The role of Public Health in Tackling Health Inequalities in Salford Basis Thursday 19 th March 2015 Ian Ashworth Consultant in Public Health

1948 Medical Officer for Health Dr Lance Burn – “to make health attractive and help people to live healthier lives”. Salford first city in GB to – wipe out diptheria, – one of the first to use mass X Rays to tackle TB – put the Clean Air act into use. – led the country in helping people with mental health issues to live in the community rather than institutions. – life expectancy was 66 years for men / 70 years for women (78 & 80) – main causes of death: heart disease and cancer – infant mortality fell from 61 to 42 per 1000 live births ( ) today’s rate 5.5/ years of Salford Public Health

So what is Public Health? Focus on the health and wellbeing of a society and most effective means of protecting and improving it. Preventing illness / disease and promoting health and wellbeing. Addresses inequalities, injustices and denials of human rights Works through partnerships that cut across professional and organisational boundaries Relies on evidence, judgment and skills and promotes the participation of the populations

Main areas of responsibility Health Improvement - Commissioning for Public Health Health Intelligence – Advice to CCG on population “Healthcare Public Health” Health Protection – Prevention – Preparedness

Local Authority Public Health commissioning responsibilities Tobacco control and smoking cessation Alcohol and drug misuse Seasonal mortality excess deaths National Child Measurement Programme* Local nutrition initiatives Increasing physical activity NHS Health Check assessments* Public mental health services Dental public health services Accidental injury prevention Population level interventions to prevent birth defects Behavioural and lifestyle campaigns to prevent cancer and long term conditions Workplace health Review and challenge of screening, immunisation Sexual health services* (outside of GP contract and HIV) Public health services for children and young people 5-19 (and by 2015 public health services for children and young people) Health protection incidents, outbreaks and emergencies*, impacts of environmental risks Public health aspects of community safety, violence prevention, and response, social exclusion Source: Public health in Local Government Commissioning Responsibilities Factsheet 2012

Some Headlines: Salford Residents Die Earlier Source: Health and Social Care Information Centre (HSCIC) (accessed 01/08/14) Source: Health and Social Care Information Centre (HSCIC) (accessed 01/08/14)

Reasons for Life Expectancy Gaps

Salford residents face health challenges Significantly Better Than England Average Significantly Worse Than the England Average Recorded DiabetesDeprivation Excess winter deaths (3 years) Children in poverty Killed/seriously injured on roadsStatutory homelessness GCSE achieved Long term unemployment Smoking at time of delivery Starting breast feeding Obese Children (Year 6) Alcohol-specific hospital stays u18 Under 18 conceptions Adults smoking Physically active adults Hospital stays for self-harm Hospital stays, alcohol related harm Drug misuse Acute STIs Hip Fractures Life expectancy – male Life expectancy – female Smoking related deaths Mortality rate CVD Mortality rate cancer.

Salford has significant deprivation

The poorest areas have worst health

The number of bars and takeaways along the main routes and in town centres serving less deprived populations such as Worsley, Claremont and Cadishead is far less

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2

Males Females © Crown copyright and database rights 2012 Ordnance Survey Adult obesity: BMI ≥ 30kg/m 2

What this means for Salford Children In 2012: Approximately year olds are obese Approximately year olds are obese Nearly 13,000 children under the age of 16 are an unhealthy weight Data from Salford child weight measurement programme

The impact of obesity on children Type 2 diabetes strongly associated with obesity - obese women 12 times more likely to develop type 2 diabetes Type 2 diabetes (disease of adults) is now seen in obese schoolchildren - likely to develop heart disease at age Research estimates diabetes will occur in 1 in 3 children born in 2000 Mental health impact - children experience stigmatisation, discrimination and prejudice - obesity linked to low self-image, low self confidence and depression in children - in one study in USA obese children rated their quality of life as low as those of young cancer patients on chemotherapy Ultimately, obesity reduces life expectancy by up to 11 years

Source: Dahlgren and Whitehead (1991)

Examples of Local Health Improvement Commissioning City Council Health Improvement Service delivering: Stop Smoking Support and Family Weight Management Programme Community Leisure Trust: Active Lifestyles, cardiac and pulmonary rehabilitation Salford Schools Sports Partnership Way2Wellbeing portal Community Asset Network Being Well Salford: Wellbeing Coaches Healthy Living Centres Health Trainer Service Healthy Communities Collaborative: Be clear on cancer campaigns Drug and Alcohol recovery Service Sexual Health promotion services

Tackling Inequalities Joint Health and Wellbeing Board and Strategy Targeted and collaborative commissioning Community assets and the vital role of VCSE Integrated Care Programmes Salford’s National Health Inequality Tool National Demonstrator site for Preventing Diabetes Policy and Licensing opportunities GM Devolution