Life expectancy tool helps address local inequalities

The new online life expectancy intervention tool is designed to support primary care trusts with their local delivery planning and commissioning. Developed by the Association of Public Health Observatories with and for the Department of Health, it builds on the Health Inequalities Intervention Tool, which previously provided information for spearhead areas only - the 70 local authority areas with the worst health and deprivation indicators.

The tool now includes all local authorities, spearhead and non-spearhead, and has information on inequalities within areas as well as between them. London Health Observatory director Bobbie Jacobson emphasises this is a tool for non-spearhead PCTs and health economies to address local health inequalities.

"The point is that the tool is customised for local use so that local priorities can be shaped by local need, rather than the national assessment. It lets you focus on key local health inequalities issues, such as alcohol in Blackpool, or infant mortality in Southwark. The 'ready reckoner' lets you look at interventions to address smoking, hypertensives and statin prescribing, and say: 'If we did this or that, what's the impact?'"

Calculating impact

The four principal areas are smoking, cholesterol, blood pressure and infant mortality and the tool provides relevant comparators for every area. Ms Jacobson points out that "its forerunner is already working, so we know people in a PCT-level partnership have been using the approach already to understand the causes of their local inequalities gap".

She says: "Everybody except us has been surprised by the different priorities it's revealed for different areas of the country. Everyone needs to be concerned about gaps around cancers and cardiovascular disease, so smoking as a root cause is key.

"Take two examples from deprived areas with very different local circumstances: for Blackpool, alcohol figures a lot - suicide and liver disease are very important, but it's not so much about coronary heart disease and cancer. In Southwark, infant mortality is really important. This tool helps local agencies to work on finding out the key priorities for them and plan interventions accordingly."

The next stage, she notes, "is modelling what happens if we do better on the number of interventions we deliver. With this new tool, you can look up any local authority (spearhead or non-spearhead). And people can decide that they want to focus on inequalities within their patch, not with the national picture".

Modelling scenarios

The tool lets you model scenarios, explains Ms Jacobson, comparing inequalities within and between areas. "It calculates the impact of putting more energy and resources into, say, smoking cessation services. So if you're able to achieve 3,500 more 'quitters', it tells you the impact on the life-expectancy gap and how many years of life are gained. Then you can ask what if we get 3,500 more 'quitters' and also increase statin prescribing?

"What you get is a model calculated of cumulative effect if you implement the four high-impact areas; smoking, blood pressure, coronary heart disease and infant mortality. If you put more energy, resolve and drive into these four, you can see what the impact would be on the most deprived fifth of your population. It's a way to model how resources can be used, using cost-effective, evidence-based interventions to help planners, policymakers and practitioners decide how to use resources."

Does Ms Jacobson see this starting to inform commissioning decisions? She says that it's seen as "an important part of the [health inequalities] national support team diagnostic in visits to spearhead PCTs. It helps to beef up the support team, which will expect local authorities and PCTs to understand the causes of problems and the impact of intervention.

"I know also that the Improvement and Development Agency healthy communities initiative uses the tool in its own leadership development programme for local politicians. That's good for health, bringing in council leaders and local authority politicians and asking them: 'Do you know the causes of your gap?'"

She emphasises that it's also an important aid to joint strategic needs assessment.

The earlier prototype of the tool was such a big hit that the hosting website crashed on the first day due to the amount of traffic. Ms Jacobson confirms that "we monitor use of these resources online and know across all our observatories that it's very widely used by PCTs and local authorities". She adds that local authorities have reported finding the tool helpful in planning their local area agreements with PCTs.

Hard challenge

Ms Jacobson notes two big challenges: "One is that we have no reliable ethnicity data to input, and we know people would want that. This is a national problem that needs to be resolved, as some of the most deprived parts of communities are ethnically diverse.

"We need to understand which communities are most affected. So we're a bit hampered and limited by the available routine local data produced to reasonable standard across the country - the routine data doesn't do ethnicity.

"The other big research challenge is that everybody knows that most health is gained or lost outside the NHS. Over time, local authorities have a much bigger role leading health and this agenda than the NHS, although the NHS still has a big role.

"The interventions for which we have evidence of clinical effectiveness are all health ones with impact in the short term (aiming at the 2010 targets) and work may need to be cranked up if we're going to deliver.

"The next bit is about making the long-term big difference to the children who are at school today. That's a hard challenge. We've got data on the health effect of being in employment, but no evidence of how much you reduce cardiovascular mortality if you increase employment by one per cent. We look forward to helping solve some of these questions."

London Health Observatory's intervention tool can be found at www.lho.org.uk