The Health of our Population& of OurselvesDoug Robertson

Clinical Champion for Prevention

Our people die too soon, too often

These six diagnoses explainmore than half of excess

years of life lost

Mortality data for the SWBCCG population compared to UK means in 2006-10

Why is this?

• Deprivations scores in bottom 10 in UK• 25% of people smoke• 20% drink at high risk• 25% of men & women are obese• 70% don’t eat 5 fruit/vegetables a day• 65% do not meet physical activity levels

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Four Health Behaviours:• Non smoker• Alcohol <14 units/wk• Not sedentary• Blood vitamin C

– >50 mmol/l(>5 servings fruit &vegetables daily).

Overall impact:14 year difference in

life expectancy. Khaw et al. PLoS Med 2008 Jan 8: 5 (1): e12EPIC-Norfolk Population study

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3

2

10

Number of prudenthealth behaviours

-2 0 2 4 6 8 10 12

100

90

80

70

Year of study

% st

ill a

live

Do these habits matter?

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Survival in 20,244 healthy adults aged 40-79 by health behaviours

A large, preventable, excess of death

CMO England report Nov 2012 : top 10 public health concerns

• tobacco use• harmful alcohol use• high blood pressure• high cholesterol• overweight and obesity• physical inactivity

• illicit drug use• low fruit and vegetable• occupational risks• poor sexual health

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NHS spends only 2% on prevention

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SWBH potential for prevention

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• We have hundreds of thousands of contacts per year

• We see patients who are at high risk & often withhigh motivation to change behaviour

• We are a large local employer: impact on community

• We can contribute to local health improvement

Use our main resource: our staffMake Every Contact Count

(MECC) An NHS programme

• To train all staff to give briefhealth advice for prevention.

• Covers smoking, drinking, dietand activity

• Makes prevention personal,nudges us to ‘walk the talk’

• Will change SWBH culture

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Problems start young & get worse

Poor Childhood

Increased Risk

Worsening Ill health

Poor Habits

Poor Employment

Early Death

Early Frailty

Clinical Disease

Risky behaviours (smoking, diet etc.)

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Long term conditions(Diabetes, COPD, Heart failure)

Early onset disease(lung, heart, stroke)

Loss of independence

Poor life chances Many of our people have a poor start in lifewhich evolve into high health risks,long term conditions, frailty & early death

Making sense of the prevention agenda:Health & Wellbeing Boards(Sandwell and Birmingham)

Need more than just NHS healthcare

Department of Health sponsoredreview to look at inequalities in health

Conclusions:• Social inequality is the biggest single

cause of poor health• Need to tackle causes of deprivation• Reducing health inequalities is vital

for the economy.• Reducing health inequalities is

‘fairness and social justice’

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'Fair Society Healthy Lives' (Marmot Review) 2010

SuttonColdfield

Walsall

Dudley

Wolverhampton

Solihull

Sandwell

Birmingham

SWBH sits in a corridor of deprivation

Things we can do together

Poor Start

Increased Risk

Increased Ill-health

Poor Habits

Poor Employment

Early death

Early Frailty

Clinical Disease

Sick people

Risky behaviours

PrimaryPrevention

SecondaryPrevention

ImprovingSocial Determinants

Active supportfor self-management

AppropriateCare

EducationInterventions

Influence the life course via social causes of healthCouncils: Health & Wellbeing BoardsSWBH: Public Health, Community Development

& Equality BoardPartners: Primary Care, Voluntary Organisations

MECC

SWBH can help reduce premature deaths

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Living well for longer: DOH 2013 We know what works: we just need to apply it.

SWBH

Reducing homelessnessSWBH

Making every contact count

Getting people into jobs

WHAT YOU CAN DO FOR YOURSELF:LATE NEW YEAR’S RESOLUTIONS

Stopping smokingReducing alcoholHealthy eatingPhysical activityMental health & wellbeing

Benefits and Top Tips

Stopping SMOKING

Benefits• Stopping smoking is one of the best things

a person can do for their health, whateverage they are. Period.

• It’s never too late. There is help to stop.

• NHS stop smoking advisors advise ontherapies such as nicotine patches andsupport people to change their habits.

• Smokers are 4 times more likely to stopsmoking if they use NHS support.

TOP TIPS

• Pick a day to stop and tell your friends.

• Get support from your local smokingcessation group, you are much more likelyto stop and stay stopped.

• If you are not ready to stop, then thinkabout protecting your family from secondhand smoke, particularly babies andyoung children.

Reducing ALCOHOL

Benefits• Reduce your risks of stroke, high

blood pressure and cardiovasculardisease

• Feel more energetic and alert in themornings

• Be more in control of the decisionsyou make

• Save money

TOP TIPS• After an episode of heavy drinking try to

abstain for 48 hours.• Drink water while you are out

(alternate water and alcohol).• Think before getting into a round with

drinkers.• Drinking alcohol before you go out can

make it harder to limit your intake onceyou are out with friends.

• Make sure you have planned to get homesafely

Healthy EATING

Benefits• Reduce your risks of coronary heart

disease, some cancers and type 2diabetes

• Live longer...on average obese peoplehave a life expectancy that is 9 yearsless

TOP TIPS• Base your meals on starchy foods.• Aim for 5 portions of fruit and vegetables

per day• Eat more fish – including a portion of oily

fish each week.• Cut down on saturated fat and sugar.• Try to eat less salt – no more than 6g per

day for adults.• Get active and try to be a healthy weight.• Drink plenty of water.• Don’t skip breakfast.

Physical ACTIVITYBENEFITS

• Feel better and look better• Reduced stress levels• Increased social activity• Increased self esteem

TOP TIPS• Adults should be moderately active for a

minimum of 30 minutes on 5 (or more)days of the week.

• 30 minutes of continuous activity givesthe best health benefit and can be workedtowards i.e. 3 x 10 minutes or 2 x 15minutes.

• Children (aged 5-18) should bemoderately active for a minimum of onehour every day.

• Moderate describes an activity that makesyou feel warmer and have a slightly raisedheart rate.

• (You should still be able to talk during theactivity!)

Looking after Mental Health & Wellbeing

• BENEFITS

• Increased self esteem• Increased social contact• Better mood

• TOP TIPS• Keep active...exercise is proven to

release chemicals in the brain thathelp lift mood.

• Avoid alcohol, caffeine and ‘junk’food as these can make symptomsworse.

• Connect.....talk to people about howyou feel….share your worries andconcerns with people who you feelmay be able to help.

• Keep learning

Next steps for the Trust

• Get involved with Health & Wellbeing Board priorities– Sandwell: Early life, Chronic Disease, Frail elderly, Alcohol– Birmingham: Children, Vulnerable, Homeless, Obesity

• Publish a Trust Public Health strategy– Include community and regeneration projects in it

• Develop a Trust-wide approach– Use our skills, people and equipment better– Make prevention a core part of what we do

• Simply, doing the right thing for our population

Any questions?