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 4 Wider determinants of health Figure 6 below shows the proportion (%) of our population experiencing income deprivation – Craven District is shown on the left and Bradford District on the right.

There is considerable variation in income deprivation across Bradford District and Craven, with a higher proportion of the population experiencing income deprivation than the national rate (18.9% compared to 12.9% for England).

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together Population health approach

Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Figure 6, 2019 Local Health - Office for Health Improvement and Disparities - Indicators: maps, data and charts, accessed 19/04/23

Section 4 Wider determinants of health Discussions of poverty often focus on urban contexts. It is important to be aware that rural areas of Craven and Bradford District also experience pockets of deprivation that may be missed by data summarised over larger areas. Geographical isolation is also crucial, particularly to access services that people visit regularly (e.g. GP practices, pharmacists, community and VCSE run venues, schools and colleges). Relative isolation can also occur in urban areas if affordable local transport options are unavailable.

In recent years, cross sector partnerships in Bradford District and Craven have made significant efforts to tackle the wider determinants of health inequalities.

For example, the Born in Bradford study and Act Early research programmes are helping us to understand what action can be taken early in life to improve health and opportunities for children.

The Bradford district Wellbeing Board has recently broadened its work to reflect the roles that transport infrastructure, stronger communities, lowering crime levels, good housing, and an anti-poverty strategy play in healthy places. Cultural and infrastructure developments (e.g. Bradford City of Culture 2025 and Bradford Clean Air Zone) can also make an impact when planned with reducing inequalities in mind.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 4 Our health behaviours

Section 1:

Our collective call to action

Section 2:

Our health behaviours and lifestyles are an important driver of health. Approximately 30% of the reasons for ill health are due to our lifestyles. These include smoking, gambling, our diet, exercise, alcohol intake, substance use and sexual activity.

People’s circumstances can also make it harder to move away from unhealthy behaviours, particularly if they are worse off in socio-economic terms (facing debt or poverty). The density of local fast-food outlets and gambling outlets, lack of local affordable healthy food options, and sophisticated marketing techniques for cheap unhealthy products are beyond our control as individuals. These require collective local and national action.

While reductions in smoking have been a key factor in rising life expectancy since the 1950s, obesity rates have increased and now pose a significant threat to widening health inequalities. Childhood obesity is a significant issue for our population. It is associated with poor psychological and emotional health, in addition to poor physical health. Children living with obesity are more likely to become adults living with obesity and have a higher risk of illness and disability. Obesity rates are higher in more deprived areas.

The table below shows the proportion of children in year 6 who are obese in both the Bradford District and Craven local authority areas. Bradford has a higher rate than the national average and increasing.

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health

Table 1: Year 6: Prevalence of obesity (including severe obesity) 2021/22 proportion %. Trend pre and post COVID. Source: Obesity Profile - Data - OHID (phe.org.uk), extracted 18/04/23

Our health behaviours Health and care services

Area England

Obesity level (2020/2021) 23%

Recent trend over last 3 years

Communities

Section 5:

Our alliance approach - getting involved

Increasing & getting worse

Bradford

27%

Increasing & getting worse

Craven

19%

No significant change

Our workplan How can you get involved?

Appendix - key sources

Section 4 Our health behaviours Appropriate and regular physical activity is beneficial at all ages and can help prevent or manage many common conditions such as type 2 diabetes, cardiovascular disease and some cancers.

Living Well is a whole systems approach to obesity and wellbeing across Bradford District and Craven. It aims to engage and support organisations and communities to make Bradford District and Craven a healthier place to live, work, study and play. It recognises that there isn’t a single organisation or programme that can make this happen – it’s ‘everybody’s business’.

We also need to address the ‘alcohol harm paradox’. This shows that on average people on low incomes drink less than people on higher incomes, but those living in poorer areas are more likely to be admitted to hospital or die of an alcohol-related cause. It is thought this is due to different alcohol consumption habits and less access to support services in poorer communities.

Variation in smoking rates in Bradford district persist. Whilst 16% of adults smoke (Annual Population Survey), this rises to 30% for those in routine and manual occupations and 45% in those with serious mental illness.

