Gwent Public Services Board

Response Analysis Template

 

On 10 March 2022, Gwent Public Services Board (PSB) made the decision to become a ‘Marmot Region’, and to use the social determinants of health approach as the basis for the response to well-being and health inequalities in Gwent.  A copy of the Marmot proposal paper is available at:

https://www.gwentpsb.org/wp-content/uploads/2022/03/03-Proposal-Gwent-Becoming-a-Marmot-Region.pdf

1.    Theme: Health and Well-being & Health Inequalities (inc. Housing)

The ABUHB Director of Public Health Annual Report 2019, ‘Building a Healthier Gwent’1, described the scale of the strategic challenge to reduce health inequalities.  For people in all communities in Gwent to live healthy, fulfilled, dignified lives, means going further to reduce the inequality gap in the number of years lived in good health between the most and least deprived communities.

 

The Gwent Well-being Assessment (2022)2 highlights the significant inequalities across communities in Gwent, whether measured by health, education, employment, or home ownership. It also demonstrates the impact of poor housing quality, which drives fuel poverty, and exacerbates health inequalities. The Gwent Well-being Assessment highlights the breadth of action necessary to narrow health inequalities between communities across Gwent. The eight Marmot Principles provide a framework for a programme of action:

 

1.    Give every child the best start in life

2.    Enable all children, young people and adults to maximise their capabilities and have control of their lives

3.    Create fair employment and good work for all

4.    Ensure a healthy standard of living for all

5.    Create and develop healthy and sustainable places and communities

6.    Strengthen the role and impact of ill health prevention

7.    Tackle racism, discrimination and their outcomes

8.    Pursue environmental sustainability and health equity together

 

2.    Outline of the issues

 

Gwent’s assets are a diverse economy, rich culture and heritage, iconic natural environment and strong communities. However, there are significant inequalities in health, education, housing, income and employment which collectively result in socio-economic deprivation. The Gwent Well-being Assessment (2022) shows that the highest levels of socio-economic deprivation are located in the valleys and Newport city centre communities.

Gwent has a high proportion of residents with limiting long-term illness, and high premature death rates in the parts of the region with high levels of socio-economic deprivation.  Over the period 2011-13 to 2018-20, for both men and women, the inequality gap in life expectancy (between the most and least deprived communities) has remained unchanged, and there continues to be a seven year gap for men and a six year gap for women. The gap in healthy life expectancy is also largely unchanged for men (13 years), but it has widened for women such that the gap is now 20 years. This means that a woman living in the most deprived part of Gwent today lives just 48 years of life in good health.3

 

Figure 1: Life expectancy at birth (years), most vs least deprived quintiles, Aneurin Bevan University Health Board area, 2011-13 to 2018-20.

Source: Public Health Wales

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 2: Healthy life expectancy at birth (years), most vs least deprived quintiles, Aneurin Bevan University Health Board area, 2011-13 to 2018-20.

Source: Public Health Wales

 

For people in all communities in Gwent to live healthy, fulfilled, dignified lives means reducing the inequality gap. This will need all of Gwent’s public, private and voluntary sector to work together with communities to address the social determinants of health.  Housing should be health-improving, climate-change resilient and suitable for an ageing population.  Communities should be safe, with a focus on well-being and empowerment.  Education should result in more equitable opportunities and narrow the attainment gap.  Transport should enable access to employment, education, culture and leisure, and be health and climate-improving.  Employment should provide a fair income and good, health-improving and protecting work, and be climate change resilient.  The environment should promote well-being, and be protected from biodiversity loss and climate change.

 

The opportunities and challenges identified in the Gwent Well-being Assessment are set against the backdrop of what has been described as the ‘triple challenge’ of the Covid-19 pandemic, the UK leaving the European Union, and the climate emergency.4 This is further intensified by the heightening cost of living crisis. Whilst the long-term impacts are not yet known, these factors all have the potential to further widen inequalities.

 

By becoming a Marmot region, Gwent will work across the wide range of social determinants for a healthy society.  Professor Sir Michael Marmot (Director of the UCL Institute of Health Equity) has developed eight Marmot Principles for achieving greater equity in health. He first proposed his original six principles in his Strategic Review of Health Inequalities in England (2010), ‘Fair Society, Healthy Lives’, which illustrated in detail that the more deprived the area, the shorter the life expectancy.5 Professor Marmot has continued to advocate these guiding principles as the framework for action in his subsequent reviews of health inequalities in England, including in Marmot communities and regions (see Gwent PSB Marmot proposal for further information and references). In his most recent report, ‘All Together Fairer: Health Equity and the Social Determinants of Health in Cheshire and Merseyside’, Professor Marmot advocates for the inclusion of two additional principles (see principles 7&8 in Section 1).6

 

The table below highlights the fit between the 8 Marmot Principles and the 15 issues for response in Gwent’s Well-being Assessment:

 

