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- Types of inequalities in Suffolk
Types of inequalities in Suffolk
How long you live and how many years you live without disability or illness depends on many different factors.
As we’ve discussed health inequalities are complicated and often overlap for one individual or a community. A helpful way to think about it is set out in the picture above which comes from Public Health England: Local Action on Health Inequalities. This framework looks at both inequalities that people can experience due to their identity or specific at risk group they are associated with. Other inequalities are described are based on economic or ‘wider determinants’, or based on location.
It’s important to note that one person can experience health inequalities due to lots of reasons: it’s one reason why understanding them and tackling them is difficult. We are not saying any of these inequalities are more important than each other, and we know that individuals often deal with several together, but using this framework allows us to look at each area separately in order to help everyone’s understanding of these difficult concepts.
A person’s position in society is one of the key factors that determines their health – and it follows a clear pattern: while there are always exceptions at an individual level, broadly speaking, the richer you are, the more opportunities you have had, and therefore the better your health will be. This pattern follows a clear gradient – at every level, higher socio-economic positions correlate with better health. Health inequalities therefore apply to the vast majority of us, not just those right at the top, or right at the bottom of the socio-economic scale. In addition they are experienced across our lives – from birth and childhood, through to old age.
Many physical and mental health conditions are closely linked with socio-economic factors, and those from poorer backgrounds will spend more time in ill health, and have shorter lives in comparison to those who come from more affluent backgrounds. This has been shown to be the case across the country.
Suffolk has a smaller proportion of people living in areas of greatest deprivation compared to the English average, but there are still 10.5% of our residents that do: equating to 1 in every 10 people in our county. For those that live in the most deprived areas in Suffolk, the data suggests there has been little improvement in the last 10 years. These most highly deprived areas of tend to be concentrated in urban or town-based communities, but there is also evidence of deprivation to be found in very small areas of Suffolk, for example one street within otherwise well-off neighbourhoods.
Using 2016-18 figures, men from the most affluent areas in Suffolk have a current life expectancy from birth which is nearly 7 (6.9) years more than those from the most deprived areas, and for women it is nearly 5 (4.8) years more (PHE Fingertips). These are smaller gaps than many of our regional neighbours and the England figure, but we need to try to reduce them.
Healthy life expectancy in Suffolk is also lower for those who are born in areas that are more deprived. Although our situation is better compared to the national average, there is some evidence that this is declining. An increasingly ageing population may increase the risk of more health inequalities for our residents – and lead to more pressures on services.
At the moment we do not fully know what the impact of COVID-19 will be for our county’s long term health and health services, economy, or the wider environment. However, some key points were raised by those from our community who contributed to this report. They spoke about four key themes: opportunities, access, sufficient income, and education. As Nathen highlighted – it’s easier for some people to do an office based job if they have the necessary education level to secure that job, and that’s not possible for everyone.
Since we know that health is affected by lots of things - jobs, education, housing and income - coming from a deprived background is going to increase the risk of someone experiencing poor health and health inequalities. Our recommendations reflect the need for a good understanding of our specific situation in Suffolk, involving all those important areas, and how they affect everyone. We must work with partners, communities and decision makers to maximise our resources and agree how we address the many varied and complicated factors that make up the inequalities of health - for all our residents.
Good project examples:
Some examples of the work you have achieved in Suffolk...
Socio-economic: Financial Hardship during COVID-19
Key Point: Small changes can make a big difference
Existing organisations who provide funding for, and provision of, household items (furniture and white goods) welcomed the proposal from the Collaborative Communities Board to work together and to develop a new Local Welfare Assistance Scheme. Organisations across Suffolk have signed up to make referrals to the Local Welfare Assistance Scheme (LWAS) which has been put in place to provide support for those who are in extreme financial hardship due to the response to COVID-19. To date (1st November 2020), 337 referrals have been submitted by professionals on behalf of clients to access household items, white goods, fuel vouchers, and supermarket vouchers.
Socio-economic: Tackling poverty in and around Haverhill
Key Point: Timely and responsive support can help people get back on their feet
Reach Community Projects have been supporting those most vulnerable and in poverty, people in debt, low income and homelessness, those who have had a relationship breakdown, low aspiration, experienced marginalisation, poor health and low self-esteem in Haverhill. Reach have been helping people at times of crisis and within a quick time frame, stating they are "helping people who slip through the nets".
