Gateshead Health and Wellbeing Strategy

Foreword by the Leader of the Council

Reducing health and social inequalities is not just a matter of fairness and social justice. Inequalities are bad for everyone in society. In unequal countries; civic participation decreases, household debt rises, and child well-being is worse.

It is morally unacceptable that there is a direct link between lower social position and poorer health. In line with other parts of the UK, inequalities have started growing again in Gateshead.

In our economically advanced society, rising inequalities suggest that the right policies are not in place to make use of all available resources to guarantee a decent standard of living for everyone. In Gateshead, one in five children live in poverty. Last year over 7,800 people accessed foodbanks in Gateshead (including over 2,500 children), and over 3,000 people needed support and advice to prevent or deal with homelessness and insecure housing. We know from our local research that Universal Credit (welfare reform) is pushing local people into debt.

The country has had over ten years of austerity which has seen public sector funding continually reduced by central government - we have lost nearly half of our previous funding, the equivalent of £900 less to spend per year on every household in Gateshead. Austerity has resulted in a significantly reduced universal and preventative service offer which, combined with a growth in the older population alongside the local impact of welfare reform, has produced an increase in demand for more expensive crisis services.

The combination of austerity and increasing need has meant it has become ever more difficult for all services to respond with the help and support people require. Closing the inequality gap is a big challenge which will need us to look beyond ill health treatment and social care services so that the causes of illness, which are rooted in the wider social issues, can be dealt with.

Put simply, the most effective way of ensuring people have the best chance of thriving, and living an enjoyable life in good health, is to make sure they have a good start in life, a good education, a warm and loving home, access to good quality work and enough income to meet their needs.

In addition, a new challenge has emerged in the form of climate change caused by the greenhouse effect which prevents heat escaping into the atmosphere and leads to global warming. There is now widespread acceptance that human activity is responsible for negatively changing the environment in which we live. Urgent action is required, and Gateshead wants to lead by example. That is why on the 23 May 2019 Gateshead Council declared a climate emergency and why this strategy is different from the ones we have produced in the past, incorporating vital action on climate change. Some of the behaviour change necessary to address poverty and climate change is of equal importance to our health and wellbeing, for example, active and more sustainable travel, buying and growing locally, tackling fuel poverty.

Delivering this strategy will require a different approach based on fairness, human rights, justice, relationships and trust that will facilitate the circumstances that enable people to have the best opportunities in life. It will need us to focus our community development expertise to galvanise both the power and commitment of individuals, supporting communities to take greater control over what happens in their neighbourhoods, creating relationships, improving confidence and encouraging a greater sense of belonging.

This foundation is where our 'Gateshead Thrive' approach originated, and it has been critical to develop a Health and Wellbeing Strategy that supports the delivery of this ambition. We want this strategy to set out where we focus our attention to reduce levels of inequality through altering the circumstances that lead to inequality. We want to prevent the ongoing cycle of disadvantage for future generations. As Sir Michael Marmot says; 'Why treat people and send them back to the conditions that made them sick?'.

This strategy is not going to be easy to deliver. It will require close collaboration between public sector organisations, our communities, the voluntary and community sector and local business. It needs to be driven by place-based approaches that are directed and influenced by local people. Within our powers, we are determined to make social rights real in Gateshead. We should not, and will not, accept anything less.

We know this will be challenging because it is complex, and it is not something that will be completed in one, five or even ten years. But if we all work together on this, fighting for a better future, we believe that Gateshead can be a place where everyone thrives.

Cllr Martin Gannon - Leader, Gateshead Council

Our vision

Our vision for health and wellbeing in Gateshead: 'Good jobs, homes, health and friends.'

Our strategic approach, 'Making Gateshead a place where everyone thrives', commits us to these pledges.

We pledge to:

put people and families at the heart of everything we do
tackle inequality so people have a fair chance
support our communities to support themselves and each other
invest in our economy to provide sustainable opportunities for employment, innovation and growth across the borough
work together and fight for a better future for Gateshead

We want Gateshead to be a place where everyone thrives.

Our current position

Our Gateshead Joint Strategic Needs Assessment helps us to understand the key issues facing people in Gateshead. The ongoing challenges, and emerging issues, for health and wellbeing in Gateshead are set out by stage of life; Best start in life, Living well for longer and Ageing well.

We know that people in Gateshead experience significant health inequalities.

The Director of Public Health Annual Report 2017-18 (PDF, 2 MB)(opens new window) focused specifically on this issue.

Two babies, born on this day in Gateshead, could have as much as a 10-year difference in life expectancy due entirely to the circumstances into which they are born. If you look beyond Gateshead those same babies could have as much as a 15-year difference in life expectancy when compared to the most affluent area in Britain.

