Title: Update
paper on ‘Gwent: Marmot Region’
Paper sponsor:
Dr Sarah Aitken, Executive Director of Public
Health and Strategic Partnerships, ABUHB
Paper authors:
Richard Lewis, Principal Public Health Practitioner,
PHW
Stuart Bourne, Consultant in Public Health, ABUHB
Date: 30th June 2022
1.0 At its meeting on 10th
March 2022, Gwent Public Services Board (PSB) formally agreed to become a
‘Marmot Region’, and to work in partnership with the Institute of Health Equity
(IHE) to address the social determinants of health. It was also agreed to align the ‘Health and
Well-being/Inequalities’ theme of the PSB Well-being Plan Response Analysis
with the Marmot Principles.
1.1 The purpose of this paper is
to up-date Gwent PSB partners on progress in establishing a Marmot Region programme,
and to seek PSB endorsement to establish a sub-group of the PSB to lead and
coordinate this work. This paper also
provides a summary of recently published data on childhood obesity and life
expectancies which adds to the body of data highlighting the importance of
addressing health inequalities in Gwent.
2.0 Under the leadership of the Director of Public Health (DPH), Aneurin
Bevan Gwent Public Health Team (ABGPHT) is coordinating the implementation of
the Marmot Region proposal. The proposal
paper agreed by Gwent PSB on 10th March 2022 can be accessed here: https://www.gwentpsb.org/wp-content/uploads/2022/03/03-Proposal-Gwent-Becoming-a-Marmot-Region.pdf
2.1 Development of the implementation plan is being undertaken in
consultation with Gwent PSB members, Gwent Strategic Well-being Action Group
(GSWAG), Gwent PSB Engagement Group and PSB Secretariat.
2.2 On 7th
December 2021 Gwent PSB agreed to adopt the six Marmot Principles as the framework
for action to reduce health inequalities across Gwent as part of the
forthcoming Gwent PSB Well-being Plan. The health and well-being / inequalities response
analysis paper is aligned to the Marmot Principles for approval separately on
the 30th June 2022 PSB agenda.
The six Marmot Principles are:
· Give every child the best start in life
· Enable all children, young people and
adults to maximise their capabilities and have control over their lives
· Create fair employment and good work
for all
· Ensure a healthy standard of living for
all
· Create and develop healthy and
sustainable places and communities
· Strengthen the role and impact of
ill-health prevention
3.0 Childhood
obesity (& overweight) has both immediate and long-term consequences. Increasingly, obese children are being
diagnosed with a range of health conditions previously seen almost exclusively
among adults such as diabetes, high blood pressure, bone, joint and respiratory
problems. Overweight or obesity in childhood can also result in serious
psychological difficulties due to bullying and low self-esteem. Some of these problems can persist
into adulthood, resulting in longer periods of poor health and a shorter life
expectancy compared with children of a healthy weight.1
3.1 Public Health Wales has
recently released the first set of data on children’s weight since 2018/19.2
The figures for 2020/21 demonstrate a significant rise in the average rate
of obesity among 4-5 year old children in the Gwent (Aneurin Bevan University
Health Board) region, up from 11.8% in 2018/19 to 18.3% in 2020/21. This 6.5 percentage point increase means that,
in 2020/21, an estimated 1,097 4-5 year olds in Gwent started school already
obese.
3.2 There is wide inequality in the rate of childhood obesity at
local authority level in Gwent (Figure 1). When the figures are analysed by
socioeconomic status, the extent of the gap is even wider. There is an almost eight percentage point
difference in child obesity rates between the most and least deprived population
quintiles in Gwent (Figure 2).
3.3 In June, Public Health Wales
published new data on the inequality gap in life expectancy and healthy life
expectancy in Gwent.3 For both men and women, the inequality gap in
life expectancy has remained unchanged, and there continues to be a seven year
gap for men and a six year gap for women (Figure 3). 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 (Figure 4).
Figure 1: Percentage of children aged
4 to 5 years with obesity, Gwent local authorities, 2020/21.
Source:
Public Health Wales
Figure 2: Percentage of
children aged 4 to 5 with obesity, deprivation fifths, Aneurin Bevan University
Health Board, Child Measurement Programme, 2020-21
Source:
Public Health Wales
Figure
3: 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
4: Healthy life expectancy at birth (years), most vs least deprived quintiles,
Aneurin Bevan University Health Board area, 2011-13 to 2018-20Source: Public Health Wales
4.0 The fact that the inequality
gap in life expectancy and healthy life expectancy has, at best, persisted
unchanged in Gwent throughout the last decade reinforces the PSB’s decision to
become a ‘Marmot Region’ to enable a concerted, whole system response to
address this issue. The widening of the
inequality gap in health life expectancy for women is particularly concerning,
with women resident in the most deprived parts of Gwent living, on average,
just 48 years of life in good health.
