NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE CENTRE for PUBLIC HEALTH Equality impact assessment

Transcription

1 PH56 NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE CENTRE fr PUBLIC HEALTH Equality impact assessment Vitamin D: increasing supplement use amng at-risk grups NICE has a duty t have due regard t the need t eliminate unlawful discriminatin, advance equality f pprtunity, and fster gd relatins. The purpse f this frm is t dcument the cnsideratin f equality issues in each stage f the guideline prductin prcess. This equality impact assessment is designed t supprt cmpliance with NICE s bligatins under the Equality Act 2010 and Human Rights Act Table 1 belw lists the prtected characteristics and ther equality factrs NICE needs t cnsider, i.e. nt just ppulatin grups sharing the prtected characteristics defined in the Equality Act but als thse affected by health inequalities assciated with sciecnmic factrs r ther frms f disadvantage. The table des nt attempt t prvide further interpretatin f the prtected characteristics. This frm shuld be initiated during scping fr the guidance, revised after cnsultatin and finalised befre guidance is published. It will be signed ff by NICE at the same time as the guidance, and published n the NICE website with the final guidance. The frm is used t: recrd any equality issues raised in cnnectin with the guidance by anybdy invlved demnstrate that all equality issues, bth ld and new, have been given due cnsideratin, by explaining what impact they have had n recmmendatins, r if there is n impact, why this is. highlight areas where the guidance shuld advance equality f pprtunity r fster gd relatins ensure that the guidance will nt discriminate against any f the equality grups. Equality impact assessment PH56 1 f 12

2 Table 1: NICE equality grups Prtected Characteristics Age Disability Gender reassignment Pregnancy and maternity Race Religin r belief Sex and sexual rientatin Additinal characteristics t be cnsidered Sciecnmic status Depending n plicy r ther cntext, this may cver factrs such as scial exclusin and deprivatin assciated with gegraphical areas, r inequalities r variatin assciated with ther gegraphical distinctins (fr example, the Nrth-Suth divide; urban versus rural). Other Other grups in the ppulatin experience pr health because f circumstances ften affected by, but ging beynd, sharing a prtected characteristic r sciecnmic status. Whether such grups can be identified depends n the guidance tpic and the evidence. The fllwing are examples f grups that may be cvered in NICE guidance: Refugees and asylum seekers Migrant wrker Lk-after children Hmeless peple. Equality impact assessment PH56 2 f 12

3 Cnsultatin dcument 1. Have the ptential equality issues identified during the scping prcess been addressed by the Cmmittee, and, if s, hw? An equality impact assessment was nt carried ut during the scping prcess fr this guideline. This was due t the intrductin f a new prcess fr equality impact assessment (EIA). The scping stage fr this guideline had already been cmpleted when this new EIA prcess started. 2. Have any ther ptential equality issues been raised in the draft Guideline, and, if s, hw has the Cmmittee addressed these? The fllwing ptential equality issues have been identified: Age The fcus f the guideline is n at risk grups wh are advised t take a vitamin D supplement. These include: Infants and children aged under 5 Older peple This equality grup is therefre an at risk grup. The draft guideline makes a number f recmmendatins t prmte the uptake f guidance t these age grups and prevent deficiency: Clarifying existing guidance, namely recmmendatins n vitamin D supplementatin fr children under 6 mnths f age and making it clear whether children aged 4 t 5 years require a vitamin D supplement. There is als a need t make it clear that lder adults with an adequate calcium intake frm a balanced diet require vitamin D supplementatin, rather than a cmbined vitamin D and calcium supplement. Increase access t vitamin D supplements and allw Healthy Start vitamins t be mre widely distributed and sld. Pharmacies and ther utlets selling fd supplements (such as supermarkets) shuld stck affrdable vitamin D supplements Equality impact assessment PH56 3 f 12

