What is a JSNA?
Local authorities have a responsibility under The Local Government and Public Involvement Health Act 2007 to work with their local NHS on a Joint Strategic Needs Assessment (JSNA) to improve health in their area. The responsibility was amended by the Health and Social Care Act 2012 to specify that this should be done through the Health and Wellbeing Board.
Men’s Health Forum & JSNAs
With JSNAs forming such an important role within local health decision-making, they are an important area for analysis. Men’s Health Forum has campaigned on the availability of gendered data, as well as worked with local authorities on tackling gender health issues. In our Men's Health Manifesto we call on organisations to use data to face up to reality.
Conducting the Audit
The basic premise of the audit is relatively simple:
- Use a checklist of health indicators commonly used
- Check through the document(s) to assess whether information provided for these indicators is gendered
- For areas with little gendered information, present gaps to the health board in charge of creating the JSNAs attention.
In practice however, due to both the nature of JSNAs and the scale of the task, there are a number of further considerations.
Creating the Checklist
This part of the process was the most time-consuming and difficult. We created an initial list from the Lambeth & Southwark and Haringey reports carried out by the Men’s Health Forum. Searching for local gendered data, these showed what datasets were available for us to include on the JSNA checklist.
In order to include areas which these reports may have missed, a search was extended to 20 JSNAs which would enable us to identify local gendered data we hadn’t previously used. Having completed this, the checklist was grouped into the broader categories, such as smoking. This thematic grouping makes searching/recording easier, with the themes ordered in the order that most JSNAs have followed (typically starting with demography, lifestyle, and then long-term/serious conditions).
The more specific the option, the more useful and easier the audit becomes. The initial list was based around more general categories – i.e. ‘Smoking’, ‘Lung Cancer’. Whilst these avoided the confusion of slightly altered categories (see below), they meant that one JSNAs inclusion of one gendered piece of data was weighted at the same level as a far more detailed gendered breakdown of all statistics within that category.
We re-assessed the JSNAs to ensure we had the correct categories included and that our initial analysis had proven effective..
Specific Measures
We then moved to an extremely specific checklist, based on data terms such as ‘Lung cancer mortality’, or ‘Healthy Life Expectancy’. By breaking it up so it makes it quicker and clearer when a positive result should be recorded, and allows a more detailed analysis.
Having a note column in the spreadsheet when collecting the information on JSNAs allows one to have miscellaneous information which can be considered following the auditing process.
Another consideration with this checklist is the variety of different measures used. That one JSNA should choose to look at all cancer mortality, whereas one may consider all cancer admissions, makes comparison difficult – and attention must be paid to whether it is the correct measure which has been gendered.
For the categories we included, see the appendices in the Gender Data Deficit Report.
What Constitutes a Gendered Mention?
Having established the checklist, one can begin to apply it to JSNAs. However, recognising a gendered mention is not necessarily obvious. Firstly,the gendered data/fact observed must be based on local, not national data. This is often difficult to determine when no reference is given. The only way to decide is to interrogate the rest of the text. This does severely slow the process of auditing the JSNAs.
Most times when a measure is gendered, it will be in the form of:
- A statistic
- Data-table
- Graph
- Other easily-identifiable form.
There are however other ways in which gendered information may be presented – and therefore if a measure appears to be missing, closer reading is needed of the text on that issue.
Making Use of the Audit
After establishing the categories and defining what constituted a gendered mention we extended the analysis to all 147 JSNAs. Every JSNA was analysed to determine whether the category was included, and if it was, was the data on it local and gendered.
This process was conducted across all JSNAs until we had a complete picture of the JSNAs and the improvements needed to improve the amount of disaggregated gendered data in JSNAs. We conducted the search by:
- Going to the JSNA and in every section seeing if the category was included,
- And if so whether the data was disaggregated by gender and local.
The difficulty auditing JSNAs is they are all different. Subsequently comparing JSNAs is a labour intensive and time consuming process. There is no quick process to doing it. The only way is to analyse every individual JSNA to the list of criteria established.
Searching terms in the JSNAs did not also facilitate a quicker analysis. Searching the terms ‘men’ or ‘male’ did not always find the disaggregated data even if it was included. For example, if one was analysing the lifestyle section of the JSNA, searching ‘men + smoking mortality’ might produce no results. Yet, contained in the JSNA there may be an image, graph or dataset providing the information for disaggregated data on smoking mortality. Key information is easily missed.
Once the analysis had taken place, we were then able to establish some correlations regarding men’s health and JSNAs across topics such as lifestyle, disease, life expectancy and mental health. This process can be applied to other issues such as sexuality, specific diseases of wider determinants of health.
General Advice
When conducting the audit, care should be made in checking for separate in-depth topic studies – for example in Manchester’s JSNA, whilst it may initially look like it only contains local sections – it also contains a list of in-depth topics. These are mentioned within the main body of other documents- and can be found hidden on the initial landing page. With JSNAs presented for a web format, it is essential to interrogate the website for less obvious sections, or newly updated work.
Noting down the author of the JSNA and their contact details speeds up later communication over gaps/strengths.
Printing off the checklist is perhaps the easiest way to work with the audit, or via a second screen – this speeds it up - and the categorisation makes it easier to refer back to measures. Spending some time with the checklist before audits is useful to familiarise those measures being checked.
Noting the date that the JSNA was checked – and indeed created makes refreshing the audit much more simple.
Using an excel spreadsheet format to input and process all the data from the audit is the best way to store and analyse the data collected. See the spreadsheet we used for our analysis.
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