Case Study:
A young parent and their young toddler were recently re-housed in Haverhill; they had been a victim of domestic violence and needed to flee their home. They arrived in Haverhill with no furniture whatsoever. Both were having to sleep on the floor, there was no money to buy food and the only means of cooking was a kettle for packet soups or instant noodles; not ideal for anyone let alone a child. We were able to help straightaway with food and a new microwave and within 24 hours we were able to get a bed, sofa & fridge and just a few days later we were able to get another bed and a cooker installed too. We were so pleased to help this family in a time of real crisis. The parent was so very pleased and said “we had made their house feel like a home!”
Protected characteristics is the term given to the group of factors that may make an individual more at risk of poor health or of experiencing health inequalities. Some of them are fixed such as ethnicity, but others may change over a person’s lifetime. Examples are: women may experience greater health risks when they are pregnant; and we all face different health challenges as we get older. Some of these risks have been observed more fully during the COVID-19 pandemic, when certain groups in our society have been more affected by the virus and its complications. Those from minority ethnic groups, people with learning disabilities and older people in our communities have been shown to have a higher risk of poor outcomes after contracting COVID-19. You will see some of these COVID-19 experiences described in the artwork of children showcased in other parts of this report.
In Suffolk, a larger proportion of our population are retired compared to the national average. This is forecast to increase significantly in the coming decades.
We also currently have a lower proportion of younger people compared to the England average and a lower proportion of the population who identify themselves as coming from minority ethnic groups compared to the national average.
One of the key points across the protected characteristic groups is the importance of good local data. Some of the facts we’ve discussed in our report come from the last census which was 10 years ago. There are few other reliable sources and although this is true across the country, not just in Suffolk, improving data sources locally would make organising and delivering services more accurate and better matched to the need in our communities. Another Census was held in March 2021 and was a key opportunity for people to update our knowledge (the data is scheduled to start being published from Spring 2022 and we'll be sharing it via this website and the Suffolk Observatory).
People are more than just a collection of facts and figures, and hearing from individuals like Gulshan and Lanai highlighted the importance of including everyone and preventing groups from feeling left out or unsupported. Outreach Youth and Suffolk Refugee Support are organisations represented in our good project examples section, they show that by actively knowing your community you can provide support in the most beneficial way. As these organisations both show, this does not have to involve big changes, it can be done by the way we communicate or how we adapt our services to become more supportive and inclusive to the needs of different communities. One size does not fit all. Active participation with communities is a key and you’ll see in our recommendations there are resources to both identify and act on issues of health inequality in your community.
Good project examples:
Some examples of the work you have achieved in Suffolk...
Protected Characteristics: Age
Key Point: Co-production is a key element to understanding need
HealthWatch Suffolk on behalf of the Sustainability and Transformation Partnership Board conducted a research project into what it's like to live in a care home in Suffolk to capture what was working well and what could be improved. The surveys were created in co-production with residents in local care homes and also their friends and relatives. Surveys were collected from those living in care homes and their relatives, as well as the professionals supporting in care homes. The findings from this report are being shared with Suffolk County Council, Suffolk Clinical Commissioning Groups and the Care Quality Commission.
Protected Characteristics: Ethnicity
Key Point: Providing asset-based support and ensuring translated information is available
Suffolk Refugee Support transformed their services during COVID-19 where a skills-exchange programme was used to help clients. The service helped clients who felt confident to lead on Zoom calls to help other clients on health advice including activities and sharing recipes. WhatsApp was used to share information on COVID-19 updates translated into main client languages. The Sports Group Leader at Suffolk Refugee Support set fitness challenges for the young men we support and made videos for them around home workouts, healthy eating, scams awareness and how to avoid exploitation. These were shared on the service's own YouTube channel to help others.
Protected Characteristics: Ethnicity
Key Point: More of the same is not an option
Workshops were held led by the ethnic minority community where system leaders listened to the communities and their experiences. The #WhatAreWeMissing events were held virtually both in East Suffolk and West Suffolk where residents of Suffolk's ethnic minority communities highlighted many key points where they felt invisible in decisions that affect them and areas needing improvements including; co-production and shaping services together. System leaders made pledges and commitments on the day on how they were going to take action.