Table 1: The Marmot Principles and ‘fit’ with the Well-being Assessment

 

#

Marmot principles

Gwent Well-being Assessment - Issues for response

1

Give every child the best start in life

 

Future housing and thermally efficient existing homes

Supportive local economies

Food

2

Enable all children, young people and adults to maximise their capabilities and have control of their lives

 

Future transport modes and infrastructure

Future housing and thermally efficient existing homes

Supportive local economies

Food

Skills for the future

Digital futures

3

Create fair employment and good work for all

 

Future transport modes and infrastructure

Supportive local economies

Skills for the future

Digital futures

4

Ensure a healthy standard of living for all

 

Future transport modes and infrastructure

Future housing and thermally efficient existing homes

Supportive local economies

Food

5

Create and develop healthy and sustainable places and communities

 

Community safety

Cohesive and empowered communities

Future transport modes and infrastructure

Future housing and thermally efficient existing homes

Supportive local economies

Food

Flood risk

6

Strengthen the role and impact of ill health prevention

 

Covid-19

Future housing and thermally efficient existing homes

Supportive local economies

Food

7

Pursue environmental sustainability and health equity together

Climate change – adaptation and mitigation

Biodiversity and species loss

Ecological footprint

Future housing and thermally efficient existing homes

Supportive local economies

Food

Skills for the future

Flood risk

Digital futures

8

Tackle racism, discrimination and their outcomes

Cohesive and empowered communities

Future housing and thermally efficient existing homes

Supportive local economies

Skills for the future

Digital futures

 

·       Housing

As noted in the table above, a recurring element to addressing inequalities is future housing and thermally efficient existing homes.

The advisory group for the UK Committee on Climate Change, chaired by Professor Sir Michael Marmot, produced the report titled “Sustainable Health Equity: A Net Zero UK,” in 2020.7 The report noted that living in a cold home that is difficult or expensive to heat increases the risk of exposure to cold and is associated with a variety of health impacts, especially respiratory infections -   the leading cause of excess winter mortality.   

Poor housing also has well evidenced effects on mental health in adults, including worry about debt and affordability and stress due to cold and damp environments. Fuel poverty has also been associated with poorer respiratory health and depressive symptoms. Conversely, warm homes have been found to contribute to reductions in the incidence of cardiovascular disease, cardiopulmonary disease, lung cancer and childhood asthmas and improved mental health and well-being. 8,9,10,11

It is estimated that close to one-third of excess winter deaths are attributable to living in a cold home. Cold-related deaths are more likely in older properties and homes with the poorest thermal efficiency ratings, and among older occupants. Overall, cold homes follow the social gradient: the lower a person’s socioeconomic status, the more likely that they will live in a cold home. 8,9,10,11

Actively reducing exposure to cold homes through improving their thermal and energy efficiency has also been found to contribute to wider social and health benefits, including: 8,9,10,11

·                   Delaying and reducing the need for primary care and social care

·                   Preventing hospital admissions

·                   Increased school attendance

·                   Increased engagement with (community and social) services

·                   Reduced incidence of risky health-related behaviours

·                   Enabling timely discharge from hospital, and preventing re-admissions

·                   Enabling rapid recovery from periods of ill health or planned admissions.

 

 

 

 

3.    Well-being objectives to be worked towards under this priority:

 

Table 1 above lists the eight Marmot Principles that will be worked towards as well-being objectives under this priority theme within the Gwent Well-being Plan. 

4.    What contribution can working towards these objectives achieve for well-being in Gwent?

 

·       Why do it - what is the case for prioritising work on this issue?

 

There is a 13 year difference for men and a difference which has widened to 20 years for women in how long life is lived in good health between the richest and poorest neighbourhoods in Gwent.  The gap in life expectancy between the most and least deprived neighbourhoods is approximately 7 years for men and 6 years for women.3  This is unjust, unfair and amenable to action by Gwent PSB partners.     

 

·       Is it an issue that could be tackled over the short, medium or long-term?

 

Reducing health inequalities in Gwent by addressing the social determinants of health, and the historical legacy of housing, will require a cross-sector response which includes actions for the short, medium and long-term. Long-term will be up to 25 years ahead, in line with the definition in the Well-being of Future Generations Act (Wales) Act (2015).

 

·       How could it contribute to the 7 Well-being Goals?

 

The table below highlights the contribution of the eight Marmot Principles to Wales’ seven well-being goals.

