A Call to Debate: A Call to Action

A report on the health of the population of NHS Greater Glasgow and Clyde

Dr Linda de Caestecker Director of Public Health

Key Messages

• There are lessons to be learned from what is getting better • Health inequalities are increasing • Our least healthy communities are unlike our healthy communities in every way • Significant changes are taking place in our population • The obesity epidemic must be taken seriously • Alcohol is an increasing problem • Sustainability should be a more explicit consideration

Tobacco

• A Scottish Prevention Action Plan – Smoking and young people – Reducing attractiveness, affordability and availability of tobacco produces • Revised Tobacco Action plan • Evaluation of smoking cessation services

Factors positively and negatively affecting success of quit attempt Characteristics

Female Smokes 31 or more cigarettes daily Smokes first cigarette within 5 mins of waking Self-reported health poor Smokes 10 or fewer cigarettes daily At least 1 attempt to quit in previous year SEG score 1 (least deprived)

Factors + + +

Phase 2 comparison of services

Bauld, Briggs, Boyd, Chesterman, Ferguson, Judge & Wilson     Both services used more by women than by men. Both treating a large number of heavily addicted smokers. 44% of pharmacy service users, but only 24% of group service users, are <40 yrs Both services have a high % of users from disadvantaged areas (58% pharmacy and 46% group service, from bottom quintile) 4-week CO-validated quit rates: • Starting Fresh (Pharmacy) 18.6% • Smoking Concerns (Group) 35.5%

Factors affecting success of quit attempt ( univariate analysis ) Characteristics

Gender Age Lives in relatively disadvantaged area Smokes first cigarette within 5 mins of waking Self-reported health poor Smokes 20 or fewer cigarettes daily At least 1 attempt to quit in previous year SEG score 1 (least deprived)

Pharmacy

x + x x x +

Group

x x x x x x x x

Outcomes at 4 weeks

• The Group participants were significantly more likely to quit than pharmacy users, even after controlling for differences in the characteristics of cases taken on by the two schemes.

• Cost per quitter for groups - £686.15

• Cost per quitter for pharmacy service £191.63

Inequalities are increasing

• Focus on social determinants of health with community planning, e.g. worklessness, child poverty and learning.

• Targeting health resources to reach unmet needs.

• Disseminate learning from effective interventions.

Our least healthy communities are different in every way

• Focus resources on early years, including early education, childcare and support for vulnerable families and young people.

• A higher priority must be given to parenting support.

• Violence is a public health issue

Parenting interventions

• Parenting interventions are amongst the most powerful and cost-effective tools available to prevent and manage conduct problems • Prevention of conduct problems has important implications for education and future well-being.

• The majority of parents do not participate in parent education.

• Parenting Survey (2007) showed over 40% had not had any support with parenting and 77% would consider parenting support if available

How can we develop parenting programmes in Glasgow?

• A favourable policy and commitment at local and national levels • Deliver evidence based programmes through primary care, social care, voluntary sector in a coordinated way.

• Use different modalities – phone, brief interventions, seminars • Support for practitioners • Effective engagement strategy

The proposed model

UNIVERSAL INTERVENTIONS ACTIVE FILTERING Parents and professionals both believe no problems .

NO INTERVENTION Parent or professionals believe there are problems .

ADDITIONAL ASSESSMENTS SPECIALIST SERVICES Parents and professionals believe there are problems .

INTERVENTION Defaulters and families with continuing problems at HV assessment

Interventions

• Public awareness and information campaigns such as : – Talk to your baby – Backward-facing buggies/ baby carriers – Netmums • Brazelton neonatal behavioural assessment • Bookstart • Open access large group classes • Evidence-based parenting groups • Parenting coordinators in each CHCP

The obesity epidemic must be taken seriously

• Obesogenic environment – Readily available, cheap and heavily marketed energy rich foods – Increase in labour saving devices (lifts, remote controls etc) – Increase in passive and motorised personal transport (cars as opposed to walking, cycling or walking to public transport hubs) – Possible decrease in participation in active leisure pursuits

Opportunities for action on obesity

Public Health Response

• Infant feeding strategy • Development of an obesity strategy • Highlight awareness of obesity • Removing unhealthy snack provision in public buildings including hospitals or leisure centres • Food in schools • Redesign of our urban environment including good examples from other places • Increase children’s physical activity • Price and promotion • Weight management services for children (new HEAT target) • Monitoring

Alcohol is an increasing problem

• Increased affordability and social acceptability of drinking to excess • Consumption is increasing – 63% of men and 57% of women exceed recommended levels • Young people’s drinking is problematic People in deprived circumstances suffer more harm – not solely due to more consumption

Cultural context

Scottish Social Attitudes Survey (2004)

• Two thirds of respondents agreed that

Drinking is a major part of the Scottish way of life

• Younger people more likely to view drunkenness and binge drinking as acceptable behaviours and less likely to think this could lead to serious long-term health effects • Perceived social stigma to not drinking • Three quarters of adults report that their most common drinking location is in the home

Affordability

Evidence: protection & controls

There is evidence for effectiveness of: • Fiscal policy (alcohol taxation), in reducing total alcohol consumption and alcohol related problems • Minimum drinking age laws, in reducing alcohol consumption, drink driving and adverse traffic related outcomes • 80mg/100ml blood alcohol concentration laws, in reducing alcohol-related crash fatalities • Selective breath testing, sobriety checkpoints and random breath testing, in preventing alcohol-impaired driving, alcohol-related crashes and associated fatal and non-fatal injuries • Intensive, high quality, face-to-face server training, when accompanied by strong and active management support, in reducing intoxication levels in customers Source: Ludbrook 2004; Mulvihill et al 2005

Evidence: prevention & education

• There is evidence for effectiveness of community prevention programmes, but these are focused on drink related problems rather than levels of alcohol consumption per se.

• Warning labels have had little effect on behaviour in the US • Little evidence that school-based interventions have lasting effects on behaviour. Interactive delivery, parental or community involvement are more likely to be successful • Lack of review-level evidence for the effectiveness of interventions in reducing alcohol misuse in young people Sources: Ludbrook 2004, Mulvihill et al 2005

Evidence: treatment & support

SIGN 74 (2004) - The management of harmful drinking and alcohol dependence in primary care: a national clinical guideline

   Covers:  Detection and assessment of harmful drinking and alcohol dependence  Brief interventions for hazardous and harmful drinking in primary care Detoxification Relapse prevention – psychosocial, pharmacological Referral to specialist treatment

• • • • •

Responding to the Problem Joint Alcohol Policy

Reducing alcohol related death and hospital admissions through the continuous improvement of alcohol services.

Reducing alcohol consumption levels in the whole population and in specific target groups who binge or drink harmfully.

Reducing alcohol related crime, violence and disorder.

Reducing harm to children affected by alcohol problems in the family.

Promoting responsible alcohol consumption among our employees and raising awareness of alcohol related harm in our role as an employer, as partners with a wide range of organisations and as procurer of services.

Action on sustainability

• Understand the health benefits of tackling climate change • Sustainable solutions incorporated into new build.

• Development of plans for recycling, green travel, energy efficiency. • Procurement policies must consider environmental health and social impact and benefits.