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Foreword by Cllr Chris Garland, Leader of Maidstone Borough Council

Welcome to Maidstone Borough Council’s Health Inequalities Action Plan. This Plan sets outs Maidstone Borough’s plans to tackle health inequalities over the next five years.

Health inequalities are stubborn, persistent and difficult to change. They are also widening and will continue to do so unless we do things differently. This means addressing not only the short-term consequences of avoidable ill-health but also the longer-term causes. The benefits of reducing health inequality are social and environmental, as well as economic. Creating a sustainable future is entirely compatible with activities to reduce health inequalities.

The reasons for health inequalities are complex and tackling them requires concerted action at all levels.  Tackling health inequalities is a key priority of the Maidstone Community Strategy and has been highlighted in the emerging Local Plan that it is an issue that needs concerted action.

No one organisation can tackle health inequalities alone and co-ordinated and targeted action in partnership is at the heart of this action plan. This plan sets out to focus and co-ordinate the actions of a range of partners that will make the biggest difference to reducing health inequalities. Many of these actions are incorporated within partner’s strategic plans and are already in development.

I am confident that this Plan creates the opportunities for sharing good ideas, support and resources helping to make stronger and healthier communities. I look forward to working with you all to ensure that Maidstone becomes even healthier going into the future.

Cllr Chris Garland

Leader of Maidstone Borough Council

Introduction by Cllr John A. Wilson, Cabinet Member for Communities and Leisure Services, Maidstone Borough Council and Chair of the Maidstone Health and Wellbeing Delivery Group

The plan has been developed by Maidstone Borough Council’s Health and Wellbeing Delivery Group who will be responsible for monitoring and reporting on progress to the emerging Maidstone Partnership Board and West Kent Health and Wellbeing Board.

Maidstone Borough is a thriving community to live in. Some parts of the area are amongst the most affluent in England; however close to these we have pockets of deprivation.

We know that social exclusion has a major effect on people’s health and wellbeing, making it much more likely that they will suffer poor health and die earlier than people who live in more affluent areas.

As Chair of the Maidstone Health and Wellbeing Group, our partners have been instrumental in the development of this plan, forming both our strategic and delivery approach to reducing health inequalities based on:

·                Continuing to develop a whole-system approach to health improvement by tackling the underlying causes of ill-health, through improving educational attainment, housing, getting local people into jobs and creating a safe and healthy, sustainable environment;

·                Delivering of short, medium and long-term actions to create sustainable improvements in health. These are based on the evidence of what works to support lifestyle changes and improve the impact of health and social care services on reducing health inequalities; and

·                Targeting areas / priority groups and empowering communities to improve their wellbeing.

As the determinants of good health relate to a broad range of issues, improvements in the health and wellbeing of the local population can only be achieved through effective partnership working.

This plan will need to be refined further over the next year; we need to ensure our actions to tackle the wider determinants recognise their impact on health. We need to move beyond just trying to change individual lifestyle behaviour to empowering communities to improve their wellbeing in a more holistic way.

Cllr John A. Wilson

Cabinet Member for Communities and Leisure Services, Maidstone Borough Council and Chair of the Maidstone Health and Wellbeing Delivery Group

What is Health Inequalities?

Health inequalities are described as the differences in health status between different groups or communities within the population.  At both community and individual level, poor health is linked to social and economic disadvantage and deprivation.  Differences in income, employment, education, housing, social environment and access to services all produce inequalities in health outcome.  Living in areas of low income, poor employment and poor infrastructure increases the risk of ill health.

Health Inequalities in Maidstone

Levels of health and wellbeing in Maidstone are generally good, being largely above national and regional averages.  This position, however, hides some pockets of deprivation and ill health.  The difference in life expectancy at birth of our most affluent wards compared to our most deprived is 8.9 years (figure 1), putting us mid-table when compared to other districts in Kent.

There is a larger difference in life expectancy of men and women; 7.0 years lower for men and 4.4 years lower for women in the most deprived areas of Maidstone than in the least deprived.  Not only does this gap mean that those living in the most deprived areas of Maidstone have a shorter life expectancy, they also have a lower disability free life expectancy than others in our communities.

The neighbourhoods that make up the areas of higher deprivation lie particularly in the electoral Wards of:

·         Park Wood

·         High Street

·         Shepway North

·         Shepway South

Priority focus will be given to work targeting the wider determinants of health in these areas as an attempt to reduce health inequalities within and between our communities.

What this plan will do to tackle health inequalities in Maidstone

The Maidstone Health Inequalities Action Plan sets out aims and objectives that deliver outcomes in the short, medium and long term, based on the 6 priorities for action outlined by Professor Marmot in his 2010 report ‘Fair Society, Healthy Lives’.  Maidstone Borough Council have adopted a strong multi-agency partnership approach; delivering a universal offer which is targeted both in terms of need (vulnerability) and deprivation (geography).

