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Prevention is better than cure: getting tougher on poor health

Dr Tracey Cooper, Chief Executive, Public Health Wales

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Global Perspective

3

United Nations: 31 October 2011

Global Trends 1: Demographic

Economic slowdown

Globalisation of diseases and emerging threats

Urbanisation

Global mobility: professionals and patients (Regional strategies, health tourism)

Ageing population: By 2050:

- people over 65 ~= children < 14

- >50’s population increase from 1.4 to 3.1 billion

Social care and support: older people, children, people with a disability

Global Trends 2: Population

HealthUniversal health coverage, integrated care and health system strengthening

Reducing inequalities (MDGs to 2015)

Quality and safety frameworks: standards, measurement and evaluation – accreditation, licensing

Informed decision-making: Cost, clinical and comparative effectiveness. Health Technology Assessment, tackling disinvestment

Measuring performance and outcomes

Optimising technology solutions

Sustainable Development Goals

Post MDG

January 2016 to 2030

17 Goals

People, Planet, Posterity

United Nations: 2015

Our Future Planet

Change in the Absolute Size of the Population

- Fertility dynamics, mortality dynamics, ageing

Change in the Relative Size of Particular Cohorts

- Youth and Ageing

Change in Spatial Distribution of Population

- International and internal migration

- Increasing urbanization (Asia ~ 50% global urban

population further + 1billion by 2040)

Environmental sustainability - by 2030:

50% more food, 30% more water (70 – 90% by 2050), 45% more energy

Young Children and Older People as a Percentage of GlobalPopulation: 1950-2050

Source: United Nations. World Population Prospects: The 2010 Revision.

Ship Management International

Life Expectancy at birth

Comparative data

Life expectancy at birth, UK: 1980 – 2012

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

Childhood Obesity

Comparative data

Proportion of children aged 4 to 5 years who are overweight or obese.

England and Wales. Child Measurement Programme for Wales. National Child

Measurement Programme England 2013/14

Obesity and DeprivationChildren aged 4 to 5 years

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)

PHW Observatory. Child Measurement Programme

2013

Smoking prevalence in adults aged 18+

Comparative data

Smoking Prevalence: by country, January to December 2013

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.”

Cancer Incidence, Survival and Mortality

Incidence Survival Mortality

Our World Tomorrow

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

Systems Approach to Improving Health

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

Settings

• Schools• Further Education

Establishments• Hospitals/ Health

Centres• Public Sector

Workplace• Custodial settings• Private Sector

workplaces• Cinemas/Theatres/E

ntertainment 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

PARTNERSHIP

PURPOSEFUL

PREVENTION

The doctor of the future will give no medicines, but will interest his

patients in the care of the human frame, in diet and in the causes and

prevention of disease. Thomas Edison