Health of the Region 2020

Foreword

Since the publication of the Marmot Review in 2010, life expectancy in England has stalled and health inequalities have continued to widen Across the West Midlands Combined Authority, both life expectancy and healthy life expectancy remain lower the national average This has been both exposed and exacerbated by the ongoing coronavirus pandemic, with our Black, Asian and Minority Ethnic (BAME) communities among those most affected

To reduce widening and persistent health inequalities, a radical shift is needed to put communities at the heart of public health, to tackle systemic discrimination and disadvantage as a public health problem, and build healthy, resilient, connected and empowered communities.

While empowering individuals and communities to improve their own health is important, it is crucial to recognise that we all live within social and environmental contexts Radical prevention is about tackling entrenched social disadvantage, working across the whole system to bring about a fundamental shift towards addressing the underlying causes of poor health.

The interdependence between health and wealth is the core theme that unites the work of the WMCA with that of health partners in the region Health and wealth are two sides of the same coin; the impact of socioeconomic deprivation on health has long been recognised, but equally prosperity cannot be achieved without good health.

The key to building a healthier, fairer and greener West Midlands is to put health and wellbeing at the heart of our social, economic and environmental policies, and to ensure that every citizen is able to maximise their full potential at every stage of their lives Despite the challenges faced in responding to and recovering from the coronavirus pandemic, the renewed focus on health inequalities gives us a once-in-a lifetime opportunity to re- evaluate, reset and redress the balance And we must do this now.

In a recent interview, Sir Michael Marmot was asked about the urgency of tackling these issues and his response was very clear: “We address structural racism today, right now We don’t say, ‘Oh, we’ll put it off while we deal with the crisis ’ No, we do it right now because it’s causing the problems right now ”

This report is a call to action for all of our partners and stakeholders to work together to address long-standing inequalities in the West Midlands, and to make a collective commitment to achieving positive change in our region.

Mayor Andy Street

Mayor of the West Midlands Combined Authority

Cllr Izzi Secombe

Portfolio holder for Wellbeing and Prevention, WMCA

Dr Mubasshir Ajaz

Head of Wellbeing and Prevention, WMCA

Acknowledgements

This report was written by the Core Group members to the WMCA Regional Health Impact of COVID-19 Task and Finish Group We are grateful to Dr Francis Howie, who contributed to the development of the initial draft The authors are grateful to all of the members to the Task and Finish Group who offered their time and expertise to steer this work

We are also grateful to the Mayor of WMCA, Andy Street, the WMCA Strategic Leadership Team and the WMCA Health & Wellbeing Board members who have greatly supported this piece of work and its next steps.

We are particularly grateful to the organisations and individuals who responded to the Call for Evidence
for their invaluable insight into the activities across the West Midlands in response to COVID-19, and the impact this has had We are also grateful to participants in two BAME roundtables hosted by the mayor who provided helpful insights at the beginning and the end of this work Without the submissions to the Call for Evidence and the roundtables, this report would not have been possible A summary of evidence is listed in Appendix 1.

Written by

Dr Lina Martino

Consultant in Public Health leading PHE Population Health Intelligence Hub

Ed Cox

Director for Inclusive Growth and Public Service Reform, WMCA

Dr Mubasshir Ajaz

Head of Wellbeing and Prevention, WMCA

Sean Russell

Head of Thrive, WMCA

Grace Scrivens

Coordinator for Regional Health Impact of COVID-19 Task and Finish Group, PHE

The members to the Task and Finish Group were as follows:

Jonathan Tew - Birmingham City Council
Stephen Raybould - Birmingham Voluntary Service Council (BVSC) - Black Country and West Birmingham CCG
Paul Maubach - Black Country Healthcare NHS Foundation Trust
Mark Axcell - BRAP
Joy Warmington - Coventry & Warwickshire STP
Chris Ham - Coventry University
Guy Daly - DPH Wolverhampton
John Denley - Mayor’s Faith Network and Nishkam Centre
Amrick Ubhi - NHSE
Alison Tonge - PHE
Lola Abudu - PHE
Sue Ibbotson - PHE
Lina Martino - PHE
Grace Scrivens (Project Coordinator) - PHE
Dave Rosser - University Hospitals Birmingham
Mike Sexton - University Hospitals Birmingham
Emma Pearce - Violence Reduction Unit
Helen Paterson - Walsall MBC
Ed Cox (Chair) - WMCA
Claire Dhami - WMCA
Sean Russell - WMCA
Bec Riley - WMREDI

