A report released by Croydon Council, exploring health inequalities in the borough, begins by acknowledging the economic, environmental and social circumstances that can significantly impact healthcare.
This lays the foundation for Croydon’s commitments going forward to tackle health inequalities across the region, for which they have devised a structured approach.
Starting well
The report states that “the impact of health inequalities on a child’s ability to lead a happy and healthy life begins even before they are born.” It begins by examining the ways in which services can influence positive health and well-being in pre-born children and those up to the ages of five.
They can do this by improving health before and between pregnancies, providing “quality and inclusive pre-conception and maternity services” personalised to support the individual and empowering mothers to make informed choices about the type of care they require.
Services in the borough will aim to reduce inequalities in care amongst women from black, Asian and mixed ethnic groups and women living in deprived areas, who were shown statistically to be the most likely to suffer during pregnancy and childbirth.
The report touches on early childhood trauma and the way children growing up in poverty are at higher risk of being exposed to ‘Adverse Childhood Experiences’ (ACEs). The report highlights that these “are early experiences that are associated with an increased risk of poorer health and other problems in later life, including mental ill health.”
Other areas of concern include children in temporary accommodation, with an estimated 2,710 Croydon children living in temporary accommodation. The COVID-19 impact on early years cohorts was also noted in the document, which demonstrated an increase in health inequalities and domestic violence as well as partial closures of early years settings such as learning and play spaces. Vaccination rates have always been negatively impacted with only 7 out of 10 children aged five or below receiving double doses of the vaccine in 2021 and 2022.
Early years
In order to combat these issues, the report states that “we recognised that a coordinated approach is needed to ensure that all our children have the best start in life”.
As such, Croydon Council has established an Early Years Strategy.
Croydon Maternity Voices Parternships will help to engage with communities and improve local maternity care, supporting women throughout their pregnancy and helping them to achieve their health goals.
The Early Years strategy involves:
- Identifying and addressing the individual needs of children and families including English as an additional language, special educational needs and learning disabilities, or families struggling with poverty.
- Giving communities a more active role and voice in the ICS
- Working to reduce the risk of inequalities in health, education and wellbeing in early years cohorts and beyond
- Providing easy access to physical and virtual services which can offer support at the right time and place
- Increasing access to high quality childcare and ensure all children are supported across multiple settings
- Supporting the emotional health and wellbeing of parents, carers and children
- Maintaining a healthy and safe environment for all children in Croydon to thrive
- Establishing support for expectant parents and carers to help them prepare for parenthood and develop a strong relationship with their children
- Protecting children from harm and disease through information sharing
Developing well
Moving on, the report states that childhood poverty is a key area of concern, with the UK millennium cohort study revealing that children born into poverty had significantly lower school test scores at ages three, five and seven compared to more affluent children (NHS Scotland, 2018).
Additionally, childhood poverty is associated with worse health outcomes in infants such as low birthweight, tooth decay, excess weight gain and accidental death.
The report lays out four main areas of focus to help tackle these inequalities: leaning and development, levelling out readiness for school, children’s physical health and well-being and food insecurity.
Firstly, learning and development will centre around celebrating diversity and the differing needs of children across the county. The report stresses the need to be mindful of potential inequalities in learning and attainment, recognising that a multifaceted approach is needed to best serve the community.
Levelling Out Readiness is a nationally-funded nursery placement programme for two, three and four year olds, designed to help children’ development in all areas, including supporting school readiness. The programme will run alongside other funded childcare providers in Croydon such as child minders, nurseries, pre-schools and school nurseries.
Children’s physical health and wellbeing is another main area of focus, particularly obesity and the various health concerns it can lead to in later life e.g. type 2 diabetes, heart disease, stroke and high blood pressure.
The report champions a ‘whole system approach’ to make healthy food more widely affordable and accessible. Croydon’s Food and Healthy Weight Partnership is comprised of a variety of partners who advocate for a physical environment that promotes healthy weight and access to affordable, healthy foods.
The report goes on to say that all Croydon partners will work together to “advocate for a long term, sustainable and strategic approach to poverty and food insecurity in the borough”.
Moving on the examine health services and context for ages 12,25, the report acknowledges that starting high school is a “major milestone” for children and marks a significant growth period educationally, physically, emotionally and socially. It notes that long-term health outcomes are formed during this stage which can dramatically impact a child’s physical and mental health as they transition into adulthood.
Other areas of significance include promoting safe sexual health and relationships and improving dental services, particularly in deprived areas to ensure children maintain good oral hygiene thus preventing long term health issues and school absences.
