Health Improvement

Dr Jane Scarlett

Consultant in Public Health

NSH Kingston

What is Public Health?

• Small groups – 10 minutes discussion

What does Public Health mean to you?

What is Public Health?

What does local Public Health do?

What is Public Health?

• Populations

• Three main strands– Health improvement – link to Local Authority– Health services quality – link to

commissioning and to providers– Health protection – Health Protection Agency

Wanless Reports

• April 2002 ‘Securing Our Future Health: Taking A Long-Term View’ – an independent review by Derek Wanless – the first ever evidence-based assessment of

the long-term resource requirements for the NHS (to 2022).

– Commissioned by Chancellor of the Exchequer

Fully engaged scenario• Best outcomes for population, and also least expensive.

– “In absolute expenditure terms the gap between the best and worst scenarios was large – around £30 billion by 2022/23, or half of current NHS expenditure”

Report - Fair Society, Healthy Livespublished in Feb. 2010

• Reviewed health inequalities in England• Clear social gradient in health• Universal action needed, proportionate to degree of disadvantage• ‘Proportionate universalism’• Reducing health inequalities will requireaction on six policy objectives:— Give every child the best start in life— Enable all children, young people and adults to maximise their capabilities and have control over their lives— Create fair employment and good work for all— Ensure healthy standard of living for all— Create and develop healthy and sustainable places and communities— Strengthen the role and impact of ill health prevention

Health Improvement

• Small groups of 4-6 people• Develop a Health Improvement Strategy for

Kingston to tackle your issue. This should include:– Why it is important– Your overall vision – where you would like to be in five

years time– Your top three actions, and top action– Who should be involved – How you will balance between universal and targeted

actions

What determines Health/being Healthy? The wider determinants of health

Barton and Grant 2005 based on Whitehead and Dahlgren 1991

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What does this translate to?

Fixed Social and economic

Environmental Lifestyle Life Chances - Access to services

Genes

Sex

Ageing

Poverty

Employment

Social exclusion

Air quality

Housing

Water quality

Environment - access to green spaces

Social Environment

Diet

Physical activity

Smoking

Alcohol

Sexual behaviour

Drugs

Education

NHS

Social services

Transport

Leisure

Our Healthier Nation (1998)

Nuffield Council on Bioethics Intervention Ladder

Relevance to Primary Care

• Identifying patients and families at risk

• Individualising risk to patients

• Respected trusted voice

• Effectiveness of brief interventions

• Linked into network of services

• Rewarding role

• And…

New Responsibilities**

Early Intervention

Stable Disease Easing the passingProtecting good health

Complex unstable conditions – living with disability

Cradle… …Grave

Local Authority Health Services Health and Social Care Services

Local Authority Public Health Responsibilities: 1.Sexual Health Services2.School Age Immunisations (HPV + school aged Booster)3.Public Mental Health (Mental Health Promotion, Mental ill-health prevention, Suicide Prevention 4.Obesity/Nutrition (including Child Measurement programme, commissioning of weight management services, School nursing)

5.Drug and Alcohol misuse (treatment and prevention)6.Tobacco Control (including Stop Smoking)7.NHS Health Check Programmes (assessment and lifestyle interventions)8.Health at work 9.Reducing and preventing birth defects

10.Prevention and early presentation (including behaviour change services, services to prevent cancer, LTC - communication and awareness raising)11.Dental Public Health (fluoridation and oral health promotion)12.Health intelligence and information (with GP’s and PHE)13.Children’s Public Health services (initially not Health Visiting* but this is the longer term goal, including school nursing services, and the Health Child Programme for school-age children)14.Social Exclusion

15.Accidental Injury Prevention including falls16.Community Safety, violence prevention 17.Seasonal Mortality (? Housing Fuel Poverty)

GP Linked Public Health Responsibilities (commissioning/provision)1.Contraception Services*2.All Childhood + Flu//Pneumococcal*3.Mental Health Treatment

4.Nutrition and weight management as part of treatment services including bariatric surgery, dietary advice in a healthcare setting, brief interventions in primary care,5.Brief interventions and alcohol health workers in a healthcare setting 6.Brief interventions in primary, secondary, dental and maternity settings7.NHS treatment and on-going risk management (following NHS Check assessment)8.NHS Occupational Health9.Interventions in primary care such as pre-pregnancy counselling, smoking cessation programmes and specialist services such as genetic services10.Integral part of cancer services, outpatients, and primary care

11.Dental Contracts*12.Health intelligence and information (with LA and PHE)13.All treatment services for Children

14.Responsibility for ensuring excluded groups have good access to services15.Health services for the consequence of falls

*NHS Commissioning Board Responsibility**Not exhaustive doesn't include Public Health England responsibilities

GP Linked Public Health Responsibilities (commissioning/provision)1.Contraception Services*2.All Childhood + Flu//Pneumococcal*3.Mental Health Treatment 4.Nutrition and weight management as part of treatment services including bariatric surgery, dietary advice in a healthcare setting, brief interventions in primary care,5.Brief interventions and alcohol health workers in a healthcare setting 6.Brief interventions in primary, secondary, dental and maternity settings7.NHS treatment and on-going risk management (following NHS Check assessment)8.NHS Occupational Health9.Interventions in primary care such as pre-pregnancy counselling, smoking cessation programmes and specialist services such as genetic services10.Integral part of cancer services, outpatients, and primary care11.Dental Contracts*12.Health intelligence and information (with LA and PHE)13.All treatment services for Children14.Responsibility for ensuring excluded groups have good access to services15.Health services for the consequence of falls

*NHS Commissioning Board Responsibility**Not exhaustive doesn't include Public Health England responsibilities

Others have been there before you….

When the winds of change blow, some people build walls and others build windmills

(Chinese proverb)