1. Practical steps to ensure people with sight loss enjoy health in all aspects of life
Sight Village Birmingham – July 18th 2017
David Allen
Faculty of Public Health

2. Introduction A personal perspective and reflection
Understanding the public health challenge
Sight loss, disability and determinants
Building on success with practical steps

3. Understanding the public health challenge
Q: Who are “the population” ?
A: 6m in UK with URE and sight-threatening conditions; 350k registered as blind or partially sighted.
Q: What does “enjoying good health” mean?
A: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (WHO)
Q: What is the current position?
A: Estimate cost of sight loss to UK economy: £28bn pa.
Q: What is the likely future position?
A: Getting worse…!
There is a small graphical picture of a pie-chart (circle divided into sections from the central point or focus of the circle) with the largest section (around 60%) with the letters “AMD” (for age-related macular degeneration), the next largest is blank (but is for “other” eye conditions); the next largest has “glaucoma” and the next has “DR” which stands for Diabetic Retinopathy. DR
AMD
Glaucoma

4. A Public Health issue? Population Impact Non-modifiable RF
Scale/trends
Morbidity/Mortality
Quality of Life
Health/Social cost
Non-modifiable RF
Age/Sex/Ethnicity
Population benefit?
Health inequalities
Unmet need?
Effective intervention?
Cost effective?
Modifiable Risk Factors
Smoking/alcohol/diet/exercise

5. Determinants of Health
the social and economic environment
the physical environment
a person’s individual characteristics and behaviours.
Note – access to health services only accounts for between 10% and 20% of health benefit across the population!

6. This slides shows a model of wider determinants of health and wellbeing. A text description of this model can be found here:
Notes:
Evidence on determinants
Transport, Housing, Energy, Urbanisation, Radiation
Food and Agriculture, Waste, Industry, Water, Nutrition and health

7. 40% of disabled children live in poverty.
Income
Education
Social Support
Health Services
Genetics and Gender
Environment
Employment
This slide shows the main health determinants (Education, Employment, social support, health services, genetics and gender, environment) in a circle surrounding “income” in the middle, shown as larger (ie with greater emphasis).
Notes:
If you are disabled
Employment rate: 82% non-disabled population; 49% for disabled people; 25% for blind an partially sighted people – and the pay gap widened by 1/3 between 2010 and 2014.
Education: disabled people 3x more likely to have no formal qualifications than non-disabled people
Health Services: disabled people are more likely to have health problems; represent 1/3 of NHS users (represent 19% of the population)
Income: the lowest fifth of the income distribution are more likely to develop mental health problems than those on average wage
Physical environment: the food you eat, the house you live in, the ability to pay heating bills, ability to travel (for social, employment, health reasons…)
40% of disabled children live in poverty.

8. The poverty cycle
Disability
Poverty
Health
If you are poor, you are more likely to be disabled and have/develop health conditions
If you become disabled, you are more likely to become poor – and more likely to develop health conditions
If you have a long term health condition, you are more likely to be poor.
This shows a small diagram linking “Health” “Disability” and “Poverty” in a circle, with arrows between them, demonstrating a cycle where one affects the other in an ongoing manner.

9. Sight loss as a public health concern
Ranks among top ten causes of disability
Increased morbidity
Can decrease quality of life
Can have adverse impact on daily living
Can cause falls and injuries
Can leads to social isolation
Can lead to depression

10. Building on success….
Public Health Outcomes Framework (2012) –preventable sight loss
Plain packaging/warning
Commissioning guidance
Free eye tests (Scotland)
Ophthalmic Public Health – mapping, research, trials…
Talking buses, inclusive streets, new Tech (Orcam)
Medical innovations – nystagmus magnets
Great Data: Registers; CVI; GOS, HES; NEHEM; Sight Loss Data Tool!
Champions!! Society!!
Shows pictures of: a copy of the Public Health Outcomes Framework document ; a number of health warnings adorning plain cigarette packages including one that says “Smoking causes blindness”; an area map of Tower Hamlets describing location of optometrist practices based outside areas of high deprivation; a woman wearing glasses with the Orcam technology on a stem above one ear; a section through a human skull showing eye orbits with magnets attached to the lower edge of the eye socket.
Note
The British Attitudes Survey points out that fewer people are saying that most social security claimants do not deserve help: in 2015 – 28% said it; in 2017 – 21% said it.

11. Practical Steps? In relation to sight loss
Improve access to eye tests/eye health checks for high risk groups: (BME, low income, pwLD) and commission vision screening in schools for children aged 4-5.
Integrate eye health into other initiatives: smoking cessation, falls prevention, reducing loneliness: MECC.
Improve sight loss training for residential care staff – build it into core training/provide supplements.
Adopt integrated care pathways - especially in primary and community care.
(Source: RNIB)

12. Practical Steps #2
Prevent it: 50% of sight loss is preventable !! – screening and eye tests (5yFV)
Invest in treatment and health care services/secondary prevention - NHS is creaking!
Use data, tools, champions to influence decision makers
Challenge delivery models – optometry, hospitals
Ensure workforce capacity is there - and helping

13. Practical Steps #3 Breaking the poverty cycle
Employment: equal opportunities and support
Welfare: support at a living level
Education: access to education and training
Regulation: laws and regulation work in prevention!
Behaviours: encourage healthy lifestyles
Health: improve access to services and information
Digital and technical literacy critical
Research: Prevention Research Partnerships: £50m!

14. Practical Steps #4 At a strategic level…
Speak with one powerful voice as a sector
Find allies to strengthen voice further
Find a public narrative that “works”
Industrial and Economic Strategy>NHS strategy
Political Choices – NHS, welfare provision, social care, education, economy – so VOTE!

15. Acknowledgements/References
Jill Pell, University of Glasgow
Nick Astbury, Past President, Royal College Ophthalmologists.
Keith Marshall, Tower Hamlets
Sonal Rughani, RNIB
John Lawrenson, City University
Duncan Selbie, Public Health England
WHO:
RNIB: reports/prevention-sight-loss/stateofthenation
Papworth: s%20and%20figures%20report% pdf

16. Thank you! David Allen Chief Executive Faculty of Public Healthe: t:

17. This slide is the last in the pack and shows FPH logo, branding and website: www.fph.org.uk