Transcript The importance of good health to breaking the poverty cycle Thursday 3

Thursday 3rd November 2011
The importance of good health
to breaking the poverty cycle
Insert name of presentation on Master
Professor
Sir Mansel Aylward CB
Slide
Wales now
• Health of the population continues
to improve
but
• The ‘inverse care law’ still persists health inequities remain stark and
resistant to change
Overview
• The importance of the early years in
laying the foundations for good health
• Harnessing Public Health expertise
• Tackling Child Poverty Public Health
Wales core business
• Bevan Commission
• Together for Health
The importance
of early intervention
Tobacco
kills
Mortality
from
Source: Heckman
Curve lung cancer, 1991 - 2008
Source: World Health Organization
www.cymru.gov.uk
Tobacco
kills
Complementary
Mortality
from lung cancer, 1991approaches
- 2008
Source: World Health Organization
Child Poverty Strategy
• Reduce the number of families living in
workless households.
• Improve the skills of parents and young
people living in low income households
so they can secure well-paid
employment.
• Reduce inequalities that exist in health,
education and economic outcomes of
children and families by improving the
outcomes of the poorest.
Our Healthy Future
www.cymru.gov.uk
• Improve the length and quality
of life.
• Fairer health outcomes for all
Early Years
Child Poverty and Health
Targets
• To reduce difference in outcomes between the most deprived 5th
and middle 5th except infant mortality (most and least deprived
5th) :-
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Teenage Conceptions
Infant Mortality
Pedestrian Injuries in Children
Low Birth Weight
Dental Caries
Public Health Expertise
Epidemiology
Understanding causal factors
Evidence Base & what should we do
Targeting and reach
Partnership working and sharing
Public health advice and consultancy
Measuring change
Example: Early Years Pathfinder
Project – low birth weight
Aim: To explore how an explicit evidence based approach and coordination
could add value to the public health activity in Wales on early years
health.
95% confidence
interval
Low birth weight by local authority, percentatge of singleton live births,
1998-2007
P ro duced by P ublic Health Wales Observato ry, using data fro m ONS (A DB E, M YE)
6.8%
Newport
4.9%
Monmouthshire
6.0%
Torfaen
7.8%
Blaenau Gwent
6.1%
Caerphilly
7.6%
5.5%
The Vale of Glamorgan
Merthyr Tydfil
5.7%
Bridgend
6.5%
5.7%
Neath Port Talbot
Rhondda Cynon Taff
5.5%
Swansea
6.2%
5.6%
Carmarthenshire
A reas o rdered geo graphically fro m no rth west to so uth east
Cardiff
5.5%
Pembrokeshire
Ceredigion
5.0%
4.4%
5.4%
Wrexham
Powys
5.3%
6.0%
Denbighshire
Flintshire
6.0%
Conwy
5.0%
Gwynedd
Isle of Anglesey
5.4%
Wales = 5.8%
Outcome indicators
Pregnancy
Birth
0 – 5 years
•Smoking
•Obesity
•Alcohol
•Mental health
•Vulnerable groups
•Pre-term birth
•Low birth weight
•Breast feeding
•Infant mortality
•Hospital admissions
•Injuries
•Language delay
•Social and emotional
capability
•School readiness
•Parenting
•Maternal mental health
Need to also capture interventions at an individual level
Evidence for interventions
Clear evidence base
Less clear
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• Obesity prevention
• Reducing inequalities
Folic acid supplementation
Smoking cessation
Breastfeeding
Newborn hearing and
bloodspot screening
• Immunisations
• Parenting programmes
(e.g. Incredible Years)
• Family Nurse Partnerships
What interventions are in place and
next steps...
• Variation between Health
Boards
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• Pathways for obesity,
smoking cessation and
perinatal mental health
• Flying start – variation in
parenting programmes
used
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Finalise outcome indicators, aligned
with the Welsh Government
Maternity Strategy.
Pilot a Reproductive and Early
Years Surveillance System.
Review literature focussing on
specific questions that address
effectiveness of interventions and
models of service provision.