With regards to our lifestyle, it is never too late to introduce preventive approaches. Being smoke free can prevent 15 different types of cancer, improve birth outcomes and increase family disposable income.

For example, the health benefits of quitting smoking are: Time after quitting

Health benefits

1 to 12 months

Coughing and shortness of breath decrease, circulation improves

1 to 2 years

Risk of heart attack drops sharply, lung function improves

3 to 6 years

Smoking related risk of heart disease drops by half

5 to 10 years

Smoking related risk of lung, mouth & throat cancer drops by half Risk of stroke decreases

Table 2 – timescales for experiencing health benefits after quitting smoking.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 4 Health and care services

Section 1:

Our collective call to action

Section 2:

The Bradford District and Craven Health and Care Partnership has been working hard to integrate services, using an Act as One ethos to enable partners to work together. In recent years, there has been a strong focus on developing an integrated ethos between the NHS, its statutory partners such as Bradford Council and Craven District Council, and VCSE sector partners.

Focussed prevention programmes to improve access to primary care and screening programmes helps reduce inequalities in key conditions such as cancer, diabetes and heart disease. Disease pathways that integrate prevention and medical treatment provide greater opportunities to tackle inequalities.

100

Male (Gap = 8.2 years)

Female (Gap = 7.8 years)

Percentage contribution (%)

80

Our local Core20PLUS5 healthcare indicators show considerable variation by Community Partnership area (in risk factors and by disease). For example, adult smoking rates vary between 11% and 24%, hypertension prevalence (high blood pressure) between 8% and 19%, and flu vaccination uptake between 22% and 73%.

By targeting diseases that contribute the most to health inequalities we could make the biggest impact on reducing health inequalities.

60

Figure 7 shows the percentage contribution of different diseases to inequalities in life expectancy across Bradford District. In the period 2020-2021, deaths from circulatory diseases (heart diseases, stroke and diabetes) and cancer contributed to over 50% of the life expectancy gap for males and females in Bradford District.

40

20

0 COVID - 19 Ciculatory Cancer

Respiratory Digestive External causes

Mental and behaviour Other Deaths under 28 days

Figure 7 - Breakdown of the life expectancy gap between the most and least deprived quintiles of Bradford by cause of death, 2020 to 2021.

Source: Segment Tool (phe.gov.uk), extracted 18/04/2023

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 4 Health and care services

Section 1:

Our collective call to action

Section 2:

Why we need to take action

It is important that we design and organise health and care services around the health and social needs of patients, with their input in the design. Bradford District and Craven Health and Care Partnership aims to do this and reduce inequalities in five priority areas (access to care, children and young people’s health, communities, mental health and our workforce).

We also need to move from a single condition view of the world to one that prevents and treats multiple conditions (multi-morbidity). Multi-morbidity is more common in poorer areas and on average starts earlier in life (affecting earning potential and opportunities to engage in community life). In the most deprived parts of England 29% of adults have three or more different health conditions, compared to 14% in the least deprived areas. People with multi-morbidity have poorer functional status, lower quality of life and are higher users of healthcare.

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 4 Communities

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Having control, autonomy and mastery over our lives is fundamentally important to our overall health and wellbeing. Strong and connected communities play an important role in the process of health creation.

Community networks lead to social relationships that have a positive influence on our overall mental well-being.

Having a voice in local decisions also makes a vital contribution to our health and wellbeing. This ‘community capital’ builds control and resilience in our lives and helps form a protective buffer against risk factors for disease.

Intersectionality is important as it describes the lived reality of people with multiple disadvantages. These could be related to ethnicity, education, gender and sexual identity. An intersectional approach recognises that each individual experience of these factors is unique (Figure 8). Discriminatory practices and social stereotyping can lead to cycles of poverty and marginalisation. So where multiple inequalities intersect a "one size fits all" will not benefit everyone equally.

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 4 Communities

Section 1:

Our collective call to action

Skin

Avera

ge

uage

Differen t shades White

ble lnera

Vu

ealth

Figure 8 The Wheel of Power/Privilege which illustrates intersectionality

Figure 8 is one example of the range of factors that can contribute to inequalities.