4 and prmte them t at-risk grups. Ensure a cnsistent multiagency apprach t increase use f vitamin D supplements, which includes targeting at risk grups and wrking with relevant cmmunity and vluntary grups. Lcal authrities shuld cnsider prviding free supplements fr at-risk grups. Lcal authrities shuld review current accessibility, availability and uptake f Healthy Start supplements and als cnsider ffering free Healthy Start supplements t all children aged under 4 years. Ensure health and scial care prfessinals recmmend vitamin D supplements t this grup by ensuring prmpts n vitamin D are integrated int health and scial care systems such as flu and ther vaccine appintments, statutry health visitr appintments fr infants and children, screening services and health checks. Develpers f the persnalised child health recrds shuld add specific questins abut the use f vitamin D supplements. Raise awareness f the imprtance f vitamin D supplements amng the lcal ppulatin and make use f lcal shps and businesses, cmmunity wrkers and grups, scial establishments, nurseries and educatinal institutins, wrkplaces, places f wrship and lcal health care establishments. The Public Health Advisry Cmmittee (PHAC) identified a number f gaps in the evidence which included: A lack f gd quality interventin evidence t increase vitamin D supplementatin amng at-risk grups in England. In the recmmendatins fr research, PHAC recmmended research questins which shuld be addressed. These included: Hw effective and cst effective are interventins t increase vitamin D awareness and uptake n a cntinuing basis amng identified at-risk grups (in particular, peple ver 65, minrity ethnic grups and peple living in institutins)? What is the impact n health utcmes? Des effectiveness vary by age, gender, ethnic, sciecnmic r ther specific ppulatin characteristics (such as depressin r a disability)? Disability The fcus f the guideline is n at risk grups wh are advised t take a vitamin D Equality impact assessment PH56 4 f 12

5 supplement. These include: Peple wh have limited expsure t the sun Depending n the nature f their disability, this equality grup culd be an at risk grup. The draft guideline makes a number f recmmendatins t prmte the uptake f guidance t these grups and prevent deficiency: Clarify existing guidance and the wrding f existing recmmendatins n vitamin D, namely clearly defining the terms husebund. Increase access t vitamin D supplements. Pharmacies and ther utlets selling fd supplements (such as supermarkets) shuld stck affrdable vitamin D supplements and prmte them t at-risk grups. C-rdinate lcal actin t increase use f vitamin D supplements, which includes targeting at risk grups and wrking with relevant cmmunity and vluntary grups. Lcal authrities shuld cnsider prviding free supplements fr at-risk grups. Raise awareness f the imprtance f vitamin D supplements amng the lcal ppulatin and make use f lcal shps and businesses, cmmunity wrkers and grups, scial establishments, nurseries and educatinal institutins, wrkplaces, places f wrship and lcal health care establishments. The Public Health Advisry Cmmittee (PHAC) identified a number f gaps in the evidence which included: A lack f gd quality interventin evidence t increase vitamin D supplementatin amng at-risk grups in England. A lack f evidence n whether the fllwing affect the effectiveness f interventins t increase vitamin D supplement use amng at-risk grups: sexual rientatin, disability, religin, place f residence, ccupatin, educatin, sciecnmic psitin r a sense f cmmunity (r scial capital ). In the recmmendatins fr research, PHAC recmmended research questins which shuld be addressed. These included: Hw effective and cst effective are interventins t increase vitamin D awareness and uptake n a cntinuing basis amng identified at-risk grups (in particular, peple ver 65, minrity ethnic grups and peple living in Equality impact assessment PH56 5 f 12

6 institutins)? What is the impact n health utcmes? Des effectiveness vary by age, gender, ethnic, sciecnmic r ther specific ppulatin characteristics (such as depressin r a disability)? Gender reassignment N. Pregnancy and maternity The fcus f the guideline is n at risk grups wh are advised t take a vitamin D supplement. These include: Pregnant and breastfeeding wmen This equity grup is therefre an at risk grup. The draft guideline makes a number f recmmendatins t prmte the uptake f guidance t grups and prevent deficiency: Increase access t vitamin D supplements and allw Healthy Start vitamins t be mre widely distributed and sld. Pharmacies and ther utlets selling fd supplements (such as supermarkets) shuld stck affrdable vitamin D supplements and prmte them t at-risk grups. C-rdinate lcal actin t increase use f vitamin D supplements, which includes targeting at risk grups and wrking with relevant cmmunity and vluntary grups. Lcal authrities shuld cnsider prviding free supplements fr at-risk grups. Lcal authrities shuld review current accessibility, availability and uptake f Healthy Start supplements and als cnsider ffering free Healthy Start supplements t all pregnant and breastfeeding wmen. Ensure health and scial care prfessinals recmmend vitamin D supplements t this grup by adding specific questins abut the use f vitamin D supplements t handheld maternity ntes. Raise awareness f the imprtance f vitamin D supplements amng the lcal ppulatin and make use f lcal shps and businesses, cmmunity wrkers and grups, scial establishments, nurseries and educatinal institutins, wrkplaces, places f wrship and lcal health care establishments. The Public Health Advisry Cmmittee (PHAC) identified a number f gaps in the Equality impact assessment PH56 6 f 12

