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  • 1. Public health white paper 2010 The ‘life-course’ approach • Early years • Start well • Working well • Living well • Ageing Well
  • 2. • Reducing social inequalities: UK Marmot review • Early years education and family support: increase % spend in early years • Maximise the capabilities and control young people have over their lives : reduce the social gradient of skills and qualifications• Create fair employment and good quality work for all and improve quality of work across social gradients • Ensure healthy standard of living for all reducing the social gradient through progressive taxation and other fiscal policies • Healthy and sustainable physical environments • Strengthen the role and effect of prevention of ill health priority for investment to reduce social gradients
  • 3. • Reducing social inequalities: UK Marmot review• Early years education and family support: increase % spend in early years
  • 4. “Changing the world – one baby at a time”
  • 5. Trials of the NFP in USA Elmira, NY Memphis, TN Denver, CO 1977 1987 1994 N = 400 N = 1,138 N = 735• Low-income • Low-income • Large portion whites blacks of Hispanics• Semi-rural • Urban • Nurse versus paraprofessio nal visitors 6
  • 6. Consistent results across 3 trials in USA• Improvements in women’s antenatal health• Reductions in children’s injuries• Fewer subsequent pregnancies• Greater intervals between births• Increases in fathers’ involvement• Increases in employment• Reductions in welfare dependency• Reduced substance use initiation and later problems• Improvements in school readinessProgram effects greatest among those most susceptible7
  • 7. Evidence for early years support Perry Preschool High Scope study Abercedarian university studyCochrane review of early years and family support for deprived communities6 sound studies review of Harden, Oakley et al BMJ 2009
  • 8. Program No program Did homework at age 15 In program for mental impairment IQ at 5 90 or more 9th %ile or better in school at 14 Average or better literacy at 19 0 10 20 30 40 50 60 70Data from the High/Scope Perry preschool project. Bars represent percentage in each of thetwo groups. The difference in major educational performance findings between program andnon-program children is significant.
  • 9. Program No program 5 or more arrests by age 27Soc.Services ever in previous 10 years High school graduate Home owner at age 27 $2000 or more monthly pay 0 20 40 60 80Further data from the High/Scope Perry preschool project. Benefits from the programcontinue to be seen in adulthood. Bars represent percentages of each of the groups Thedifference between program and non-program children is significant.
  • 10. • Reducing socialinequalities: UK Marmot review • Maximise the capabilities and control young and adults people have overtheir lives : reduce
  • 11. • Reducing social inequalities: UK Marmot review• Create fair employment and good quality work for all and improve quality of work across social gradients
  • 12. • Reducing social inequalities: UK Marmot review • Ensure healthy standard of living for allreducing the social gradient through progressive taxation and other fiscal policies
  • 13. • Reducing social inequalities: UK Marmot review The spirit level -Richard Wilkinson work looking at how the more equal societies are invarialy healthier, happier, more free of crime, better achievers with lower unintended pregnancy rates and other adverse social indicators
  • 14. • Reducing social inequalities: UK Marmot review• Healthy and sustainable physical environments-
  • 15. Supportive environments - safe routes to school
  • 16. Increasing the supply of healthier food in Sandwell From this….
  • 17. ….to this
  • 18. By 2003 the mixed use site was in production…
  • 19. Increasingtheproductionofhealthierfood _Sandwellcommunityagriculture strategy
  • 20. Making it Happen Editorial “The challenge is to make politicians work for an environment that promotes walking, and to call on doctors to encourage patients to walk…” BMJ 9th June 2007
  • 21. Healthy towns-Sandwell Healthy Urban Development UnitOutcomes• Healthy urban development approach• Working with town planners and transport engineers – to influence policy and design• Emphasis on environment and open spaces- create safer places where people• Encouraged to walking and cycling• Health impact assessment on all developments• Spin off for comments on health care impacts eg new nursing homes
  • 22. Reducing social inequalities: UK Marmot review• Strengthen the role and effect of prevention of ill health priority for investment to reduce social gradients- will discuss in relation to NICE guides
  • 23. Reducing the social gradient throughtargetted health promotion• Cardiovascular disease identifying people at risk
  • 24. Implementing effective interventions : NICE public health guidelines Cardiovascular disease identifying people at risk Communities for health Sandwell model • Nurse led programme of CVD risk management for patients at> 20% risk of heart attack in 10 years • Health trainer intervention for those >15% risk • Universal advice and information service via community organisations for general population at lesser risk
  • 25. Sandwell CVD risk reduction model: projected benefitSandwell Eligible CVD Events for prevented over ten treatment yearsAspirin 11,382 410Antihypertensive 6,860 288therapyStatin 11,694 947Total 1,645Total if attendance 1,020same as for pilotIf 30% of 494 based oncirculatory events eligibilityresult in death, 306 based on
  • 26. Martin Bobak about the catastrophic rise in death rate in Russia in 1990-1995 due to destruction of Soviet economy Will western countries under austerity measures be spared extra deaths?Stuckler and McKee argue that social welfare spend should be preserved in times of recession and reduced in good times. WHO have argued health investment is protective for national economies (Brundtland 2000,susana 2010)
  • 27. The Changing landscape for public health in England, John Middleton Warrington,March 2nd 2011 Public health – a role for councils
  • 28. The Changing landscape for public health in England, John Middleton Warrington, March 2nd 2011 Civic Pride That the people I represent die youngerthan people in other parts of the country is not acceptable –That the people in one part of my area are dying younger than others is unacceptable
  • 29. The Changing landscape for public health in England, John Middleton Warrington, March 2nd2011 Sun cream, health fairs and pest control ? Or : Housing and excess winter deaths, Air quality and heart disease, Traffic congestion and walking to school Fear of crime and lack of exercise ? Littering and obesity ?
  • 30. The Changing landscape for public health in England, John Middleton Warrington,March 2nd 2011 The inverse care law:‘People who need the most health care get the worst, and the poorest quality’ ‘Poor people get poor services’
  • 31. Thank you John MiddletonDirector of Public Health for Sandwell John.middleton@sandwell- pct.nhs.ukVice President, UK Faculty of Public Health