1. Public Health Challenges and Opportunities in the West Midlands
Local Government’s New Public Health Role – 12th July 2012
Karen Saunders, Senior Public Health Manager, Department of Health, West Midlands

2. Overview What we mean by ‘Public Health’
Challenges and health inequalities in the West Midlands
Opportunities for action
National context
‘Old and New’ Public Health
The Role of Councillors
Maybe out of date ?

3. Definition of Public Health
‘Public Health is the science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.’
(Source: Faculty of Public Health, adapted from Acheson Report 1988)
Keep
Health Improvement: Inequalities; Education; Housing; Employment; Family/community; Lifestyles; Surveillance and monitoring of specific diseases and risk factors
Health Protection: Infectious diseases; Chemicals and poisons; Radiation; Emergency response; Environmental health hazards
Healthcare PH: Effectiveness of services; Audit and Evaluation; Equity in Healthcare

4. Challenges

5. The train station map shows that in this region:
KEEP – and encourage them to get up and have a look. Maybe have some A4 paper copies available
The train station map shows that in this region:
Male life expectancy at birth is now 77.9 years and female life expectancy is 82.2 years, both slightly below the England average
But the map also shows significant variation of life expectancy within the region:
Men in Solihull can expect to live to 80.6 years, those in Sandwell 75.5 years;
Women in Wychavon can expect to live to 84.0 years, those in Stoke 80.2 years
(Source: ONS (2011), ‘Life expectancy at birth and at age 65 by local area in the UK, to ’)

6. YES - Bit difficult to read
(Source: ONS (2011) Life expectancy at birth by local area in the UK, to )

7. YES - Bit difficult to read
(Source: ONS (2011) Life expectancy at birth by local area in the UK, to )

8. Standardised Mortality Ratio for all causes in people aged under 75 2005-9 by MSOA - Coventry
Source: APHO

9. Inequalities begin from birth
Charles
Mark
Aged 60
Died from massive stroke
Retired early to spend time with his grand- children and travel
Baby
Born to affluent parents – will live 10 years longer than Mark
One of teenage conceptions. Will live 10 years less than Charles
Aged 10
Enjoying a good life, lots of opportunity to play sport
Growing up in poverty
Aged 20
At university with 10 x A* at GCSE. Plays rugby and eats a healthy diet
Left school with no qualifications, casual labourer, drinks, smokes and takes drugs
Aged 45
Fit and healthy businessman, manages stress by playing squash
Weighs 18 stone, has high cholesterol, type 2 diabetes
YES -
Source: NHS North West SHA

10. Child Poverty
There are health inequalities within the West Midlands which are closely associated with deprivation and child poverty:
Deprivation: 27.4% of WM people live in 20% most deprived areas in England (England average 19.9%)
Child Poverty: 24.8% of WM children live in families receiving means-tested benefits (England average 22.4%)
(Source: Health Profile 2010)

11. (Source: Health Profile 2010)
yes
(Source: Health Profile 2010)

12. Costs
Large and escalating burden of disease not just from the public health perspective but also from an economic one
Cardiovascular disease, diabetes, cancer and respiratory diseases
Social burdens include
prolonged disability
diminished resources within families
reduced productivity
tremendous demands on health systems
Source: UN High-Level Meeting on NCDs 23 September 2011
True for upper income countries as is for low/middle income
Approx two thirds of deaths worldwide due to NCD now

13. Smoking
Smoking accounts for over 50% of health inequalities across different groups
Direct Cost to NHS £5.2bn pa
Approx 5% of total NHS expenditure
Healthcare costs for smokers up to 40% higher than for non-smokers
Smoking in the West Midlands has decreased from 40% to 22% over 30 years, however challenges remain
Routine and manual workers
Pregnant women
Second hand smoke