7 evidence which included: A lack f gd quality interventin evidence t increase vitamin D supplementatin amng at-risk grups in England. A lack f evidence n whether the fllwing affect the effectiveness f interventins t increase vitamin D supplement use amng at-risk grups: sexual rientatin, disability, religin, place f residence, ccupatin, educatin, sciecnmic psitin r a sense f cmmunity (r scial capital ). In the recmmendatins fr research, PHAC recmmended research questins which shuld be addressed. These included: Hw effective and cst effective are interventins t increase vitamin D awareness and uptake n a cntinuing basis amng identified at-risk grups (in particular, peple ver 65, minrity ethnic grups and peple living in institutins)? What is the impact n health utcmes? Des effectiveness vary by age, gender, ethnic, sciecnmic r ther specific ppulatin characteristics (such as depressin r a disability)? Race The fcus f the guideline is n at risk grups wh are advised t take a vitamin D supplement. These include: Peple with darker skin because their bdies are nt able t make as much vitamin D. Fr example, peple f African, African Caribbean and Suth Asian rigin. This equity grup is therefre an at risk grup. The draft guideline makes a number f recmmendatins t prmte the uptake f guidance t these grups and prevent deficiency: Increase access t vitamin D supplements and allw Healthy Start vitamins t be mre widely distributed and sld. Pharmacies and ther utlets selling fd supplements (such as supermarkets) shuld stck affrdable vitamin D supplements and prmte them t at-risk grups. C-rdinate lcal actin t increase use f vitamin D supplements, which includes targeting at risk grups, wrking with relevant cmmunity and vluntary grups and ensuring actin is culturally apprpriate. Lcal authrities shuld cnsider prviding free supplements fr at-risk grups. Raise awareness f the imprtance f vitamin D supplements amng the lcal ppulatin and make use f lcal shps and Equality impact assessment PH56 7 f 12

8 businesses, cmmunity wrkers and grups, scial establishments, nurseries and educatinal institutins, wrkplaces, places f wrship and lcal health care establishments. Infrmatin shuld als be culturally apprpriate. The Public Health Advisry Cmmittee (PHAC) identified a number f gaps in the evidence which included: A lack f gd quality interventin evidence t increase vitamin D supplementatin amng at-risk grups in England. A lack f evidence n whether the fllwing affect the effectiveness f interventins t increase vitamin D supplement use amng at-risk grups: sexual rientatin, disability, religin, place f residence, ccupatin, educatin, sciecnmic psitin r a sense f cmmunity (r scial capital ). In the recmmendatins fr research, PHAC recmmended research questins which shuld be addressed. These included: Hw effective and cst effective are interventins t increase vitamin D awareness and uptake n a cntinuing basis amng identified at-risk grups (in particular, peple ver 65, minrity ethnic grups and peple living in institutins)? What is the impact n health utcmes? Des effectiveness vary by age, gender, ethnic, sciecnmic r ther specific ppulatin characteristics (such as depressin r a disability)? Religin r belief The draft guideline recmmends increased access t vitamin D supplements. These supplements shuld be safe, acceptable and are halal. Sex and sexual rientatin N. Sciecnmic status The draft guideline has carefully cnsidered the rle f the Healthy Start scheme in prviding vitamin D t at-risk grups. Healthy Start is a UK-wide gvernment scheme t imprve the health f lw-incme pregnant wmen and families n benefits and tax credits. All recmmendatins in relatin t Healthy Start will therefre apply t lw incme grups. Equality impact assessment PH56 8 f 12

9 Other Other equity grups are: Refugees and asylum seekers Migrant wrkers Refugees, asylum seekers and migrant wrkers may be frm ppulatins with darker skin and therefre culd be an at-risk grup. Hwever under the current arrangements fr the Healthy Start scheme, asylum seekers are nt eligible t receive Healthy Start supplements. 3. D the preliminary recmmendatins make it mre difficult in practice fr a specific grup t access any recmmended services cmpared with ther grups? If s, what are the barriers t, r difficulties with, access fr the specific grup? N. The draft guideline aims t increase supplement use amng at-risk grups t prevent vitamin D deficiency. 4. Are there any recmmendatins r explanatins that the Cmmittee culd make t remve r alleviate barriers t, r difficulties with, access identified in questin 3, r therwise fulfil NICE s bligatin t prmte equality? Nt applicable. 5. Have the Cmmittee s cnsideratins f equality issues been described in the cnsultatin dcument, and, if s, where? The draft guideline utlines that the recmmendatins shuld be implemented in light f duties set ut in the Equality Act Equality impact assessment PH56 9 f 12

