Transcript Powerpoint template

Putting the Public back in
Public Health –
New Approaches to improving
Health & wellbeing for the 21st
century.
11-04-2014
Wendy Meredith
Director of Public Health
Bolton Council
The presentation will cover:
•Reflection on features of public
health in 21st century
•Discussion of emerging trends
•Outline possible approaches to new
and old problems
Public Health in 21st century
A powerful case for change
We face significant challenges to the public’s health:
• Two out of three adults are overweight or obese
• Smoking costs the NHS £2.7 billion per year. And there are
wider economic and social costs from preventable ill-health:
• drug use and smoking cost over £10 billion per year
• Major health threats, ranging from the risk of new pandemics
to the potential impact of terrorist incidents
• Inequalities in health remain: in 2008-2010, the gap between
local authorities with the highest and lowest life expectancy
was nearly 12 years for males and just under 11 years for
females.
Life expectancy
Internal gap
12 years
Gap with
England –
bigger than
ever
Bolton Health & Wellbeing Survey 2010
Key changes since 2007 survey
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Self perceived general health has slightly worsened
Increases in backache and joint pain
Diabetes has continued to increase (BBHC)
Mental health worsened
Obesity has increased further
More people experiencing financial difficulties
More negative perceptions of neighbourhood
• Smoking has continued to fall
• Regular dental check ups continue to increase
Lifestyle factors & risk factors
• Smoking has reduced but still 1 in 3 adults admit to smoking in some
deprived areas
• Alcohol - 30% adults binge at least once a week, 24% drink over the
recommended wkly level, 12% have just 0-1 alcohol free day a week
Alcohol consumption is greatest in least deprived areas but the
reverse is seen related mortality rates
• Obesity – 20-25% adults are obese
9% Reception aged children, 21% by Year 6 are obese
• Physical activity – 17% adults leading a sedentary lifestyle, 43% do 5
sessions
• Substance misuse – estimates of 2272 opiate and or crack users –
‘traditional’ drug user profile is changing
• Sexual health & teenage pregnancy – significant improvement in TP
in recent years but still above national average
• Infectious disease - HIV prevalence and TB incidence increasing
However good the NHS gets, until
we get better at dealing with public
health, poverty, housing, job-lessness, education and giving kids a
sure start in life, we were running
up the down escalator.
Roy Lilly, NHS Commentator
‘Three Horizons’ Model Of Innovation
(Adapted by Duggan and Marsh 2008)
VIABILITY
How to Read a Change of Age
radically
different
operating
environment
increasing
synchronous
failure
HORIZON 1
new paradigm
fits and takes off
less
Innovation to try
and keep things
going
disruptive
change
HORIZON 2
new context for
useful old ways
HORIZON 3
NOW
THE TURBULENT TRANSITION
www.internationalfuturesforum.com
TIME
An effective public health system
•Accounts for the changing nature, assets and strengths of the population – is vigilant
for new health threats
•Ensures economic development creates health and well being
•Advocates wise use of environmental resources
•Promotes individual and community well being
•Helps people limit behaviours damaging to their health.
•Secures equitable access to good quality health and social care, with prevention
incorporated into all contacts.
•Systematically works to reduce health inequalities and embeds health and well being in
all policies.
Essential Public Health system
1.Monitor health status to identify community problems
2.Diagnose and investigate health problems and health hazards in the community
3.Inform and educate people about health issues and empower them to deal with the
issues
4.Mobilise community partnerships to identify and solve health problems
5.Develop policies and plans that support individual and community efforts
6.Enforce laws and regulations that protect health and ensure safety
7.Link people to needed personal health services and ensure the provision of health
care when otherwise unavailable
8.Ensure a competent public health and personal care workforce
9.Evaluate effectiveness, accessibility and quality of personal and population based
health services
10.Research for new insights and innovative solutions to health problems
Emerging trends
Strategic shift from healthier habits to wellbeing
The Wellbeing Shift
Illness
Wellness
Proximal
Distal determinants
(the root causes)
Deficits/
problems
Assets/ goals
What you are
doing
Why you are doing it
Passive recipient
Active,
empowered citizen
Health Inequalities
People
Places
Power
Protecting health and improving wellbeing throughout
life
1.Empowering local government and communities
2.Tackling health inequalities
3.Coherent approach to different stages of life
4.Giving every child the best start in life
5.Making it pay to work
6.Designing communities for active ageing and sustainability
7.Protecting communities from threats
8.Working collaboratively with business and voluntary sector
Possible approaches to new and
old problems
What could be different?
•Five ways to well-being – Large scale change
•Asset based working
•Community resilience and coproduction
•Community oriented primary care
•Integrated Wellness Services
•Investment for Health – “Health in all policies”
Five Ways To Well-being Action that
individuals can take …….
1.Connect - with family, friends, colleagues,
neighbours
2.Be active - walk, run, garden, dance
3.Take notice - be curious, reflect on
experiences
4.Keep learning - try something new
5.Give - doing something for others
What could be different? - Better preventive services
• Improved use of
wellness based
prevention services
• Prevention incorporated
into every care contact
What could be different? – access to information
•Better access to public health information
•Extensive use of internet based communication
and services - www.health2works.com
Web 2.0
What could be different? - JSNA or JSAA?
Traditional Approach
Asset Based Approach
JSNA
JSNA
Specialist
interventions
Areas where
support may
be required
Filled with
public
service
provision
Community
assets and
capacity
POPULATION NEED
Community
What could be different? – Community involvement
“You can’t know what you need until
you know what you have”
“Look in your back yard before you go
to the store”
John McKnight
Institute for Asset-Based Community Development
Northwestern University, Chicago
The 12 Principles of ABCD Community Involvement
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Everyone has gifts
Relationships build a community
Leaders involve others as active members of the community
People care about something
Motivation to act must be identified
A listening conversation
Ask, Ask, And Ask
Asking questions rather than giving answers invites stronger
participation
• A citizen centred ‘inside-out’ organisation is the key to
community engagement
• Institutions have reached their limits in problem solving
• The institution as servants
What could be different? – Health in all polices
Policies
• Local policy decisions made whilst
knowing their possible health
impacts
• Health in All Policies
Conclusion
• Now seeing limitations of risk theory of
disease and lifestyle approach
• Shift from Illness to Wellness
• Putting “public” back in public health
References
http://www.idea.gov.uk/idk/aio/26995259 Joint Strategic Needs
Assessment: a springboard for action
http://www.idea.gov.uk/idk/aio/18410498 A Glass Half Full: How
an asset approach can improve community health and wellbeing
http://www.nwph.net/hawa/writedir/2fa6The%20Asset%20Appro
ach%20to%20Living%20Well.pdf The Asset Approach to Living
Well
http://www.nwph.net/hawa/writedir/da0dNW%20JSAA.pdf
Development of a Method for Asset-Based Working
http://www.abcdinstitute.org/ ABCD Institute, Northwestern
University, IL, USA
http://www.youtube.com/watch?v=NhZOLLaLNDY
Putting the Public back in
Public Health
11-04-2014
Wendy Meredith
Director of Public Health
Bolton Council