ukphr consultative forum 5 th november 2015 dr anne kilgallen

UKPHRConsultative Forum 5th November 2015

Dr Anne Kilgallen

Welcome to Northern Ireland

This morning I shall discuss....

• The Major Public Health Challenges Facing the People of Northern Ireland

• Our strategies to improve health• Brief reflections on implications for

workforce development and capacity building

Dr Samuel Browne

Health Challenges for NI • Demographic – ageing population -

growth in chronic conditions• Higher rates of preventable illness and

premature deaths in most deprived areas

• Correlations with wider determinants such as educational attainment

• “At risk”/vulnerable groups

Life expectancy in Northern Ireland

30

40

50

60

70

80

90

Ag

e

Male

Female

50

55

60

65

70

75

80

85

90

Most dep 3 5 7 9

Year

s

Deprivation decile

Males

Females

Linear (Males)

Linear (Females)

Life expectancy by Deprivation Northern Ireland 2008‐10

Life expectancy at selected points along a Belfast Metro bus line (2006-08)

Health Inequalities - General• Average male life expectancy is now 77.5 years (2009/11), and female life expectancy is

82.0

• In the same period the gender gap in life expectancy has decreased by 2 years to 4.4 years

• Coronary heart disease, cancer and respiratory disease continue to be the main causes of death for both sexes

• There is a notable increase in death rates from cancer, CHD and respiratory disease as level of deprivation increases

• Health surveys show that respondents in more deprived areas are less likely to meet the lifestyle choice recommendations when compared with those in less deprived areas

Smoking prevalence

1998

/99

2000

/01

2002

/03

2004

/05

2006

/07

2007

/08

2008

/09

2009

/10

2010

/11

2011

/12

2012

/13

0

5

10

15

20

25

30

35

40

Smoking Prevalence Northern Ireland 1998/99-2010/11

All Adults

Manual Workers

Year

Per

cen

tag

e

Smoking and health inequalities

Profe

ssion

al

Emplo

yer,

Man

ager

Inte

rmed

iate

non-

man

ual

Junio

r non

-man

ual

Skilled

man

ual

Semi-s

killed

man

ual

Unskil

led m

anua

l0

10

20

30

40

50

60

1983 2012/13

Socio-economic group

Per

cen

tag

e o

f sm

oke

rs

Prevalence of Obesity

Health Survey Northern Ireland (HSNI) 2013/14 • Adults - 61% of adults were either overweight

(37%) or obese (24%).

• Children - These findings use International Obesity Task Force (IOTF) cut-off points of the BMI percentiles for children aged 2-15 years of age.

• 17% of children aged 2-15 were classed as overweight and 7% were classed as obese.

Obesogenic Environment

Overweight and Obesity and other risk

factors

Increased risk of associated health conditions:

· Type II Diabetes· Heart disease/stroke

Physical inactivity and unhealthy eating (and other

risk factors)

Individual Factors· Knowledge· Skills and habits· Attitudes· Psychological factors

Social Factors· Educational level· Socioeconomic status – poverty,

health inequalities

Environmental FactorsAffecting the behaviour of the individual

· Portion sizes· Ready Access (vending machines)· Physical activity opportunities (green

spaces)· Occupational inactivity

Immutable factors· sex· age · genetics

Trends in diagnoses made in Northern Ireland GUM Clinics, 2000-2014

Table 2: New diagnoses of HIV and AIDS in Northern Ireland, by year of diagnosis, and deaths in HIV-infected individuals, by year of death

Alcohol related hospital admissions by deprivation

Alcohol related hospital admissions per 1,000 population(2007/8 - 2009/10)

0

5

10

15

20

25

30

35

40

Mostdeprived

Quintile 2 Quintile 3 Quintile 4 Leastdeprived

(Alcohol related admissions are here defined as the same causes as for alcohol related deaths)

Stan

dard

ised

Adm

issi

on R

ate

per 1

,000

pop

ulati

on

Male

Female

NI

% Difference from the NI average Suicide rate by economic deprivation

Percentage difference from the NI average rate for suicide by geographic proxy for economic deprivation

-20%

0%

20%

40%

60%

80%

100%

2000-04 2001-05 2002-06 2003-07 2004-08 2005-09

NI average = 0%

Economic deprivedareas

Not deprived areas

Economic deprivation domain: 2005

WIDER DETERMINANTS

More than 1 in 5 children growing up below the poverty line42% of households in fuel poverty Unemployment rate 6.0 %:

Rate for 18-24 yr olds 28%Long Term unemployed 59% of the total unemployed

A WHOLE SYSTEM STRATEGIC FRAMEWORK FOR PUBLIC HEALTH

2013 - 2023

Vision and Aims

All people are enabled and supported in achieving their full health and wellbeing potential.

The aims are to achieve better health and wellbeing for everyone and reduce inequalities in health.

Key Features

• High level/strategic/cross – cutting

• Collaboration, engagement and empowerment

• Thematic approach - wider determinants and lifecourse

• Outcomes and supporting actions

• The social gradient – proportionate universalism

• Whole system approach

Values

• Social justice, equity and inclusion

• Engagement and Empowerment

• Collaboration

• Evidence informed

• Addressing local need

Making Life Better - Themes

• Giving Every Child the Best Start

• Equipped throughout Life

• Empowering Healthy Living

• Creating the Conditions

• Empowering Communities

• Developing Collaboration

Making it Work

Challenges for The Public Health Function

• Ensuring we have the capacity to meet our public health challenges across the three domains.

• Ensuring we continue to have a highly skilled specialist workforce to meet our needs

• Ensuring we develop specialists from disciplines other than medicine

Challenges for the Public Health Function

• Ensuring closer working across the devolved administrations and Ireland

• Developing our wider public health workforce within the HSC and beyond

Thank You