Maidstone Borough Council aims to reduce health inequalities by reducing the gap in health status within and between our communities, by improving health most quickly for areas with high levels of deprivation.  This action plan sets out how all partners will work together to achieve this aim, so that people will live longer in better health, and the variances in life expectancy in Maidstone will reduce.

Who will do what?

The Action Plan provides a framework and tools to identify, analyse and evaluate partnership actions that will contribute to reducing health inequalities in the Maidstone Borough.

Maidstone Borough Council recognises the importance of reducing health inequalities and improving health and wellbeing, a theme that runs through the 3 strategic priorities and 7 key outcomes set out in the Strategic Plan 2011-15.  As such, many of the actions contained in this plan are drawn from service plans and strategies that sit across the council.  This action plan seeks to draw together priorities and actions from across the authority and partners that seek to reduce health inequalities in Maidstone. 

The delivery of this action plan will only be successful if delivered in partnership; crucial to this is the development of the Maidstone Health and Wellbeing Group which will have the responsibility to oversee the delivery of this plan and report progress back to the Kent Health and Wellbeing Board, the West Kent CCG Health and Wellbeing Board and Maidstone Strategic Board.  The Group will own the action plan, but will not be the sole owner of some of the actions contained within it.

Work on reducing health inequalities cannot be tackled alone and needs the support of a wide range of local partners.  With this in mind Maidstone Borough Council held a Health Inequalities Stakeholder day in July 2013 where partners were asked to identify how they could contribute to reducing health inequalities in Maidstone.  The outcomes of the workshop are the actions that are included within this plan.

PRIORITY 1a: Give every child the best start in life (conception to 9 months)

Why is this a priority for Maidstone?

Infant mortality

·         The rate of infant mortality in Maidstone is 3.5 per 1,000 live births compared to the England Average of 4.7. 

·         Deaths in infancy disproportionately affect life expectancy.  Reducing infant mortality in Maidstone would increase overall life expectancy in the borough.

Low birth weight

·         Babies born with a low birth weight may be more likely than babies born at a normal weight to have certain medical conditions later in life.  These include high blood pressure, diabetes and heart disease.

·         4.9% of babies born in Maidstone weigh less than 2.5kg compared to 5.12% in Kent and 7.5% nationally.  However, low birth weight is as high as 11% (more than double the county average) in some wards of the borough.

Smoking

·         Levels of smoking in pregnancy are just under the England average.  Smoking in pregnancy is known to affect both birth weight and incidence of infant mortality and continues to impact on the health of a child.  Rates are disproportionately high in teenage mothers.

Domestic Abuse

·         Domestic abuse is more likely to occur to women in their reproductive years, from lower socio-economic areas and often increases during pregnancy. 30% of new domestic abuse cases in England are pregnant women.

·         A particularly vulnerable group is teenage mothers who are much more likely to be posing considerable risk to both themselves and their babies. They are also highly likely to access services late, potentially further compromising their care. Teenage mothers had a statistically significant higher rate of stillbirths. Postnatally they have much lower rates of breastfeeding at both birth and at 6-8 weeks.

·         The rate of teenage pregnancy in Maidstone is higher than the national average.

Breast feeding

·         Breastfeeding is beneficial for baby and mother with some of these protective effects lasting well beyond the period of feeding. A modest increase in breastfeeding rates could result in a reduction in childhood obesity by about 5% or a decrease of 16,300 obese children nationally.  This in turn would see a reduction in annual health-care expenditures of circa £1.63 million (Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK, UNICEF, 2012).

·         Breast feeding initiation in Maidstone is fractionally under the England average at 74.6%, with only 41.5% of mothers continuing to breast feed at 6-8 weeks. 

PRIORITY 1b: Give every child the best start in life (9 months +)

Why is this a priority for Maidstone?

Obesity

·         Obesity is an important issue in Maidstone; 10.7% of 4-5 year olds are obese, while 20% of 10-11 year olds are obese.  Nationally, 9.4% of 4-5 year olds are obese and 19% of 10-11 year olds are obese.

·         Mounting evidence suggests that a critical period during which to prevent childhood obesity and its related consequences is before the age of five. The best thing we can do for children from 0-5 is create ways of life which continue to make obesity unlikely.

·         Children who live in more deprived areas are more likely to be overweight and obese than those from the most affluent areas. Making what may seem like simple changes to daily habits (physical and nutritional) is sometimes simply too difficult given all the other difficulties many families have to confront.  Maidstone has the highest level of overweight children in reception year in 2011/12 at 16% of children measured.

·         In some of our most deprived wards obesity levels in children aged 4-5 is higher than 12%. 

Immunisations

·         Immunisation rates for under-5s are 91.4% against a 95% target nationally.