Discriminatory practices and social stereotyping can lead to cycles of poverty and political marginalisation. So where multiple inequalities intersect a "one size fits all" approach may not benefit everyone equally.

Engaging with communities, on a geographical level or with a marginalised group spread across an entire area, is needed to explore intersectionality.

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

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Why we need to take action

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Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 4 Communities

Section 1:

Our collective call to action

Section 2:

Evidence supports the benefits of a person and community-centred approach to health and wellbeing. One that actively involves citizens in shaping services and strengthening community assets (particularly in poorer areas), to help improve the health of the poorest fastest. To do this we need to follow important guiding principles of co-production with communities (Figure 9).

Nine guiding principles Principle 1: Power should be shared amongst all partners Principle 2: Embrace a wide range of different perspectives and skills to ensure these are represented in the project Principle 3: Respect and value of lived experience and how different forms of knowledge can be expressed and transmitted Principle 4: Ensure that there are benefits to all parties involved in co-production activities Principle 5: Go to communities. Do not expect communities to come to you Principle 6: Work flexibly Principle 7: Avoid jargon and ensure communities have access to the right information at the right time

There is an essential role for the VCSE sector in reducing inequalities. This comes from a need for communities to own and shape local assets, and to provide community-based health and support services. This can be strengthened by a commitment from funders to the principle of subsidiarity – that decisions are taken as close as possible to where they will have their effect.

Locally this comes from a strong network of community anchor organisations. This is led strategically by the VCS Alliance with its Here 4 Bradford District and Craven Communities (H4BDCC) infrastructure and Community First Yorkshire.

Principle 8: Relationships with communities should be built for the long term and not for the short term Principle 9: Make sure co-production initiatives are adequately resourced

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Figure 9 Adapted Guiding Principles of Co-production. Source: Co-production in ActEarly: Nothing About Us Without Us.

Section 5 Our alliance approach - getting involved The Alliance aims to support and coordinate action to reduce inequalities.

To do this, we need shared system leadership and planning which brings together action on civic, service and community interventions. The requires people working together across the NHS, Local Authority, VCSE sector, other statutory bodies, business and academic partners. We want to create a culture where addressing inequalities is everybody's business.

We aim to adopt a ‘Health in all policies’ approach. This requires a collaborative approach to tackle interlinked issues that impact on inequalities, such as:

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach

•

How to make Bradford a better district for children and young people to grow up in?

•

How to prevent poverty and respond to the housing and cost of living crisis?

•

How to recruit, train and upskill a diverse and inclusive workforce?

•

How to prevent illness developing and treat people living with multiple health conditions?

•

How to enable people to move into secure jobs and training (in an increasingly digital age)?

•

How to embrace and create a green and sustainable local economy?

•

How to design our towns and cities so that healthy choices are made easy and affordable?

•

How to increase belonging and trust in our communities?

Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

We will need innovative solutions, and a new way of thinking about policy that breaks down a ‘siloed’ approach to reducing inequalities.

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 Our alliance approach - getting involved There are three levels of activity within the Alliance

1

A core team (based within Bradford District and Craven Health and Care Partnership), that supports action within an alliance network (but deliver on some specific pieces of work).

2

A wider network of partners from a range of organisations working across Bradford District and Craven to reduce inequalities. This group oversees the development of the Alliance workstreams.

Members meet every six weeks and lead on activity related to their organisations or programmes.

A movement. Our aspiration is that the membership of the alliance will change and grow in a movement of coordinated action. Ultimately our key audience is you, our 30,000+ workforce across partner organisations in Bradford District and Craven.

3

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

The Alliance will: •

Work without organisational bias, spanning our Bradford District and Craven partners and West Yorkshire partnerships.

•

Extend our reach and learning to other parts of the country to keep up to date with best practice and the latest research findings.

•

Encourage diversity of perspectives and challenge, with strong connections through to our population and communities.

Health and care services Communities

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Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 Our workplan

Section 1:

Our collective call to action

Section 2:

Why we need to take action

The Alliance is currently working on four workstreams, with the following objectives:

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities

Setting the strategic vision for reducing inequalities in health (and the determinants of health)

Building confidence and skills in our workforce to reduce inequalities

Supporting best practice in the ways we work, the skills we use and the evidence we draw on to reduce inequalities

Creating opportunities to evaluate and share learning to evaluate our work and share learning

Wider determinants of health Our health behaviours Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan

Figure 10: Workstreams in the Reducing Inequalities Alliance workplan How can you get involved?

