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

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

3. 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.

4. 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.

5. Determinants of Health

6. 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

7. 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

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Data Source HSE 2011 Volume 1 HSCI
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9. Greatest reduction in CVD
Data source Avoidable Mortality in England and wales 2011 ONS may2013
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10. Public health working with healthcare professionals- reducing stillbirths.

11. Unfinished business- inequalities
Data source: ONS Inequalities in LE and DFLE , to
Source: ONS Statistical bulletin Life expectancy at birth and at age 65 for local areas in England and Wales,
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12. 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

13. Years of disability and dependency

14. 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

15. 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

16. Immediate causes of disease burden
Ed AM, Monika
Strategic Review

17. …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 Reducing risks, promoting healthy life. World Health Organisation, 2002.
Lung cancer figure – Cancer Research UK

18. Causes of long term disability

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

21. Public Health England
“Public Health England exists to serve the system, a system led locally by elected members” 21
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22. 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

23. 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

24. 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

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

26.
Cross-government narrative on health

27. Political
Strategic Review

28. 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
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29. 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

30. 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

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