leading health and wellbeing: from transition to transformation professor kevin a. fenton national...

Leading Health and Wellbeing: From transition to transformation

Professor Kevin A. FentonNational Director, Health and Wellbeing

26 June, 2013

The new public health system: a recapHealthy Lives, Healthy People white paper– Published November 2010 to set out a new approach to public health– Responsibility for local health improvement returned to local authorities from

1 April 2013– Public Health England is the expert national public health agency which

fulfils the Secretary of State for Health’s statutory duty to protect health and address inequalities, and executes his power to promote the health and wellbeing of the nation.

Health and Social Care Act 2012– Set the legislative framework for the changes to the health and care system

that led to the creation of Public Health England as an operationally autonomous executive agency of the Department of Health

– Received Royal Assent 27 March 2012

2 Leading Health and Wellbeing: From transition to transformation

Public health outcomes framework

3

To improve and protect the nation’s health and wellbeing and improve the health of the poorest, fastest

Outcome 1)Increased healthy life expectancy – takinginto account health quality as well as length of life

Outcome 2)Reduced differences in life expectancy betweencommunities (through greater improvements in moredisadvantaged communities)

Improving the wider determinants of health1

19 indicators, including:

• Children in poverty• People with mental

illness or disability in settled accommodation

• Sickness absence rate• Statutory

homelessness• Fuel poverty

Health improvement2


• Excess weight• Smoking prevalence• Alcohol-related

admissions to hospital• Cancer screening

coverage• Recorded diabetes• Self-reported wellbeing

Health protection3


• Air pollution• Population vaccination

coverage• People presenting

with HIV at a late stage of infection

• Treatment completion for tuberculosis

Healthcare and publichealth preventingpremature mortality

4


• Infant mortality• Mortality from causes

considered preventable• Mortality from cancer• Suicide• Preventable sight loss• Excess winter deaths


What is Public Health England?

“Public Health England (PHE) is the expert national public health agency

which fulfils the Secretary of State for Health’s statutory duty to protect health and address inequalities, and executes

his power to promote the health and wellbeing of the nation.”


Outcome-focused priorities


1. Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol

2. Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency

3. Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics

4. Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme

5. Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives

Supporting priorities


6. Promoting the development of place-based public health systems

7. Developing our own capacity and capability to provide professional, scientific and delivery expertise to our partners

Structure – Public Health England


Chief Executive

Director of HealthProtection and

Medical Director

Director of Healthand Wellbeing

Chief KnowledgeOfficer

Director ofNursing

Chief of Staff

PrivateOffice Secretariat

InternalAudit

CorporateGovernance

LegalService

Director ofStrategy

Chief OperatingOfficer

Director ofProgrammes

Finance andCommercial

Director

Director ofHuman

Resources

Director ofCommunications

RegionalDirectors

CentreDirectors

DevelopmentAdvisor

Advisory Board

Microbiology


Four regions, 15 centresEight Knowledge and Intelligence Teams

– London– South West– South East– West Midlands– East Midlands– North West– Northern and Yorkshire– East

Other local presence– ten microbiology laboratories– field epidemiology teams

Additional support– Local teams can also draw on national

scientific expertise based at Colindale, Porton Down and Chilton

Local presence

Place-based approach to public health


Public health advice

Health and wellbeing boards

Local government CCGsPHEcentre

NHSE area team

• EPPR• Screening and immunisation• Offender public health programmes• Specialised commissioning• Primary care public health programmes

and population healthcare

NHS providers

Non-statutory

providers*People and communities

*Including voluntary and community sector

10

PHE provides expert advice to local government

DsPH have influence across all local government spend

PHE provides expertise in local area teams

Embedding ‘making every contact count’

Influence on wider spending in

commercial and voluntary sectors

Clinical Commissioning

GroupsAnd

NHS England


Leverage from the public health ring fence

Transforming health and wellbeing


We will focus on the major drivers of disease, disability, disadvantage and death

and tackle health inequalities.

12 http://www.healthmetricsandevaluation.org; The Lancet, Early Online Publication, 5 March 2013doi:10.1016/S0140-6736(13)60355-4

Overall, the three risk factors that account for the most disease burden in the United Kingdom are dietary risks, tobacco smoking, andhigh blood pressure. The leading risk factor for both children under 5 and adults aged 15-49 years was tobacco smoking in 2010. Tobaccosmoking as a risk factor for children is due to second-hand smoke exposure.