 

Table 2:  The 8 Marmot Principles and the 7 Well-being Goals

 

#

Marmot principles

Well-being goals

1

Give every child the best start in life

 

Healthier

More Equal

Cohesive Communities

Vibrant Culture and Thriving Welsh Language

2

Enable all children, young people and adults to maximise their capabilities and have control of their lives

 

Prosperous

Healthier

More Equal

Cohesive Communities

Vibrant Culture and Thriving Welsh Language

3

Create fair employment and good work for all

 

Prosperous

Resilient

Healthier

More Equal

Cohesive Communities

Vibrant Culture and Thriving Welsh Language

Globally Responsible

4

Ensure a healthy standard of living for all

 

Healthier

More Equal

Cohesive Communities

Vibrant Culture and Thriving Welsh Language

5

Create and develop healthy and sustainable places and communities

 

Resilient

Healthier

More Equal

Cohesive Communities

Vibrant Culture and Thriving Welsh Language

Globally Responsible

6

Strengthen the role and impact of ill health prevention

 

Healthier

More Equal

Cohesive Communities

Vibrant Culture and Thriving Welsh Language

7

Pursue environmental sustainability and health equity together

 

Prosperous

Resilient

Healthier

More Equal

Cohesive Communities

Vibrant Culture and Thriving Welsh Language

Globally Responsible

8

Tackle racism, discrimination and their outcomes

 

Prosperous

Healthier

More Equal

Cohesive Communities

Vibrant Culture and Thriving Welsh Language

Globally Responsible

5.    Where are we now?

 

·       Evidence of current situation – data, research, etc.

 

The current situation is set out in both the Gwent Well-being Assessment2 and the proposal for Gwent to become a Marmot region (link on page 1), including the health inequalities ‘headlines’ in section 4 above.

 

As illustrated in the local government diagram below, local authorities have an influence in every social determinant of health, with some services, e.g. Planning, influencing more than one determinant of the health and well-being of the local population.12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 3: Local government and the social determinants of health and well-being

 

Source: Local Government Association (2020)  

 

·       What is currently being done and by whom?

 

The table in Annex 1 shows the linkages between the 2018-23 local well-being objectives for the five former PSBs in the Gwent region and the Marmot Principles. The table in Annex 2 shows examples of linkages between the delivery programmes of the five former PSBs in the Gwent region and the Marmot Principles. Both tables are informed by published documents from the five former Gwent PSBs.

 

·       Do we have a comprehensive picture of all activity e.g. private sector, third sector, community interventions?

 

There will be a whole host of interventions in place currently.  Some interventions Gwent PSB partners will be aware of as either funded programmes or areas of direct delivery.  Some will be happening as a result of less formal community action which Gwent PSB partners may not be aware of.  A picture of what is happening, and crucially what is the impact, will need to be explored further with the Institute of Health Equity during the first year of the Well-being Plan. 

 

There is a need to strengthen business sector involvement and collaboration in the Marmot programme. Business and the economy has a key part to play in improving social conditions that affect health and health equity, including employment conditions, goods and services, and wider impacts.13

 

South Wales Fire and Rescue Service are ensuring all children receive education at Key Stage 1&2 on fire safety in the home. Adults deemed most vulnerable to accidental fires have comprehensive home fire safety checks.

 

Examples of work underway in Newport City Council are listed in Annex 3. 

 

In respect of tackling the historic legacy of the poor thermal efficiency of the existing housing stock in Gwent, progress is being made.  With the target set by Welsh Government, informed by the research “Better Homes, Better Wales, Better World – decarbonising the existing homes in Wales14, the social housing sector is leading in this area. As noted above, from the report titled “Sustainable Health Equity: A Net Zero UK”7 it highlights the importance of improving thermal efficiency, and the decarbonisation programme that flows from the Welsh Government targets will address a number of the eight Marmot Principles.  This is illustrated below:

 

Table 3:  Housing and impact on the eight Marmot Principles

 

#

Marmot principles

1

Give every child the best start in life

 

 

Decarbonisation of existing homes (i.e. improve the thermal efficiency) supports the healthier well-being goals of reducing health inequalities that living in a cold home that is difficult or expensive to heat, or both, increases the risk of exposure to cold and is associated with a variety of health impacts

3

Create fair employment and good work for all

 

 

Decarbonisation of existing homes (i.e. improve the thermal efficiency) supports the prosperous well-being goals as the target requires retrofitting of the affordable housing sector by 2030 at a cost of up to Ł1bn, which in turn will create a significant number of new green jobs in the region.  This is sustainable as that programme will continue after 2030 with home owners seeking such improvements (the demand enhanced by the 2022 cost of living crisis impact on energy costs).

4

Ensure a healthy standard of living for all

 

 

See above (Marmot Principle 3) in terms of sustainable jobs from decarbonisation

7

Pursue environmental sustainability and health equity together

 

 

Decarbonisation of existing homes (i.e. improve the thermal efficiency) supports the Gwent region’s response to climate change, given the significant impact that decarbonisation by achieving Energy Performance Standard A on reducing the levels of greenhouse gases emissions that come from (directly or indirectly) residential homes

 

·       How effective is the current work?

 

At a local level, some work will be extremely effective.  Whether in relation to early years, housing, training and employment, there will be some examples of effective practice.  However, the gap in healthy life expectancy across Gwent is not narrowing, which suggests that population level impact is not currently being achieved and a coordinated, whole system approach is necessary. 

