1. Insert name of presentation on Master Slide The importance of good health to breaking the poverty cycle Thursday 3 rd November 2011 Professor Sir Mansel Aylward CB

2. Wales now Health of the population continues to improve but The ‘inverse care law’ still persists - health inequities remain stark and resistant to change

3. Overview The importance of the early years in laying the foundations for good health Harnessing Public Health expertise Tackling Child Poverty Public Health Wales core business Bevan Commission Together for Health

4. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk The importance of early intervention Source: Heckman Curve

5. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Complementary approaches Reduce the number of families living in workless households. Improve the skills of parents and young people living in low income households so they can secure well-paid employment. Reduce inequalities that exist in health, education and economic outcomes of children and families by improving the outcomes of the poorest. Improve the length and quality of life. Fairer health outcomes for all Child Poverty Strategy Our Healthy Future

6. Early Years

7. Child Poverty and Health Targets To reduce difference in outcomes between the most deprived 5 th and middle 5 th except infant mortality (most and least deprived 5 th) :- Teenage Conceptions Infant Mortality Pedestrian Injuries in Children Low Birth Weight Dental Caries

8. Public Health Expertise Epidemiology Understanding causal factors Evidence Base & what should we do Targeting and reach Partnership working and sharing Public health advice and consultancy Measuring change

9. Example: Early Years Pathfinder Project – low birth weight Aim: To explore how an explicit evidence based approach and coordination could add value to the public health activity in Wales on early years health.

10. Outcome indicators Pregnancy Smoking Obesity Alcohol Mental health Vulnerable groups Birth Pre-term birth Low birth weight Breast feeding Infant mortality 0 – 5 years Hospital admissions Injuries Language delay Social and emotional capability School readiness Parenting Maternal mental health Need to also capture interventions at an individual level

11. Evidence for interventions Clear evidence base Folic acid supplementation Smoking cessation Breastfeeding Newborn hearing and bloodspot screening Immunisations Parenting programmes (e.g. Incredible Years) Family Nurse Partnerships Less clear Obesity prevention Reducing inequalities

12. What interventions are in place and next steps... Variation between Health Boards Pathways for obesity, smoking cessation and perinatal mental health Flying start – variation in parenting programmes used Finalise outcome indicators, aligned with the Welsh Government Maternity Strategy. Pilot a Reproductive and Early Years Surveillance System. Review literature focussing on specific questions that address effectiveness of interventions and models of service provision. Model potential impact of risk factors and interventions to inform effective targeting of action

13. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Annual Quality Framework 2011-2012 Teenage conceptions (Under 16s) Source: StatsWales Teenage conceptions Under 18, Teenage Conceptions, 2007-2009 Source: Office for National Statistics

14. Reducing the teenage conception rate in Wales Background: (a) Poor health and social outcomes for young mothers and children (b) conceptions clustered amongst; repeat pregnancies, looked after children and care leavers, areas of high social deprivation Phase one – to reduce repeat conceptions (currently 20% of pregnancies) Phase two – to reduce conceptions amongst looked after children and care leavers (in some areas up to 1/3 conceptions amongst this group) and young people with substance misuse problems Phase three – wider population

15. Health and worklessness Combined rate of workless benefits (IB, ESA, JSA) within local authorities The areas with the poorer health outcomes are also the places with the highest rates of worklessness To improve the health of our population it is vital to get people to meaningful work Healthy Working Wales 2011-2015 Source: Nomisweb

16. The Bevan Commission: First Minister’s Announcement ‘….. a source of independent, expert advice on the development of health services here in Wales. its core purpose will be to provide ………. assurance that the reforms ………. will succeed ….. a health service which is publicly owned and publicly provided; a service which is rooted in an ethic of care, rather than competition and a service which has, at its core, the pursuit of health, as well as the treatment of illness. A NHS, in other words, which would be recognisable to its founder.’ First Minister: 16 July, 2008

17. What Bevan wanted in 1948 Comprehensive treatment, within available resources Universal access, based on need Services delivered free at the point of delivery

18. What he might have added – the Bevan Commission additional principles 1.A shared responsibility for health between the people of Wales and the NHS 2.A service that values people 3.Getting the best from the resources available 4.A need to ensure health is reflected in all policies 5.Minimising the effects of disadvantage on access and outcome 6.A high quality service that maximises patient safety; 7.Patient and public accountability 8.Achieving continuous performance improvement across all dimensions of healthcare

19. Going for gold – “World Class Healthcare” Services best suited to Wales but comparable with the best anywhere 1 Essential Elements include: Balance and integration Measured quality as good as or better than comparable systems A step change in population health A crucial leadership role for government Performs well against Bevan Commission Principles 2 1.Bevan Commission Report 2008 – 2011 2. Bevan Commission. World Class Health Care for Wales (2010)

20. So how is the NHS doing? Outstanding business The NHS must do more on : cutting health inequalities and inequities promoting a ‘sea-change’ in public attitudes driving out waste in the health system effective partnerships across public health and local government getting solutions to health problems across all policy agendas.

21. The Answer: Partnership with the Welsh People Government, the NHS and the people of Wales need to work together to: look after themselves – with help take control of their lives use the system well redesign services get real about what is feasible

22. The answer: Real Political leadership Help and encourage people be responsible citizens Don’t change the system if it isn’t broken Look for health benefit in every policy area Help educate the public that change is needed; and Champion a culture geared towards quality

23. The Commission, the NHS and the future Aneurin Bevan’s principles still stand as strong today as they did in the late 1940s The Welsh system will be distinctively Welsh Tough challenges that require commitment, tenacity, leadership and partnership throughout healthcare, government and society A system willing to match itself against the best

24. The Welsh Government’s response On 1 November 2011 Lesley Griffiths AM, Minister for Health and Social Services launched ‘Together for Health’ A vision for the next 5 years responding to the Bevan Commission report

25. Acknowledgments Dr Tony Jewell, CMO, Welsh Government Tony.jewell@wales.gsi.gov.uk Dr Shantini Paranjothy ParanjothyS@cardiff.ac.uk Dr Noel Craine Noel.craine@wales.nhs.uk Eryl Powell eryl.powell@wales.nhs.uk