The science of creating wellness

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The science of creating wellness

• Prof Carol Tannahill, Director,
• Glasgow Centre for Population Health

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Scotland other Western European countries
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Not always the Sick Man of Europe
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Comparison to WE Mean(Males)
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Proportionate Contribution by Cause - Males
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Coronary heart disease mortalityMen aged 15-74
years
Age-standardised mortality per 100,000
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Healthy Life Expectancy
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Percentage of adults aged 16 and over with a
long-standing illness, disability or health
problem by SIMD quintile, 2007/08    (Scottish
Household Survey)      
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Percentage of adults aged 16 and over with a
long-standing illness, disability or health
problem by SIMD quintile, 2007/08    (Scottish
Household Survey)      
2001 Census figures. Scotland 20 NHSGGC range
from 16 - 30
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A whistlestop tour around some concepts

• Prevention
• Reduce the incidence of health problems (primary
  prevention)
• Reduce the progression of health problems
  (secondary prevention)
• Reduce the impacts of disease (tertiary
  prevention)
• Reduce unnecessary health interventions
  (quarternary prevention)
• BUT

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A whistlestop tour around some concepts

• Prevention
• Reduce the incidence of health problems (primary
  prevention) health problems only?
• Reduce the progression of health problems
  (secondary prevention)
• Reduce the impacts of disease (tertiary
  prevention)
• Reduce unnecessary health interventions
  (quarternary prevention)

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A whistlestop tour around some concepts

• Prevention
• Reduce the incidence of health problems (primary
  prevention) health problems only?
• Reduce the progression of health problems
  (secondary prevention) covers almost all of
  health care activity
• Reduce the impacts of disease (tertiary
  prevention)
• Reduce unnecessary health interventions
  (quarternary prevention)

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A whistlestop tour around some concepts

• Prevention
• Reduce the incidence of health problems (primary
  prevention) health problems only?
• Reduce the progression of health problems
  (secondary prevention) covers almost all of
  health care activity
• Reduce the impacts of disease (tertiary
  prevention) covers almost all of social care
  activity
• Reduce unnecessary health interventions
  (quarternary prevention)

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A whistlestop tour around some concepts

• An alternative
• Prevention of the onset or first manifestation of
  a disease process, or some other first
  occurrence, through risk reduction
• Prevention of the progression of a disease
  process or other unwanted state, through early
  detection when this favourably affects outcome
• Prevention of avoidable complications of a health
  problem or other unwanted state
• Prevention of the recurrence of an illness or
  other unwanted phenomenon.

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A whistlestop tour around some concepts

• Preventative spend
• Spending now that is expected to reduce public
  spending demands in the future by reducing
  avoidable health and social problems
• Must increase healthy lifespan/compress morbidity
• Wanless requirement for fully engaged scenario

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A whistlestop tour around some concepts

• Wellness

Sir Harry Burns
Aaron Antonovsky
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Sense of coherence....
.....expresses the extent to which one has a
feeling of confidence that the stimuli deriving
from one's internal and external environments in
the course of living are structured, predictable
and explicable, that one has the internal
resources to meet the demands posed by these
stimuli and, finally, that these demands are seen
as challenges, worthy of investment and
engagement."
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For the creation of health....

• ....the social and physical environment must be
• Comprehensible
• Manageable
• Meaningful
• ......or the individual would experience chronic
  stress

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Summary

• Scotlands health ranking is a relatively recent
  phenomenon, and reflects a slower rate of
  improvement than other countries
• The outcomes for (young) working age men and
  women are particularly concerning
• For many causes of death, Scotlands improvement
  is in line with other countries
• But social dis-eases are increasing
• Inequalities are also increasing
• There is a lot of evidence (and more emerging all
  the time) that traditional explanations of
  socio-economic deprivation (underpinned by
  effects of post-industrial decline) are not
  sufficient.

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How do we respond?
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1. Programmatically on individual issues?

• The most common response
• Evidence-based and often with a clear method
• Positive outcomes for (a proportion of)
  participants
• Tends to increase inequality
• Rarely achieves population-level impact
• Need to respond to each new issue afresh

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2. Through national policyon individual issues?

• Smoking in public places
• Alcohol minimum pricing
• Screening and immunisation programmes
• Housing quality standards
• Social protection
• School meal standards
• Less likely to increase inequality
• More likely to achieve population-level impact
• But still need to respond to each new issue afresh

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3. On the cross-cutting determinants operating at
individual community levels?

• Fundamental influences that perpetuate poorer
  health outcomes, regardless of the issue
• Power distribution
• Knowledge
• Social networks
• Access to (financial and other) resources
• Asset-based working

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Creating wellbeing
Sense of coherence Seeing the world
as Structured Predictable Feeling that it
is Manageable Meaningful Wanting to engage
Generalised resistance resources Family
Nurture Intelligence Work Material
resource Identity Cultural stability Optimism Stab
le set of answers
Events Stress Tension Resolution Wellbeing
Antonovsky. Health, stress and coping. 1979
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Inflammation in plaques
cytokines
MMP
Lumen
Inflammatory Cells
Degraded matrix
SMC apoptosis
Cap
Core
Inflammatory cells MMPs, IL-6, IL-15, IL-18,
CRP
Thin Fibrous Cap
Unstable
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Choice reaction time
plt0.001
milliseconds
Age (years)
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Environmental determinants of inflammatory status
CRP (median) mg/dl
affluent
deprived
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Implementing at scale.can it be done?
Will Ideas Execution
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The Early Years Collaborative - Aims

• 1. To ensure that women experience positive
  pregnancies which result in the birth of more
  healthy babies as evidenced by a reduction of 15
  in the rates of stillbirths (from 4.9 per 1,000
  births in 2010 to 4.3 per 1,000 births in 2015)
  and infant mortality (from 3.7 per 1,000 live
  births in 2010 to 3.1 per 1,000 live births in
  2015).
• 2. To ensure that 85 of all children within each
  Community Planning Partnership have reached all
  of the expected developmental milestones at the
  time of the childs 27-30 month child health
  review, by end-2016.
• 3. To ensure that 90 of all children within each
  Community Planning Partnership have reached all
  of the expected developmental milestones at the
  time the child starts primary school, by end-2017.

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Lochrin Nursery
weekly average displayed for parents
Research information handed to parents.
Books available at collection time.
Grassmarket changes introduced.
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90 of children at Grassmarket nursery school
will receive a bedtime story at least 3 times a
week.
Family garden party
A very hot weekend
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Alfie

• I like my bedtime story because it helps me
  to dream

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Do one brave thing today.then run like hell!