Putting the Public back in Public Health –

New Approaches to improving Health & wellbeing for the 21st

century.

Wendy MeredithDirector of Public HealthBolton Council11-04-2014

The presentation will cover: •Reflection on features of public health in 21st century •Discussion of emerging trends •Outline possible approaches to new and old problems

Public Health in 21st century

A powerful case for change

We face significant challenges to the public’s health:

•Two out of three adults are overweight or obese•Smoking costs the NHS £2.7 billion per year. And there are wider economic and social costs from preventable ill-health:•drug use and smoking cost over £10 billion per year •Major health threats, ranging from the risk of new pandemics to the potential impact of terrorist incidents •Inequalities in health remain: in 2008-2010, the gap between local authorities with the highest and lowest life expectancy was nearly 12 years for males and just under 11 years for females.

Life expectancy

Internal gap 12 years

Gap with England – bigger than ever

Bolton Health & Wellbeing Survey 2010

• Self perceived general health has slightly worsened• Increases in backache and joint pain• Diabetes has continued to increase (BBHC)• Mental health worsened• Obesity has increased further• More people experiencing financial difficulties• More negative perceptions of neighbourhood

• Smoking has continued to fall• Regular dental check ups continue to increase

Key changes since 2007 survey

Lifestyle factors & risk factors• Smoking has reduced but still 1 in 3 adults admit to smoking in some

deprived areas• Alcohol - 30% adults binge at least once a week, 24% drink over the

recommended wkly level, 12% have just 0-1 alcohol free day a week

Alcohol consumption is greatest in least deprived areas but the reverse is seen related mortality rates

• Obesity – 20-25% adults are obese

9% Reception aged children, 21% by Year 6 are obese• Physical activity – 17% adults leading a sedentary lifestyle, 43% do 5

sessions• Substance misuse – estimates of 2272 opiate and or crack users –

‘traditional’ drug user profile is changing• Sexual health & teenage pregnancy – significant improvement in TP in

recent years but still above national average• Infectious disease - HIV prevalence and TB incidence increasing

However good the NHS gets, until we get better at dealing with public health, poverty, housing, job-less-ness, education and giving kids a sure start in life, we were running

up the down escalator.

Roy Lilly, NHS Commentator

‘Three Horizons’ Model Of Innovation

(Adapted by Duggan and Marsh 2008)

How to Read a Change of Age

increasing synchronous

failure

Innovation to try and keep things

going

Radically new ideas

with better fit to new

environment new context for

useful old ways

less

disruptive change

new paradigm fits and takes off

innovation

shifts allegiance

TIME

THE TURBULENT TRANSITION

HORIZON 1

HORIZON 2

HORIZON 3

VIABILITY

radically different operating

environment

NOW

www.internationalfuturesforum.com

An effective public health system

•Accounts for the changing nature, assets and strengths of the population – is vigilant for new health threats

•Ensures economic development creates health and well being

•Advocates wise use of environmental resources

•Promotes individual and community well being

•Helps people limit behaviours damaging to their health.

•Secures equitable access to good quality health and social care, with prevention incorporated into all contacts.

•Systematically works to reduce health inequalities and embeds health and well being in all policies.

Essential Public Health system

1.Monitor health status to identify community problems

2.Diagnose and investigate health problems and health hazards in the community

3.Inform and educate people about health issues and empower them to deal with the issues 4.Mobilise community partnerships to identify and solve health problems

5.Develop policies and plans that support individual and community efforts

6.Enforce laws and regulations that protect health and ensure safety

7.Link people to needed personal health services and ensure the provision of health care when otherwise unavailable 8.Ensure a competent public health and personal care workforce

9.Evaluate effectiveness, accessibility and quality of personal and population based health services 10.Research for new insights and innovative solutions to health problems

Emerging trends

Strategic shift from healthier habits to wellbeing

The Wellbeing Shift

Illness Wellness

Proximal Distal determinants (the root causes)

Deficits/ problems

Assets/ goals

What you are doing

Why you are doing it

Passive recipient Active,

empowered citizen

PeoplePlacesPower

Health Inequalities

Protecting health and improving wellbeing throughout life 1.Empowering local government and communities 2.Tackling health inequalities 3.Coherent approach to different stages of life 4.Giving every child the best start in life 5.Making it pay to work 6.Designing communities for active ageing and sustainability

7.Protecting communities from threats 8.Working collaboratively with business and voluntary sector

Possible approaches to new and old problems

What could be different?

•Five ways to well-being – Large scale change •Asset based working •Community resilience and coproduction •Community oriented primary care •Integrated Wellness Services •Investment for Health – “Health in all policies”

Five Ways To Well-being Action that individuals can take ……. 1.Connect - with family, friends, colleagues, neighbours

2.Be active - walk, run, garden, dance 3.Take notice - be curious, reflect on experiences 4.Keep learning - try something new

5.Give - doing something for others

• Improved use of wellness based prevention services

• Prevention incorporated into every care contact

What could be different? - Better preventive services

•Better access to public health information •Extensive use of internet based communication and services - www.health2works.com Web 2.0

What could be different? – access to information

JSNAJSNA

Filled with public

service provision

Community

Traditional Approach Asset Based Approach

Areas where support may be required

POPULATION NEED

Specialist interventions

Community assets and capacity

What could be different? - JSNA or JSAA?

“You can’t know what you need until you know what you have”

“Look in your back yard before you go to the store”

John McKnightInstitute for Asset-Based Community Development

Northwestern University, Chicago

What could be different? – Community involvement

• Everyone has gifts• Relationships build a community• Leaders involve others as active members of the community• People care about something• Motivation to act must be identified• A listening conversation• Ask, Ask, And Ask• Asking questions rather than giving answers invites stronger

participation• A citizen centred ‘inside-out’ organisation is the key to

community engagement• Institutions have reached their limits in problem solving• The institution as servants

The 12 Principles of ABCD Community Involvement

Policies •Local policy decisions made whilst knowing their possible health impacts •Health in All Policies

What could be different? – Health in all polices

Conclusion

• Now seeing limitations of risk theory of disease and lifestyle approach

• Shift from Illness to Wellness

• Putting “public” back in public health

http://www.idea.gov.uk/idk/aio/26995259 Joint Strategic Needs Assessment: a springboard for actionhttp://www.idea.gov.uk/idk/aio/18410498 A Glass Half Full: How an asset approach can improve community health and wellbeinghttp://www.nwph.net/hawa/writedir/2fa6The%20Asset%20Approach%20to%20Living%20Well.pdf The Asset Approach to Living Wellhttp://www.nwph.net/hawa/writedir/da0dNW%20JSAA.pdf Development of a Method for Asset-Based Workinghttp://www.abcdinstitute.org/ ABCD Institute, Northwestern University, IL, USAhttp://www.youtube.com/watch?v=NhZOLLaLNDY

References

Putting the Public back in Public Health

Wendy MeredithDirector of Public HealthBolton Council11-04-2014