More universal measures, coupled with systematic identification of people in need - as opposed to targeting by deprived areas - has the best chance of improving health and reducing inequalities, says Jyoti Atri, Cambridgeshire and Peterborough’s Director of Public Health, in her first annual report.
The report, discussed by Cambridgeshire County Council’s Adults and Health Committee, and previously by Peterborough City Council’s Adults and Health Scrutiny Committee – outlines that the main causes of health inequalities are identified by national experts as poor housing, education, employment and income, and a lack of healthy environments.
“It is how society responds to these different risk factors that should lead to a reduction in inequalities in outcomes,” she says.
“Put simply, it’s likely that all our areas, even the wealthiest, are home to people on low incomes. If we were to focus our attentions on the most deprived areas, we would only reach 31% of individuals who are income deprived and miss the majority. Even the least deprived areas of Cambridgeshire and Peterborough contain 11% of the income deprived individuals across the county,” she said.
Geographic targeting of interventions is often used as a way to make the most of limited resources and to target resources to those who most need them, but this can lead to most individuals in need being missed and can fail to reduce inequalities in health says Ms Atri. “Attempts to reduce health inequalities once people reach the door of the health service or those who are most unwell, will not result in a reduction of inequalities in health outcomes. It is too late.”
As an example, in attempting to reduce obesity which affects the majority of adults, she cites making changes to local environments to support people to walk or cycle or restricting advertising of fast foods and getting all children moving as part of the school day, as being far more effective overall than simply offering intensive individual support to people who are overweight. “Of course, we will want to offer additional support and interventions to those who are overweight, but this cannot be at the cost of universal approaches,” she says.
In her report, she highlights universal approaches that have had great success in reducing inequalities, such as the indoor smoking ban in public places – which has reduced overall numbers of people smoking, reducing the harm to people in both deprived and less deprived areas and has reduced inequalities in smoking rates. The full report is available here: https://www.cambridgeshire.gov.uk/residents/annual-public-health-report