We have developed a Local Index of Need (LIoN) to identify geographically where our most vulnerable communities are within Gateshead, so that we can effectively target our resources.

Overall Local Index of need (LIoN) 2019 (opens new window)

From this we know that, during 2019, 40% were in vulnerable, or very vulnerable, situations with a further 29% just coping.

Gateshead Residents' level of need - 2019

We want to change this, to make Gateshead a place where fewer people need direct support and more people are thriving.

We want to help our communities not just survive, but to flourish, prosper and succeed. We are working differently, with partners, to achieve the right outcome for those people and families who require more care and support.

We have reviewed available evidence on the most effective way to achieve our ambitions. In response to our review, we have adopted the six policy objectives set out in the 'Marmot Review: Fair Society, Healthy Lives' (2010), as a framework to help deliver our vision of making Gateshead a place where everyone thrives.

The policy objectives are:

give every child the best start in life
enable all children, young people and adults to maximise their capabilities and have control over their lives
create fair employment and good work for all
ensure a healthy standard of living for all
create and develop healthy and sustainable places and communities
strengthen the role and impact of ill health prevention

Our approach

To achieve our vision, we know the importance of working together, across Gateshead, with communities, breaking down boundaries between organisations and services.

Our Strategy has been developed and agreed by our strategic partners. It will be delivered with the different organisations in the Gateshead Health and Wellbeing Board.

Many underlying factors govern our health and well-being. They are rooted in the social, environmental and economic circumstances into which we are born and grow, the wider determinants of health. To effectively reduce health inequalities, we must understand these causes, so that we can see the opportunities for action.

The diagram below demonstrates the complexity of the issues which cause ill-health and allow inequalities to develop. It shows the different factors that impact our health, where they originate, and how they interact, multiply, and reinforce each other. At the centre of this are people and the communities in which they live. When viewed this way we can see that acting on single factors in isolation is likely to provide only a partial and incomplete response. Rather than acting on individual issues we recognise the need for a place-based approach.

Wider determinants of health

access to goods / services
income and debt
employment / quality of work
education and skills
housing
power and discrimination
natural and built Environment
health behaviours (including smoking, diet and alcohol consumption)
psycho-social factors (including isolation, social support, social networks, self-esteem and self-worth, perceived level of control and meaning or purpose of life)
physiological impacts (including high blood pressure, high cholesterol, anxiety and depression)

Our Health and Wellbeing Strategy recognises that to deliver improvements at a population level we will need comprehensive action across the whole system of community, civic, and service interventions. We accept that approaches which are multifaceted and complementary are more likely to be successful in reducing inequalities and helping people in Gateshead thrive.

We will develop methods which consider and address this complexity as a whole system. The population intervention triangle below illustrates how the different elements required for a joined-up approach to treating a place fit together:

civic-led interventions refer to a wide range of functions, across a range of public sector organisations, such as planning, broadband, water, housing, road infrastructure and schools
service-based interventions refer to the range of public services, for example the NHS
community-centred interventions recognise the vital contribution that the community themselves make to health and wellbeing

While each element makes an important contribution, when isolated from each other the impact is not as great as it could be. No one part is more important than any other, but the ambition must be to effectively combine these parts into a coordinated, multifaceted whole through place-based planning.

Population intervention triangle

We will use our Local Index of Need (LIoN) alongside conversations with local communities and professionals working with those communities, to help us understand the relative needs of different places and people. This will support us in identifying and developing appropriate interventions and where they would be best targeted within local communities.

In addition to geographically defined communities we will also consider the needs of communities of interest and develop approaches which tackle health inequalities for these groups.

Our methodology

We aim to deliver the most positive outcomes for everyone, but we will focus our resources to benefit those in the most need - this will mean doing different things in different places.

We know we need to do more to address inequalities so we will prioritise the use of our collective resources to those communities in Gateshead that need us most. This is very different to how we have previously allocated resources based on equality (everyone getting the same).

Delivering on the identified aims require action across a much broader range of partners, strategies and structures. We recognise that there are already active workstreams which aim to address many of the actions required. This strategy will not replace existing work but instead acknowledge, connect, streamline and enhance current activity, within and between our partners and our communities. Each aim identifies the current ways in which actions are being delivered.

We recognise that many of the outcomes we aspire to deliver are enormously ambitious. However, we feel passionately that all Gateshead residents deserve to live in conditions that facilitate good health and wellbeing.

Our aims

Give every child the best start in life, with a focus on conception to age two
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create the conditions for fair employment and good work for all
Ensure a healthy standard of living for all, in accordance with international law on economic and social rights
Create and develop sustainable place and communities
Strengthen the role and impact of ill health prevention

Give every child the best start in life, with a focus on conception to age two

The foundation for a healthy life starts in pregnancy and extends throughout childhood. To address inequalities, we need to reduce the differences in children's access to positive experiences in early life and eradicate adverse childhood experiences.

