dr raymond jankowski

TUBE TRAVEL TO EUSTONTUBE TRAVEL TO EUSTONStrategic plan for the next four years:

Better outcomes by 2020

TUBE TRAVEL TO EUSTONTUBE TRAVEL TO EUSTON“ Public Health is about creating the

conditions in which people can live

healthy lives for as long as possible”

The Public Health System

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PHE: Our functions and the priorities

we deliver to our stakeholders:

We do this through world-class science, advocacy,

partnerships, knowledge and intelligence,

and the delivery of specialist public health services4

Our seven priorities

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HOW? - Approach

• Focused on 3 domains of PH: – Health Improvement– Health Protection– Population Healthcare

• Building PH system capacity and capability• Evidence into action• Influencing PH policy• An approach which is based on:

– Local place – Community Assets– Addressing wider determinants– Life course

HOW? – Game changers

• Place- based approach

• Return on investment evidence (ROI) of PH interventions

• Evidence of effective behavioural change at scale and pace

• Harnessing Digital technologies to improve outcomes

• Employer contributions to staff health and wellbeing

• Developing holistic and person-centred measurement of Health and Wellbeing

• Evidenced based NHS prevention programme with NHS England and NHS improvement partners.

Leading causes of death in England (all ages)

8Getting serious about

prevention

2013 figures

Understanding the Non Communicable Disease (NCD) Challenge

GBD: Leading causes of DALYs 1990 & 2013

Making an impact on the public's health and wellbeing in England


prevention

40% of DALYs are linked to smoking, hypertension, alcohol, being overweight or physical inactivity

The case for behaviour change

Current challenges across the PH system

• More people living longer with chronic ill health

• Millennial generation and ‘always on’ culture across work and play

• Smaller public sector delivering to a growing burden of expectation

• Challenges in the confidence and financial sustainability of the third and community sectors

• Continued pressures of communicable disease threats while NCD burden grows


Contents Introduction The public Our role Our vision Our health New Some of our The next Our actions Our local People and health system for success today opportunities achievements four years for 2016/17 public health budgets – and our place in 2015/16 programmes resources

Our health today – why we must improve The next four years will offer significant

challenges but there has never been a greater

opportunity to improve the public’s health. There

is a renewed commitment across the board to

tackle the wider determinants of health. The time

is now right to see that determination embedded

in decision making in local and central

government, the NHS, as well as in industry and

business. We have the opportunity to make

improving the public’s health mainstream –

saving lives and making better use of resources.

We know that a range of factors shape our

health, including our genetic inheritance,

place and position in society, behaviour

patterns and the healthcare we receive. While

healthcare has an important role to play –

supporting us when we are ill and helping to

improve our health and wellbeing – other

factors have a greater influence on our health. The modelling from the most recent Global

Burden of Disease study 20133, led by PHE

and published in The Lancet in September

2015, shows that behavioural risk factors make

the greatest contribution to years lost to death

and disability. Known risk factors operating

together explain 40% of ill health in England;

unhealthy diet and tobacco are the two largest

contributors to disease burden. This includes

non-communicable diseases which, as a group,

cause the large majority of avoidable deaths. The World Health Organization, as set out in its 2006 publication, Preventing Disease Through Healthy Environments: Towards an Estimate of

Proportional contribution to premature death

Social

circumstances

Genetic

15%

predisposition Environmental

30%

5% exposure

10% Healthcare

40%

Behavioural

patterns

the Environmental Burden of Disease

4, estimates

that 24% of global diseases burden (healthy life

years lost) and 23% of all deaths (premature

mortality) can be attributable to preventable

environmental factors. The environmental disease

burden varies across the globe from 17% in

Western Europe to over 30% in Africa. The risk factors reflect the choices that we

all make, and the ways that our choices are

shaped by the social circumstances of our lives, such as employment, education,

housing, income and relationships. McGinnis et al showed how healthcare is but

one factor in preventing early deaths, and has

a relatively small role.5

Understanding the NCD challengeWhy prevention matters


Responding to the challengeDelivering on tobacco


Contents Introduction The public Our role Our vision Our health New Some of our The next Our actions Our local People and health system for success today opportunities achievements four years for 2016/17 public health budgets – and our place in 2015/16 programmes resources

Our vision for success come 2020 is one in which:

the country is kept safe from threats to

health, including outbreaks of

infectious disease and environmental

hazards in the UK and abroad our public health scientists, working with

experts across the country and the world, are

providing authoritative and practical expert

advice to government, local government, the

NHS and the public based on the evidence

and on our expertise and experience

health outcomes are improving and the

health gap between the most affluent

and the most vulnerable is reducing

prevention is core to the government’s

agenda, on which we are a trusted

adviser nationally and locally

local authorities and the NHS regard us as the

‘go to’ partner for advice on protecting and

improving health and return on investment and

we support directors of public health as the

local leaders for the public’s health

early intervention and prevention is

recognised as integral to delivering

the NHS efficiency challenge and

the wider NHS is fully engaged in

improving population health

we continue to demonstrate that we are

efficient, economic and effective in all that

we do, with a growing reputation as one of

the world’s leading public health agencies

• Health equity, mental health and community-centred approaches (cross-cutting and foundational)

• Advocating a life course approach

• Advance and support health in all policies at national & local levels

• Maximise opportunities to engage individuals and families through social marketing and behavioural insights

• Developing science and evidence to inform and improve policy

• Development of guidance and recommendations, based on evidence of effectiveness

• Technical skills in health and wellbeing, and driving improvement

• Disease surveillance and registration with world renowned information systems


Responding to the challengeCore principles underpinning PHE’s approach to NCDs

Looking back over the last three years

• Public Health England has:• Been clear in its mission to protect and

improve the health of the nation• Established itself as a trusted advisor to

Government at national and local level • Spoken to the evidence on controversial

issues like e-cigarettes• Stepped up to the challenge of Ebola

–Now we are a leaner organisation, with strong consistency across the organisation on our priorities and our unique role in the system at a national and local level, supporting action and impact at scale.