·         The national immunisation programme is an essential part of protecting children’s health. Low vaccine uptake puts children at risk. Measles has made resurgence in the UK and the rate of take up of the MMR vaccine in Kent whilst improving, is not at the 95% level recorded by the World Health Organisation as being necessary to prevent an outbreak. Maidstone is currently under the national target 95% coverage rate of childhood MMR immunisations, but performing better than the Kent average of 88.3%.

·         Work needs to focus on supporting those communities with poor access to primary care to take up immunisation for their children.

PRIORITY 2: Enable all children, young people and adults to maximise their capabilities and have control over their lives

Why is this a priority for Maidstone?

Teenage conception

·         The under 18 conception rate for Maidstone is 34.3 per 1,000 girls aged 15-17 each year, compared to the England average of 34 per 1,000 and a county rate of 31 per 1,000.

·         Our most deprived wards have teenage conception rates over 50 per 1,000, with one ward having a rate of over 100 conceptions per 1,000 girls.

·         Teenage mothers under the age of 20 have a 13% higher chance of a stillbirth than mothers aged over 20.

·         The risk of infant death is increased by 47% for mothers aged under 20.

·         Teenage mothers and their children face particular inequalities. The link with a lack of aspiration is significant, young people need the motivation as well as the means to prevent pregnancy and engagement in education through the teenage years is a strong protective factor.

Self harm

·         The rate of admission to hospital for self harm in Maidstone is higher than the national average at 215.3 per 1,000 population.  This measure often indicates mental health stress often in teenagers.

Smoking

·         18.7% of Maidstone’s population smoke compared to the national average of 20%, an increase from 16.6% in 2010/11

·         The rates of smoking are greater in the most deprived wards in the Borough with rates of  more than 35% in parts of Park Wood, Shepway South, High Street and North wards

·         Smoking related deaths are just under the national average at 189 per 100,000 over 35 population.

·         Smoking is a major cause of lung cancer, cardiovascular disease and chronic obstructive pulmonary disease (COPD) and contributes to many other cancers and conditions, such as asthma or high blood pressure.

·         In Kent 39% of 11-15 year olds have tried smoking with 9% self reporting as regular smokers.  Girls are more likely to smoke than boys and the number of teenagers starting to smoke remains a concern.

Alcohol

·         Increasing and higher risk drinking in Maidstone is higher than the national average at 23.9% of the adult population. However, hospital stays for alcohol related harm are lower at 1282 per 100,000 population. 

·         Life expectancy for Maidstone (79.4 years for males and 83.3 for females) is above the England average (78.9 for males and 82.9 for females).

Older people

·         We estimate that there are over 7,000 people aged 65+ in Maidstone who live alone.  Of those, just fewer than 3,000 report their health as being bad or very bad. 

·         There are currently 2118 people in Maidstone suffering with dementia.  This is expected to double over the next 30 years.

·         Falls are a concern to older people.  There has been a 53% increase in the number of falls related hospital admissions in West Kent over the last 5 years.  The age standardised rate for falls related hospital admissions in Maidstone is 2,400 per 100,000 population aged 65+, lower than both the Kent and West Kent rates.

·         Hip fracture in the over 65s in Maidstone is higher than the national average, at 468 admissions per 100,000 compared to 457 per 100,000.

PRIORITY 3: Create fair employment and good work for all

Why is this a priority for Maidstone?

Not in education, employment or training (NEET)

·         The number of 16-18 year olds not in education, employment or training in Maidstone is 6%. 

·         Research has shown that not being in employment, education or training (NEET) between the ages of 16 and 18 is a major predictor of future unemployment, low income, teenage parenting and poor health. Young people who are NEET are also 5 times more likely to enter the criminal justice system, with the life-time cost to the state of each young person who is NEET standing at £97,000.

Employment

·         The number of young people between the ages of 18 and 24 who are unemployed in Maidstone is 4.1%.

·         Young people continue to be disproportionately affected by the economic downturn with those aged 18-24 making up the biggest proportion of unemployed in the KCC area. Again areas of deprivation are experiencing the biggest impact and the social gradient can be clearly demonstrated.

·         Unemployment in Maidstone stands at 2.7% (measured as JSA claimants).  Slightly higher than the 2.4% rate for Kent, but below the national average of 2.9%

·         The average earnings for full time worker in 2011 were lower in Maidstone compared with the national average.  The average weekly earnings in England were £520, in the South East £550, in Kent £540 and in Maidstone £500

PRIORITY 4: Ensure a healthy standard of living for all

Why is this a priority for Maidstone?

Deprivation

·         The level of deprivation in Maidstone is low with only 7.2% of people living in the 20% most deprived areas in England.  However, the borough-wide picture hides pockets of deprivation in key wards.

