Public Health Challenges and Opportunities in the West MidlandsLocal Government’s New Public Health Role – 12th July 2012

Karen Saunders, Senior Public Health Manager, Department of Health, West Midlands

Overview

• What we mean by ‘Public Health’• Challenges and health inequalities in the West

Midlands• Opportunities for action

– National context– ‘Old and New’ Public Health– The Role of Councillors

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Definition of Public Health

• ‘Public Health is the science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.’

(Source: Faculty of Public Health, adapted from Acheson Report 1988)

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4

Challenges

West Midlands Strategic Health Authority

(Source: ONS (2011) Life expectancy at birth by local area in the UK, 2004-06 to 2008-10)

West Midlands Strategic Health Authority

(Source: ONS (2011) Life expectancy at birth by local area in the UK, 2004-06 to 2008-10)

West Midlands Strategic Health Authority

Standardised Mortality Ratio for all causes in people aged under 75 2005-9 by MSOA - Coventry

Source: APHO

Inequalities begin from birth

BabyBorn to affluent parents – will live 10 years longer than Mark

BabyOne of teenage conceptions. Will live 10 years less than Charles

Aged 10Enjoying a good life, lots of opportunity to play sport

Aged 10Growing up in poverty

Aged 20At university with 10 x A* at GCSE. Plays rugby and eats a healthy diet

Aged 20Left school with no qualifications, casual labourer, drinks, smokes and takes drugs

Aged 45Fit and healthy businessman, manages stress by playing squash

Aged 45Weighs 18 stone, has high cholesterol, type 2 diabetes

Charles

Mark

Aged 60Died from massive stroke

Aged 60Retired early to spend time with his grand-children and travel

Source: NHS North West SHA 9

There are health inequalities within the West Midlands which are closely associated with deprivation and child poverty:

Deprivation: 27.4% of WM people live in 20% most deprived areas in England (England average 19.9%)

Child Poverty: 24.8% of WM children live in families receiving means-tested benefits (England average 22.4%)

(Source: Health Profile 2010)

Child Poverty

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West Midlands Strategic Health Authority

(Source: Health Profile 2010)

• Large and escalating burden of disease not just from the public health perspective but also from an economic one

• Cardiovascular disease, diabetes, cancer and respiratory diseases

• Social burdens include – prolonged disability – diminished resources within families – reduced productivity– tremendous demands on health systems

Source: UN High-Level Meeting on NCDs 23 September 2011

Costs

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• Smoking accounts for over 50% of health inequalities across different groups

• Direct Cost to NHS £5.2bn pa – Approx 5% of total NHS expenditure

• Healthcare costs for smokers up to 40% higher than for non-smokers

• Smoking in the West Midlands has decreased from 40% to 22% over 30 years, however challenges remain– Routine and manual workers– Pregnant women– Second hand smoke

Smoking

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Alcohol • Alcohol related hospital admissions increased in the

West Midlands - more than doubled in period 2002/3 to 2009/10– 46,616 to 113,205

• Direct cost to NHS of alcohol harm reduction estimated at £1.7bn per year

• Costs to society, approx £20 bn per year

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Source: NCHOD 2009 Equity from the Start15

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Infant Mortality – Key Actions• Reduce smoking in pregnancy• Reduce child poverty• Increase breast feeding initiation• Improve housing and reduce overcrowding• Reduce obesity • Reduce teenage pregnancy • Reduce unexpected deaths in infancy

Equity from the Start17

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Opportunities

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Healthy Lives, Healthy People: our strategy for public health in England

Aims to:• empower local leadership to strengthen health and

wellbeing• support self esteem, increased confidence and

personal responsibility• promote healthier behaviour and lifestyles• change the environment to support healthier choices• protect the public from threats to health.

December 2011: continuing to finalise key elements of the design of the new public health system

Following extensive consultation, further details published in July 2011’s Update and Way Forward

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Local Government’s “New” Functions

New duty to improve the health of the population:• some of most important levers for improving health and wellbeing -

planning, transport, leisure, education - are instruments of local government

• health and wellbeing boards will integrate commissioning approaches (JSNA; JHWS)

• working with Clinical Commissioning Groups

• collaborating with the voluntary sector

• providing population healthcare advice to the NHS

• working with national bodies – PH England; NHS Commissioning Board

Local political leadership critical to making this work and ensuring a ‘safe landing’ of public health functions.