Opportunities and Enablers

• NHS Five Year Forward View» Radical upgrade in prevention

• Sustainability and Transformation Plans (STPs)

• Devolution agenda

18 Getting serious about prevention

• PHE and other national health bodies are currently reviewing Sustainability and Transformation Plans (STPs) for 44 areas.

• 90% of STPs include prevention plans – discussion is ongoing to ensure these plans are robust.

• An important step forward to a more integrated, place-based approach to public health, with leaders from local government and the NHS working together to get the best possible value from their shared work.

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Sustainability and transformation plans

Health and wellbeing gap

Care and quality gap

Finance and efficiency gap

Prevention Plan

Getting serious about prevention

Local Health and Care Planning:Menu of preventative interventions

November 2016

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Alcohol identification brief advice

Smokers in secondary care

Alcohol care teams

Screen patients at next consultation spread over five years, with GPs/nurses providing brief advice on alcohol

Expand 'identification and referral to improvement safety‘ programme in primary care to increase detection of those suffering from domestic violence

Screen patients who smoke in secondary care, and refer to stop smoking services

Introduce alcohol care teams (nurses) to manage alcohol-related repeat admissions in all hospitals

PHE carried out an assessment to identify the most effective preventative interventions, focusing on areas of high spend in the NHS and other organisations. If delivered at the anticipated scale of ambition, the potential savings could be up to £500m each year by 2020/21.

Opportunities offered up by STPs for prevention

Domestic violence

CCGs

CCGs

CCGs and LAs

CCGs and LAs

Commissioned by:

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Pu

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Getting serious about prevention

The devolution agenda

• The Cities and Local Government Devolution Act 2016 will see even greater devolution of powers to combined and local authority areas in England.

• Devo Manc: combined authority with greater control over spending on hospitals, GP surgeries and drop-in centres, and the ability to fully integrate funding for health and social care, delivering efficiencies and bottom up solutions to local problems.

• Aim to boost local economies, create jobs and improve local infrastructure, all of which have the potential to impact positively on public health and wellbeing.

• Work continues in other parts of the country to devolve health and social care spending from Whitehall.


prevention

Responding to the challenge – a systems approach

Getting serious about prevention23

• Report and recommendations for government on sugar, based on evidence from SACN

• Support local authorities to deliver whole-system approaches to tackle obesity

• Change4Life social marketing campaigns – more than 2 million people have downloaded the Sugar Swaps app

• Increased engagement and support for parents through National Child Measurement Programme.

•Commitment from national Government:• Soft drinks industry levy• Reformulation – work in progress• Childhood Obesity Plan – the UK is doing more to tackle

obesity than any other country in the world – but we must do more.

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Integrated pathways e.g. Diabetes

PreventingChildhood obesity

DPP

Reducing variation in meeting NICE standards

Specialised services

Visual impaired benefits in LAs

The NHS cannot tackle obesity aloneWe need to see action across a wide range of players:

• Reformulation

• Fiscal measures to reduce unhealthy food consumption

• Restrictions on advertising and promotions

• Enhanced planning powers

• Government Procurement Standards for food in

public sector organisations

• Access to weight management services

• Public campaigns to support healthier choices

• Promotion of activity (as part of healthier lifestyle)

• Leadership to tackle the new social norms

• A wide coalition with industry and opinion formers

Getting serious about prevention26Getting serious about prevention

Local Health and Care Planning:Menu of preventative interventions

November 2016

Understanding the NCD challenge Inequalities

• While life expectancy has increased overall, there has been little, if any, improvement in inequalities:

– By 2013, those living in the most deprived areas are only just approaching the levels of life expectancy that less deprived groups enjoyed in 1990.

– More deprived groups are affected proportionally more by disease risk factors than less deprived groups. The types of disease and risk factor are roughly the same across all deprivation areas however.

• While the data highlights regional differences in life expectancy and disease burden, inequalities are actually greater within regions than between them - so largely related to deprivation not geography.


Responding to the challengeMulti-level approach to NCDs and their determinants


2. Clinical interventions

3. Long lasting protective

interventions

4. Changing the context to make individuals’ default

decisions healthy

5. Socioeconomic factors

Increasing population impact

Increasing individual

effort needed

1. Counselling and education

Changing the context could have more

potential, but takes time to realise. Proposals so far

include tackling diet and alcohol.

Focus to identify savings to the NHS in

short-term, incl. tackling 1) alcohol

and tobacco consumption, and 2)

diabetes and hypertension.

dr raymond jankowski

Government & Nonprofit