Prevention

Discussion Workshop

Jonathan Williams

Chief Executive East Coast Community Healthcare

Key questions •What’s important for Norfolk and why? •What should be in the new Norfolk Health and Wellbeing Strategy?

National Prevention Picture – Good Practice Norfolk Health & Wellbeing Board 21st June 2017

Sarah Hughes Chief Executive

Overview – 4 areas of increasing concern

Perinatal mental health Children and young people Suicide Prevention Community resilience

Perinatal mental health

Perinatal mental health interactive toolkit released 2015 by PHE Aids commissioners and providers to plan approach in local area Supports local areas to use evidence based information

‘Healthy social and emotional development in babies and toddlers is important as it creates a foundation for healthy behaviour in the future and helps prevent behavioural and mental health problems’

Public Health England 2015

Missed opportunities

All children and young people deserve good mental health and well-being

Mancroft Advice Project (MAP)

Up my street

Works with young African-Carribean men aged 15-25 to develop their mental wellbeing within the community Aims to build resilience and the extent that they feel supported to problem solve Uses ‘Streetherapy’ approach developed by The Integrate Movement, which actively reaches out to underserved groups in places they feel comfortable

1000 Children: Different approaches work for different children

The often forgotten 5%

‘There is consistent high quality evidence for the effectiveness of well implemented group programmes (such as Incredible Years and Triple P level 4 and 5) in promoting positive parenting techniques and in improving children’s behavioural problems between the ages of three and eleven’ All children and young people deserve good mental health and wellbeing

Parenting programmes

The key to really effective parenting programmes is to follow what works; Target families with greatest difficulty; Ensure all local services know about the programmes (schools, GPs, health visitors, housing staff etc); Programme accessibility (times, location, childcare etc); Deliver programme as intended, including supervision and coaching.

Suicide Prevention

Biggest killer of men between 18-45 Kills more people that RTA’s Is of primary concern for PHE England and across government agencies Cost of each death by suicide is approximately £1.5 million

Working across organisations and sectors

Stop Suicide Cambridgeshire & Peterborough Samaritans Call for Action CALM https://www.thecalmzone.net/2017/06/teamcalm-westminster-10k-july-9-2017/

Resilience

Building communities Reducing costs of long term help Emerging evidence about creating networks and capability using MHFA & ASIST Across life course, intergenerational opportunities Assets based approach

Resilience in Action

Resilient Together http://www.cpslmind.org.uk/what-we-do/resilient-together/ Boing Boing http://www.boingboing.org.uk/ Local Mind Network

Lessons from all of these local initiatives

Grassroots Third sector at the helm Policy support Evidence important but innovation cutting edge Ongoing evaluation and research Learning networks

Thank you & Over to You M: 07415 119 064 E: sarah.hughes@centreformentalhealth.org.uk T: @_Sarah_Hughes_ W: www.centreformentalhealth.org.uk Main Twitter: @CentreforMH IPS: @CentreforMH_IPS

Key questions •What’s important for Norfolk and why? •What should be in the new Norfolk Health and Wellbeing Strategy?

Tobacco: Where next?

Vicky Salt Action on Smoking and Health

vicky.salt@ash.org.uk

A story of success • In 1980 almost 40% of adults smoked. • By 2013 smoking rates had declined to

around 19%. • The most recent data for 2016 shows

smoking has declined to 15.5%. • Smoking rates also hit a record low among

teenagers – 8% in 2014. • In Norfolk the smoking rate in 2016 was

13.5% comparing favourably to the East of England regional figure of 14.4%.

UK Success

23

…but it remains the leading cause of preventable death…

Obesity: 34,100 Smoking:

79,100

Alcohol: 6,592

HIV: 504

Traffic: 1,775

Illegal drugs: 1,605

Health Inequalities • Smoking is responsible for half the difference in

life expectancy between rich and poor in the UK. • High smoking rates are the main reason people

with a mental health condition die 10-20 years earlier than the general population.

• Among pregnant women, maternal smoking is responsible for up to 5,000 miscarriages, 300 perinatal deaths and 2,200 premature births each year in the UK.

• Children are 3 times more likely to smoke if they grow up in a smoking household.

Norfolk Inequalities

18.6 17.4 16.8

15.6

13.5

30.8 31.7

27 25

27.4

0

5

10

15

20

25

30

35

2012 2012.5 2013 2013.5 2014 2014.5 2015 2015.5 2016

Smoking prevalence (APS 2016)

Smoking prevalence in adults Smoking prevalence in routine and manual occupations

13.9

Norfolk Inequalities

• Smoking prevalence in adults in routine and manual occupations is 27.4%.

• Smoking prevalence in adults with serious mental illness is 40.7%.

• This is compared to 13.5% prevalence across the adult population.

• Smoking status at the time of delivery is 12.7% compared to 10.6% nationally.

Prioritise for Norfolk: Reducing inequalities • Focusing on high prevalence groups

• Routine and manual occupations • Mental health conditions • Pregnant women

• Targeted support to quit • Stop Smoking Services • NHS

• Preventative action • Enforcement • Smokefree

• Harm reduction • NRT • E-cigarettes

Local action: Stop smoking Services • Stop Smoking Services are both effective

and cost-effective in helping people quit. • Smokers are four times more likely to quit

with this support compared to unaided. • Especially important for those who face

multiple barriers to quitting and are more addicted.

• These services are cost effective and far cheaper than treating the effects of smoking related diseases.

Local action: Trading Standards • Effective enforcement by trading

standards is essential to successful tobacco control work.

• One of the most important areas is illicit.

• However, trading standards has experienced a 12% decline in staff since 2014.

• Joined up models of working shown to be effective and can deliver value

Local action: Harm reduction • NICE guidance on tobacco harm

reduction: quitting best BUT if you can’t then nicotine alternatives better than smoking

• Massive rise in use of e-cigarettes now 2.9 million users in GB – just over half ex-smokers

• Locally need to maximise benefits and minimise risks e.g. ‘Ditch or Switch’ message

A growing evidence base Public Health England 2015: • “It had previously been estimated

that e-cigarettes are around 95% safer than smoking. This appears to remain a reasonable estimate.”

• “The health risks of passive exposure to electronic cigarette vapour are… likely to be extremely low”.

• “As per existing NICE guidance, all smokers should be supported to stop smoking completely, including ‘dual users’ who smoke and use e-cigarettes.”

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/457102/Ecigarettes_an_evidence_update_A_report_commissioned_by_Public_Health_England_FINAL.pdf

Royal College of Physicians 2016: • “However, the hazard to health arising

from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco.”

• “Harm to others from vapour exposure is negligible.”

• E-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely.

https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0

Burning injustice recommendations • The report contains 7 specific recommendations

for local authorities. • These focus on:

1. Creating budgets informed by Public Health 2. Developing local tobacco control plans 3. Developing roles for HWBB to oversee implementation of local

plans and facilitating coordination with local NHS organisations. 4. Reliance on current evidence of the impact and cost-effectiveness

of different interventions. 5. Prioritising provision of specialist services for vulnerable groups

when budgets prevent provision of a universal service. 6. Collaboration across boundaries in forming regional partnerships 7. Commitment to sharing best practice and exploring joint working

and commissioning

Figure 2.3 Projection of smoking prevalence in England to achieve prevalence of less than 5% in all socio-economic groups by 2035

What’s Norfolk’s vision for all smokers?

Key questions •What’s important for Norfolk and why? •What should be in the new Norfolk Health and Wellbeing Strategy?