Model potential impact of risk
factors and interventions to inform
effective targeting of action
Teenage
Tobaccoconceptions
kills
Under
18, Teenage
Mortality
from lungConceptions,
cancer, 19912007-2009
- 2008
Source:
Office
forHealth
National
Statistics
Source:
World
Organization
Data
70
Average
Merthyr Tydfil
2SD limits
65
3SD limits
www.cymru.gov.uk
60
Rhondda,
Cynon, Taff
Cases per 1000 Population
55
Cardiff
50
45
40
Annual Quality Framework 2011-2012
35
Teenage conceptions (Under 16s)
Source: StatsWales
30
25
20
0
2,000
4,000
6,000
8,000
Population
Source: ONS
10,000
12,000
14,000
16,000
18,000
Reducing the teenage conception rate
in Wales
• Background: (a) Poor health and social outcomes for young
mothers and children (b) conceptions clustered amongst; repeat
pregnancies, looked after children and care leavers, areas of high
social deprivation
• Phase one – to reduce repeat conceptions (currently 20% of
pregnancies)
• Phase two – to reduce conceptions amongst looked after
children and care leavers (in some areas up to 1/3 conceptions
amongst this group) and young people with substance misuse
problems
• Phase three – wider population
Health and worklessness
Combined rate of workless benefits (IB, ESA, JSA)
within local authorities
Quartile 4 (Highest)
Quartile 3
Quartile 2
Quartile 1 (Lowest)
Source: Nomisweb
• The areas with the poorer
health outcomes are also
the places with the
highest rates of
worklessness
• To improve the health of
our population it is vital to
get people to meaningful
work
• Healthy Working Wales
2011-2015
The Bevan Commission:
First Minister’s Announcement
‘….. a source of independent, expert advice
on the development of health services here in
Wales.
its core purpose will be to provide ……….
assurance that the reforms ………. will succeed
…..
a health service which is publicly owned
and publicly provided; a service which is
rooted in an ethic of care, rather than
competition and a service which has, at its
core, the pursuit of health, as well as the
treatment of illness.
A NHS, in other words, which would be
recognisable to its founder.’
First Minister: 16 July, 2008
What Bevan wanted in
1948
• Comprehensive treatment, within
available resources
• Universal access, based on need
• Services delivered free at the point
of delivery
What he might have added –
the Bevan Commission additional
principles
1. A shared responsibility for health between the people of
Wales and the NHS
2. A service that values people
3. Getting the best from the resources available
4. A need to ensure health is reflected in all policies
5. Minimising the effects of disadvantage on access and
outcome
6. A high quality service that maximises patient safety;
7. Patient and public accountability
8. Achieving continuous performance improvement across all
dimensions of healthcare
Going for gold –
“World Class Healthcare”
Services best suited to Wales but comparable
with the best anywhere1
Essential Elements include:
• Balance and integration
• Measured quality as good as or better than comparable
systems
• A step change in population health
• A crucial leadership role for government
• Performs well against Bevan Commission Principles2
1.
Bevan Commission Report 2008 – 2011
2.
Bevan Commission. World Class Health Care for Wales (2010)
So how is the NHS doing?
Outstanding business
The NHS must do more on :
• cutting health inequalities and inequities
• promoting a ‘sea-change’ in public attitudes
• driving out waste in the health system
• effective partnerships across public health
and local government
• getting solutions to health problems across
all policy agendas.
The Answer:
Partnership with the Welsh
People
Government, the NHS and the people
of Wales need to work together to:
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look after themselves – with help
take control of their lives
use the system well
redesign services
get real about what is feasible
The answer:
Real Political leadership
• Help and encourage people be responsible
citizens
• Don’t change the system if it isn’t broken
• Look for health benefit in every policy area
• Help educate the public that change is
needed; and
• Champion a culture geared towards quality
The Commission, the NHS
and the future
• Aneurin Bevan’s principles still stand as strong
today as they did in the late 1940s
• The Welsh system will be distinctively Welsh
• Tough challenges that require commitment,
tenacity, leadership and partnership throughout
healthcare, government and society
• A system willing to match itself against the best
The Welsh Government’s
response
• On 1 November 2011 Lesley
Griffiths AM, Minister for Health and
Social Services launched
‘Together for Health’
A vision for the next 5 years
responding to the Bevan
Commission report
Acknowledgments
Dr Tony Jewell, CMO, Welsh Government
[email protected]
Dr Shantini Paranjothy
[email protected]
Dr Noel Craine
[email protected]
Eryl Powell
[email protected]