Refreshing our Marmot city approach to reduce health inequalities
Coventry has had Marmot City status for over ten years, underlining an on-going commitment to reducing health inequalities in the city. Health inequalities are caused in part by health services, but mainly by wider determinants that impact health including education, housing, and employment. Work to reduce health inequalities has been driven by the Marmot Partnership, with the wide membership reflecting the focus not just on health services but also on broader determinants. While the Marmot city approach has had significant impact, particularly in relation to skills and employment, it is important that all services understand the links between life circumstances and access to good services. Where a resident lives, their level of education, what job they have all influence their ability to benefit from our services. The conditions people live in will determine their access to services, the quality of the service they receive and the benefit they will gain. When we design services with our most vulnerable residents in mind, then the service is improved for all residents. This is the ethos of the Marmot approach to reducing inequalities and needs to be understood by all services to see the reduction in inequalities that we have committed to.
We don’t always know how best to deliver a service to meet the needs of all our residents. For example, working long or anti-social hours, having significant caring responsibility, not having English as a first language and living somewhere with limited public transport options can all have an impact on access to services, the residents’ experience of these services and the benefit that they gain from them. It is important that we understand which residents are (and more importantly those who are not) benefiting from services. We need to better understand reasons for this and redesign services accordingly. Existing initiatives within the council like the new customer experience team, commitment to better collation of data and focus on performance management through safeguarding and performance board, and National Institute for Health Research funding to develop a Health Research Determinants Collaboration could all be mobilised to improve services for all.
Life expectancy
The life expectancy at birth of the average person in Coventry is 76.8 years for males and 81.6 years for females. Following a 10-year plateau, since 2019 this figure has fallen for both, in line with England and West Midlands trends. However, this masks significant health inequalities across the city as illustrated in the bus route number 7 graphic below.
Coventry bus route number 7 runs between Brownshill Green in the north-west and Bell Green in the north-east of the city. It crosses some of the city’s most affluent areas, as well as some of the most deprived.
The Coventry map graphic sets out the bus route (in black) across the city; and the base map sets out the neighbourhoods (known as MSOAs (Middle Layer Super Output Area)) of Coventry. The colours represent the average life expectancy at birth of residents in each of Coventry’s neighbourhood areas (MSOA) in 2016-2020.
On the ‘bus stop’ graphic, the height of each bus stop represents the average life expectancy at birth of residents in each area in 2016-2020. Life expectancy serves as a useful summary measure of mortality, as it quantifies the differences between areas in the years of life lived; and therefore, illustrates the stark health inequalities across the city.
Cleaner streets, supported by action against fly-tipping
The number of fly-tipping incidents reduced from 6,840 in 2022/23 to 5,883 in 2023/24. The Environmental Enforcement Team exceeded the target of the 5% reduction and will continue to drive down fly tipping through a combination of education and enforcement focussing attention on the streets that are causing the most issues. Working closely with colleagues in streetpride and domestic waste, it is hoped that we will see further reductions over the coming years, whilst maintaining or increasing the current level of enforcement.
Good development at age 5
By the end of the Early Years Foundation Stage (5 years old), a child is defined as reaching a 'good level of development' (GLD) if they have attained the expected learning outcomes in a number of key areas of learning.
There has been an improvement in performance in Coventry in 2023. 63.9% of all the city’s five-year-olds achieved a good level of development at age 5, in 2023 up from 61% in 2022.
We have seen a bigger gain in the percentage of children achieving GLD when compared with statistical neighbours, although our figures remain below national average.
Early years continues to be a citywide priority through the Early Years Strategy and the Start for Life programme. Key activity within this work includes improving support for children’s speech, communication and language development through workforce development and improving opportunities for families to play and learn together within the home environment and local community. The use of two ‘Apps’ – ‘Easy Peasy’, and ‘50 things to do before you’re 5’ has been effective in providing universal and targeted support.
Data for children’s achievement communication and language indicates a 1.4 ppt improvement from 2021/22, with 76% of all children achieving this Early Learning Goal showing we are making some strong progress through current initiatives.
Case Study – 50 things to do before you’re 5
This app helps children reach important milestones, by providing 50 low or no cost ideas for play, to the people caring for them. Activities have a strong focus on communication and language. The app can be translated into 132 different languages. Since its introduction in 2023 we have seen 1,360 unique downloads reaching over 6% of the under 5 population. The app is used by a number of practitioners across Education, Children’s Services, Health and Libraries and is advertised across a number of Council venues. A number of schools have also delivered family learning sessions centred around the use of the app. Throughout 2024 we will continue to promote the use of the app as we work towards a delivery target of 3,000 users.
Overweight and obese children
Coventry has seen a small improvement the rates of obesity in both reception and Year 6 pupils. Coventry has taken part in a pilot programme run by Newcastle University, who were commissioned by the Secretary of State, to evaluate the impact of additional resources for parents as part of the National Childhood Measurement Programme. This involved using body image scales and a website to support parents around maintaining healthy weight in children. The findings of the pilot should be published in the next few months and Coventry are using the local data to help target interventions and improvement to the service. The Family Weight Management Team, who are part of the Family Health and Lifestyles Service in Coventry, delivered by South Warwickshire University Foundation Trust, have reviewed and redesigned their service offer. This work commenced in July 2023 and the team introduced new ways of working towards the end of 2023 and this will continue to be reviewed and evaluated to monitor progress.
A food-resilient city where no one goes hungry
Coventry Food Network (CFN) is registered as a Charitable Incorporated Organisation (CIO). CFN is a dynamic multi-agency partnership with the specific aim of providing a coordinated and sustainable infrastructure for the provision of accessible, nutritious and affordable food for those most vulnerable in society; supporting people with dignity and helping them to navigate their way out of the challenges and drivers of food poverty. Food is used as a tool to build more resilient communities in which people’s health and wellbeing are improved and their lives become more manageable.
A number of valuable initiatives and events have evolved through this partnership:
- CFN continues to work closely with Coventry City Council to create and deliver a system of emergency food provision to those eligible for government support through the Household Support Fund (HSF).
- CFN has invested in a shared database, which has been rolled out across the fifteen food hubs and currently is use by all HSF providers. This has been a critical element in supporting the re-design of HSF process.
- CFN continues to work with an ever-increasing range of partners across public, private and voluntary and community sectors.
- CFN is building on its successful community engagement model, by entering into discussions and sharing information with the Integrated Care System (ICS) and the broader health sector.
- With support from CCC, CFN is leading an approach which facilitates tailored ‘wraparound’ responses to progress households from dependency to independency, at their own pace by addressing complex needs contemporaneously, rather than by the referral/linear approach, historically adopted.
- CFN continues to work with Fare Share to pursue the potential of established relationships with food suppliers beyond donations to purchase.
- CFN & Coventry Foodbank collaborated to provide practical and innovative solutions, sharing knowledge, space and financial resources:
- Purchase of a shared walk-in freezer, to minimise food waste; Foodbank contributed 25% cost and housing freezer, with CFN contributing remaining 75%.
- STEP Support System: Coventry Foodbank invested time in developing and testing, with CFN investing financially to enable roll out across frontline support organisations. (The STEP System is an application that offer our communities effective signposting to relevant organisations).
- CFN distributed circa 32,000 food parcels between April 2023 – March 2024.
- CFN distributed circa 28,000 HSF food parcels between April 2023 – March 2024