Ruth Hussey

1
Setting the scene how to move the needle on
health and health outcomes
Creating Good Health
Ruth Hussey
Regional Director of Public HealthNorth West, SHA
2
Content of presentation

• Context
• What it takes to stay healthy
• Action at individual level /population level
• The role of the NHS and other sectors
• Some challenges!

3
Context

• Overall health and life expectancy
• Life expectancy is rising, but inequalities
  remain
• Disease profile trends
• More people are living with chronic physical and
  mental illnesses
• Demographic trends
• An aging population in most areas, with a young,
  multi ethnic population in some areas
• Lifestyle trends
• Smoking, alcohol, exercise, nutrition, sexual
  health are lifestyle factors of significance
• NHS relationships
• Interfaces with social care and other services
  increasingly important
• Public expectations of services are rising both
  in terms of speed and quality of service

4
Analysis at Local Authority level shows higher
mortality in the north and in inner cities
Life expectancy at birth, 2002-04 Quintiles of
Local Authority areas
Males
Females
Longest
78.4 years and over
82.3 years and over
77.5 to 78.3 years
81.7 to 82.2 years
76.6 to 77.4 years
81.0 to 81.6 years
75.5 to 76.5 years
80.2 to 80.9 years
Shortest
Under 75.5 years
Under 80.2 years
Spearhead Group
Rest of England
Rest of England
Spearhead Group
Source National Statistics
5
Inequalities begin from birth
6
A number of different models identify the drivers
of health and health inequalities all span a
number of sectors but are amenable to joint
health and local authority change
ONS report Focus on Social Inequalities
WHO Europe Report The Solid Facts

• Educational attainment
• Occupation
• Income
• Type of housing
• Sex
• Ethnicity
• Where people live

• Poor environment in the womb (maternal
  nutrition, smoking)
• Social exclusion (poverty, discrimination, poor
  education)
• Lack of control and reward at work
• Unemployment - Weak social cohesion
• Addiction (alcohol, tobacco, illicit drugs)
• Unhealthy eating - Inadequate exercise

In 1991, Dahlgren and Whitehead described five
categories of determinants of health

• Age, sex and hereditary factors
• Individual and lifestyle factors
• Social and community influences
• Living and working conditions
• General socioeconomic and environmental
  conditions

7
What does it take to keep the population healthy?

• Improve health and well-being status - lifestyle
  and social conditions
• Fair access to, and use of health, care and other
  services
• Increased quality of care to deliver better
  population outcomes

8
And even when services are accessed, translating
this into improved outcomes is a challenge

• People from black and ethnic minority groups
  report significantly worse access than white
  British people
• Only 19 of disabled women have cervical smears,
  compared with 77 in the general population.
  People in more deprived communities have lower
  coverage for breast and cervical screening
• Only 19 of older people with a diagnosis of
  alcohol misuses disorder were referred by
  psychiatrists to specialist alcohol services

9
And even when services are accessed, translating
this into improved outcomes is a challenge

• Across socio-economic groups
• Prescription rates are lower prevalence of
  statins in people with CVD - 67 of higher
  managerial and professionals receive statins,
  compared to 48 in routine and 29 in never
  worked and long term unemployed
• Spearhead PCTs report lower cancer survival rates
  
• Five-year relative survival for women with breast
  cancer is 2.4 less, for colon cancer in men 3
  less and women 2.7 less, for lung cancer in men
  0.6 less and women 0.5 less and for prostate
  cancer in men 3.8 less

10
What canbe done ?
11
The National Health Inequalities Support Team
experience of supporting front line delivery of
the target is that

• The NHS should be more systematic in its delivery
  of known effective interventions.
• Make sure programmes reward reaching the hardest
  to reach.This is a significant role for
  commissioning and provider organisations
• NHS and Local Authorities can contribute to the
  reduction in health inequalities in important
  ways
• As service commissioners
• As service providers
• As major employers
• As good corporate citizens
• As community leaders and advocates

12
Everybodys business - whose responsibility?

• Role of different organisations means not always
  clear on overall responsibility
• Who will occupy the health space?

13
Our journey to good health
Health space
14
Whose responsibility?Deliberative event, Sept
2007
15
Public expectation?

• Help on individual risk
• Information on healthy living
• Help people help themselves
• BUT advice alone not enough
• Priorities for the public
• Childhood obesity
• Alcohol misuse
• Mental health
• Smoking
• Drug misuse

• Foresight report, 2007
• Most adults in UK already overweight
• By 2050 60 men and 40 women could be clinically
  obese, without action will cost 45.5 billion per
  year
• Obesity epidemic cannot be prevent by individual
  action alone and demands societal approach

16
Social Marketing and NHS Choices

• Understanding where the person is starting from,
  their knowledge, attitudes and beliefs, and the
  social context in which they live and work.
• A clear focus on understanding existing behaviour
  and key influences
• Using a range interventions or methods to achieve
  a particular behavioural goal. 
• Clarity of audience focus using audience
  segmentation
• The exchange concept understanding what is
  being expected of the customer, the real cost
  to them.
• The competition concept understanding factors
  that impact on the customer and that compete for
  their attention and time.

17
Enablers

• Leadership
• Sustained and systematic action on prevention in
  all pathways using and generating evidence
• Intelligence - Predict and prevent e health
  information
• Collaboration with Local Authorities, Social Care
  and Third sector action to support individual and
  population change
• Public involvement to inform social/ population
  action Nuffield Centre for Bioethics,
  Intervention ladder
• Health promoting NHS - all work stream leads play
  a part to embed this work and help to drive
  solutions

18
A new NHS

• Prevention at the heartof everything we do