collaborating to improve our public’s health
DESCRIPTION
Presentation from WCVA's Annual Conference 2014TRANSCRIPT
Insert name of presentation on Master Slide
Collaborating to Improve our Public’s Health
Healthier, Happier and Fairer Wales
Health Improvement
Healthcare Improvement
Health Protection
Screening Services
Microbiology Services
Policy advice
DEMOGRAPHIC CHALLENGES
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
OECD EU27 Japan Korea USA World Brazil China
Global Population Aged over 80 years
Source: OECD Labour Force and Demographic Database, 2010
Young Children and Older People as a Percentage of GlobalPopulation: 1950-2050
Source: United Nations. World Population Prospects: The 2010 Revision.
Increasing Ageing Population in Wales
WIDER DETERMINANTS AND LIFE EXPECTANCY
22% of children in Wales live in poverty
In some areas 55-68% of children live in poverty
19.0
13.4
19.6
23.7
24.0
26.6
24.1
20.2
16.7
19.8
22.1
16.9
20.1
13.4
16.9
19.8
20.4
22.8
26.2
22.7
17.7
26.4
26.2
28.2
25.7
30.4
23.8
13.1
25.5
Wales= 22.2%
Betsi CadwaladrPowys
Hywel DdaABM
Cardiff & ValeCwm Taf
Aneurin Bevan
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
Powys
Ceredigion
Pembrokeshire
Carmarthenshire
Swansea
Neath Port Talbot
Bridgend
Vale of Glamorgan
Cardiff
Rhondda Cynon Taf
Merthyr Tydfil
Caerphilly
Blaenau Gwent
Torfaen
Monmouthshire
Newport
% of children living in poverty, persons aged under 20, 2010Produced by Public Health Wales Observatory, using DWP
Life expectancy is related to socio-economic deprivation
61.2
60.8
65.3
64.7
81.4
80.4
59.1
58.7
63.5
62.8
77.0
75.9 8.6
9.2
18.4
18.9
14.6
14.8
6.5
7.1
17.4
17.8
12.3
12.5
2001-05 2005-09
Life expectancy
Healthy life
expectancy
Disability-free life
expectancy
Life expectancy
Healthy life
expectancy
Disability-free life
expectancy
Males
Females
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD/WHS (WG)
Life expectancy with 95%
confidence intervalInequality gap
(SII in years)
Comparison of life expectancy, healthy life expectancy and disability-free life
expectancy at birth, Wales 2001-05 and 2005-09
62.5
62.1
65.9
65.4
81.7
80.6
59.8
59.2
63.7
63.0
76.9
75.9 12.9
12.8
22.5
22.7
17.2
17.1
8.8
10.0
21.0
22.0
12.312.9
2001-05 2005-09
Life
expectancy
Healthylife
expectancy
Disability-free life
expectancy
Life
expectancy
Healthylife
expectancy
Disability-free life
expectancy
Males
Females
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD/WHS (WG)
95% confidence interval
Inequalitygap (SII in years)
Comparison of life expectancy, healthy life expectancy and disability-free
life expectancy at birth, Cardiff 2001-05 and 2005-09
62.5
66.1
81.0
61.5
64.7
77.3
62.0
65.5
79.9
60.8
63.9
75.9
0 10 20 30 40 50 60 70 80 90
Disability-free life expectancy
Healthy life expectancy
Life expectancy
Disability-free life expectancy
Healthy life expectancy
Life expectancy
2001-05 2005-09
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Comparison of life expectancy, healthy life expectancy and disability-free life expectancy
at birth, Wrexham 2001-05 and 2005-09
Females
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD/WHS(WG)
Males
THE BIG KILLERS
Circulatory disease and cancer are the biggest killers
Circulatory
33% all ages
25% <75 years
Neoplasms
28% all ages
40% <75 years
THE MAIN CAUSES
Smoking Deaths
“Smoking continues to be the greatest single cause of avoidable mortality in Wales. In people aged 35 and over, smoking causes nearly one in five of all deaths and around one third of the inequality in mortality between the most and least deprived areas.”
