"Practical Public Health for the Geriatrician". Paul Johnstone PHE Regional Director North of England

What is Public Health? Facts and figures Older people focus How is PH organised? How to get involved and work on Dementia

What is public health? The Faculty defines public health as: The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.

Public health: is population based not patient individual base emphasises collective responsibility for health, its protection and disease prevention recognises the key role of the state, linked to a concern for the underlying socio- economic and wider determinants of health, as well as disease emphasises partnerships with all those who contribute to the health of the population.

Determinants of Health

Three domains of public health practice: Health Improvement Inequalities, Education, Housing, Employment Family/community Lifestyles Surveillance and monitoring of specific diseases and risk factors Improving services Clinical effectiveness, Efficiency Service planning Audit and evaluation, Clinical governance Equity Health Protection Infectious diseases Chemicals and poisons, Radiation Emergency response Environmental health hazards

Public health and healthcare success stories Most of the early improvements were due to improvements in child health (including vaccination) and Data Source: Mortality in England and Wales Average Life Span, December 2012 A tale of two populations- 26th Sept 2013

Presentation title - edit in Header and Footer Data Source HSE 2011 Volume 1 HSCI Presentation title - edit in Header and Footer

Greatest reduction in CVD Data source Avoidable Mortality in England and wales 2011 ONS may2013 Presentation title - edit in Header and Footer

Public health working with healthcare professionals- reducing stillbirths.

Unfinished business- inequalities Data source: ONS Inequalities in LE and DFLE , 2001-2004 to 2007-2010 Source: ONS Statistical bulletin Life expectancy at birth and at age 65 for local areas in England and Wales, 2009-11 Presentation title - edit in Header and Footer

Increasing retirement age will not increase tax revenue if people are too ill to work By the time retirement age reaches 68, only the richest 10% of people will reach retirement without disability Marmot review - Life expectancy and disability-free life expectancy at birth by neighbourhood income level

Years of disability and dependency

Unfinished business- obesity Morbidly obese 83,000 Morbidly obese 96,000 2009 2015 Obese 930,000 Obese 930,000 Healthy weight 870,000 Healthy weight 1.65 m Obese 1.45 m Over-weight 1.48 m Over-weight 1.45 m

Unfinished business- primary care Unfinished Business- primary care prevention Unfinished business- primary care In 2007 UK admission rates for diabetes acute complications in the population aged 15 and over were twice that of Germany. Percentage of people with diabelets whose last HbA1c was 7.5 or less by GP practice 2008/09. From The big opportunity part one Only 10% of practices across the region had over 70% of patients with HbA1c levels treated to the then QOF payment target of under 7.5 mmol/l or less

Immediate causes of disease burden Ed AM, Monika Strategic Review

…leading to the major killers. Top causes of under 75 mortality – 2010 Raised blood pressure accounts for 50% of all heart disease Around 86% of lung cancer deaths in the UK are caused by tobacco smoking Chart from GBD data 2010 for UK after cause of death processing, PHE / GBD team analysis Blood pressure figure - World Health Report 2002. Reducing risks, promoting healthy life. World Health Organisation, 2002. Lung cancer figure – Cancer Research UK

Causes of long term disability

http://www.wmpho.org.uk/olderpeopleatlas/Atlas/atlas.html

What is Public Health? Facts and figures Older people focus How is PH organised? How to get involved and work on Dementia

Public Health England “Public Health England exists to serve the system, a system led locally by elected members” 21 Presentation title - edit in Header and Footer

PHE’s National Priorities REDUCING PREVENTABLE DEATHS Helping people to live longer by reducing preventable deaths from conditions such as heart disease, stroke, cancer and liver disease REDUCING THE BURDEN OF DISEASE Increasing healthy life expectancy by tackling conditions which place a burden on many lives, such as anxiety, depression and back pain PROTECTING THE COUNTRY’S HEALTH Protecting the population from infectious diseases and environmental hazards, including emerging risks and the growing problem of antimicrobial resistance GIVING CHILDREN AND YOUNG PEOPLE THE BEST POSSIBLE START Supporting families to give children the best start in life, through working with health visitors, Family Nurse Partnerships and the Troubled Families Programme IMPROVING HEALTH IN THE WORKPLACE Helping employers to facilitate and encourage their staff to make healthy choices

PHE’s local presence Four regions, fifteen centres Centres in North: Cumbria and Lancs Cheshire and Mersey Greater Manchester Yorkshire and Humber North East Knowledge Intelligence Teams North West Northern and Yorkshire Other local presence microbiology laboratories field epidemiology teams Centre for Radiation, Chemicals and Environmental Hazards units

Place-based approach to public health Non-statutory providers* NHS providers People and communities Health and wellbeing boards PHE centre NHSE area team Local government CCGs EPPR Screening and immunisation Offender public health programmes Specialised commissioning Primary care public health programmes and population healthcare Public health advice *Including voluntary and community sector 24

What is Public Health? Facts and figures Older people focus How is PH organised? How to get involved?

http://www.makingeverycontactcount.co.uk/ Cross-government narrative on health

Political Strategic Review

Local Govt Funding and Social Care ‘Regional variations in spending cuts … compound longstanding differences in regional economic growth and productivity. Indeed, these two factors create something of a vicious cycle. But it would be wrong to assume that such a cycle is inevitable.’ Rebalancing the books IPPR North January 2014 Presentation title - edit in Header and Footer

National Executive Meeting 18 February 2014 Dementia The purpose of the session is to seek steers of the DPPB on the emerging dementia work programme National Executive Meeting 18 February 2014

Why is dementia an area of focus? Health Impact Dementia is the 3rd leading cause of disability for the over 70s, and the 10th leading cause of premature mortality for all ages (GBD – UK figures) c.25% of hospital beds are occupied by people with dementia, with increased length of stay c.21m people in England know a close friend or family member with dementia Health Inequalities Higher vascular risk in certain BAME communities and socioeconomic groups Particularly challenging cultural norms in many BAME communities Women more likely to develop dementia and to be carers Unique System Leadership All major dementias have a vascular component (eg 80% in Alzheimer’s) Opportunity to build on successful primary prevention approaches for eg heart disease and stroke PHE expertise in social marketing and national corporate partnerships Effective Interventions The evidence on prevention is growing - particular benefits in midlife Opportunity to build on existing Dementia Friends and Dementia Friendly Communities programmes with new social marketing approaches Responsiveness Numbers of people with dementia are expected to rise as population ages – need to get ahead of the curve as well as improving support for people now. DPHs require data, intelligence, and best practice interventions

Dementia Friends Movement in Partnership with Alzheimer's Society in 2014/15 :