Protected Characteristics: Sexual Orientation
Key point: Supporting each individual in a way which best suits them
Outreach Youth have been supporting young people and their families who identify as LGBTQ+. The support provided does not have a time limit or a maximum number of sessions, it is a person-centred approach. Since COVID-19, many of the sessions were moved to online zoom calls or telephone to continue the support and young people attending the youth groups have increased during lock down. For some clients, zoom calls were not their preference as they did not like being in front of the camera and in these cases they were offered alternative method of support. Outreach Youth also facilitate a peer support group via Facebook and this has been useful for families to contact each other and gain peer support especially during COVID-19.
Suffolk is a rural county; and while this can bring physical and mental health benefits for many it also presents challenges. For example, those who live in small villages, may find accessing services is more complicated than for those people living in large towns where transport is more available, and they may also feel more isolation and loneliness. Our residents Jill and June summed up the situation: describing the beautiful places Suffolk offers to its residents, but also the possible difficulties people can face. What this digital report shows is both the assets and challenges we have, and how they can affect our health and wellbeing.
We also need to remember our residents who live in towns. They too may be at risk of loneliness and socially exclusion as well as a greater risk of noise and air pollution. Balancing the needs of different areas in the county goes part way to explain why designing many types of service is challenging in Suffolk, not just health services. We need to think about ways to answer those questions involving all the organisations that can help – particularly as we eventually move to recovering from the COVID-19 pandemic.
One effective approach is giving the leadership back to our residents. Some communities have addressed their health inequalities by taking asset-based approaches which utilise the skills in local communities. An example of this is Connected Communities project in our good project examples.
Like the socio-economic section of this digital report, a key point to highlight from this section is that several areas in Suffolk were measured as more deprived in 2019 compared to 2010. The reasons for this are not always clear but it is a situation which is concerning. One thing this report notes is that local data is key to addressing health inequalities. Please look at the data about the individual wards in Ipswich for instance and other place-based needs assessments. Having data at a local level can demonstrate the differences and challenges in our community that are often masked or hidden in bigger datasets. This report recommends that addressing health inequalities requires an approach that focuses on people and their immediate communities and surroundings. You can find out more about this on our commitment to change page: supporting resources section, where you can view the toolkit to addressing health inequalities at a local level where communities working in active participation with organisations can together create change.
Good project examples:
Here are some examples of the work that have been achieved in Suffolk...
Geography: East Suffolk
Crucial Point: Taking an Asset-based approach asking the question "What matters to you"
Suffolk Family Carers ran "Connected Communities", a project using social prescribing to support older people in their community, as often these people find access to services difficult due to factors including mobility and transport limitations. The service was that asset-based, building on local support and putting the older person at the centre. The ethos of this way of working can be captured by the staff asking; “What matters to you?” and not “What is the matter with you?” During COVID-19 the project offered zoom calls.
Geography: Across Suffolk
Crucial Point: Learning "how to adapt to a ‘new world’ and finding new ways to reach out to our communities to keep them connected and supported"
Physical library spaces in Suffolk were closed throughout the early stages of lockdown, but Suffolk Libraries quickly adapted to provide services to customers in different ways. Staff delivered filmed activities through social media, and introduced new online services including podcasts and streaming sessions. Staff also were involved in community volunteering and a new telephone service - Suffolk Lifeline - which was set up to support older and more lonely customers to check on their well-being and provide some much-needed social interaction.
"Staff at Gainsborough Community Library have worked alongside a local food bank preparing and delivering food parcels to over 250 families every week. Members of our team set up and delivered the Suffolk Lifeline telephone and email support services, making around 8,000 calls during lockdown and beyond".
To find out more, you can visit BBC News which has a feature on how libraries in Suffolk provided a lifeline in lockdown.
Our digital report has highlighted only a couple of examples of groups at particular risk of health inequalities in Suffolk. You may be wondering why that is.
