Jim McManus, OCDS, CPsychol, CSci, AFBPsS,FFPH, FRSPH Director of Public Health, Hertfordshire County Council 24 th September 2014 Hertfordshire Health Walks Conference Public Health in Hertfordshire: Health Walks as a vital part

Some issues On the whole we do better than England Look below that though year gap in life expectancy between richest and poorest Significant avoidable disease, disability and death

Premature deaths in Hertfordshire

Obesity

Contributors to overall health outcomes and why elected councillors are important leaders Smoking 10% Diet/Exercise 10% Alcohol use 5% Poor sexual health 5% Health Behaviours 30% Education 10% Employment 10% Income 10% Family/Social Support 5% Community Safety 5% Socioeconomic Factors 40% Access to care 10% Quality of care 10% Clinical Care 20% Environmental Quality 5% Built Environment 5% Built Environment 10% Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.

The Opportunity for Herts The conditions for everyone to be healthy The conditions for the poorest and worst off to be healthier Public services which put this at the core of their business People thriving and prosperous Healthy workforce, prosperous County

Priorities 1. Longer Healthier Lives 2. Start Healthy, Stay Healthy 3. Closing the Gap 4. Understand what’s needed and do what works 5. Partnership: Making PH everybody’s business 6. Protecting our communities from harm

Healthier Herts: A Public Health Strategy for Hertfordshire OUR PURPOSE to work together to improve the health and wellbeing of the people of Hertfordshire, based on best practice and best evidence OUR VISION: A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well against Hertfordshire Priority 5: We understand what’s needed and we do what works Priority 6: We make public health everybody’s business and work together HOW WE WILL WORK TOGETHER ( our strategic priorities: how we do it for our County) The Public Health Outcomes Framework (the national PHOF will Help us measure Our success) WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUR RESIDENTS (our strategic priorities: what we achieve for our County) Priority 1: Our Populatio n lives Longer, Healthier Lives Priority 2: Our Population Starts Life Healthy and Stays Healthy Priority 3: We narrow the gap in life expectancy and health between most and least healthy Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental) Building Blocks For the Public Health Family Strong Leadership Capable, Skilled People Co-production with citizens Effective Partnerships Evidence and Knowledge Driven Plan and Deliver for Localism Whole System Approaches Making better use of behavioural sciences at individual, interpersonal, community and service levels

Why: We are facing an epidemiological crisis with avoidable disability creating huge burdens Avoidable early deaths Chronic disease – poor self management, poor management of sub-clinical risk, must do better on prevention and early intervention Disability and costs to social care and NHS Some sections of our population at very high risk of avoidable misery and death Mental health – intervening too late Resilience and Happiness – likewise

Wins and delivery tools Five big wins 1. Shift up clinical complexity in primary care 2. Step up secondary prevention of complex cases and 3. Step up self care and self management in chronic disease 4. Commission secondary prevention pathway 5. Commission primary prevention for key risk groups Policy and Delivery Tools Pathways and structured care approached Health and social care integration Behavioural sciences Health Checks and public health services Brief interventions

Phasing and Layering Phasing across the lifecourse and time Working age Accumulation Of risk in Late working age Good early Years outcomes For lifetime Mental health

Phasing and Layering across lifecourse Think through what we can do short term Start work on the medium term Set the policy framework for the long term Build this understanding among partners Get started and realise County, District, Parish, NHS, Business and Community Sector working together

What it means for NHS Services Preventive services in every patient pathway Levels and competencies from brief intervention onwards Preventive services in clinical services link up to community services (referral for leisure and behavioural interventions) Commissioning for self-management in chronic disease

What it means for you The Public Health Army Physical Activity side of Walking Social and Psychological support side of walking Turning you into health trainers Keeping you doing what you do best

Hertfordshire’s strategic commitment to physical activity 1. A priority for the Lifestyle and Legacy Partnership (formerly the Olympic legacy partnership) bringing 40 agencies together 2. priority in each district council strategy and there are multiple services 3. A priority for the University in Sports Science 4. A large and thriving Sports Partnership 5. A large network of community sports clubs 6. A priority in the health and wellbeing, Public Health and Sustainable Transport Strategies 7. A priority in the Better Care Fund Plan for health and social care integration 8. A priority in each NHS Commissioning strategy

Whats going on now – a selection 1 Significant district council investment in leisure services and offers, every district offering a form of exercise on referral but this will be further developed over the next year Every district has a leisure offer encompassing indoor and outdoor leisure activities Chief Leisure Officers Association and Sport England are working on a joint District-County-Sports Partnership project to develop a commissioning framework for physical activity for Herts Community grants fund for physical activity funded by public health to be developed by Sports Partnership Every leisure service employee in Hertfordshire can access free public health training £1m per annum public health investment in district councils

Whats going on now – a selection is year of cycling, year of walking next…. Public Health and CCGs and Districts are working with an at scale physical activity programme Workplace health challenge funded by Public Health Workplace health work funded by public health Pool bikes and bike to work scheme in the County Council District councils working on targeted and universal physical activity and leisure offer Public Health and NHS about to employ physical activity promotion manager in primary care to develop physical activity pathways 32,000 people go on Health Walks a year funded by Public Health and District Councils, led by Countryside Management Service Cycling development small grant fund for community agencies as part of Year of Cycling Key third sector agencies commissioned like Groundwork and others 2,500 bikeability courses in schools

Nothing less than a cultural shift to physical activity as mother nature’s way of keeping us healthy will resolve the challenges we face And nothing less than firm resolve to share the same strategy and vision, and work to deliver that, from every partner, will get us there (get behind the Sports and Physical Activity Framework consultation])

Avoidable disability

Avoidable Disability 2 74 year old sedentary male

Avoidable Disability 3 70 year old tri-athlete

Walking...mother nature’s way of keeping us well Social benefits Psychological and resilience benefits Blood pressure and hypertension benefits Cardiovascular and respiratory benefits Musculoskeletal benefits What’s not to love?

Ok, so if that’s why, then how? We cant just turn off the tap We can just shift huge quantities of money, the need is still there A culture shift to everybody active has got to be part of our plan

So how do we get there? 1. Produce a clear single framework for physical activity and sport we all sign up to 2. Build a system wide approach to deal with it 1.Be clear on roles, responsibilities and outcomes 3. A more nuanced understanding of lifecourse and behavioural change 1. Cogntiive and Planned 2. Habitual and automatic

From the Annual Report

Year of Cycling We will put cycling on the map in Hertfordshire as a leisure, health and transport activity Complete revision of some work we’ve been doing including website and apps Start of a 3 year plus cultural push on physical activity County Council, Cycle Clubs, Districts, NHS, Police, working together

Year of Cycling 1 year plus legacy period Year of walking follows Then year of swimming Culture change Already having an impact £2m investment in District Councils by Public Health Chief constable and county council agree to new policy on cycling events/races

Year of Walking Be ambitious You are a public health army You are vital in cultural change We want to work with you

Thank you! Public Health page Free learning resources for public health