What on earth is going on? Data, Health Inequalities and Localism.

I was in a local authority meeting recently and someone said – “the problem with keeping track of the impact of the economic crisis on the poor is that we don’t have the resources to do it!”.

This meeting was part of a piece of work I am doing for the Institute of Health Equity who have been commissioned by the London Health Inequalities Network to develop a set of indicators that will help London Boroughs map the impact of the economic crisis and the government policy response on health inequalities.

The starting point was to undertake a literature search to establish which factors have the greatest impact on health inequalities. The outcome of this work which was led by Ellen Bloomer was a good report “The impact of the economic downturn and policy changes on health inequalities in London” This found that the following determinants have a substantial impact on health inequalities:

• Unemployment – unemployed individuals particularly the long term unemployed have a higher risk of poor physical and mental health compared with those in employment.

• Income – Living in poverty is associated with worse mental health outcomes, particulalry among women.

• Housing – Both with regard to access to housing and its quality.

• Mental Health – one of the outcomes that is affected by all of the above determinants is a greater likelood of poor mental health.

The next step was to start to pull together the indicator set based around these determinants. This work is still ongoing and I am not going to talk about it directly. One of the challenges that has emerged is that many of the official indicators that are used by statutory agencies are not that helpful when it comes to mapping real time impacts on the most excluded populations. I think that this is for a number of reasons that include:

• Not gathered frequently enough to usefully inform yearly commissioning cycles
• Tend to capture service demand rather than actual circumstances of people in need

I also suspect that a number of existing data sets assume that things like economic crises don’t happen and that government policies won’t try to substantially redefine who is deserving and underserving. Both these assumptions are clearly mistaken.

To reiterate – I think the key issue is capturing peoples actual circumstances and to avoid being confounded by measures of service useage or definitions of deserving and undeserving that change according to policy whim.

The data is out there.

I am increasingly confident that the data does exist but it is currently not easily accessible to local commissioners. I think it sits in 3 places. National Government, the third sector and the private sector.

National Government

The Department for Work and Pensions (DWP) clearly has information on every individual who is currently claiming benefits. However much of this information is not easily available at borough level or on a sufficiently frequent basis to enable local authorities to have an accurate picture of what is happening within their populations. There are obviously problems with this data. It is after all a rationed service and populations can ‘disappear’ if need is redefined to exclude people.

Third Sector

A number of voluntary organisations have access to useful data. One of the best is Consumer Credit Counselling Service whose 2012 report documents the shocking rise in clients with pay day loans, the impact on people who rent and the growth in need for debt advice among older people.

At the moment none of this (very good) information is available at local authority level or more frequently than yearly. In case you think that CCCS is a small voluntary organisation – in 2011 they supported 370,000 people – there are approximately 23 million households in the UK at the moment – so CCCS is supporting more than 1% of UK households every year!

There is also useful data held by services like Citizens Advice who have received some development funding from the Department of Health to help them  develop their information systems to provide information at local authority level for Joint Strategic Needs Assessments.

However, the reality is that much voluntary sector data – even that held by big nationals is not easily accessible often because intelligence gathering systems lack the capability to provide the information in useable form to help commissioners.

There is of course a growing recognition that the personal narratives and experiences of people that are often captured by voluntary and community organisations are in themselves a powerful source of intelligence.

Private Sector

The best data is of course held by the private sector. It is interesting that the the Department of Health has focused on ways to try to persuade the private sector to make the services they provide healthier (Department of Health Responsibility Deal) rather than seeking to persuade private sector agencies to share what is potentially a much greater asset – their data.

In my view the most powerful private sector data source is CAIS (Credit Account Information Sharing), this is run by Experian and holds information on most of the adult population – 440 million credit accounts of which 33 million are currently in default.

The type of information that CAIS holds on each credit account includes:

• The lender
• The borrower, e.g. full name, full address
• Type of account (loan, mortgage, etc.)
• Default date
• Current balance outstanding
• Repayment amount and term
• Credit limit
• History of payment over the last 36 months

All of this information is available to be shared across all member agencies. Membership is managed through the Steering Committee on Reciprocity which is a cross industry forum made up of pretty well everyone you could think of:

• British Bankers Association
• British Retail Consortium
• Consumer Credit Association
• Council of Mortgage Lenders
• Credit Services Association
• Energy Retail Assocation
• Finance and Leasing Association
• Mobile Phone Operators
• UK Cards Assocation

So…….the data is there and systems are in place to share it already.

What the Department of Health needs to do.

As a key advocate for localism the Department of Health needs to create the environment where this will flourish. Local Commissioning needs data that is relevant to place and supports Health and Wellbeing boards drive forward cross sectoral strategies to address health inequalities.

The Department of Health needs to:

• Persuade key players within the private sector – starting with the financial institutions – to share the data they hold with local government

• Invest in a systematic programme to support the third sector to modernise its intelligence analysis capability.

• Ensure that that other Government Departments starting with DWP provide the data they hold in a form that can be used by local authorities.