‘Narrowing the gap’ of these inequalities will be achieved by the following measures:
- Rolling out mentoring programmes for children who have had adverse childhood experiences (ACEs)
- Improved access to weight management support and leisure/fitness opportunities
- Schools to adopt a ‘whole-school anti-bullying approach’
- Early identification and support for mental ill health
- Increased awareness and signposting to support and prepare young people for adulthood
Vulnerable young people
Here, the report explores the link between adverse childhood experiences and behavioural issues, noting that children who have experienced trauma are more vulnerable to high risk behaviours later in life. This includes and is not limited to racial, sexual, religious and cultural discrimination.
Some of the current programmes working to tackle these inequalities include Trauma Informed Training, which is part of Croydon’s goal to become a trauma informed borough.
The programme commissions a 600 place training course for people living and working in Croydon with an aim to help people understand the source of trauma and how to recognise the signs early.
In addition, the roll-out of anonymous health and wellbeing surveys to children in years four, six, 10 and 12 is to provide a learning opportunity for Croydon Council and partners to understand how best to support children across the borough, and gain insight into their health and wellbeing needs. The survey is expected to run for the next seven years, which will allow progress to be measured over time in order to gain a comprehensive knowledge base.
Other important goals include encouraging all partners in Croydon to adopt unconscious bias training within their organisations, ensuring that people of all races and backgrounds are given equal opportunities and treatment.
Living and working well
This section of the report begins by stating that “adulthood can bring new and exciting opportunities for many; however, it can also be a challenging time because new factors can potentially influence the rest of one’s life.”
Inequalities that can impact many working age residents include: unemployment or poor access to good employment, long term health conditions, poor mental health and unhealthy coping behaviours such as drug use, alcohol or smoking.
“All of these factors interact and compound previous inequalities” the report notes, which emphasises the importance for enhanced support structures in the community to prevent and protect people from the detrimental symptoms of inequality.
This section places focus on workforce health and wellbeing, sharing aims to implement the London Good Work Standard (GWS) to ensure that more people in Croydon will benefit from fairer pay, progression opportunities and better workplace wellbeing. The four pillars of the GWS are:
- Fair pay and conditions
- Workplace wellbeing
- Skills and progression
- Diversity and recruitment
The council, with the help of their business support team, is working to ensure that businesses across Croydon are “aware of opportunitiess open to them such as mental health first aid training, trauma training and suicide awareness training” however the report notes that these programmes will be more beneficial once they are “embedded at the very core of the business.”
Te five ways to wellbeing
The report then gives five examples of how residents can maintain and improve positive mental and physical health.
The five ways to wellbeing are described as
Connect – placing importance on family, friends and colleagues who make you feel valued, both at work and at home is “critical to boosting wellbeing.”
Keep Learning – rediscover an old interest or try something new .
Be Active – take time to enjoy what you do.
Give – volunteering your time or simply do something altruistic for someone else can increase your happiness and general sense of wellbeing.
Take Notice – be present in the moment and pay attention to your thoughts and feelings.
These five factors will be embedded in the council’s new Workforce Health and Wellbeing Strategy which will promote people to take an active role in their wellbeing.
In terms of systemic inequality, Croydon Council has launched two pledges: Croydon’s Equalities pledge and the George Floyd Race Matters pledge which was created to unite local organisations in reinforcing their “commitment toward a fairer and more inclusive borough.”
Ageing well
“Ageing is influenced by factors we can and cannot change, such as biology, lifestyle, environment, and socio-economic factors,” the report states. “These factors accrue over time and reinforce and interact to create a virtuous or vicious cycle for those affected.”
Healthy ageing is “achieved by fostering healthy, safe and socially inclusive lifestyles” and is supported by “active community and economic participation.”
The report shares some of the current schemes in place to support healthy ageing in the borough:
Personal Independence Co-ordinators (PICs) with Age UK Croydon are one of the organisations helping older residents to enjoy a better quality of life. They work with individuals to set achievable health and wellbeing goals, including weight-loss programmes, socialising and practical support, helping with transport so residents can take day trips across the local area. PICs take a holistic approach, meeting with GPs, pharmacists and community nursers to discuss the wellbeing of each individual in their care.
The Dementia Support Service operates from two centres and helps to reduce social isolation, provide person-centred care and improve wellbeing for those attending the day services. They also provide Dementia Friend sessions to carers, students and volunteers.
The Memory Tree Cafe in Croydon is a safe space for people living with dementia and their carers, offering face-to-face and online support which “provides a more flexible and accessible service.”
The report summarises that it hopes to inspire “collective action” going forward to address inequalities in a sustainable and impactful way, noting that it “needs to be embedded into long term practice.”
A hope is shared that “as all Croydon statutory organisations work towards more data-driven decision making and embedding a quality improvement process within services, that this will enable the data and information in this report to be the basis for further analyses. Further analysis is required to understand why there are differences across various groups in the borough and will inform actions and changes to services and support to reduce them.”
For more information about Croydon Inequalities Strategy, please click here.