14. Alcohol
Alcohol related hospital admissions increased in the West Midlands - more than doubled in period 2002/3 to 2009/10
46,616 to 113,205
Direct cost to NHS of alcohol harm reduction estimated at £1.7bn per year
Costs to society, approx £20 bn per year
Reviews of the literature and secondary analysis conducted to support the development of the
Alcohol Harm Reduction Strategy for England
(2004) indicated that damage to health, crime
and disorder, and the loss of work productivity
resulting from alcohol misuse cost around
£20 billion per year in England and Wales.
• The Alcohol Harm Reduction Strategy for
England estimated that total annual healthcare
costs alone related to alcohol misuse add up to
£1.7 billion per year. The bulk of these costs is
borne by the NHS.
• In addition to reduced productivity at work,
excessive drinking is associated with
unemployment. Costs arising from such
increased unemployment are estimated to be in
the region of £1.9 billion per year.
• However, alcohol-related harm should not be
viewed in isolation, as alcohol consumption can
also have positive effects.
• Drinking at a responsible level can be a source
of enjoyment for the vast majority of those
who participate.
• Over 1 million people are employed in hotels,
pubs, bars, nightclubs and restaurants in the
UK.21
• Furthermore, the development of the evening
economy, driven by the alcohol leisure industry,
has supported a revival of city centres across
England and Wales.22 21

15. Source: NCHOD 2009
Equity from the Start

17. Infant Mortality – Key Actions
Reduce smoking in pregnancy
Reduce child poverty
Increase breast feeding initiation
Improve housing and reduce overcrowding
Reduce obesity
Reduce teenage pregnancy
Reduce unexpected deaths in infancy
Equity from the Start

18. Opportunities

19. Healthy Lives, Healthy People: our strategy for public health in England
Aims to:
empower local leadership to strengthen health and wellbeing
support self esteem, increased confidence and personal responsibility
promote healthier behaviour and lifestyles
change the environment to support healthier choices
protect the public from threats to health.
Following extensive consultation, further details published in July 2011’s Update and Way Forward
The publications in December 2011 link directly from the vision and framework set out in the White Paper and the subsequent detail and finalisation of policy set out in the Update and Way Forward paper in July, which followed an extensive public consultation.
That consultation demonstrated, for example, the real enthusiasm for the new leadership role for local government.
December 2011 public health system factsheets
The December 2011 publications were a series of fact sheets published on the DH website. Further factsheets will follow as other elements of the new system are finalised.
The final slide includes the web address for accessing these factsheets
The slides refer to where further information can be found in the factsheets (note: not all slides include a picture0
December 2011: continuing to finalise key elements of the design of the new public health system

20. Local Government’s “New” Functions
New duty to improve the health of the population:
some of most important levers for improving health and wellbeing - planning, transport, leisure, education - are instruments of local government
health and wellbeing boards will integrate commissioning approaches (JSNA; JHWS)
working with Clinical Commissioning Groups
collaborating with the voluntary sector
providing population healthcare advice to the NHS
working with national bodies – PH England; NHS Commissioning Board
Local political leadership critical to making this work and ensuring a ‘safe landing’ of public health functions.
This slide serves to introduce the detail in the following batch of slides
The following slides include further information on commissioning and on population healthcare advice to the NHS

21. “New” Duty to Ensure Plans in Place to Protect the Health of the Population
Nothing new for local authorities - have had health protection responsibilities since the 19th century and currently have major powers and responsibilities under existing legislation including Environmental Protection and Public Health Control of Diseases Acts
Councils will have a new responsibility for ensuring adequate and appropriate health protection plans
Most health protection incidents are contained locally
The DPH will routinely assess intelligence on all incidents, and will lead the local response working with PHE and the NHS
This will include outbreak management, infection prevention and control, and non-infectious environmental hazards
System management still emerging