 

South Wales Fire and Rescue Service has found that, since the introduction of preventative measures, the fire service has seen a reduction in Accidental Dwelling Fires deaths of over 60%.

 

In respect of the decarbonisation of the existing social housing homes, there is ongoing monitoring across the country by Welsh Government on the energy efficiency improvements being delivered by the housing association sector.  Currently, Welsh Government is in the evaluation mode, using an investment programme called the ‘Optimise Retrofit Programme’, which is being used to help determine the most effective way to deliver decarbonisation at scale.

  

·       How well does what is currently being done take account of the 5 ways of working?

 

The table below illustrates how becoming a Marmot region will align to the 5-ways of working.

 

Table 4: The 5-ways of working and Gwent becoming a Marmot region.

 

5-ways of working

Steps being taken

Collaboration

Gwent becoming a Marmot Region is a collaborative programme of Gwent PSB. 

Integration

The delivery of the Marmot programme will be whole system and include all PSB partners in working together.

Involvement

The delivery of the Marmot programme will be underpinned with a communications and engagement plan, which will reach out to cross-sector stakeholders and Gwent’s communities.

Long-term

The recommendations which will follow from the Institute of Health Equity should inform delivery over the next 10-25 years.

Prevention

The Marmot principles have preventing inequalities as their core (the causes of the causes), together with a specific Marmot principle on preventing ill-health.  

 

How the decarbonisation of homes links to the 5-ways of working is illustrated below.

 

Table 5: How decarbonisation of existing homes aligns with the Well-being of Future Generations Act’s 5-ways of working.

 

5-ways of working

Steps being taken

Collaboration

Joint working within housing sector – housing associations and local authorities - around supply chains / procurement / contracts

Public Bodies collaborating on commitment, leadership, funding

Opportunities for joint pilots and trials across Gwent

Integration

Reduced Greenhouse gas emissions

Increased economic activity and prosperity

A more resilient housing stock

A healthier population

Reduced inequality

More cohesive communities

Involvement

Making best use of local communities and community groups

Using existing regional and community networks

Important role for SMEs

Engagement with stakeholders and public

Enhanced roles for planning and building control

Long-term

30-year programme to deliver immediate and long-term benefits

Prevention

Tackling fuel poverty and providing improvements to the health and well-being of citizens

More cohesive communities enabled by improving the housing stock

 

South Wales Fire and Rescue Service work in collaboration with numerous partners to tackle accidental dwelling fires and deliberate fire setting. This has been in place for over 20 years. All members of society are able to receive this education/ prevention training.

 

6.    What could be done (steps)?

 

·       Additional work identified?

 

During 2022-23, a series of Marmot region events will be held to develop a set of partnership actions and accompanying delivery plan, facilitated by the Institute of Health Equity.  This work should be completed in the first half of 2023 and will inform how each of the Marmot Principles can contribute to reducing health inequalities in Gwent. The table below lists examples from Marmot cities/regions/communities elsewhere in the UK to provide an illustration of some of the areas of focus likely to come out of this process.      

 

Table 6:  Examples of areas of focus of Marmot cities/regions/communities

 

Marmot Principle

Areas of Focus

1. Give every child the best start in life

Reducing the impact of child poverty

Improving the quality and availability of early years services

2.  Enable all children, young people and adults to maximise their capabilities and have control of their lives

Reducing inequalities in educational attainment

Reducing school exclusions

Ensuring all young people are engaged in education, employment or training

Improving the prevention and treatment of mental health problems among young people

3.  Create fair employment and good work for all

 

Reducing in-work poverty

Providing post-school apprenticeships and support for in-work training

Providing good, fair work

Increasing local recruitment into jobs

4.  Ensure a healthy standard of living for all

 

Introducing a health equity in all polices approach

Introduce contractual mechanisms where ‘additional social value’ is included in the tender requirements and contracts partly awarded on the basis of what additional social value they bring in terms of good employment, local procurement and sustainability.

Supporting food aid providers and charities

Supporting community and voluntary sector provision of debt advice.

Offering support for those who are in debt

5.  Create and develop healthy and sustainable places and communities

Use place based approaches to service delivery

Engage with communities on local priorities and service design

Develop resilient communities

Provide affordable, good quality housing

6.  Strengthen the role and impact of ill health prevention

Develop equity targets for services with clear lines of accountability

Develop actions to improve community safety and reduce anti-social behaviour.

