Presentation on public health aims for year of cycling, to the first meeting of the multi stakeholder Herts Cycling Forum , 31 July 2014

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Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FCIEH, FRSPH
Director of Public Health, Hertfordshire County Council
31st August, Hertfordshire Cycling Forum
Public Health and the Year of Cycling
in Hertfordshire

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Overview
• We have an opportunity in cycling no other
county has
• Lots of clubs, lots of participation
• Amazing cycle infrastructure
• A need to revise policy on cycling events –
Chief Constable has now agreed this!
• Working together
• Cycling expertise, public health investment
brings a year of cycling

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Events in 2014
• Womens tour
• Mens tour
• We intend to look at a full leg in 2016 being held
in Hertfordshire
• Cycling events all over the County this year
• Nomination for national transport award for
promoting cycling to children and cycle training

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Our ambitions
• More people cycling more often
• Cycling as sustainable transport
• Cycling as pleasure and keeping healthy
• Cycling on referral from health professionals
• Cycle safety and learning for kids and adults
• Mental health and physical health benefits
• A new way of doing the Cycling Forum

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We are facing an epidemiological crisis
• Avoidable early deaths
• Chronic disease – poor self management, poor
management of sub-clinical risk, must do better
on prevention and early intervention
• Some sections of our population at very high
risk of avoidable misery and death
• Mental health – intervening too late
• Resilience and Happiness – likewise

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Strategies
• Priority on maintaining a
healthy weight
• Priority on Physical activity

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Phased Approach to public health transformation
• Phase 1 – to Sept 2012. Focus on transactional issues,
accommodation, co-location, scoping further work
• Phase 2a – to March 2013 – moving into transformational. Wide
engagement of team and staff etc
• Phase 2b – to March 2013 – Transformational – the vision and
strategy of what Public Health is offering Hertfordshire
• Phase 3 – march 2013 to March 2014 – Embedding the
transformation and new way of working
• Phase 4 – 2014 onwards – the hard long term work of making
Hertfordshire a public health county.

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Healthier Herts: A Public Health Strategy for Hertfordshire
OUR PURPOSE
to work together to improve the health and wellbeing of the people of
Hertfordshire, based on best practice and best evidence
OUR VISION:
A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy
and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
Priority 5:
We
understand
what’s
needed and
we do what
works
Priority 6: We
make public
health
everybody’s
business and
work together
HOW WE WILL WORK TOGETHER
(our strategic priorities: how we do it for
our County)
The
Public
Health
Outcomes
Framework
(the national
PHOF will
Help us measure
Our success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUR
RESIDENTS
(our strategic priorities: what we achieve for our County)
Priority 1:
Our
Populatio
n lives
Longer,
Healthier
Lives
Priority 2:
Our
Population
Starts Life
Healthy
and Stays
Healthy
Priority 3: We
narrow the
gap in life
expectancy
and health
between
most and
least healthy
Priority 4: We
protect our
communities
from harm
(chemical,
biological,
radiological and
environmental)
Building
Blocks
For the
Public Health Family
Strong
Leadership
Capable,
Skilled People
Co-production
with citizens
Effective
Partnerships
Evidence and
Knowledge
Driven
Plan and
Deliver for
Localism
Whole
System
Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels

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Some key challenges
• Inactivity
• Disease of Lifestyle
• Culture
• Cost
• Sustainability
• Air Quality

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The Opportunity for Herts
• The conditions for everyone to be healthy
• The conditions for the poorest and worst off to
be healthier
• Public services which put this at the core of their
business
• People thriving and prosperous
• Healthy workforce, prosperous County

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Cycling as part of a County of Opportunity
• Physical activity becomes second nature
• Health benefits from self propelled transport
(walking, cycling)
• Sustainability benefits from self propelled
transport
• Cycling on referral

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Year of Cycling
• We will put cycling on the map in Hertfordshire
as a leisure, health and transport activity
• Complete revision of some work we’ve been
doing including website and apps
• Start of a 3 year plus cultural push on physical
activity
• County Council, Cycle Clubs, Districts, NHS,
Police, working together

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Year of Cycling
• 1 year plus legacy period
• Year of walking follows
• Then year of swimming
• Culture change
• Already having an impact
• £2m investment in District
Councils by Public Health
Chief constable and county council agree
to new policy on cycling events/races

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The Policy Context (England) does give us scope
to address this
• Local Authorities – duty to promote and protect
health of population
• NHS CCGs – duty to reduce inequalities in
health
• Behaviour change is a tool but we need to use it
properly and use the right methods
• A balanced strategy using a range of tools and
strategies

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Contributors to overall health outcomes and why elected
councillors are important leaders
Smoking 10%
Diet/Exercise 10%
Alcohol use 5%
Poor sexual health
5%
Health
Behaviours 30%
Education 10%
Employment
10%
Income 10%
Family/Social
Support 5%
Community
Safety 5%
Socioeconomic
Factors 40%
Access to care
10%
Quality of care
10%
Clinical Care
20%
Environmental
Quality 5%
Built
Environment 5%
Built Environment
10%
Source: Robert Wood Johnson Foundation and University
of Wisconsin Population Health Institute. Used in US to
rank counties by health status
While this is from a US context it does have significant
resonance with UK Evidence, though I would want to
increase the contribution of housing to health outcomes
from a UK perspective.

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Primary
Prevention
Secondary
Prevention
Tertiary
Prevention
in and
Out of hospital

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Phasing and Layering across Lifecourse
• Layering levels of action
• Population – smoking ban
• Sub-Population – NHS health checks
• Individual – motivational interviewing, asserting
clinical management of risk factors, pathways

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Phasing and Layering
• Phasing across the lifecourse and time
Working age
Accumulation
Of risk in
Late working
age
Good early
Years
outcomes
For lifetime
Mental
health

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Just some actions being taken so far (more will be
done)
1. New weight management service already
commissioned and reached 1st 1,000
referrals in three months, more will be
commissioned
2. Obesity pathway in place for tiers 1 -3
obesity care. Revision late 2014
3. New lifestyle partnership launched with
lifestyle offer for Herts residents to be ready
by Easter for phased roll out
4. New online lifestyle service launched in
February
5. Workplace physical activity challenge
funded and running (Herts Sports
Partnership)
6. Workplace Health improvement programme
running (Business in the Community)
7. 93% of GPs in Herts now doing NHS
HealthChecks
1. Obesity Plan approval by Cabinet due
March 2014
2. New child weight management service to
be commissioned in 2014
3. Broxbourne whole area obesity pilot
underway with Borough and County
Council, schools and NHS
4. Fast food takeaway restrictions
5. Countryside walks scheme
6. Year of Cycling launching May 2014
7. Funding for District Councils to work on
health improvement agreed and each
District working out its plans
8. Continue child weight measurement
programme

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Thank you!
Jim.mcmanus@hertfordshire.gov.uk
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