4.1 This paper proposes the
establishment of a Gwent Marmot Region Programme Leadership Group to provide
leadership and partnership coordination in implementing the Marmot Region programme. The Group will consist of PSB members with
the delegated authority to make decisions on behalf of Gwent PSB relating to
programme implementation, including communications and engagement. It is needed to maintain the pace of work in
2022/23 with IHE as they help Gwent to establish itself as a Marmot Region in
the next twelve months. A draft Terms of
Reference for the Leadership Group are included in Annex 1 for Gwent PSB approval.
4.2 The Leadership Group will be
supported by a programme team within the Aneurin Bevan Gwent Public Health Team
(ABGPHT) under the leadership of the Director of Public Health. Three fixed term posts have recently been put out to advert to support this work in 2022/23.
4.3 Since the 10th March PSB meeting,
a contract has been signed between IHE and ABUHB to formally establish IHE’s
role working with Gwent PSB to develop its plan to address each of the Marmot Principles.
A Service Level Agreement is also due to be signed, which will formalise the
work-packages in the proposal.
4.4 A working timetable has been developed for
the delivery of the work packages with IHE so that work can commence from IHE’s
start in June. This is included in Annex 2 for information. Preparatory meetings with IHE have been taking
place since 10th March to shape these outputs. A briefing of
Wales/Gwent specific data sources is being prepared by the ABGPHT programme
team to assist IHE with its data analysis.
4.5 The PSB’s Engagement Group will support the building
of the stakeholder invitation list to support participatory events in Gwent. Planning
of the events is being informed by the approach and lessons learnt from the
involvement programme that followed publication of the ‘Building a Healthier
Gwent’ DPH Annual Report in 2019.
4.6 Learning from the experience of the Cheshire and Merseyside
‘Marmot Community’, there is a need to strengthen business sector involvement
and collaboration in the Marmot programme in Gwent. The business sector has a
key part to play in improving the social conditions that affect health and
health equity, including employment conditions, goods and services, and wider
impacts.4 Engagement with this sector will be progressed via the
Marmot workshops in the autumn, to which representatives of Cardiff Capital
Region, South Wales Chamber of Commerce, CBI Wales and FSB (Federation of Small
Businesses) in Wales will be invited.
5.1 In May 2022, IHE published its final report
‘All Together Fairer: Health Equity and the Social Determinants of Health in
Cheshire and Merseyside’.5 It presents recommendations across the
‘Marmot 8’ Principles and system-wide recommendations.
5.2 The ‘Marmot 8’ Principles
include the addition of two new additional Marmot Principles to the original six,
which are:
·
‘Tackle racism, discrimination and their outcomes’
·
‘Pursue environmental sustainability and health
equity together’.
5.3 As a consequence, this paper proposes Gwent PSB extends its decision
to adopt the Marmot Principles to include these two additional principles. The
latter principle is consistent with Gwent PSB’s theme of ‘Environment (Climate
and Nature emergencies)’ in its Response Analysis.
5.4 As an indication of the recommendations that may
arise from adopting the 8 Marmot Principles as the framework for the Gwent
Marmot Region programme, the system-wide recommendations arising from the
Cheshire and Merseyside Marmot Region programme are:
1.
Increase and make
equitable funding for social determinants of health and prevention.
2.
Strengthen
partnerships for health equity.
3.
Create stronger
leadership and workforce for health equity.
4.
Co-create
interventions and actions with communities.
5.
Strengthen the role
of business and the economic sector in reducing health inequalities.
6.
Extend social value
and anchor organisations across the NHS, public services and local authorities.
7.
Develop social
determinants of health in all policies and implement Marmot Beacon indicators.
6.0 A draft communications and engagement strategy is being developed
to promote Gwent PSB’s decision to become a Marmot Region and to illustrate how
people can get involved. Development of
the strategy is being co-ordinated by ABUHB’s Strategic Head of Communications,
Population Health.
6.1 This paper proposes in principle, the Gwent Marmot Region
communications and engagement strategy should:
· Follow the Chartered Institute of Public Relations’
communication principles of Transparency, Support, Honesty and Trust, and
Accessibility
· Be developed collaboratively with the PSB’s
Engagement Group and Secretariat
· Be informed by the experience of other Marmot local
approaches, particularly Cheshire and Merseyside
· Develop an evidence based narrative on the action
needed to reduce inequalities, particularly the move from individual
responsibility towards collective, whole-systems responsibility
· Tailor its key messaging and tone of voice to a
variety of professional and community audiences.