·         Deprivation is associated with a cluster of health problems including higher levels of unhealthy weight and obesity, physical inactivity, smoking, poor blood pressure control, and other factors that effect physical health. It is also integral to lower educational attainment, lack of employment opportunities, poor housing status, poor access to services, referral differences of practitioners and poor compliance with disease management.

·         In Maidstone the average house price is £229,099, lower than the region (£281,148) and England (£242,415) averages.

·         Low income has far reaching implications of health including long term health and life expectancy

Child poverty

·         Child poverty in Maidstone is relatively low at 15.2%. This compares to a Kent rate of 17% of children living in poverty, and a national figure of 21%.  This has a detrimental impact on children and their families.

Fuel poverty

·         In 2011 Maidstone Borough Council had 10.8% fuel poor households (6,694 out of 61,845 households). This was below the Kent Average of 13.1% and the South East average of 11.5%.

·         The people most likely to die or become ill during the cold weather are those least able to afford to heat their homes. For every one degree Celsius that the outdoor temperature falls below the winter average, there are an 8,000 extra winter deaths in England. This would equate to an estimated 240 deaths across Kent. Living in a cold home can lead to or worsen a large number of health problems including heart disease, stroke, respiratory illness, falls, asthma and mental health problems.

·         We aim to provide access to affordable warmth through local initiatives which will contribute to reducing levels of fuel poverty in the borough.  We will have regard to government targets to reduce fuel poverty by 2016. ((UK Fuel Poverty Strategy 2001)(Reduction by baseline 2010 NI187)).

·         We will take advantage of any government initiatives (financial assistance and other benefits) for energy efficient measures and tackling fuel poverty.

PRIORITY 5: Create and develop healthy and sustainable places and communities

Why is this a priority for Maidstone?

Homelessness

·         Rates of statutory homelessness in Maidstone are 3.1 per thousand households, higher than the England average of 2.3.

·         Our latest figures show almost double the number of people in temporary accommodation than our target of 15 at our monthly snapshot.

·         Homeless households in temporary accommodation suffer greater health inequalities.  Issues range from losing touch with primary healthcare providers through changing addresses, increased mental health issues due to losing support and social networks, to reduced achievement and increased difficulties in school by young people living in unsettled accommodation. 

·         The average length of stay in temporary accommodation in Maidstone was over 8 weeks in quarter 3 2013/14, against a target of 6 weeks. 

·        

Crime and Antisocial behaviour

·         The most recent strategic assessment shows that all crime in Maidstone fell by 12.9% from October 2011 to September 2012.  This compares with a fall of 0.6% in the previous year.  With the exception of the percentage of domestic violence repeat victims and shoplifting, levels of crime of all types reduced, with the largest percentage reductions being seen in criminal damage, drug offences, robbery and motor vehicle thefts. The decrease in crime in 2011/12 has meant that Maidstone has improved its position relative to other Kent districts from 8^th place county-wide (62.1 crimes per 1,000 population), to 5^th place (53.2 crimes per 1,000 population).

·         The violent crime rate for Maidstone in 2012/13 was 11.10 compared to the England average of 13.6.

·         The number of first time entrants in to the youth justice system is 13.7%.

Air quality

·         We will work to implement the Maidstone Borough Council Carbon Management Plan to reduce carbon emissions from our activities by 2014-15 by 20% compared to 2008-9 baseline.

PRIORITY 6 Strengthen the role and impact of ill health prevention

Why is this a priority for Maidstone?

Obesity and physical activity

·         Maidstone has slightly higher rates of healthy eating and physical activity compared to England as a whole.

·         60.9% of adults in Maidstone participate in at least 150 minutes of physical activity per week.  However, this hides some pockets of inactivity in the borough.

·         66.2% of our population is either overweight or obese, higher than the national average of 63.8%.

·         26% of our population is obese, which puts Maidstone in the top 20% of Local Authorities with the highest levels of obesity.

·         Access and choice in making healthy food choices are very much more limited in the areas of greatest deprivation.  There are more take aways in the most deprived areas of Maidstone, as compared to the most affluent.

·         Obesity can contribute to a range of health conditions, such as heart disease, high blood pressure, diabetes, indigestion and some cancers. Adult and child obesity levels are becoming an increasing issue for the health service, as greater numbers of people put on extra weight, through poor diet or insufficient exercise.  Obesity is far more prevalent in disadvantaged groups.

Mental Health

·         Hospital stays for self harm are higher in Maidstone than the national average at a rate of 215.3 per 100,000 population.

·         There is a social gradient in self-harm and some wards present a significantly higher rate of self harm and suicide than Maidstone generally.

Malignant Melanoma

·         The incidence of malignant melanoma in Maidstone is higher than the national average at a rate of 19.4 per 100,000 under 75.

·         It is unclear if this is related to a higher use of sun beds, or exposure to sun and further work needs to be undertaken to establish the best way to tackle the high malignancy rate.

Targets

Glossary of terms