Executive Summary

The Health of the Region 2020 report presents
a comprehensive analysis of the health of the West Midlands population In particular, it highlights national and regional evidence of the impacts of the coronavirus (COVID-19) pandemic which shows that long-standing inequalities in physical and mental health have widened as a consequence of the pandemic, both through direct effects of the virus, and through indirect effects of the control measures taken – and particularly among our Black, Asian and Minority Ethnic (BAME) communities

The report shows that:

We must begin with the urgent task of improving outcomes for BAME communities Targeted and immediate action to tackle structural racism is an urgent and immediate priority
But lasting change will only happen when we take a systemic approach to tackling the wider determinants of health and dealing with the structural inequalities we find in our economy, housing market, education, justice and transport systems
Similarly, we must tackle inequalities in the health and care system and widen access to health and care services This requires a fundamental rebalancing of funding and focus on primary and preventative care
These challenges, in turn, will create the conditions in which people-powered health can flourish and healthy lifestyles can become the norm

Health inequalities in the West Midlands:

Even prior to the pandemic, there were entrenched and persisting health inequalities in our region On average people in the WMCA have a shorter life expectancy than England overall, and spend more of their lives in poor health Women in the WMCA live for 82 2 years on average (England 83 2) and spend 22 years in poor health; men live for 78 0 years on average (England 79 6) and spend 18 years in poor health
This is due largely to above national average rates of premature deaths from preventable causes (cardiovascular disease, cancer, liver disease and respiratory disease) as well as higher infant mortality rates These correspond to higher rates of problem drinking, obesity (child and adult) and physical inactivity as well as lower cancer screening cover
Premature deaths from preventable causes in turn correspond to wider determinants of health, or the ‘causes of the causes’ Most areas in the WMCA have a greater level of socioeconomic deprivation than the national average, with approximately a quarter of children living in low income households Gross Disposal Household Income (GDHI) per person in 2017 was £16,479 compared with £19,514 in the UK as a whole
The lives of many people in the WMCA are hard, and unhealthy behaviours are often coping mechanisms for people who live in challenging circumstances, or reflect the limitations of the environments they live in Often people want to make positive changes to improve their health, such as being more active or giving up smoking, but are not supported to do so and feel powerless to make positive change

The impact of Covid-19 in the West Midlands

In line with national findings, the pandemic has exposed and exacerbated existing health inequalities The WMCA has a higher rate of cases overall than the region as a whole, with Birmingham and Sandwell most affected; rates are also high in Solihull, Walsall and Wolverhampton The highest rates of COVID-19 related deaths are in more deprived areas, and areas with a greater proportion of residents from BAME communities
Lockdown and social distancing measures have had direct impacts on wellbeing and on health behaviours Anxiety has increased significantly in the West Midlands region, with almost half of people surveyed (47 9%) reporting high levels of anxiety compared to a 2019 average of 21 9% On average, people reporting feeling ‘often lonely’ ranged from 4 9% to 6 5% over this period; and was generally higher for younger people
Although the pathways are complex and multi-faceted, the fundamental link between health and wealth is still clear Ultimately, where people are already marginalised and excluded, they are likely to be left further behind as we respond to and recover from COVID-19 unless we actively work to address this Engagement with stakeholders has consistently highlighted the need to address structural racism and discrimination, which interacts with social and economic determinants of health across the whole system

A ‘radical prevention’ approach

In order to address the immediate and emerging health impacts of Covid-19 and take steps towards a happier and healthier population, more resilient to future pandemics, we need to adopt a ‘radical prevention’ approach
Radical prevention means taking action as a whole system to tackle the underlying causes of poor health and health inequalities (the ‘causes of the causes’) and shifting to more person and community-centred approaches to health and wellbeing Early intervention and prevention in the early years can have lifelong impact, as well as yielding significant return on investment
Radical prevention also involves demanding more inclusive economic growth which can reduce health inequalities This can be done through improving access to employment, raising income, increasing community safety, improving housing quality and affordability, raising aspirations and improving educational outcomes, providing a high quality local environment and green space, enhancing social relationships and connectedness, and increasing opportunities for participation

