Starting Well - Adverse Childhood Experiences


The Marmot review “Fair Society, Healthy Lives” published in 2010 highlighted the scale of health inequalities in England.  It also made recommendations on how to tackle this. – Professor Sir Michael Marmot said:

‘People with higher socioeconomic position in society have a greater array of life chances and more opportunities to lead a flourishing life. They also have better health. The two are linked: the more favoured people are, socially and economically, the better their health. This link between social conditions and health is not a footnote to the ‘real’ concerns with health – such as health care and unhealthy behaviours – but should become the main focus.

Consider one measure of social position: education. People with university degrees have better health and longer lives than those without. For people aged 30 and above, if everyone without a degree had their death rate reduced to that of people with degrees, there would be 202,000 fewer premature deaths each year. Surely this is a goal worth striving for.  It is the view of all of us associated with this Review that we could go a long way to achieving that remarkable improvement by giving more people the life chances currently enjoyed by the few. The benefits of such efforts would be wider than lives saved. People in society would be better off in many ways: in the circumstances in which they are born, grow, live, work, and age. People would see improved well-being, better mental health and less disability, their children would flourish, and they would live in sustainable, cohesive communities.’

Fair Society, Healthy Lives, February 2010

Many health-related issues are worse for people living in poverty, including an increased risk of dying prematurely.  People living in poverty are less likely to benefit from education to the same degree as others; are less likely to be in professional, managerial and skilled jobs; and are more likely to live in poor housing and in neighbourhoods where crime is more prevalent and where community safety is threatened.  All of these conditions and circumstances can have an adverse effect on physical and mental health and well-being.  These social determinants of health play a significant role in the health of the population. 

Poverty, or relative poverty, is commonly defined in terms of households with an income which, after tax, is below 60% of the median (average) household income (Aldridge et al, 2012).  As such, the income required to prevent poverty depends upon household composition.

In 2019 concerns are growing about the continuing effects of inequality with the increase in life expectancy stalling and the effects of austerity being felt in communities across the country. 

Almost half of adults in England admit to feelings of loneliness. For those aged over 65, persistent loneliness (often or always feeling lonely) is an issue for 10% of the population. Research has shown that the prevalence of persistent loneliness in the over 65s is increasing dramatically (Help the Aged). The reasons for this increase are multi-faceted and include changing family relationships, a greater geographical spread of families and a reluctance to be the main care giver of older relatives.

Older people continue to be particularly vulnerable to social isolation and loneliness, as their advanced years make them more likely to have lost friends and family, and have reduced mobility and a lesser income than they had previously. The English Longitudinal Study of Ageing (ELSA) placed  people aged 80 and older as the most vulnerable to loneliness in society, with women more likely to report feeling lonely than men.  Levels of depression have an effect on levels of loneliness, but only up to age 75.  After 75 the previously discussed feelings of loss are a larger determining factor in loneliness than wealth and deprivation. Regular contact with children reduces loneliness, although those who don’t feel close to their children experience higher rates of loneliness than those without children. However a lack of friends was a bigger factor in loneliness than contact, or lack of, with children (ELSA).                                                                                                                                                                      

Communities and support services can help people address some of the causes of loneliness such as social isolation, financial problems, or difficulties with their accommodation.  Self-reported happiness scores have shown that levels of happiness that are lowest in people in their 40s and 50s, increase as retirement starts and reduce from the age of 70 onwards, with social isolation and loneliness a major factor.

Poverty & Isolation

The proportion of children living in low income families in Hartlepool, at both under 16 and under 20 year olds, are above the England average.

For under 16s the latest figures for children living in low income households shows that in 2015 Hartlepool was at its lowest level in 10 years, falling 4% from 31.0% in 2014 to 27.0% in 2015. During this same period the England rate has fallen from 21.8% in 2006 to 16.8 in 2015. This means that while Hartlepool’s level is at its lowest point in 10 years, the gap between Hartlepool and the England average is actually larger than it was 10 years ago.

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When comparing Hartlepool across the region, Hartlepool has the 2nd highest rate of under 16s in low income families in the north east. Only Middlesbrough, which has the highest rate in the whole of England, is above Hartlepool in the regional comparators.

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When the age range for children is increased from under 16 to under 20, a similar pattern remains. Again Hartlepool has the second highest rate in the region, and is above the regional and national average, and again the gap between Hartlepool and the England average is larger than it was in 2006.