Gwent PSB is asked:
7.1 To NOTE the
recent data on childhood obesity and life expectancies in Gwent and the
widening inequalities in both measures (Section 3)
7.2 To AGREE to the establishment and terms
of reference for a Gwent Marmot Region Programme Leadership Group (para 4.1 &
Annex 1)
7.3 To AGREE to
include the two additional Marmot Principles as the framework for action to
reduce inequalities across Gwent, bringing Gwent into line with current
approach of eight Marmot Principles (para 5.2)
7.4 To AGREE the
principles for the Marmot Region communications and engagement strategy (para
6.1)
7.5 To NOTE the
timetable of work (Annex 2)
References
1. https://post.parliament.uk/research-briefings/post-pn-0640/
3. https://phw.nhs.wales/news/inequalities-in-life-expectancy-on-the-increase-in-wales/
4. The Business of Health Equity: The Marmot Review
for Industry - IHE (instituteofhealthequity.org)
5. Champs
| Public Health Collaborative (champspublichealth.com)
Annex 1: Gwent
Marmot Region Programme Leadership Group – DRAFT Terms of Reference
Gwent Marmot Region Programme Leadership Group
Terms of Reference (v0.4)
Role:
The role of the Gwent Marmot Region
Leadership Group (‘the Group’) is to provide leadership and partnership
coordination to establish Gwent as the first ‘Marmot Region’ in Wales. The Group will consist of PSB members with
the delegated authority to make decisions on behalf of Gwent Public Services
Board relating to matters of establishing the Gwent Marmot Region programme in
2022/23. This will provide a mechanism
to ensure that work progresses at pace and in a way that is coordinated across Gwent
partner organisations.
The eight Marmot Principles are:
· Give every child the best start in life
· Enable all children, young people and adults to
maximise their capabilities and have control over their lives
· Create fair employment and good work for all
· Ensure a healthy standard of living for all
· Create and develop healthy and sustainable places
and communities
· Strengthen the role and impact of ill-health
prevention
·
Tackle racism, discrimination and their outcomes
·
Pursue environmental sustainability and health equity
together
Approval of the eventual recommendations and
actions to address the Marmot Principles will sit with Gwent Public Services
Board. The focus of the Leadership Group
is the quality of the process that develops the recommendations.
Responsibilities:
·
To make decisions
relating to the development of a Gwent-wide response to the eight Marmot
Principles, ensuring the process to develop an action plan is robust and valid.
·
To agree and
oversee delivery of all aspects of the Marmot Region programme plan for
2022/23.
·
To agree and
oversee delivery of all aspects of the Marmot Region communications and
engagement strategy for 2022/23.
·
To ensure actions
are delivered on time and in accordance with the programme plan and
communications and engagement strategy in 2022/23.
·
To oversee the
development of a set of recommended actions arising from the Gwent Marmot
programme for consideration and agreement by Gwent PSB.
·
To monitor any
risks to delivery and provide a forum to resolve escalated issues.
·
To receive and
note Marmot Region up-date papers from the Gwent Marmot Region Programme Team
(ABGPHT) in advance of each meeting of Gwent PSB.
Membership
Chief Executive, Monmouthshire County Council
(Joint chair)
Chief Executive, Torfaen County Borough
Council (Joint chair)
Chief Executive, Tai Calon Community Housing
Chief Executive, Gwent Association of Voluntary
Organisations
Executive Director of Public Health and
Strategic Partnerships, Aneurin Bevan University Health Board
Deputy Director - Prosperous Futures Division, Welsh
Government (Observer)
Officers from the Gwent Marmot Region
Programme Team (ABGPHT) will be in attendance. Secretariat will be provided by
Aneurin Bevan Gwent Public Health Team (ABGPHT).
Governance:
The Gwent Marmot Region Leadership Group will
take the form of a sub-group of Gwent Public Services Board with a specific
remit to lead work to agree a set of recommended actions for Gwent PSB to
address the eight Marmot Principles.
The Group will report on progress to Gwent
Public Services Board at each meeting during 2022/23.
Frequency:
Meeting frequency and how the Group meets will
be decided by the Group members, but is anticipated to be at least monthly and
to continue up to June 2023.
Date of review of terms of reference: December 2022.
Annex 2: DRAFT working timetable for the delivery of
the work packages with Institute of Health Equity (v10)
Please see the
Excel spreadsheet attached.
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