Commitments to action and recommendations

We have identified 4 key challenges arising from this work and for each of these challenges, the WMCA and its partners have made over 50 commitments to action and set out a series of 12 recommendations to government These are summarised in the tables on the following two pages

Challenge 1: Improving outcomes for BAME communities
Challenge 2: Tackling the wider determinants of health
Challenge 3: Widening access to health and care
Challenge 4: People-powered health

Challenge 1: Improving outcomes for BAME communities

Selected Commitments to Action (full list in Section 3)

PHE West Midlands will develop a BAME and Disparities workplan
Birmingham and Solihull STP will routinely produce data with detailed analysis of factors including ethnicity and deprivation
WMCA will develop a targeted Thrive mental health programme co-designed with BAME employers and employees

Recommendations to government

Government should produce a clear and comprehensive action plan setting out how
it will work with local and regional partners to take action on race disparities and associated risk factors
Government should commission further data, research and analytical work at the local and regional level to understand the geographical and place dimensions of race disparities in health

Challenge 2: Tackling the wider determinants of health

Selected Commitments to Action (full list in Section 3)

WMCA will work with partners to become a Marmot City- Region and develop a 3-year action plan for change
The new multi-agency Midlands System Transformation Recovery (STaR) Board, working with PHE WM, will establish a Health Inequalities Working Group which will:
support Integrated Care Systems to plan and
be held accountable
for addressing health inequalities within the populations they serve;
provide standards, guidance and tools to ensure health inequalities are considered in the design and evaluation of new NHS services

Recommendations to government

The NHS should make local action on tackling health inequalities the focus of the NHS ‘Phase 4 Letter’ on Covid19
Government should make health and wellbeing outcomes a key driver of economic development and levelling-up policies including industrial strategy and local industrial strategies; the UK Shared Prosperity Fund; Towns Fund; and future devolution deals
Government should double the proportion of health and social care spending focused on prevention and public health from 5 to 10 percent over time

Challenge 3: Widening access to health and care

Selected Commitments to Action (full list in Section 3)

Black Country and West Birmingham CCG will develop an Academy to provide population health management capacity to the system It
is developing a number of population health management projects that will widen access to health and care including early diagnosis of cancer in vulnerable groups
Birmingham and Solihull STP will develop population health management within Primary Care Networks (PCNs) and ensure its primary care estate is under one digital domain by March 2021 promoting digitally enabled care for staff to work together in virtual multi- disciplinary teams
University Hospitals Birmingham will use digital transformation to reduce health inequalities by enabling people to access healthcare and information in a more accessible way, including creating community diagnostic hubs in local neighbourhoods

Recommendations to government

Government should ensure that Local Authorities
have sufficient powers to improve public health and reduce health inequalities, with Mayoral Combined Authorities providing support where they can add value
Government should support the WMCA’s proposal to establish digital screening hubs in high footfall transport locations
Government must close the gap in primary care provision between the most and least deprived neighbourhoods in terms of funding per patient and serving GPs
Government must widen its plans and increase its investment to tackle digital poverty with a particular focus on those who do not access health and care services online

Challenge 4: People-powered health

Selected Commitments to Action (full list in Section 3)

WMCA is committed to increase cycling from 3% to 5% of mode share by 2023 through the delivery of the WM Cycling Charter and extending cycling and walking routes
WMCA will work with other Commonwealth Games Delivery Partners to develop a long lasting physical activity and wellbeing legacy for the region
Black Country & West Birmingham CCG PCNs
will have recruited 63 social prescribing link workers, 38 care coordinators and 12 Health and Wellbeing Coaches by March 2021 and plan to recruit more than 200 posts by March 2024
The Walsall for All Board will raise public awareness about the support available to improve mental and physical wellbeing through the Walsall Together partnership

Recommendations to government

Government should invest in the WMCA’s Radical Health Prevention Fund to drive forward innovation, social prescribing and other initiatives to tackle health inequalities in the region
Government should pilot the Kruger report’s Community Right to Serve provisions for health and social care in the West Midlands