Academic journal article Perspectives in Public Health

Tackling Inequalities in Infant and Maternal Health Outcomes

Academic journal article Perspectives in Public Health

Tackling Inequalities in Infant and Maternal Health Outcomes

Article excerpt

Dr Marilena Korkodilos from London Specialised Commissioning Group, Dr Ray Earwicker from the Department of Health, Marcia Perry from Wye Valley NHS Trust and Allison Thorpe, Freelance Science Writer look at the good practice that is fundamental in ensuring progress continues to be made in tackling inequalities in infant and maternal outcomes

Tackling health inequalities in infant mortality has been a priority for successive governments.1-4 The progress that has been made in recent years is a consequence of sustained effort and has required robust partnership working across every level of the NHS and local governmental delivery systems. Ensuring this progress is maintained against a context of structural change and service re-design will be a key challenge over the coming months. By drawing on the unique learning offered from the Infant Mortality National Support Team (IMNST) visits, this article provides an insight into the good practice that is fundamental to successful future working relationships.

Infant mortality in England

Infant mortality is an internationally recognised measure of the health of a society. In England, the infant mortality rate (deaths under one year per 1,000 live births) is at its lowest ever level - 4.5 per 1,000 live births (2007-09) - yet health inequalities persist.i Infant mortality rates are worse in disadvantaged groups and areas, and these health inequalities are linked to social and economic factors such as education, work, income and the environment; as Sir Michael Marmot's review on health inequalities makes clear.5 Lifestyle choices and the quality, availability and accessibility of services also play a part.

Learning from the visits

Between 2008 and 2011, the IMNST carried out 24 visits. The purpose of these visits was to help disadvantaged local areas address inequalities in infant mortality and improve infant and maternal health outcomes. Each visit drew together key stakeholders, working with them to identify the strengths, weaknesses, opportunities and threats of current services across a range of social factors. A confidential report was issued after each visit for use by local partners to develop a shared approach to help reduce these inequalities, building on the evidence of what works.

Key themes that emerged from an analysis of IMNST visit recommendations included:

Coordination and leadership: strong local leadership is vital for an effective cross agency approach to improving maternity and early years services and reducing infant mortality and to ensure governance arrangements are in place so local services can work together to deliver reductions in infant mortality. A strategic lead is essential to provide oversight of individual programmes. Interventions need to be backed by a strategic approach to workforce issues, ensuring that a whole system approach to planning, development and delivery is taken, building on the best available evidence and effective partnership working.

Commissioning: integrated commissioning will ensure a whole systems approach to tackling infant mortality and improving infant and maternal health. GP commissioners will need to work closely with colleagues in Public Health England and the NHS Commissioning Board to ensure a seamless care pathway for families between primary, secondary, tertiary and local authority services. A balanced scorecard/database of risk factors for infant mortality indicators will strengthen local performance management and commissioning through assessing the need of the local population.

Communication: Understanding the roles and responsibilities of different agencies and staffwill promote greater effectiveness and improved service delivery, for example, closer working between housing and health. …

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