Improve leadership for health inequalities

Develop shared local indicators

Train staff in the social determinants of health

7.  Pursue environmental sustainability and health equity together

 

·       Minimise air pollution from all sources

·       Design and retrofit homes to be energy efficient, climate resilient and healthy

·       Build a sustainable, resilient and healthy food system

Develop a transport system that promotes active travel and road safety, and which minimises pollution

·       Develop healthy and sustainable models of work

 

Also see Environment theme in Response Analysis

8.  Tackle racism, discrimination and their outcomes

 

Improving the quality of recording of ethnicity

Improve the analysis of ethnic inequalities related to service use

Develop culturally competent and inclusive services

Assess equality as well as quality of services

 

Also see Community Cohesion theme in Response Analysis

 

With the decarbonisation of existing homes, there is work required on behaviour change. Given that reducing greenhouse gas (GHG) emissions from existing homes in Gwent will require both people and organisations to change their behaviours; interventions drawing on the science of behaviour change are needed to understand and promote the necessary change.  In Wales, 84% of all homes are owner-occupied or privately rented. It is clear that for decarbonisation to succeed across Gwent, then policy and delivery must be designed with homeowners and private landlords in mind.

 

·       Working more collaboratively?

 

Alongside business and the education sector, Gwent PSB will need to involve and work collaboratively with communities across Gwent who are living with the impacts of inequalities. The Institute of Health Equity will provide advice on how best to engage with citizens, alongside other resources including Public Health Wales’ ‘Principles of Community Engagement for Empowerment’ and the ‘National Principles of Community Engagement’ framework.15,16

 

·       Examples of evidenced good practice elsewhere

 

There is now a body of evidence from other parts of the UK of the galvanising effect on health inequalities of adopting the Marmot Principles.  This includes Coventry (Coventry: a Marmot City – Coventry City Council), Greater Manchester City Region (Greater Manchester is a “Marmot city region” – what does that mean, and how will it improve our health and reduce inequalities? - GMHSC) and Cheshire and Merseyside Champs | Public Health Collaborative (champspublichealth.com). 

 

Wigan Council adopted an approach with some similarities to the ways of working found in Marmot regions.  Called ‘The Deal’, this was a series of tailored agreements with communities aimed at creating a better borough.  In ‘The Deal’, the Council’s pledges are published alongside the part which it needs local residents and businesses to play.17

 

In terms of impact, Coventry has the longest history of working to the Marmot Principles and, whilst it is not possible to solely attribute changes in population indicators to their ‘Marmot City’ status, there is evidence of a narrowing of health inequalities and falling levels of deprivation.18 Wigan’s headline achievement in relation to population health is a significant increase in healthy life expectancy, as well as reductions in premature mortality from cardiovascular disease and cancer.17i  

 

The Local Government Association’s Health Inequalities Hub (England) is a rich source of case-studies. Table 7 illustrates some examples of local community action across the Marmot 8 Principles.19

 

Table 7: Examples of local community case-studies which contribute to the social determinants of health / Marmot Principles

 

Name of case-study

Example of contribution to Marmot 8 Principles

No child left behind: Cheltenham Borough Council’s year of action

1. Give every child the best start in life

Social Housing Connectivity in Leeds

2.  Enable all children, young people and adults to maximise their capabilities and have control of their lives

Greater Manchester Combined Authority: building an integrated skills and work system

3.  Create fair employment and good work for all

 

Lewisham: Working with partners to address food poverty

4.  Ensure a healthy standard of living for all

 

Healthy place-shaping in Bicester

5. Create and develop healthy and sustainable places and communities

Kent: using health and wellbeing shop to reach out to communities facing health inequalities

6. Strengthen the role and impact of ill health prevention

 

Cheshire West and Chester Council: Enhancing health, tackling climate change

7. Pursue environmental sustainability and health equity together

Tackling inequalities and disproportionality – Camden Council

8. Tackle racism, discrimination and their outcomes

·       Are additional resources required or re-tasking of existing resources?

 

It is difficult at this stage to be prescriptive about resources as the list of agreed actions for Gwent are not decided.  However, the experience of other Marmot regions/cities/communities, as well as other similar programmes in the UK, is that this is not about new money, but it is about how existing money is allocated and decisions about how resources are deployed.  This may involve discussions about pooling funding to create scale, increasing the proportion of funding spent on prevention, and working more directly with communities to decide how money is spent.

 

·       What resources would be needed? Are they already in place?

 

The resources required to make an impact on the social determinants of health are in place.  The amount of capital, both human and physical, among Gwent partners and within Gwent communities is sufficient to reduce the gaps in life expectancy and healthy life expectancy.  It may require difficult or challenging thinking about how resources are deployed, but the resource is available.   

 

In respect of housing, decarbonisation is not fully funded, although research is underway to find ways to support grant funding. 

7.    How have you engaged with stakeholders?

·       Community events and meetings

 

Through the involvement of the UCL Institute of Health Equity a series of workshops with a wide-range of cross-sector stakeholders and representatives of local communities will be held in 2022. These hybrid workshops are currently being scoped with the Institute of Health Equity for delivery from early autumn onwards.

 

The draft well-being plan is subject to a 12-weeks formal consultation.