We know that many children and young people in Gateshead already have circumstances which enable them to have the best start in life. We understand there are some families, or communities, where additional pressures make the best start in life more difficult to achieve.

We know the importance of an environment that makes confident, resilient and positive parenting possible.

We will provide universal support to families in health and education. We will also deliver targeted support proportionately to meet health and social needs of different families.

We know that investing in interventions early on that support preschool development, is the most effective way of enhancing a child's long-term outcomes.

We also recognise the importance of transition points in children's lives. We will develop programmes to support key milestones.

The action we will take

We will:

focus our efforts on supporting confident, positive and resilient parenting, to those who most need our support
increase the focus of existing expenditure on early years to reduce inequalities in early development
build the resilience and wellbeing of all children and young children
make sure maternity services, parenting programmes, childcare and early years education are of high quality and meet needs of all groups
support our schools to deliver an effective curriculum that addresses the skills required for later life and supports emotional wellbeing
develop a framework to support Gateshead as a child friendly place

We will deliver this through:

Early Help Strategy
Education Gateshead and Gateshead Schools
Gateshead Safeguarding Children Partnership
Children and Young People's Mental Health and Emotional Wellbeing Plan
the Children's System Board
Voice of the Child

We will know we have made a difference when:

the circumstances which result in adverse childhood experiences are prevented
parents can access support proportionate to their needs, to be the best parents they can
all children start school ready to learn
all permanent school exclusions are prevented

Enable all children, young people and adults to maximise their capabilities and have control over their lives

Without life skills and readiness for work, young people and adults will not be able to realise their full potential, to develop and take control over their lives.

We will strive to make sure that the emotional health and wellbeing of local people is a priority. Positive emotional health increases life expectancy, improves our quality of life, increases economic participation, improves educational attainment and facilitates positive social relationships.

We will make sure that all local people can contribute to and engage with the future of Gateshead.

The action we will take

We will:

focus efforts on creating the conditions for people to enjoy positive emotional health and well-being
consider measures across the whole population alongside specific action in various settings, for example, the workplace, schools and opportunities for volunteering and social action
prioritise our resources towards those groups and communities who are most in need
ensure that the views and opinions of local people are represented in all aspects of our work through our democratic process and asset-based community development approaches
focus on improving our residents' achievement in education and skills for life
prioritise preventing and reducing the scale and impact of violence and domestic abuse giving everyone control of their lives

We will deliver this through:

the Mental Health and Well-being Network
our approaches to community development and democratic engagement
our Learning and Skills steering group
Culture Strategy
North East Strategic Economic Plan
Local VCSE organisations and Connected Voice

We will know we have made a difference when:

all young people are resilient, with good physical and mental health and wellbeing
all young people are ready and appropriately skilled for the workplace
Gateshead is a positive place in which everyone's mental health and wellbeing can flourish
everyone is able to be an active part of their community
all domestic abuse is prevented

Create the conditions for fair employment and good work for all

Being in good quality work is good for health and wellbeing.

We know that good quality employment is critical for people's health and wellbeing. The core attributes for good work to support a healthy life, are defined by the Health Foundation as; pay fairly and offer lasting security, ensure good working conditions, enable a good work life balance, and finally provide training and opportunities to progress.

We want to create the conditions for high quality employment for every Gateshead resident.

The action we will take

We will:

help to create the conditions for local wealth and economic growth across Gateshead
encourage local enterprise through self-employment and develop community-led, cooperative employment opportunities
support sustainable, diverse and flexible opportunities for employment, innovation and growth
encourage volunteering and social action as a positive pathway to work
encourage employers to create or adapt jobs, with flexible working patterns, that enable people to balance employment with personal commitments that support their wellbeing
support employers to effectively promote physical and mental health and wellbeing at work
support our local public sector to provide apprenticeships and employment
review current ways of supporting people into employment, with consideration of those with different needs, who may be disadvantaged in the labour market

We will deliver this through:

Gateshead's Local Plan
Culture Strategy
North East Joint Transport Plan
Gateshead Goes Local, Community-Led Local Development
Community Wealth Building
North East Strategic Economic Plan
Local VCSE organisations and Connected Voice
Procurement Strategy

We will know we have made a difference when:

all working age residents have access to good quality, sustainable work with decent pay and conditions
all people in low paid, low skilled jobs have opportunities to improve their skills base so they can more easily achieve personal progression and attain an improved standard of living

Ensure a healthy standard of living for all, in accordance with international law on economic and social rights

We know how important it is to give people the power to make the most of their money and their lives, to give people a fair chance and reduce the stress faced by people moving between benefit entitlements and work. An essential part of this is to tackle inequality so people of all ages have a fair chance and receive an income sufficient for healthy living.