Appendix - key sources

Section 5 Our workplan

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy

The Alliance is also partnering with the Equity, Diversity and Belonging programme for Bradford District and Craven. This has a range of activities and aims to: •

Lead inclusively by diversifying our workforce and leadership representation, with improved place monitoring.

•

Bridge the gap between our communities and services and increase participation for meaningful voice and influence.

•

Inspire belonging by amplifying key diversity dates and months of significance, to recognise diversity as a local strength.

•

Develop an intersectional approach in identifying and acting on common areas of discrimination.

•

Being anti-racist in our practice and approach.

COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 How we can help you

Section 1:

Our collective call to action

Section 2:

Why we need to take action

We aim to support and coordinate action to reduce inequalities in Bradford District and Craven by: •

Linking staff to a learning network of like-minded people who have already agreed to tackle inequalities.

•

Working with our workforce to capture examples of ‘what works’ locally.

•

Sharing best practice and learning across our network (via our events, newsletter and website).

•

Signposting to the latest data, resources, inequality tools and evidence

•

Providing advice and guidance on how to measure the impact of work to reduce inequalities.

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together Population health approach

Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 How can you get involved?

There are a number of ways you can get involved.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy

1 By developing your own

reducing inequalities plan

Everybody can play an important role in tackling inequalities. We want to support the workforce to act on the inequalities they experience in work, home or the community.

A simple 3’A’s framework helps illustrates this.

What is your ‘Awareness, Action and Advocacy’ to reduce inequalities?

• What do you know about inequalities? (awareness) • What can you do to reduce inequalities, or are already working on? (action) • How you can take this further to champion the needs of your patients, service users or communities? (advocacy)

COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Figure 11: Adaptation of The Kings Fund. My role in Tackling Inequalities.

Section 5 2 By getting involved with one of the programs A whole system approach to reducing inequalities and improving wellbeing requires a flexible approach.

We need to be able to react to emerging themes and develop new programmes of work. The alliance can only succeed if key strategic programmes can deliver at scale and work together. Get involved!

Our Bradford District and Craven Health and Care Partnership has five enabler programmes.

Collectively these programmes work across different organisations and services.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Reducing Inequalities Alliance To support and coordinate work to reduce inequalities.

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Living Well Making it easier to live healthy and active lives. To coordinate collective action to create a district where it’s easier to adopt healthier lifestyle behaviours.

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services

Research and Innovation Academic institutions are at the forefront of population health and inequalities research. Locally we have the new Health Determinants Research Collaborative (between Bradford Institute for Health Research and Bradford Council), the existing Act Early and Born in Bradford research programmes, and the University of Bradford Faculty of Health studies.

Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 2 By getting involved with one of the programs

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Estates Climate change and air pollution are contributory factors to poor health and health inequalities. We aim to make efficient use of our estate, to reduce our carbon footprint and environmental impact, and minimise travel between sites for patients, communities and staff.

Digital, Data, Insights and Intelligence Digital First is an initiative across Bradford District and Craven our partnership involving all health services working collaboratively to share information as part of a new tech-driven health improvement programme.

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Equality, Diversity and Belonging (Diversity Exchange) Creating a fairer place to live, learn and work, based on strong foundations of trust and fairness. Where everyone feels they belong and are treated equitably and can reach their full potential.

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

District Strategy Bradford District Digital Strategy is the strategic map for the digital transformation of Bradford. Digital Inclusion is part of this strategy and aims to improve access to a device, affordable and adequate digital connection and basic digital skills.

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 3 Engaging with the wider partnerships Bradford District and Craven Health and Care Partnership Work to reduce inequalities is not just happening in the programmes mentioned above. To reduce inequalities, we need to work effectively across local strategies and partnerships. To understand how you fit in, a good place to start is the Bradford District Plan (our Well-Being Strategy) and Bradford District and Craven Health and Care Partnership priorities.

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Figure 12: Bradford District and Craven Health and Care Partnership’s operating model.