22. Local authority commissioning responsibilities: leadership role in
tackling the causes of ill health; reducing health inequalities; promoting and protecting health; promoting social justice and safer communities * = mandated
Tobacco control & smoking cessation
Alcohol and drug misuse
Services for children 5-19
National Child Measurement Programme*
Obesity and weight management
Local nutrition services
Increasing physical activity
NHS Health Checks*
Public mental health services
Dental public health services
Injury prevention
Birth defect prevention
Behavioural and lifestyle campaigns to prevent LTCs
Local initiatives on workplace health
Support and challenge of NHS services (immunisation and screening)
Public health advice to NHS*
Sexual health services*
Seasonal mortality initiatives
Local role in health protection incidents*
Community safety
Social exclusion
NOTE: not intended to talk through this slide in detail. Instead, it provides an opportunity to mention:
our aim is to create a set of responsibilities which clearly demonstrate local authorities’ leadership role in
tackling the causes of ill-health and reducing health inequalities
promoting and protecting health
promoting social justice and safer communities
why local authorities have these responsibilities – and why some are mandated
Local authorities have responsibilities across a range of services. Where possible, we have devolved responsibility and resources.
The exceptions are where a services is deeply intertwined with the delivery of clinical services or part of a primary care contractual arrangement
Some services will be mandated, but only where uniformity in provision is necessary, where is crucial for other parts of the system or where the SofS is under a legal duty to ensure provision.
commissioning
Local authorities can fulfil those in a range of ways.
We expect they will engage local community and voluntary sector more widely as providers.
* Indicates mandated services

23. 23

24. FAIR SOCIETY,HEALTHY LIVES CONCEPTUAL FRAMEWORK.
REDUCE HEALTH INEQUALITIES AND IMPROVE HEALTH AND WELLBEING FOR ALL.
Create an enabling society that maximises individual and community potential.
Ensure social justice, health and sustainability are at heart of policies.
Policy objectives A.
Give every child the best start in life. C.
Create fair employment and good work for all. E.
Create and develop healthy and sustainable places and communities. B.
Enable all children, young people and adults to maximise their capabilities and have control over their lives. D.
Ensure healthy standard of living for all. F.
Strengthen the role and impact of ill health prevention.
Policy mechanisms
EQUALITY AND HEALTH EQUITY IN ALL POLICIES.
EFFECTIVE EVIDENCE BASED DELIVERY SYSTEMS 24 24

25. Principles Social justice
Material, psychosocial, political empowerment
Creating the conditions for people to have control of their lives
Connects people, places and prospects

26. New approach to Public Health
Protect and improve the public’s health, improving the health of the poorest fastest
Reach Out and Reach Across
Address root causes and reach those who most need support
Representative
Owned by communities and shaped by their needs
Resourced
Ring-fenced funding and incentives to improve
Rigorous
Professionally and politically led, evidenced, efficient and effective
Resilient
Sustainability and protecting health
Source: Healthy Lives, Healthy People, Update and Way Forward, 2011

27. Moving from the old to the new
Deficit
Process
Disease
Knowledge
Medical
Professional led
Do to
Asset
Outcomes
Wellbeing
Action
Social
People led
Do with
Not sure this adds much
Uses a positive notion of health creation
Encourages full participation of local communities in the health development process
Self-care in Long Term Conditions such as diabetes
individuals and communities

28. Councillors as champions for their communities

29. Local Government Focus on needs of local population
Capacity to orchestrate action to address the social determinants of health
Whole system leadership
Increasing participation and empowering communities in coproducing local issues and solutions
Local democratic accountability

30. Opportunities for Councillors
Leadership and Advocacy for Improving health and Reducing Health Inequalities
Maximise opportunities for delivery of the new public health function and prevention services
Enable wider understanding of how all Local Authority portfolios can deliver improved health (housing, education, economy, regeneration, planning, social care, children’s services ..)
Champion for improved public health through existing local government powers (e.g. using licensing in controlling cheap alcohol; fast food outlets)
Leadership on population behaviour change programmes (e.g. Change 4 Life; improved physical activity, increased walking and cycling for health, etc.)
Communicating with and in touch with local people (the power of social media)
Challenge poor outcomes through the Health and Wellbeing Board/Healthwatch/Scrutiny
Use of local health data and evidence base of what works with support from the Director of Public Health and service users through local Healthwatch
Develop new/strengthen existing local/national partnerships and alliances
Clinical Commissioning Groups
PH England
VCS

31. More Information? Karen.saunders@dh.gsi.gov.uk
The new public health system factsheets are available at
Sign-up to the national Transforming Public Health bulletin
Contact the DH Public Health England transition team
West Midlands PH Transition website
West Midlands Councils