 

·       Professionals and businesses

 

A professional audience will be part of the Marmot workshops (above). Also see section 5 above on need for further involvement and collaboration with business and education sectors.

 

8.    How does this area link with the other response areas?

·       What are the opportunities to collaborate?

 

To be able to reduce inequalities, it is the correct approach to address health inequalities in parallel with improving community cohesion and mitigating and adapting for a changing climate and loss of biodiversity. This is reflected in the eight Marmot Principles.

 

Community cohesion – As highlighted in Greater Manchester’s ‘Marmot City region’ work, strengthened community resilience and social cohesion, and improved safety support good health and reduce inequalities. Health equity interventions which strengthen community assets are important, including the provision of accessible and affordable public transport. build-back-fairer-in-greater-manchester-executive-summary.pdf (instituteofhealthequity.org)

  

Environment - Action to improve health equity can also be consistent with measures to decarbonise. Professor Marmot’s report ‘Sustainable Health Equity: Achieving a Net-Zero UK’, which was commissioned by the UK Committee on Climate Change, identifies four key areas for action:7

 

·       Minimising air pollution

·       Building energy efficient homes

·       Promoting sustainable and healthy food

·       Prioritising active and safe transport

The Chief Medical Officer for Wales’ Special Report, ‘Protecting Our Health’,20 published following the first phase of Covid-19 advocates for the ‘One Health’ concept which recommends work across sectors and disciplines to address issues or risks that occur at the animal health, human health, and environmental health interface, including disaster preparedness and food and water safety and security. It recommends that the strong collaborations forged in response to the Covid-19 pandemic, including public bodies, third sector and academia, should be built upon to prioritise these threats.

·       Have possible tensions been identified and resolved?

 

Tensions have not been identified at this stage as objectives and actions are not agreed, but this will be worked through as part of action plan development in 2022-23. 

9.    Conclusions and Recommendations

 

Health, as measured by life expectancy, has stopped improving, and health inequalities are widening.3 The Gwent Well-being Assessment2 shows that, in 2015-17, people in the most deprived communities in Gwent were dying 6-7 years earlier than they should.  More recent figures from ONS for Wales as a whole demonstrate that the gap in life expectancy has widened still further during the COVID-19 pandemic.21,21i As well as how long people live, how many years’ people live in good health also shows a strong social gradient. Women in particular will now spend almost a third of their life in poor health in the most deprived communities in Wales.3  

 

This situation is unjust and almost entirely due to social conditions - poverty, poor-quality housing, low-paid or unstable jobs, food insecurity, lack of public transport links, limited access to green space and social isolation. It is unjust that it is a person’s postcode at birth rather than their genetic code that is the predictor of how long they will live and how long they will live in good health. This is illustrated in The Health Foundation infographic below.

 


 

Figure 4: What makes us healthy?

 

Source:  The Health Foundation https://www.health.org.uk/

 

The areas where partners in Gwent need to prioritise action are captured in the Marmot Principles and the commitment already made by Gwent Public Services Board to become a Marmot region. The underlying feature of a Marmot region is a determined and joint effort to true partnership working across a number of areas to improve the lives of all, but in a way that is proportionate to the level of need. The areas of focus are enshrined in the Marmot Principles:  

 

1.    Give every child the best start in life

2.    Enable all children, young people and adults to maximise their capabilities and have control of their lives

3.    Create fair employment and good work for all

4.    Ensure a healthy standard of living for all

5.    Create and develop healthy and sustainable places and communities

6.    Strengthen the role and impact of ill health prevention

7.    Pursue environmental sustainability and health equity together

8.    Tackle racism, discrimination and their outcomes

 

Through this commitment, improved health and reduced inequalities will be at the centre of how partners in Gwent develop approaches to early years, education and skills, transport, housing, places and spaces, and jobs and businesses over the short, medium and long term.

 

The specific actions that Gwent will take to respond to each of the eight Marmot Principles will be worked through during 2022/23 as part of year one of the Well-being Plan.  As such, this Response Analysis does not put forward recommendations for specific interventions at this stage.  This is, in essence ‘the’ objective of the response plan when it comes to health inequalities – to embed the eight Marmot Principles in order to tackle health inequalities between communities in the region.   