Section 5 3 Engaging with the wider partnerships

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Bradford District plan (Well-Being strategy)

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Children have the best start in life

Residents achieve good health and wellbeing

Sustained economic growth and decent work for all

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health

Safe, sustainable and inclusive communities

Action at all levels to address climate and environmental change

Our health behaviours Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan

North Yorkshire Council (Craven) Joint Health and Wellbeing Strategy - 5 priority areas: 1. Start well 2. Live well 3. Age well 4. Connected Communities 5. Dying well

How can you get involved?

Appendix - key sources

3 Engaging with the wider partnerships

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19

You can also enroll to be a Health Equity Fellow, as part of the West Yorkshire Health and Care Partnership Health Inequalities Academy. Health Equity Fellows carry out projects to support work to tackle health inequalities and help make West Yorkshire an equity-informed system. Those projects are making a positive difference to people’s lives.

You can learn more about the Health Equity Fellowship on the West Yorkshire Health and Care Partnership website.

Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 4 Share your story Our workforce stories highlight the people working in Bradford District and Craven to reduce inequalities. These stories are an example of best practice and a reminder that everyone can play a role in reducing inequalities.

Watch Nadia’s story below

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together Population health approach

Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

We’re looking for people to come forward in sharing their story or be nominated by colleagues.

If you’d like to learn more or nominate a colleague please contact ria@bradford.nhs.uk

Appendix - key sources

Section 5 3 How to get in touch

Section 1:

Our collective call to action

Section 2:

Why we need to take action

For further information, please visit our website at www.bdcpartnership.co.uk/ria or email us RIA@bradford.nhs.uk

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 Appendix Local Bradford District and Craven Reducing Inequalities Alliance

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging

Bradford District plan (Well-Being Strategy) 2021-2025 Social and financial

Bradford District and Craven Health and Care Partnership priorities Wellbeing Board Strategy for North Yorkshire Craven Living Well (Bradford District) Diversity Exchange

Section 3:

Why we need to work together Population health approach

Different types of inequalities Key measures of inequality

Section 4:

VCS Alliance strategy

Local Inequalities Wider determinants of health

Community Action Bradford and Craven Bradford District Anti-Poverty Strategy Digital strategies People First : Digital First – Happy, healthy, at home (peoplefirst-digitalfirst.org) Digital Strategy | Bradford Council

Our health behaviours Health and care services Communities

Section 5:

Our alliance approach - getting involved

West Yorkshire West Yorkshire Health Inequalities Academy

Our workplan How can you get involved?

Appendix - key sources

Section 5 Appendix National Health Equity in England: The Marmot Review 10 Years On Core20PLUS5 national approach to reducing healthcare inequalities Health Foundation - Evidence hub: What drives health inequalities?

Kings Fund – What are health inequalities?

Local Government Association – Health Inequalities Hub NHS Race and Health observatory Beckfoot Trust - Schools Pandemic Recovery Summit

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together

Population health approach Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities

Sources of data and intelligence Community Partnership and Area Profiles (Bradford District JSNA) Data and intelligence packs for Community Partnerships are available on request (ria@bradford.nhs.uk) Craven District profile Data linked to Bradford District plan (Well-Being strategy) - Wider determinants of health for areas (constituency) and wards Health Needs Assessments (Bradford JSNA) for Bradford District Public Health Outcomes Framework for Bradford District

Wider determinants of health Our health behaviours Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Section 5 Appendix Local research Born In Bradford Act Early Bradford Inequalities Research Unit University of Bradford

Section 1:

Our collective call to action

Section 2:

Why we need to take action

Differences in Life Expectancy COVID-19 Equality Diversity and belonging Social and financial

Section 3:

Why we need to work together Population health approach

Different types of inequalities Key measures of inequality

Section 4:

Local Inequalities Wider determinants of health Our health behaviours

Health and care services Communities

Section 5:

Our alliance approach - getting involved

Our workplan How can you get involved?

Appendix - key sources

Thank you

This call to action has been authored by the Reducing Inequalities Alliance team with a group of representatives from Bradford District and Craven Health and Care Partnership, Bradford Council, Bradford Institute for Health Research and the VCS Alliance.