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Collaborating to Improve our Public’s Health
Healthier, Happier and Fairer Wales
Health ImprovementHealthcare ImprovementHealth ProtectionScreening ServicesMicrobiology ServicesPolicy advice
DEMOGRAPHIC CHALLENGES
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
OECD EU27 Japan Korea USA World Brazil China
Global Population Aged over 80 years
Source: OECD Labour Force and Demographic Database, 2010
Young Children and Older People as a Percentage of GlobalPopulation: 1950-2050
Source: United Nations. World Population Prospects: The 2010 Revision.
Increasing Ageing Population in Wales
A higher proportion of the Welsh population is 65+ compared to rest of UK
WIDER DETERMINANTS AND LIFE EXPECTANCY
22% of children in Wales live in poverty
In some areas 55-68% of children live in poverty
19.013.419.623.724.026.624.1
Wales= 22.2%Betsi Cadwaladr
PowysHywel Dda
ABMCardiff & Vale
Cwm TafAneurin Bevan
Life expectancy is related to socio-economic deprivation
THE BIG KILLERS
Circulatory disease and cancer are the biggest killers
Circulatory33% all ages25% <75 years
Neoplasms28% all ages40% <75 years
THE MAIN CAUSES
Nearly a quarter of adults still smoke
% currently smoking, 2009-2010Age-standardised percentage, persons aged 16+, Wales Health Boards
0
5
10
15
20
25
30
35
% Men 16+
Women 16+
All
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.”
5,450
Nearly half of young people report drinking too much
% of persons aged 16-24 who reported drinking above the recommended guidelines on at least one day in the previous week, 2008-2011
43.046.044.946.848.245.144.9
Wales = 45.5Betsi Cadwaladr
PowysHywel Dda
ABMCardiff & Vale
Cwm TafAneurin Bevan
Alcohol is killing an estimated 1,500 per year
Produced by Public Health Wales Observatory, using ADDE, MYE (ONS), fractions (PHE)
More deaths in areas of high deprivation
Alcohol-attributable mortality rate, males, all ages, Wales, 2003-05 to 2010-12
Too few people eat a healthy diet
36
37
40
35
37
30
32
Wales = 35
Betsi Cadwaladr UHB
Powys THB
Hywel Dda HB
ABM UHB
Cardiff & Vale UHB
Cwm Taf HB
Aneurin Bevan HB
95% confidence interval
% eating five portions of fruit and vegetables the previous day, 2009-2010 Age-standardised, persons aged 16+, Wales health boards
12.5% of children aged 4-5 are obese
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%
… and more than half of adults are overweight or obese
55
56
58
58
54
62
59
Wales = 57
Betsi Cadwaladr UHB
Powys THB
Hywel Dda HB
ABM UHB
Cardiff & Vale UHB
Cwm Taf HB
Aneurin Bevan HB
95% confidence interval
% obese or overweight (BMI*>=25), 2009-2010 Age-standardised, persons aged 16+, Wales health boards
0
10
20
30
40
50
60
70
2003
/04
2004
/05
2005
/06
2007
(a)
2008
2009
2010
2011
2012
2013
% Men 16+
Women 16+
All
LIVING WITH ILLNESS
Large numbers of people live with illness
48% of adults are being treated for a chronic illness–19% for high blood pressure–14% for respiratory illness–14% for arthritis–10% for mental illness–9% for a heart condition–6% for diabetes
CANCER
Bowel cancer now has the highest incidence, but lung cancer kills
more people
Mortality is falling slowly
… but there are inequalities everywhere
Incidence Survival Mortality
EMERGENCY ADMISSIONS, INJURIES AND INFANT
MORTALITY
More inequality…
77.685.397.1107.6127.1
Wales = 101.9Least deprived
Next least deprivedMiddle
Next most deprivedMost deprived
Emergency admissions* by deprivation fifth, persons aged 0-24, Wales, EASR per 1,000, 2011
15.120.928.838.851.0
Wales = 31.7Least deprived
Next least deprivedMiddle
Next most deprivedMost deprived
Admissions for pedestrian injuries by fifth of deprivation, children aged 5-14, Wales, rate per 100,000, 2006-2010
3.83.84.14.35.6
Least deprivedNext least deprived
MiddleNext most deprived
Most deprived
y y g ( )
Wales = 4.4
Infant mortality by fifth of deprivation, Wales, rate per 1,000 births, 2006-2010
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
Prudent Healthcare
‘Healthcare which is conceived, managed and delivered in a cautious, safe and wise way characterised by forethought, vigilance and careful budgeting which achieves tangible benefits and quality outcomes for patients’
Bevan Commission, 2013
Provisional Principles
1. Treating greatest clinical need first2. Do no harm – achieve measurable good3. Do the minimum appropriate intervention to achieve
the desired outcomes4. Choose the most Prudent Care, openly together with
the patient5. Consistently and appropriately apply evidence based
medicine in practice6. Co-produce health with the public, patients and
partners
HOW DO WE CHANGE DESTINY?
Keeping people healthier for longer
Shifting the equilibrium of health, wellbeing and care
New Focus for the Future
Focus on reducing absolute inequalities, primary prevention and early yearsPrudent Healthcare Building a social movement – transforming societal policy and approachWorking together for tangible changeBoundaryless approach at local levelWorking closely with partners and communitiesWell-being of Future Generations Bill
New Focus for the Future
Untapped potential for housing and public health to work togetherJoint ventures and new models of supported housing supporting people at home Opportunities to maximise capital and assetsHousing included as part of care pathways and budget planningAddress barriers/incentives to support innovation together
If we are ever in doubt about what to do, it is a good rule to ask ourselves
what we shall wish on the morrow that we had done.
John Lubbock