The social determinants of health international evidence of the impact of Social Work in improving health outcomes.

Transcription

1 The social determinants of health international evidence of the impact of Social Work in improving health outcomes. Primary Care Social Workers AGM 2013 Dr Catherine Darker Adelaide Assistant Professor in Health Services Research

2 Ireland health data Low SES groups have worse health outcomes overall (Barry et al 2001) Perinatal data (Eurostat, 2004) Infant mortality x3 more likely in low SES groups Low birth weight x2 more likely in low SES groups Rates of hospitalisation for mental illness six times higher in low SES groups (Daly & Walsh, 2002) Chronic disease 47% in low SES, compared with 23% of general population (Layte et al 2007) 2

3 Deprivation Dispersion 2011 (Census Data)

4 Life Expectancy at Birth x Social Class

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6 High income Low income 6

7 How does Ireland compare to other countries? 7

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9 Obesity Rates are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) 5 9

10 Growing Up in Ireland study (Layte & McCrory, 2011) 10

11 Teenage Birth Rates are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) 5 11

12 Drug Use is More Common in More Unequal Countries Index of use of: opiates, cocaine, cannabis, ecstasy, amphetamines Source: Wilkinson & Pickett, The Spirit Level (2009) 5 12

13 Rates of Imprisonment are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) 5 13

14 Health and Social Problems are Worse in More Unequal Countries Index of: Life expectancy Math & Literacy Infant mortality Homicides Imprisonment Teenage births Trust Obesity Mental illness incl. drug & alcohol addiction Social mobility Source: Wilkinson & Pickett, The Spirit Level (2009) 5 14

15 So the evidence suggests that an equal society is better for everyone even the rich.. Do Irish people buy into this concept? What will be the cost of inaction on inequalities? 15

16 Health and Social Problems are not Related to Average Income in Countries Index of: Life expectancy Math & Literacy Infant mortality Homicides Imprisonment Teenage births Trust Obesity Mental illness incl. drug & alcohol addiction Social mobility Source: Wilkinson & Pickett, The Spirit Level (2009) 5 16

17 Central Statistics Office (2010) Income Disposable income 21, , , , , Poverty % % % % % % At risk Consistent Indicators of income equality Gini coefficient Income distribution

18 What can be done to reduce health inequalities?

19 Michael Marmot (2010)

20 What is Ireland s response to ending health inequalities?

21 Programme for National Recovery Single tiered health service Access based on need, not ability to pay European model of social solidarity Universal Health Insurance (UHI) Introduced by 2016 Multi-payer model (managed competition) Compulsory purchase by every citizen Subsidies for low/no income

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23 Basket of Services Range of services within primary and secondary care Dental care typically excluded Pharmaceuticals generally covered (co-payments?) Paramedical services generally covered (referral from doctor) Process for determining the scope of Standard Basket of Services (initially & reviewed; same for <18 and >18 yrs? ) A National Priority Setting Framework (HRB) Advocacy piece? Cost? 23% of pop to pay 1000 (Turner, 2013) Social Care services NOT included in UHI = bad news

24 Governance: New Organisational Structure

25 Primary Care key focus Universal Primary Care Universal Primary Care Act (legislative basis) Remove fees for GP care (1 st term) GP training places New GP contract (GPs employed directly; intro salaried GPs) Phased introduction ( recruitment)» Minister for Primary Care (Alex White Incentives for chronic disease management (similar to UK QoF system?)

26 Primary Care Social Work Six roles (Jacob, 2013) Assessment of biopsychosocial aspects of health & well-being Concrete service provision case management Counseling & therapeutic services Consultation with other HCP Education & training for intervention Community development & capacity building

27 Butler, (2005) Cross over between other disciplines? Nursing, Psychology? Danger of being jack of all trades and master of none Traditional model = assessment & case management; confined to children of families at risk (child protection) Modern model = life course; community based; integrated care Move towards a competencies based framework? System specialists navigators of integrated care?

28 What is the evidence that social work can improve health outcomes?

29 School based SW Systematic review (Allen-Meares et al., 2013) N=23 studies; mostly US based Outcome improvements: sexual health, aggression, self-esteem, school attendance, identity, depression

30 Integrated case management 12 month Pilot study NHS (Lyon et al., 2006) SW & nurse to co-ordinate services for elderly on discharge Outcome Improvements: Same day assessments for 97% (previously 6 weeks Discharge planning pt still in hospital (previously no planning or when pt already left) Reduced readmissions <1130 bed days saved Budget stabilized (previously overspend)

31 Integrated care frail elderly with multiple chronic conditions 12 month RCT intervention NHS problem solving & case management (Geron & Keefe, 2006; 2011) Outcome improvements: 59% of problems identified were resolved (exercise & weight loss; medical equipment needs; home & garden maintenance; medication adherence) SW twice more likely to solve problems than other HCP

32 End of life Advanced Care Directives RCT US nursing home Outcomes: Intervention pts preferences regarding cardiopulmonary resuscitation artificial nutrition and hydration intravenous antibiotics and hospitalization Control pts were significantly more likely than intervention residents to receive treatments discordant with their prior stated wishes.

33 SW in a medical emergency SARS in Singapore (Rowlands, 2008) Role of SW in a national medical emergency Outcomes: Role redefinement infection control; public education/counseling (timeliness of care re: symptoms Changes made to SW training curriculum as result disaster trauma, greater emphasis on public health issues

34 MSM Pilot to increase service engagement for highrisk MSM US pop (Natale & Moxley, 2009) Outcomes: Increased attendance at sexual screening appts Increased uptake of condom usage

35 Summary & Conclusions Health & social problems have strong social class gradients More equal societies better health & social outcomes Government commitment to greater health equity UHI Reduce the social gradient Public awareness? 35

36 Summary & Conclusions Social work broad focus biopsychosocial Valuable evidence based profession Health inequalities vulnerable groups Traditional and modern Systems focused Community based Integrated Care

37 How ready are we? Lost opportunity will the public just see UHI as another tax? Universal Social Charge 1 st Jan 2011 Communications strategy needed with equal emphasis on system of payments AND on the benefits to everyone (Egalitarian argument) UHI is a mechanism 37

38 Improved population health = main goal 38

39 Thank you Any questions? Primary Care Social Workers AGM 2013 Dr Catherine Darker Adelaide Assistant Professor in Health Services Research