 

References:

 

1          https://abuhb.nhs.wales/healthcare-services/staying-healthy/building-a-healthier-gwent/further-information/

 

2          Gwent Well-being Assessment - Gwent Public Services Board Gwent Public Services Board (gwentpsb.org)

 

3          https://phw.nhs.wales/news/inequalities-in-life-expectancy-on-the-increase-in-wales/

 

4          Rising to the Triple Challenge of Brexit, COVID-19 and Climate Change for health, well-being and equity in Wales - World Health Organization Collaborating Centre On Investment for Health and Well-being (phwwhocc.co.uk)

 

5          https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review

 

6          Champs | Public Health Collaborative (champspublichealth.com)

 

7          https://www.instituteofhealthequity.org/resources-reports/sustainable-health-equity-achieving-a-net-zero-uk

 

8          The-Case-for-Investing-in-Prevention-Housing.pdf (phwwhocc.co.uk)

 

9          https://phw.nhs.wales/files/housing-and-health-reports/a-case-for-investment-report/

 

10        The importance of household energy efficiency for health and well-being - World Health Organization Collaborating Centre On Investment for Health and Well-being (phwwhocc.co.uk)

 

11        The Full Cost of Poor Housing in Wales - World Health Organization Collaborating Centre On Investment for Health and Well-being (phwwhocc.co.uk)

 

12        https://www.local.gov.uk/publications/social-determinants-health-and-role-local-government

 

13        The Business of Health Equity: The Marmot Review for Industry - IHE (instituteofhealthequity.org)

 

14        Independent review on decarbonising Welsh homes: report (gov.wales)

 

15        Rules of community engagement: Relinquish your power so that communities can take control - Public Health Wales (nhs.wales)

 

16        Engagement - WCVA

 

17        What is The Deal? (wigan.gov.uk)

 

17i        The King’s Fund (2019) A citizen-led approach to health and care: Lessons from the Wigan Deal.  Available at: https://www.kingsfund.org.uk/publications/wigan-deal

 

18        Institute of Health Equity (2020) Coventry Marmot City Evaluation 2020.  Available at: https://www.instituteofhealthequity.org/resources-reports/coventry-marmot-city-evaluation-2020

 

19        Case studies | Local Government Association

 

20        https://gov.wales/sites/default/files/publications/2021-01/chief-medical-officer-for-wales-special-report.pdf     

 

21        Office for National Statistics (2021) National life tables – life expectancy in the UK: 2018 to 2020.  Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2018to2020 

 

21i        Office for National Statistics (2022) Health state life expectancies by national deprivation quintiles, Wales: 2018 to 2020.  Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/healthstatelifeexpectanciesbynationaldeprivationdecileswales/2018to2020  

 

 

 

 

 

 

Version: v0.8

 

Date: 17/06/22

 

 

Please now complete the table on the next page outlining what initial steps could be taken to achieve each potential objective.

[Table can be completed before 30 June if possible, but above must be completed by 30 June]


If the PSB chose this as a well-being objective, what key steps should be undertaken in the first 12 months, and by whom? (We acknowledge that the objective is a long-term issue, but identifying some initial steps will help the PSB to understand what could be done)

 

Objective 1: Embed the Marmot principles in order to tackle health inequalities in the region

                    

Objective 1: Steps

Partners involved

Lead organisation

Target

Date

Comment

All Gwent PSB partners will work with the UCL Institute of Health Equity in 2022/23 to create a common position on the impact of health inequalities in Gwent, and agree system-wide actions and commitments to reduce equalities.

All PSB partners

ABUHB

March-May’23

 

 

Objective 2: To embed addressing the thermal efficiency of the homes in Gwent as a key determinant in reducing health inequalities in Gwent

                    

Objective 2: Steps

Partners involved

Lead organisation

Target

Date

Comment

Workshops with business to highlight the opportunities created by the green agenda in the form of decarbonising the homes of Gwent.

 

 

 

Seeking to develop the market of suppliers into this emerging green sector

Explore the appetite for joint procurement opportunities for decarbonisation, using the collective impact of the Gwent PSB.

 

 

 

Help drive down costs on what initially could be expensive new technologies

Workshops with education sector in Gwent to drive training initiatives within the new decarbonisation economy.

 

 

 

Ensure in the medium term that sufficiently trained local people become available to support this emerging green sector


 

 

 

 

 

Annex 1: Linkages between the first set of local well-being objectives of Gwent’s PSBs and the ‘Marmot Principles’

 

 

 

 

 

 

Marmot Principles

 

 

 

 

 

PSB Well-being Objectives

 

 

 

 

 

Giving every child the best start in life

Enabling all children, young people and adults to maximise their capabilities and have control over their lives

Creating fair employment and good work for all

Ensuring a healthy standard of living for all

Creating and developing sustainable places and communities

Strengthening the role and impact of ill health prevention

Blaenau Gwent

 

 

 

 

 

 

Blaenau Gwent wants everyone to have the best start in life

 

 

 

 

 

 

 

Blaenau Gwent wants safe and friendly communities

 

 

 

 

 

 

 

Blaenau Gwent wants to look after and protect its natural environment

 

 

 

 

 

 

Blaenau Gwent wants to forge new pathways to prosperity

 

 

 

 

 

 

 

Blaenau Gwent wants to encourage and enable people to make healthy lifestyle choices in the places that they live, learn, work and play

 

 

 

 

 

 

Caerphilly

 

 

 

 

 

 

Positive Change – a shared commitment to improving the way we work together

 

 

 

 

 

 

Positive Start – Giving our future generations the best start in life

 

 

