The new PH landscape Opportunities for collaboration Dr Ann Hoskins Director Children, Young People & Families Health and Wellbeing Content Overview of new PH system PHE function and structure Challenges for population health Approaches to improve population health and address inequalities Opportunities for joint working 1
Public Health Transformation A year of great change A new landscape with return of public health to local government: - Potential to focus on wider determinants of health (housing, education, jobs, transport, green spaces) In the context of austerity, budget gaps and resource constraints - Investing in prevention/health improvement: very cost-effective - New ways of delivering public health: making every contact count What is PHE for? To protect and improve the nation s health and to address inequalities, working with national and local government, the NHS, industry, academia, the public and the voluntary and community sector. 4 2
Public Health Outcomes Framework To improve and protect the nation s health and wellbeing and improve the health of the poorest, fastest Outcome 1) Increased healthy life expectancy taking into account health quality as well as length of life Outcome 2) Reduced differences in life expectancy between communities (through greater improvements in more disadvantaged communities) 1 Improving the wider determinants of health 2 Health improvement 3 Health protection 4 Healthcare and public health preventing premature mortality 19 indicators, including: Children in poverty People with mental illness or disability in settled accommodation Sickness absence rate Statutory homelessness Fuel poverty 24 indicators, including: Excess weight Smoking prevalence Alcohol-related admissions to hospital Cancer screening coverage Recorded diabetes Self-reported wellbeing 7 indicators, including: Air pollution Population vaccination coverage People presenting with HIV at a late stage of infection Treatment completion for tuberculosis 16 indicators, including: Infant mortality Mortality from causes considered preventable Mortality from cancer Suicide Preventable sight loss Excess winter deaths 5 What does PHE do? Public Health England: works transparently, proactively providing government, local government, the NHS, MPs, industry, public health professionals and the public with evidencebased professional, scientific and delivery expertise and advice ensures there are effective arrangements in place nationally and locally for preparing, planning and responding to health protection concerns and emergencies, including the future impact of climate change supports local authorities, and through them clinical commissioning groups, by providing evidence and knowledge on local health needs, alongside practical and professional advice on what to do to improve health, and by taking action nationally where it makes sense to do so 6 3
Local presence Four regions, 15 centres Eight Knowledge and Intelligence Teams London South West South East West Midlands East Midlands North West Northern and Yorkshire East Other local presence ten microbiology laboratories field epidemiology teams Additional support Local teams can also draw on national scientific expertise based at Colindale, Porton Down and Chilton 7 Urgent threats and realities 4
Health and Wellbeing Strategic areas of focus of PHE 1 Promote healthier lifestyles: better nutrition, more exercise and lower rates of alcohol, tobacco and drug use and risky sexual behaviour 2 Deliver chronic disease prevention programmes, national health marketing and health equity programmes 3 Work with health improvement and healthcare public health staff across PH system 4 Provide system-wide leadership and support for colleagues working to improve the public s health and wellbeing 5 Work with DH and other departments to promote health and wellbeing, and to tackle inequalities 6 Develop science and evidence to inform and improve policy and programmes Health and Wellbeing our approach Health impact priorities Wellbeing and mental health Alcohol and drugs Tobacco control and smoking cessation Obesity, nutrition, exercise HIV, sexual and reproductive health Lifecourse Perspective Healthy Children, Young People, Families Healthy Adults and Older People Healthy People in Healthy Places Healthcare Public Health 5
Opportunities for joint working/influence Work programme 1 Detailed plans on key health improvement topics 2 Major new health marketing campaigns 3 Stronger focus on evidence, translation and guidance Stronger collaboration, NICE; Evidence into Practice Seminar Behavioural Insights Research; Wellbeing What Works Centre, Universities 4 Greater responsiveness to emerging issues and threats Sugar, Diet, E-cigarettes, Austerity/Food Poverty Opportunities for joint working/influence Key programmes Make the case for promoting wellbeing, prevention and early intervention as the best approach to improving health across lifecourse Support people to live healthier lives via NHS Health Checks Promote tobacco control and reduce smoking Promote healthy weight and tackle childhood obesity Improve recovery rates from drug dependency Improve sexual health and reduce the burden of STIs Develop a national programme on mental health Lead gold standards for vaccination and screening programmes Developing approaches to dementia prevention 6
Tackling risk factors Example: tobacco The biggest preventable cause of death in England; the single largest contributor to disabled life years Reduced rate of smoking cuts mortality rapidly and over the long term (heart attacks, acute strokes, cancer rates reduced, long-term impact of nonsmoking in pregnancy) Reducing smoking prevalence to below 18.5% and sustained downward trend through evidence-based approaches of smoking in children and pregnant mothers Health marketing campaigns: and the always on of publicising health harm and quitting Evidence-based activity on e-cigarettes: reviews, position statements Tackling risk factors Example: physical inactivity Inactivity is 4 th greatest cause of ill-health in the UK (and socio-economic inequalities are linked to wide variation in levels of inactivity) Physical activity is effective for the prevention and management of over 20 chronic physical and mental conditions Impact across life course (increased activity at most ages can almost negate impact of sedentary lifestyle) Effective interventions require cross-sector partnerships (voluntary sector, national/local government, citizens, business, healthcare profession) PHE is consulting on a national physical activity framework. We are committed to a vision of: everyone active, every day Evidence will underpin the framework 7
Example: early years Life-course approach to tackling health inequalities The evidence base shows we can make a difference through early intervention and public health approaches There are economic and social arguments for investing in childhood. Marmot showed that of c. 700,000 children born in 2010, if policies could be implemented to eradicate health inequalities, then each child could expect to live two years longer Effective interventions require cross-sector partnerships (health and social care, education, voluntary sector, national/local government, families, communities) PHE has commissioned rapid review of the Health Child Programme (0-5) to inform commissioning and delivery Evidence will underpin the work programme especially a focus on outcomes Factors that have been shown to /are likely to facilitate translation of research into practice Opinion leaders/early adopters of good practice Partnerships between researchers and practitioners Change agents/boundary spanners Change tools/knowledge products Interventions based on social and behavioural science (e.g. reminders, decision aid tools etc) 8
Health and wellbeing matters: Health is a vital resource for our country Healthy People A virtuous circle Being productive Building a strong society 9