5,450
Nearly half of young people report drinking too much
% of persons aged 16-24 who reported drinking above the recommended guidelines on at least one day in the previous week, 2008-2011
43.0
46.0
44.9
46.8
48.2
45.1
44.9
Wales = 45.5
Betsi Cadwaladr
Powys
Hywel Dda
ABM
Cardiff & Vale
Cwm Taf
Aneurin Bevan
% of persons aged 16-24 who reported drinking above the
recommended guidelines, 2008-2011Produced by Public Health Wales Observatory, using WHS (WG) & MYE (ONS)
Alcohol is killing an estimated 1,500 per year
Produced by Public Health Wales Observatory, using ADDE, MYE (ONS), fractions (PHE)
More deaths in areas of high deprivation
Alcohol-attributable mortality rate, males, all ages, Wales, 2003-05 to 2010-12
Too few people eat a healthy diet
36
37
40
35
37
30
32
Wales = 35
Betsi Cadwaladr UHB
Powys THB
Hywel Dda HB
ABM UHB
Cardiff & Vale UHB
Cwm Taf HB
Aneurin Bevan HB
95% confidence interval
Proportion of adults who reported eating five portions of fruit and
vegetables the previous day, age-standardised, persons, aged
16+, Wales health boards, 2009-2010
Produced by Public Health Wales Observatory, using Welsh Health Survey (WG)
% eating five portions of fruit and vegetables the previous day, 2009-2010 Age-standardised, persons aged 16+, Wales health boards
12.5% of children aged 4-5 are obese
9.411.4
13.2 13.5 14.3
Least
deprived
f ifth
Next least
deprived
Middle
deprived
Next most
deprived
Most
deprived
f ifth
Wales= 12.5%
Percentage of children aged 4-5 years who are obese,
Welsh Index of Multiple Deprivation fifths, Child
Measurement Programme for Wales, 2011/12Produced by Public Health Wales Observatory, using CMP data (NWIS), WIMD 2011 (WG)
… and more than half of adults are overweight or obese
55
56
58
58
54
62
59
Wales = 57
Betsi Cadwaladr UHB
Powys THB
Hywel Dda HB
ABM UHB
Cardiff & Vale UHB
Cwm Taf HB
Aneurin Bevan HB
95% confidence interval
Proportion of adults who reported being obese or overweight
(Body Mass Index >= 25), age-standardised, persons, aged 16+,
Wales health boards, 2009-2010
Produced by Public Health Wales Observatory, using Welsh Health Survey (WG)
% obese or overweight (BMI*>=25), 2009-2010 Age-standardised, persons aged 16+, Wales health boards
LIVING WITH ILLNESS
Large numbers of people live with illness
48% of adults are being treated for a chronic illness
–19% for high blood pressure
–14% for respiratory illness
–14% for arthritis
–10% for mental illness
–9% for a heart condition
–6% for diabetes
CANCER
Bowel cancer now has the highest incidence, but lung cancer kills
more people
Mortality is falling slowly
… but there are inequalities everywhere
Incidence Survival Mortality
EMERGENCY ADMISSIONS, INJURIES AND INFANT
MORTALITY
More inequality…
77.6
85.3
97.1
107.6
127.1
Wales = 101.9
Least deprived
Next least deprived
Middle
Next most deprived
Most deprived
Emergency hospital admissions* by deprivation fifth, persons
aged 0-24, Wales, EASR per 1,000, 2011
*Patients are counted more than once if they had multiple admissions during 2011
Emergency admissions* by deprivation fifth, persons aged 0-24, Wales, EASR per 1,000, 2011
15.1
20.9
28.8
38.8
51.0
Wales = 31.7
Least deprived
Next least deprived
Middle
Next most deprived
Most deprived
Admissions for pedestrian injuries by fifth of deprivation,
children aged 5-14, Wales, rate per 100,000, 2006-2010 Produced by Public Health Wales Observatory, using WDS, PEDW (NWIS) & WIMD 2011 (WG)
Admissions for pedestrian injuries by fifth of deprivation, children aged 5-14, Wales, rate per 100,000, 2006-2010
3.8
3.8
4.1
4.3
5.6
Least deprived
Next least deprived
Middle
Next most deprived
Most deprived
Infant mortality by fifth of deprivation, Wales, rate per 1,000
births, 2006-2010 Produced by Public Health Wales Observatory, using ADDE & ADBE (ONS),
Wales = 4.4
Infant mortality by fifth of deprivation, Wales, rate per 1,000 births, 2006-2010
We must deliver a more preventative
approach for our public’s health that has
maximum impact to reduce inequalities
and keep people healthier for longer
Prudent Healthcare
‘Healthcare which is conceived, managed and delivered in a cautious, safe and wise way characterised by forethought, vigilance and careful budgeting which achieves tangible benefits and quality outcomes for patients’
Bevan Commission, 2013
Provisional Principles
1. Treating greatest clinical need first
2. Do no harm – achieve measurable good
3. Do the minimum appropriate intervention to achieve the desired outcomes
4. Choose the most Prudent Care, openly together with the patient
5. Consistently and appropriately apply evidence based medicine in practice
6. Co-produce health with the public, patients and partners
HOW DO WE CHANGE DESTINY?
New Focus for the FutureDesign and transform a health service to be fit, effective, efficient and viable to meet population needs today and tomorrow
Embed an emphasis on 1’ and 2’ prevention through lens of reducing absolute inequalities
Use the interventions we know work
Creating a healthier destiny for our young and keeping people healthier for longer:
- early years focus (from preconception)
- realigned role of ‘primary’ and ‘community’ care
- better skilled workforce and capacity for older age
- optimising all public services and third sector
- engaging with people to enable positive choices
Aligning social policy to drive transformation
Systems Approach to Health Improvement
Optimising our Assets
National, regional, town
or county
Communities
Workplaces
Children’s settings
Healthy
schools
Healthy
pre-
schools
Healthy Working Wales
Health of the Valleys project
Training,
award
schemesNetwork
initiation
NHS
LA’s
Housing
Police
Aligning Policy, Settings and People
People
• Making every contact count
• Training and education
• Multi-interventionalists
• Smoking, obesity and alcohol tailored support
• Ensure workplace policies tackle well-being
• Become public health advocates
• All public servants, voluntary organisations
• Connecting with local community leaders and role models
Specific Settings
• Schools• Further Education
Establishments• Hospitals/ Health
Centres• Public Sector
Workplace• Custodial settings• Private Sector
workplaces• Cinemas/Theatres/En
tertainment venues• Retail establishments• Fast Food shops• Local communities
Public Policy
• Taxation – sugar, soft drinks
• Planning – restriction of outlets, designed for health
• Bans- promotions, sponsorship, products
• Licensing – what can be sold and where
• Restrictions – on sales to children, on marketing on access to health care
• Parenting Orders• Profiling for obesity at birth• Raising public awareness
away from personal responsibility to coping with environment
Working Together for a Healthier Future
Focus on reducing absolute inequalities, primary prevention and early years
Building a social movement – transforming societal policy and approach
Working together for tangible change
Boundaryless approach at local level
Working closely with partners and communities
Well-being of Future Generations Bill
If we are ever in doubt about what to do, it is a good rule to ask ourselves
what we shall wish on the morrow that
we had done.John Lubbock