1. Public Health challenges in the South West Dr Shona Arora Centre Director, Avon, Gloucestershire and Wiltshire Public Health England

2. Key Issues – Demographic pressures – Inequalities – Financial challenges for Local Authorities & the NHS Wider, but fragmented system – how do we work together?

4. (Some) Shared priorities

5. Public Health Outcomes Framework Where is the SW an overall outlier? Healthcare and preventable mortality: – suicides (5/13 LAs worse than national) Health Improvement: – Smoking in pregnancy (4/13 LAs) – Excess weight in children (6/13) – Injuries in young people (4/13) – Health checks take up (7/13)

6. SW demographic pressures

7. Change in healthcare consumption

8. Long term health problems

9. Healthy life expectancy

10. LGA Graph of Doom Councils were cut earlier and harder than the rest of the public sector as the government began to implement its deficit reduction policy National gap in income versus expenditure of £16.5b by 2019/20

11. Inequalities Marmot review (2010) ‘Fair Society, Healthy Lives’ Differences in health outcomes reflect, and are caused by, social and economic inequalities in society Genetics, lifestyle and access to healthcare are not the only factors that cause health inequalities People in poorer areas die earlier but spend more of their shorter lives with a disability Cost to NHS = More than £5bn a year Response needs to be across the lifecourse, and proportionate to need

12. Life Expectancy and deprivation in the SW Life expectancy continues to rise generally but is below the national average in certain parts of the SW: – E.g. Plymouth, Gloucester, Swindon Gaps in life expectancy of 8+ years within some areas Deprivation varies across the SW, which also has some of the least deprived areas in England, but is often in small pockets in more affluent LAs

13. What contributes to health inequalities?

14. Wider determinants of health – the causes of the causes

15. Influences on population health King’s Fund summary:

16. Impact of social relationships on health

17. Public Health Challenges What is the balance between the full range of actions we need to take – from prevention to palliation, from cradle to grave, that will ensure health & wellbeing into the future, and help to ensure are services are affordable? How do we stop health inequalities from increasing? How do we build a lifecourse approach into our approach to the challenges facing health & social care? How do we develop a stronger evidence base? And disseminate good practice and evidence more quickly?

18. Link between social and health inequalities How can the NHS take action? – Treating patients – Every Contact Counts, PH in Clinical Networks – Community leadership through H&WBB – action on wider determinants – Advocacy for most disadvantaged – Preventative Strategies, e.g. primary care