 

 

 

 

Positive People – Empowering and enabling all our residents to achieve their own potential

 

 

 

 

 

 

Positive Places – Enabling our communities to be resilient and sustainable

 

 

 

 

 

 

Newport

 

 

 

 

 

 

Everyone feels good about living, visiting, and investing in our unique city

 

 

 

 

 

 

Everyone has the skills and opportunities they need to develop, prosper, and contribute to a thriving sustainable city

 

 

 

 

 

 

Everyone belongs to resilient, friendly, connected communities, and feels confident and empowered to improve their well-being

 

 

 

 

 

 

Newport has healthy, safe, and resilient environments with an integrated sustainable travel network

 

 

 

 

 

 

Monmouthshire

 

 

 

 

 

 

Provide children and young people with the best possible start in life

 

 

 

 

 

 

Respond to the challenges associated with demographic change

 

 

 

 

 

 

Protect and enhance the resilience of our natural environment whilst mitigating and adapting to the impact of climate change

 

 

 

 

 

 

Develop opportunities for communities and business to be part of an economically thriving and well connected county

 

 

 

 

 

 

Torfaen

 

 

 

 

 

 

Develop a functional, connected network of natural areas that support the current and future well-being needs of local populations

 

 

 

 

 

 

Develop mitigation and adaptation responses to the impacts of climate change

 

 

 

 

 

 

Provide children and young people with the best possible start in life

 

 

 

 

 

 

Support healthy lifestyles and enable people to age well

 

 

 

 

 

 

 

Tackle the inter-generational patterns of poverty and develop economic resilience

 

 

 

 

 

 

Improve local skills through work-force planning, training, apprenticeships, and volunteering opportunities

 

 

 

 

 

 

Create safe, confident communities and promote community cohesion

 

 

 

 

 

 

 


 

Annex 2: Examples of linkages between the delivery programmes of Gwent’s PSBs and the ‘Marmot Principles’

Giving every child the best start in life

Enabling all children, young people and adults to maximise their capabilities and have control over their lives

Creating fair employment and good work for all

Ensuring a healthy standard of living for all

Creating and developing sustainable places and communities

Strengthening the role and impact of ill health prevention

GWENT PUBLIC SERVICES BOARD

Delivery of Local Well-being Plans

Flying Start

 

SE Wales Education Achievement Service

Cardiff Capital Region City  Deal

Communities for Work (Blaenau Gwent)

Gwent Green Grid Partnership

Building a Healthier Gwent

 

SE Wales Safeguarding Children Board

Children and Families Strategic Partnership

Cardiff Capital Region Skills Partnership

Caerphilly Academy –Gateway to Employment

Health and Housing Strategic Partnership

Gwent Regional Partnership Board

 

Best Start in Life programmes

21st Century Schools Programme

Regional Economic Growth Partnership

Welfare Reform Group / Partnership

Resilient Greater Gwent

Gwent Healthy Travel Charter

 

Healthy Pre-schools

Gwent Care Career Pathway

Our Valleys Our Future (2016-21)

Financial Inclusion Strategy (Torfaen)

Sustainable Food Partnerships

Resilient Communities (Caerphilly)

 

First 1,000 Days Community of Practice

Learning Network Schools

EU Rural Development Programme

Skills@Work (Monmouthshire)

Caerphilly Cares

Healthy Schools

 

Early Years Integrated Transformation Programme

Early Action Together (All Wales)

CLES Progressive Procurement

Gwent VAWDASV Partnership Board

Sustainable Travel (Newport)

Mental Health and Learning Disability Partnership

 

What Matters Approach

The Iceberg Model

Right Skills Board (Newport)

Reach Restart (Newport)

Climate Ready Gwent Network

Integrated Well-being Networks

 

 

Youth Engagement and Progression Framework (Newport)

The Newport ‘Offer’ / City Centre Regeneration

Employment Support Programmes

Green and Safe Spaces Network (Newport)

Mental Well-being website ‘MELO’

 

 

Digital / Film Careers Sector (Newport)

Economy and Skills Strategy (Torfaen)

 

Gwent Future Scenarios

 

Participatory Budgeting

 

 

Youth Councils

Community Wealth Building

 

Blaenau Gwent Climate Assembly

 

 

 

Operation Encompass

 

 

Gwent Citizens Panel

 

 

 

 

 

 

Placemaking Wales Charter (Newport)

 

 

 

 

 

 

Blaenau Gwent on the Move

 

 

 

Sources:

The Blaenau Gwent We Want Three Years of Progress 2020-2021

Caerphilly PSB Delivery Plan Progress Reports March 2021, Sept2021

Monmouthshire Public Service Board Well-Being Plan Annual Report 2021

Torfaen Public Services Board Annual Report April 2020 to March 2021

Newport’s Well-Being Plan 2018-23 Annual Report 2020-21

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annex 3: Examples of work in Newport City Council