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This shows that while both the under 16s and under 20s rate are improving, they are doing so at a pace slower than the country as a whole, which risks Hartlepool being left behind on this issue.

Hartlepool’s level of fuel poverty, that is households where the fuel costs are higher than average and the money spent on fuel leaves the household below the poverty line, has increased in recent years.

Hartlepool’s fuel poverty rate of 14.7% in 2016 was the 14th highest rate in England and the highest rate for Hartlepool in the six year reporting period.

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Hartlepool’s rate of 14.7% in 2016 was not only the largest rate, but also the largest year on year increase and the largest gap between the Hartlepool rate and the national average. England’s rate has remained very stable across the reporting period, with no more than 0.5% difference in any year on year movement and 0.7% from its lowest rate to its highest. Across the same period Hartlepool’s rate has moved up to 1.9%, and between the lowest and highest rate is 3.1%. In 2016 the gap between the Hartlepool and England rates was 3.6%. This almost twice the size of the next largest gap. 

The Index of Multiple Deprivation (IMD) in 2015 gave Hartlepool an income deprivation level of 23.9%. This is the 2nd highest rate in the north east and the 11th highest in England. This means that nearly one in four people in Hartlepool are experiencing deprivation relating to income, which will include people in work as well as those unemployed.

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Hartlepool’s level of income deprivation is more than one and a half times the size of the England average.

Looking specifically at income deprivation in older people, those aged 60 and over, Hartlepool has an income deprivation level of 24.4%, which is only the 5th highest in the north east region.

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While the levels of deprivation between the population as a whole and for older people specifically are comparable, there is only 0.5% between them, the disparity in the regional and national standing of the two rates shows that income deprivation in older people is not the main driver for Hartlepool’s elevated standing nationally for income deprivation.

Hartlepool’s level of income deprivation affecting children, those aged 0-15 living in income deprived households, in the IMD was 30.7%. This, like income derivation as a whole, is the 2nd highest in the north east region, and is also the 13th highest in England.

In January 2017 Age UK released work predicting the prevalence of loneliness f those aged 65+ within a given locality. This work was used to produce maps at lower super output area to show visually the predicted likelihood of loneliness. This was done by examining data in both the English Longitudinal Study of Aging and the 2011 census, looking at indicators associated with a person being often lonely. The factors chosen were marital status, self reported health status, age and household size, as these factors account for 20% of loneliness in people aged 65+.

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Within Hartlepool there are several areas with large concentrations of high or very high risk of loneliness in those aged 65+. Owton, Stranton and Brus are areas of the town that are particularly affected by areas of high and very high risk of loneliness in those aged 65+.

Social isolation within social care users is measured as an indicator of physical and mental health. Within Hartlepool the percentage of adult social care users who have as much social contact as they would like has been significantly better than the national average for the last 3 years.

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Over the course of the 8 year reporting period Hartlepool has only once been below the national average and Hartlepool has been statistically superior to the national average on five on the eight years. Within the north east region, Hartlepool has the 3rd highest level of adult social care users who have as much social contact as they would like.

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For adult carers social contact Hartlepool ranks 2nd in the north east region and 1st amongst its statistical neighbours in 2016/17.

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This data comes from the bi-annual Personal Social Services Survey of Adult Carers in England, and while Hartlepool has remained statistically superior to both the England and north east regional averages across the 3 surveys, the percent of people reporting having as much social contact as they would like has fallen in each survey.

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In 2012/13 Hartlepool percentage was 58.5%, this had fallen to 52.6% in 2014/15 and again to 50.5% in 2016/17. However this largely follows the same trend as both the nationally and regional rates, which have also fallen from their 2012/13 levels in 2014/15 and 2016/17.

Future Intentions

All the above priorities remain our intentions plus –

  • A co-ordinated strategic approach, led by the council, to support reductions in poverty
  • An information strategy enabling professionals and residents take action by knowing what services and options are available to them
  • Targeted money advice services to residents that are using Welfare Support Services but unable to demonstrate any positive financial change
  • Preparations underway with JRF to deliver a new FuelBank
  • Preparations underway with Trussell Trust to open a shopping centre outlet to share information on services across the town and to recruit volunteers
  • Grow the furniture recycling work and ideally hand over to the VCS for co-ordination and delivery
  • Further debt advice services, money advice services and budgeting education