Like most other countries around us, the UK has voluntarily subscribed to international legal standards that declare that everyone is entitled to an adequate standard of living, including healthy food and decent housing.

The action we will take

We will:

commission and provide advice, information and guidance which is local and meets individuals needs
promote the real living wage and agile and flexible working to employers
maximise household income and improve financial skills to increase financial wellbeing across all age groups including pensioners
encourage the availability of Credit Union facilities for all our communities
support community-based initiatives and plural forms of ownership that aim to ensure a more sustainable community approach to living
advocate for vulnerable people and communities to reduce differences in access to local services
implement the socio-economic duty (Section 1 of the Equality Act, 2010)

We will deliver this through:

Tackling Poverty in Gateshead Board
Gateshead Strategic partners
community wealth building
North East Strategic Economic Plan
VCSE networks including Connected Voice

We will know we have made a difference when:

all working age residents receive a living wage that considers the true cost of healthy living
individuals and families are supported to have the best possible financial wellbeing, to access debt and social welfare advice, to maximise household income and improve financial management skills
affordable childcare is accessible to those who need it

Create and develop sustainable places and communities

Our health and wellbeing is influenced by where we live and the communities and homes we live in. Our understanding of the impact of climate change, air pollution, housing and active forms of travel, is improving rapidly. The environment, 'our place', is a major determinant of health, thought to account for almost 20% of all deaths in Europe. Using place-shaping approaches, our vision is that by 2030 Gateshead will be a more prosperous, attractive and sustainable place to live with improved quality of life and thriving communities.

The action we will take

We will:

develop policies, with health impact assessment embedded, to reduce the scale and impact of climate change and health inequalities
support the development of quality community activities, prioritising neighbourhoods with greatest need, remove barriers to community participation and support people to be involved locally
promote community cohesion and the prevention of crime and anti-social behaviour
ensure all communities are able to access and benefit from the natural environment
actively support measures that deliver clean air and environmental improvements, including energy efficiency
ensure provision of homes at the right number, type, quality and affordability, and choice of tenure, to meets the current and future needs of all residents
make Gateshead accessible to all, achieving a shift to sustainable forms of travel

We will deliver this through:

Gateshead's Local Plan
Gateshead Community Safety Partnership
Economic, Housing and Procurement Strategies
North East Joint Transport Plan
The Gateshead Housing Company
Local VCSE organisations and Connected Voice

We know we will have made a difference when:

local communities and social networks are strong
social connections are improved for groups in need
all residents have access to a high quality, affordable, warm and energy efficient home
all communities have access to good quality natural environment
Gateshead has clean air with low levels of pollution
Gateshead has low levels of crime and anti-social behaviour
Gateshead is carbon neutral by 2030

Strengthen the role and impact of ill health prevention

We know our health and care services are changing, and demand is increasing as our population gets older and technology advances. We must ensure that our services support everyone's needs. We will involve local communities and the voluntary and community sector in the planning of services to reflect local priorities and needs. We will integrate our health and care services whilst ensuring they are placed based and bespoke to the needs of individuals.

Our health and care system will measure success in terms of improved wellbeing, independence and social connections. We will try to move existing resources away from expensive acute care provision, so we can reinvest in prevention and early intervention measures. We will keep people who need complex support, living at, or near, home, to have the support of their family and community.

The action we will take

We will:

prioritise funding for the prevention of ill-health and high cost intervention at all levels
embed the local VCSE organisations in ill health prevention, planning and delivery
integrate how we plan, make decisions and provide health, social care and housing, to respond to needs where people live
prevent homelessness and better understand its root causes and how we address them
ensure that no-one is living in unhealthy or unsafe accommodation
reduce the scale and impact of substance misuse (alcohol, tobacco and drugs)
adopt a system-wide Make Every Contact Count approach
monitor the health of people in Gateshead together with our partners through shared long-term measures
design how we work, and what we do, together across Gateshead, to recognise and facilitate effective social prescribing approaches

We will deliver this through:

Gateshead Health and Care System Board
integrated planning, performance and commissioning plan
public service reform
Gateshead Housing Company
Homelessness and Rough Sleeping Strategy
local VCSE organisations and Connected Voice
Gateshead Smoke Free, Healthy Weight and Substance Misuse Alliances
Procurement Strategy

We know we will have made a difference when:

all preventable ill health in Gateshead is reduced, to end the gap in inequalities within the borough
no one will be homeless, or living in accommodation that does not provide a safe and healthy environment
all residents will be able to access flexible health and care support, when and where they need it