dr raymond jankowski
TRANSCRIPT
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
10Getting serious about
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
Making an impact on the public's health and wellbeing in England
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
Making an impact on the public's health and wellbeing in England
Responding to the challengeDelivering on tobacco
Making an impact on the public's health and wellbeing in England
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
Making an impact on the public's health and wellbeing in England
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.
Making an impact on the public's health and wellbeing in England
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:
Red
uci
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vari
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n
Pu
shin
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ou
nd
arie
s
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.
22Getting serious about
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.
Making an impact on the public's health and wellbeing in England
Responding to the challengeMulti-level approach to NCDs and their determinants
Making an impact on the public's health and wellbeing in England
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.