10 3. Final Public Health Guideline dcument 1. Have any ptential equality issues raised in sectin 2 been addressed by the Cmmittee and if s, hw? The PHAC will cnsider all the equity issues raised and make necessary amendments t the guideline t ensure these are addressed. 2. Have any additinal ptential equality issues been raised during the cnsultatin, and, if s, hw has the Cmmittee addressed these? Stakehlders raised a number f ptential equity issues. These include: The draft guideline recmmends a campaign t raise awareness f the imprtance f vitamin D and emphasise the imprtance f a daily supplement fr identified at-risk grups. Hwever a stakehlder respnded that there is a real danger that campaigns are mre likely t reach welleducated peple and thereby increase inequalities. The draft guideline recmmends prmting vitamin D t grups at higher risk in settings such as places f wrship. A stakehlder cmmented that this may be inapprpriate and culd super-saturate and irritate peple. Hwever this cmment was nt reflected in respnses frm ther stakehlders. The term ethnic minrity was cnsidered nt applicable in this cntext and shuld instead refer t peple with darker skin. Ethnic minrity can include white-skinned peple such as eastern Eurpeans. It was suggested that campaign material shuld be picture-based r simple English as vitamin D deficiency ften affects thse with English as a secnd language. The translatin f resurces t ther languages was als recmmended. It was suggested by ne stakehlder that disabled children and yung peple culd be given as an example f thse requiring vitamin D supplements due t lw r n expsure t sunlight (in additin t the current Equality impact assessment PH56 10 f 12

11 example f husebund peple). Disabled children and yung peple have reduced expsure t sunlight thrugh mre limited access t utdr activities, physical disabilities that restrict utdr activity and a reduced family incme that als restricts utdr activities as well as pprtunities fr hlidays in sunnier climates. Children and yung peple with disabilities are at increased risk f bne disease, especially steprsis, and given their mre limited expsure t sunlight, it is imprtant t highlight this grup fr receiving vitamin D supplements t try t prevent bne disease. Clarificatin was sught fr the term lder peple. It was suggested that vitamin D supplements be ksher and suitable fr the Orthdx Jewish cmmunity. Imprved access t Healthy Start vitamins was raised with numerus suggestins t imprve update made. This has sci ecnmic implicatins and in particular will have a psitive impact n lw incme grups. 3. If the recmmendatins have changed after cnsultatin, are there any recmmendatins that make it mre difficult in practice fr a specific grup t access any recmmended services cmpared with ther grups? If s, what are the barriers t, r difficulties with, access fr the specific grup? N, the recmmendatins have been amended in respnse t stakehlder cmments t increase supplement use amng at-risk grups. 4. If the recmmendatins have changed after cnsultatin, are there any recmmendatins r explanatins that the Cmmittee culd make t remve r alleviate barriers t, r difficulties with, access identified in questins 2 and 3, r therwise fulfil NICE s bligatins t prmte equality? The fllwing revisins have been made t the final guideline in respnse t equity issues raised by stakehlders: References t ethnic minrity grups have been replaced with peple with Equality impact assessment PH56 11 f 12

12 darker skin. Recmmendatin ne was amended t ensure that vitamin D supplements were suitable t thse n a ksher diet. Strengthened recmmendatins abut access t Healthy Start vitamins. Mre clearly define lder peple (with reference t SACN reprt). 5. Have the Cmmittee s cnsideratins f equality issues been described in the final Public Health Guidance dcument, and, if s, where? Yes, the Guideline has the fllwing paragraph in the Status f the Guideline sectin: The recmmendatins shuld be read in cnjunctin with existing NICE guidance unless explicitly stated therwise. They shuld be implemented in light f duties set ut in the Equality Act Apprved by Centre r Prgramme Directr:.. Date: [xx/xx/year] Equality impact assessment PH56 12 f 12