Focusing our effort

Health Impact PrioritiesThe health and wellbeing contribution to our corporate priorities

Health and Wellbeing

DirectorateHealth Impact

Priorities

Well being and Mental

Health

Mental disorder accounts for largest burden (23%) of diseases in England and affects >1 in 4 of the population at any timeMental wellbeing assoc with improved outcomes in health, education, employment, reduced crime and antisocial behaviourPublic mental health: Better assessment; interventions; prioritization

Diet, Obesity, and

Physical Exercise

All major causes of CVD and cancer. Poor diet accounts for one third of deaths from cancer and CVD. Low levels of physical activity increases the risk CVD, colorectal and breast cancer by 20-35%. Obesity increases risk of type II diabetes (5-13 times), hypertension (2-3 times) and colorectal cancer (3 times) in men.

Tobacco Control and

Smoking Cessation

Accounts for 20% of new cases of cancer (23%M and16%F)Tobacco causes nearly 1 in 5 deaths in England annuallyFor each death, 20 more suffer tobacco-related illnessesComprehensive cessation programs; excise tax increases; 100% smoke-free policies; media campaigns; cessation access; advertising restrictions work.

Alcohol Moderation

and Drug Recovery

Much of the cost of drug and alcohol misuse occurs to the criminal justice system. The main costs to society from drug an alcohol is from related crime. This is different to other lifestyle health related areas and needs a different public health response.

HIV and Sexual health

By the end of 2012 likely more than 100,000 PLWHA in the UKLate diagnosis a major problem with 50% diagnosed with CD4<350Millions of STD diagnosed annually, esp. among youth, MSM, minoritiesHIV/STD screening, early treatment, partner notification, social marketing campaigns, condom access, and policy to address stigma and discrimination are key interventions

While supporting and ensuring progress against the PHOF, the Directorate

will provide enhanced focus on the major drivers

of mortality and morbidity in England

where further gains may be made by scaling known,

effective strategies

Life course perspective


Expert advisors will assist PHE technical leads to develop, implement and monitor population health, and health and wellness across the lifespan in five domains. They will also assist PHE in promoting the value and impact of this approach to our partners and stakeholders.

Healthy Infants, Children, and Young Adults

Healthy Adults and Older

Adults

Healthcare Public Health

Healthy People in Healthy

Places

Health in All Policies

A focus on improving health and health outcomes for mothers and infants, children, teens and young adults.

All people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health, including mental health, in every stage of life.

Support sound decision-making and policy change within the NHS to deliver, scale up, evaluate and improve effective clinical preventive services that drive population health.

Ensuring that the places where people live, work, learn, and play will protect and promote their health, especially those people at greater risk of health disparities.

Inform and support DH and other government partners in sound decision-making and policy change at all levels to deliver and evaluate programmes and address social determinants of health.

The challenges we will tackle togetherAn example: The national Child Measurement Programme


Child overweight (including obesity)/ excess weight: BMI ≥ 85th centile of the UK90 growth reference

One in five children in Reception is overweight or obese (boys 23.5%, girls 21.6%)

One in three children in Year 6 is overweight or obese (boys 35.4%, girls 32.4%)

The challenges we will tackle togetherAn example: The national Child Measurement Programme


Child obesity: BMI ≥ 95th centile of the UK90 growth reference

12.8%

14.4%15.5%

17.0%17.9%

19.7%21.0%

22.5%23.9% 24.2%

6.2%7.2%

7.8% 7.9%8.6%

9.5% 10.0%10.8%

11.7%12.4%

0%

5%

10%

15%

20%

25%

Least deprived

Most deprived

Obe

sity

prev

alen

ce

Index of Multiple Deprivation 2010 decile

Year 6

Reception

The challenges we will tackle togetherInforming personal choiceInforming individual choice


Questions

Professor Kevin A. FentonNational Director, Health and Wellbeing

[email protected]

www.gov.uk/phe Follow Public Health England on Twitter at @PHE_uk

mailto:[email protected]

https://twitter.com/search?q=phe&src=typd



leading health and wellbeing: from transition to transformation professor kevin a. fenton national...

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