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“New” Duty to Ensure Plans in Place to Protect the Health of the Population

• Nothing new for local authorities - have had health protection responsibilities since the 19th century and currently have major powers and responsibilities under existing legislation including Environmental Protection and Public Health Control of Diseases Acts

• Councils will have a new responsibility for ensuring adequate and appropriate health protection plans

• Most health protection incidents are contained locally• The DPH will routinely assess intelligence on all

incidents, and will lead the local response working with PHE and the NHS

• This will include outbreak management, infection prevention and control, and non-infectious environmental hazards

• System management still emerging......................

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Local authority commissioning responsibilities: leadership role in tackling the causes of ill health; reducing health inequalities; promoting and protecting health; promoting social justice and safer communities * = mandated

• Tobacco control & smoking cessation

•Alcohol and drug misuse

•Services for children 5-19

•National Child Measurement Programme*

•Obesity and weight management

•Local nutrition services

•Increasing physical activity

• NHS Health Checks*

•Public mental health services

•Dental public health services

•Injury prevention•Birth defect prevention

•Behavioural and lifestyle campaigns to prevent LTCs

•Local initiatives on workplace health

• Support and challenge of NHS services (immunisation and screening)

•Public health advice to NHS*

•Sexual health services*

•Seasonal mortality initiatives

•Local role in health protection incidents*

•Community safety •Social exclusion

* Indicates mandated services

FAIR SOCIETY,HEALTHY LIVES CONCEPTUAL FRAMEWORK.

REDUCE HEALTH INEQUALITIES AND IMPROVE HEALTH AND WELLBEING FOR ALL.

Create an enabling society that maximises individual and

community potential.

Ensure social justice, health and sustainability are at heart

of policies.

A. Give every child the best start in

life.

C. Create fair

employment and good work for all.

B. Enable all children, young people and adults to maximise

their capabilities and have control over their lives.

D. Ensure healthy

standard of living for all.

E. Create and develop

healthy and sustainable places and communities.

F. Strengthen the role

and impact of ill health prevention.

EQUALITY AND HEALTH EQUITY IN ALL POLICIES.

EFFECTIVE EVIDENCE BASED DELIVERY SYSTEMS

Policy objectives

Policy mechanisms

Principles

• Social justice• Material, psychosocial, political empowerment • Creating the conditions for people to have

control of their lives• Connects people, places and prospects

New approach to Public HealthProtect and improve the public’s health, improving the health of the poorest fastest

• Reach Out and Reach Across– Address root causes and reach those who most need support

• Representative– Owned by communities and shaped by their needs

• Resourced– Ring-fenced funding and incentives to improve

• Rigorous– Professionally and politically led, evidenced, efficient and effective

• Resilient– Sustainability and protecting health

26Source: Healthy Lives, Healthy People, Update and Way Forward, 2011

Deficit

Process

Disease

Knowledge

Medical

Professional led

Do to

Asset

Outcomes

Wellbeing

Action

Social

People led

Do with

Moving from the old to the new

Councillors as champions for their communities

Local Government

• Focus on needs of local population

• Capacity to orchestrate action to address the social determinants of health

• Whole system leadership

• Increasing participation and empowering communities in coproducing local issues and solutions

• Local democratic accountability

Opportunities for Councillors Leadership and Advocacy for Improving health and

Reducing Health Inequalities Maximise opportunities for delivery of the new public health

function and prevention services Enable wider understanding of how all Local Authority

portfolios can deliver improved health (housing, education, economy, regeneration, planning, social care, children’s services ..)

Champion for improved public health through existing local government powers (e.g. using licensing in controlling cheap alcohol; fast food outlets)

Leadership on population behaviour change programmes (e.g. Change 4 Life; improved physical activity, increased walking and cycling for health, etc.)

Communicating with and in touch with local people (the power of social media)

Challenge poor outcomes through the Health and Wellbeing Board/Healthwatch/Scrutiny

Use of local health data and evidence base of what works with support from the Director of Public Health and service users through local Healthwatch

Develop new/strengthen existing local/national partnerships and alliances

Clinical Commissioning Groups PH England VCS

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More Information?

• Karen.saunders@dh.gsi.gov.uk• The new public health system factsheets are

available at http://healthandcare.dh.gov.uk/publichealth• Sign-up to the national Transforming Public Health

bulletin http://phbulletin.dh.gov.uk/• Contact the DH Public Health England transition

team PublicHealthEngagement@dh.gsi.gov.uk• West Midlands PH Transition website

http://www.wmpho.org.uk/lfph/phtransition.aspx• West Midlands Councils www.wmcouncils.gov.uk/