Improving the public’s health … … in Southampton Dr Andrew Mortimore Director of Public Health Southampton

Our mission “Public health in the Council will work in partnership for a healthier city, a place which is safe and healthy and where all people thrive”

JSNA summary The PHAR begins with a summary of the JSNA. The nine key themes of the JSNA are being refreshed in a rolling programme of updates.

The patch .. and its people 250,000 Diverse Ageing Students ++ Migration Rising birth rate A tale of two cities …

Key health needs The “big killers” are still killing – heart disease, stroke and cancer but survivorship is improving - cancer, chronic lung disease More people are living longer with long term conditions but there is often an extended period of poorer health / disability / dependency … and many are lonely Lifestyle factors are holding back health improvement – choices, compulsions and addictions Living circumstance are lowering life chances – incomes, skills deficits, housing / tenure, social cohesion, vulnerable families Mental distress and ill health is common Young people’s health and wellbeing is poorer than it could and should be – compared nationally and internationally although improving, educational attainment and teenage pregnancy remain key challenges The health gap is not narrowing fast enough

Problems High numbers of people in relative and absolute socioeconomic disadvantage (40%) A legacy of low skills and low educational attainment Constrained housing, affecting elderly and families Falling household incomes relative to the rest of England, the South East and comparator cities Welfare benefits “reforms Local authority grant reductions Smoking continues to kill too many people Activity and diet – we need to improve Dental health of children remains poor Teenage pregnancy rates are high Alcohol misuse is causing more ill health Stress and depression is very common There are still big health differences across the City

Causes of preventable deaths in England (ASH 2012) References: 1. ASH Factsheet, Smoking Statistics: illness & death, June 2011 (http://www.ash.org.uk/files/documents/ASH_107.pdf) NB area represents value Obesity 34,000 Smoking 81,400 Alcohol 8,724 Suicide 5,377 Murder 648 HIV (UK) 529 Traffic (GB) 2,946

Priorities Improving outcomes Reducing inequalities Investing to save and gain

Marmot’s Six recommendations Marmot 2010 Fair Society, Healthy Lives The JSNA themes embrace all the Marmot recommendations A - Give every child the best start in life B - Enable all children, young people and adults to maximise their capabilities and have control over their lives C - Create fair employment and good work for all D - Ensure healthy standard of living for all E - Create and develop healthy sustainable places and communities F - Strengthen the role and impact of ill health prevention The nine themes dovetail into the Marmot recommendations. Marmot published an influential report in 2010 which proposed an evidence based strategy to address the fact that the conditions in which people are born, grow, live, work and age impact on their health. It draws attention to the fact that most people in England are not living as long as the most well-off in society etc. It states that it is not sufficient to just focus on the bottom 10% because there are poorer outcomes all the way down from the top.

IMD (2015) – Map of ENGLAND Deprivation Deciles

IMD (2015) – Analysis of Changes since 2010 Southampton has become relatively more deprived Of the 326 LAs in England…. Southampton ranked 54th (previously 72nd) most deprived LA based on average rank of LSOAs Southampton ranked 67th (previously 81st) most deprived LA based on average score of LSOAs

IMD (2015) – Change in ENGLAND Decile Assignment Since IMD (2010)

What is in the JSNA? www.publichealth.southampton.gov.uk/jsna Data analysis of over 500 indicators across 31 distinct topics Information on services, stakeholder views, what works and recommendations Links to other resources e.g. mini needs assessments, profiles, national resources etc www.publichealth.southampton.gov.uk/jsna The Southampton JSNA is an online resource and is structured so that each of the nine themes has sub-sections within it. These cover population needs, services, evidence about what works etc.

Improving Southampton’s Health Improving economic wellbeing Improving mental health Early years Taking responsibility for health Long term conditions More years, better lives Creating a healthier environment Improving safeguarding Protecting people The result of the stakeholder views were to come up with these nine themes. These still exist today as the structure for the Southampton JSNA.

www.publichealth.southampton.gov.uk Look at the website and the resources that we have other than just JSNA. Briefings etc Ward profiles – for looking below city level.

Tackling health inequalities Health inequalities exist and are persisting in Southampton Acheson Report (1998) & Marmot Review (2010) Social gradient to health inequalities Annual cost of health inequalities is £36 billion through lost taxes, welfare and NHS costs Health inequalities monitored in the city by comparing the 20% most deprived and 20% least deprived areas as defined by the IMD (2010) Overall health has improved but, significant gradient remains: Inequality gap of 10 years in life expectancy and 18 years in healthy life expectancy for men Striking inequalities found for indicators relating to early years, oral health, morbidity and mortality Marmot Review produced comprehensive review of the evidence for effective intervention 6 key policy areas proposed

Gap between most and least deprived quintiles

DPH Recommendations Based on the best evidence available, the City’s Health and Wellbeing Board should develop a city-wide targeted programme of actions to tackle health inequalities due to wider social and environmental factors affecting the public’s health. The Health and Wellbeing Board should make specific recommendations on urgent, high priority actions to be taken by the Council and the local NHS that will have the most impact in the short to medium term, based on findings in this report. The local NHS, led by the Clinical Commissioning Group, should assess health inequalities that could be reduced by health service interventions, and develop deliverable plans to reduce these. The Health and Wellbeing Board should use the opportunity of its next five-year strategy to prioritise actions that will reduce inequalities, improve overall health and create a fairer Southampton.

Going where the evidence tells us we should …

Opportunities and challenges

Invest to save and gain For every £1 spent on sexual health services to prevent teenage pregnancy, there is a net saving of £11 Every new teenage mothers costs £100,000 over the next 5 years, including £15K per year in housing-related costs Family Nurse Partnerships have generated savings of more than five time the programme costs Targeted parenting programmes to prevent conduct disorders pay back £8 over six years for every £1 invested (savings to NHS, education and criminal justice system) Good social and emotional health outcomes through investment in good education provide returns of up to £7 for every £1 invested For every £1 spent on alcohol treatment £4 is saved in other public sector costs Employee wellness programmes return £2 - £10 for every £1 spent Improving air quality – the overall benefit-cost return can be over £600 for every £100 spent (eg Kensington and Chelsea) Investment in falls prevention and bone health saves £5 for every £2 spent, through saving lives and maintaining independence For £1 spent on smoking cessation and tobacco control measures, £5 are saved over a five year period For £1 spent on measures to reduce obesity, there is a net saving of £2 over five years