Community health profiles in England

Dr Claire Bradford has years of expertise on writing on issues of community health and health improvement. Here, she broaches the subject of community health profiles and their impact on neighbourhoods.

Introduction

Health is vitally important to everyone. In every local authority there are inequalities in health between different communities. Local authorities have a major role in improving the health of their communities.  For example improvements in education and youth services can lessen teenage pregnancy rates; and bringing in byelaws banning smoking on certain premises can reduce smoking related ill health and early deaths. The creation of cycle lanes and improving leisure services can increase physical activity levels.

In recognition of the influence local authorities have over health, comprehensive performance assessment now assesses local authorities on their action taken to reduce inequalities among their residents.

But how do councillors and their officers find out about residents’ health in their area? Sir Derek Wanless’s report on the NHS in 2004 observed that:

“Health data is essential for monitoring the health of the population and for evaluating the effects of health interventions. Yet the information collected nationally is often poor and there is no regular mechanism by which a primary care trust (PCT) or a local authority can gather reliable information on its own population.”

The Choosing Health White Paper made a commitment to produce English local authority based Health Profiles that will be updated annually. The Association of Public Health Observatories (APHO) produced the first health profiles in 2006.

Health profiles 2006

The aims of the health profiles were:

• to provide a consistent, concise, comparable and balanced overview of the population’s health
• local needs assessment, policy, planning, performance management, surveillance and practice
• to be a distillate of the absolutely key, most useful and currently available indicators referring to new data/indicators and unavailable data/indicators
• to be utilised in joint efforts between local government and the health service to improve health and reduce health inequalities with the aim of empowering the wider community

The health profiles for England were produced in June 2006 and are available in both web based and hard copy reports. They are targeted at local authority members and officers, and also healthcare and public health professionals. Every councillor in England was sent a copy of their health profile. Copies were also sent to senior officers of each local authority, strategic health authority and PCT. The profiles describe the health of the local population and enable local, regional and national comparisons.

The health profiles indicators had to be those which were available on a consistent basis for all but two of the 388 local authorities in England. City of London and Isles of Scilly were not covered due to data limitations in small populations. The criteria for choosing the indicators are set out below.

Criteria for selecting indicators for the health profiles

• Impact on the health of the population.
• Support local government and NHS management frameworks.
• Validity  – criteria must measure what it purports to measure.
• Criteria must be primarily based on existing indicators – although crucial to highlight non-existent and new data where important? 
• Criteria be available at local authority level, although sub local authority data will be explored.
• Criteria must be amenable to meaningful comparison over time, place, person.
• It must be able to be communicated easily to a wide audience.
  

The impact of health profiles 2006

To ensure the ‘health profiles 2007’ are an improvement on the prototype for 2006, APHO undertook a qualitative evaluation in the autumn of 2006. It was based on nearly 400 responses from across England including nearly 100 members of the public.

There was an overwhelmingly positive response to the content and format of the ‘health profiles 2006.’ It was clear that the majority of respondents felt that the health profiles did 'what it says on the tin' by providing a unique summary of local authority based health and health inequality information that is both accessible and understandable.

The health profiles were generally found to be useful documents and considered helpful for local prioritisation work and partnership working. In particular they are highly valued by those working in local authorities who may struggle to get access to data that is seen as being owned by the NHS.

Quotes from respondents

• “I find it very difficult to access relevant information and whenever I ask anyone in the NHS for it they tell me that drawing down such information from the myriad systems used by the NHS is not easy or even always possible”.
• “Before the recently published health profiles, it was very difficult to source high quality and up to date information".
• “Gives a rounded picture of principal health indicators for particular areas against regional and national figures”.
• “I found it to be very informative and liked the fact that it informed me about my local area and that I was able to look at other areas”.
  
  A number of recommendations were made for improvement for both the content and format of future health profiles.

Case studies

One of the aims of the health profiles is that they are used to support local action to improve health and reduce health inequalities. Case studies have been identified to demonstrate examples of the use of health profiles in action

Childhood obesity

South Bucks District Council was concerned about the levels of obesity identified in their health profile. Resulting from these concerns the council set up in partnership with Burnham Health Promotion Trust, Health for All (supported by Chiltern and South Buckinghamshire PCT - now Buckinghamshire PCT). They also set up a partnership with Dorney Lake (the 2012 Olympic rowing venue situated in their district). The programme’s aim was to help overweight teenagers.

The programme involved rowing participation and advice on diet and nutrition. Twenty children successfully completed the course and were presented certificates by Olympic gold medal winning rower Ed Coode. As a result of the success of this initiative future courses are planned.

Spreading the news

A summary of the North Tyneside Health Profile was compiled by members of the Public Health Team of North Tyneside PCT and colleagues from North Tyneside Council. The purpose of the profiles was explained together with the main findings set in a local context, whilst highlighting the need for cautionary interpretation. 

Celebratory achievements were described together with challenges needing attention. Actions underway or in progress were detailed.  Specific action points have since been incorporated into strategy documents to address the gaps identified in service delivery. The local summary was presented to:

• North Tyneside Strategic Information Group for Public Health
• Health Partnership Board
• PCT PEC and Board
• Clinical Policy Group of the local foundation trust

It was also used as the basis of a press release which raised local media interest, added to the PCT website and published as Part 1 of the DPH Annual Report 2005/2006
To look at the Newcastle upon Tyne Health Profile see below:
Newcastle upon Tyne Health Profile (PDF, 4 pages, 418KB)

Health profiles 2007

‘Health profiles 2007’ will be a recognisable development from the prototype of 2006.  The changes for ‘health profiles 2007’ have been based upon a number of strands of work including:

• evaluation of ‘health profiles 2006’
•  review of stakeholder feedback and comments received during the development and after release of 'Health profiles 2006'
• advice from the health profiles sub group of the APHO technical sub group.

The four-page format will be the same. Of the 30 indicators in the health summary, 21 will be the same or have minor modifications, five are new improved indicators and five continue to be gaps (one less than last year). Data for all indicators will be updated where possible.  The design of the profiles will be improved with simplified graphics.  Input to the design process is being aided through consultation with a consumer panel which includes local authority members. 

Health Profiles 2007 will be produced in the summer of 2007. In the meantime the current health profiles and the information about the indicators and their production continue to be freely accessible at: www.communityhealthprofiles.info.

Please continue to send us your comments on the Health Profiles and examples of how they are used. Your feedback will help us to make them increasingly useful and relevant.

Dr Claire Bradford is operational director for the health profiles project delivered by the APHO. Email her at: claire@c4hi.co.uk