The information we have on groups at risk of disadvantage is often limited to national data, which can be out of date, or incomplete. We do collect specific data through our Suffolk-based services and organisations, but the information is often not configured in a way that tells the right story. Reasons for limited useful local data can be due to the way in which the data is organised or collected, but it is also the case that many people do not wish to disclose some information for fear of consequences to themselves and their families. This is a concern and is a recommendation of this report that ongoing work on local data is important for the future.
Similar, to the section on protected characteristics some of the key themes highlighted by people we spoke to, was their wish to be included and feel supported. COVID-19 has focussed attention on several health needs for people within disadvantaged groups. Ian, for example, mentions how he is now in a much better situation due to having a permanent house because of the pandemic response. Others, like Darren and Becky, who are homeless have found the COVID-19 situation very difficult in terms of their physical and mental health. The importance of local community assets as sources of information and support is clear and demonstrated in the comments made by our Suffolk residents, as well as the good project examples set out in our health inequalities sections. Building on community conversations, actively listening, and working with communities of need is vital to reducing health inequalities and is an important recommendation within this report.
Good project examples:
Some examples of the work you have achieved in Suffolk...
Group: Families with young children
Key Point: COVID-19 can make it all more difficult, providing support can be like a lifeline to families.
Home-Start, a charity made up of a local community network of trained volunteers and experts supporting families with young children through challenging times. During COVID-19, telephone support has been provided where visits could not be made and this has often felt like a lifeline for families. To listen to Helen, a single parent in Ipswich, and Mandy, a Home-Start Volunteer, you can watch the BBC Look East Video Home-Start clip on what is has been like for families during COVID-19.
Group: Carers supporting those living with dementia
Key Point: "Even during the best of situations living with dementia and caring for the person with dementia can be stressful. With the added challenge of a pandemic, this can make it a whole lot harder" - Suffolk Family Carers
Suffolk Family Carers developed a bespoke project during COVID-19 with grant funding from Suffolk Community Foundation. Caring for Dementia with Confidence – Problem Solving in the Home provided tools and strategies to support and help carers "deal with their own, and their cared for's, stress (and stress experienced by other family members) to enable them to cope" during COVID-19.
“I really wanted to convey how fantastic it is to have people like yourself who are proactive, kind and helpful, advising us when we really are uncertain what to do, as we can feel in a rut, and finding life difficult on so many levels as dementia is very challenging on all the family, particularly when we very close as we are.” (A family carer in Suffolk).
Group: Individuals in Suffolk who do not have access to digital technology (Digital Exclusion)
Key Point: One method does not suit all
Healthwatch Essex and Healthwatch Suffolk were funded to lead on a project on the impact on digital health and care services. Many of the ways people receive advice or services have changed to online appointment systems or virtual consultations. COVID-19 has allowed some people to access services that they were previously not able to access before, however for others it has meant they have felt isolated because they have been unable to access the services moving to online. This work is ongoing and part two of this work will involve co-production with the community.
Group: Individuals who were shielding or were not able to access support during COVID-19
Key Point: "A wonderful piece of partnership working, all working with the same aim and a clear vision" - Gemma Levi, Specialist, Localities and Partnerships
The Home But Not Alone Service was developed and live within two days. The service was developed to support those shielding to be able to access food, including emergency food parcels, and also medication. It was able to match people shielding with volunteers using the Tribe App and community teams. Contracts with community transport teams (who would normally taxi 11,000 children around the county that could not take place) were utilised to help deliver food parcels to those who were shielding and had no-one else to support them. Food was initially the main reason people called the helpline, this then moved more towards medication and also more concerns around mental health and emotional wellbeing. The service worked with districts and boroughs and many community organisations across Suffolk to ensure residents were able to get the support they needed.
Case studies:
An elderly woman, who lives alone, needed help with her medication delivery which was arranged for the longer term. She was also offered the number of a nearby befriending service which she was very happy to accept.
A social worker contacted Home But Not Alone with concerns for a couple she works with. They live in temporary accommodation and needed a food delivery that day. An emergency food package was arranged for the same day and provisions were made with a local shop to take payment over the phone for longer-term support. The social worker was grateful for the help received.
A neighbour raised concerns about an elderly man who she hadn’t seen for a while. The team at Home But Not Alone made contact with him and he reassured the officer that he was getting help from friends and family with food deliveries. The phone line details were left with him in case he needed help on another occasion and he was very thankful for the support offered.