Presentation from WCVA's Annual Conference 2014

1. Insert name of presentation on Master
Slide
Collaborating to Improve
our Public’s Health

2. Healthier, Happier and
Fairer Wales
Health Improvement
Healthcare Improvement
Health Protection
Screening Services
Microbiology Services
Policy advice

3. DEMOGRAPHIC CHALLENGES

4. 0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
OECD EU27 Japan Korea USA World Brazil China
Global Population Aged over 80 years
Source: OECD Labour Force and Demographic Database, 2010

5. Young Children and Older People as a Percentage of Global
Population: 1950-2050
Source: United Nations. World Population Prospects: The 2010 Revision.

7. Increasing Ageing Population in Wales

8. WIDER DETERMINANTS AND
LIFE EXPECTANCY

9. 22% of children in Wales
live in poverty
In some areas 55-68% of children live in poverty
19.0
13.4
19.6
23.7
24.0
26.6
24.1
20.2
16.7
19.8
22.1
16.9
20.1
13.4
Wales=22.2%
Betsi Cadwaladr
Powys
Hywel Dda
ABM
Cardiff & Vale
Cwm Taf
Aneurin Bevan
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
Powys
% of children living in poverty, persons aged under 20, 2010
Produced by Public Health Wales Observatory, using DWP

10. Life expectancy is related to socio-
economic deprivation
61.2
60.8
65.3
64.7
81.4
80.4
59.1
58.7
63.5
62.8
77.0
75.9 8.6
9.2
18.4
18.9
14.6
14.8
6.5
7.1
17.4
17.8
12.3
12.5
2001-05 2005-09
Life expectancy
Healthy life
expectancy
Disability-free life
expectancy
Life expectancy
Healthy life
expectancy
Disability-free life
expectancy
Males
Females
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD/WHS (WG)
Life expectancy with 95%
confidence interval
Inequality gap
(SII in years)
Comparison of life expectancy, healthy life expectancy and disability-free life
expectancy at birth, Wales 2001-05 and 2005-09
62.5
62.1
65.9
65.4
81.7
80.6
59.8
59.2
63.7
63.0 22.5
22.7
17.2
17.1
8.8
10.0
21.0
22.0
12.3
12.9
Healthylife
expectancy
Disability-free life
expectancy
Life
expectancy
Healthylife
expectancy
Disability-free life
expectancy
Females
62.5
66.1
81.0
61.5
64.7
77.3
62.0
65.5
79.9
60.8
63.9
75.9
0 10 20 30 40 50 60 70 80 90
ancy
ancy
ancy
ancy
ancy
ancy
2001-05 2005-09
Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
ncy, healthy life expectancy and disability-free life expectancy
5 and 2005-09
Observatory, using ADDE/MYE (ONS), WIMD/WHS(WG)

11. THE BIG KILLERS

12. Circulatory disease and cancer are
the biggest killers
Circulatory
33% all ages
25% <75 years
Neoplasms
28% all ages
40% <75 years

13. THE MAIN CAUSES

14. Smoking Deaths
“Smoking continues to be
the greatest single cause
of avoidable mortality in
Wales. In people aged 35
and over, smoking
causes nearly one in five
of all deaths and around
one third of the
inequality in mortality
between the most and
least deprived areas.”
5,450

15. Nearly half of young people report
drinking too much
% of persons aged 16-24 who reported drinking above the
recommended guidelines on at least one day in the previous
week, 2008-2011
43.0
46.0
44.9
46.8
48.2
45.1
44.9
Wales = 45.5
Betsi Cadwaladr
Powys
Hywel Dda
ABM
Cardiff & Vale
Cwm Taf
Aneurin Bevan
% of persons aged 16-24 who reported drinking above the
recommended guidelines, 2008-2011
Produced by Public Health Wales Observatory, using WHS (WG) & MYE (ONS)

16. Alcohol is killing an estimated
1,500 per year
Produced by Public Health Wales Observatory, using ADDE, MYE (ONS), fractions (PHE)

17. More deaths in areas of
high deprivation
Alcohol-attributable mortality rate, males, all ages, Wales, 2003-05
to 2010-12

18. Too few people eat a
healthy diet
36
37
40
35
37
30
32
Wales = 35
Betsi Cadwaladr UHB
Powys THB
Hywel Dda HB
ABM UHB
Cardiff & Vale UHB
Cwm Taf HB
Aneurin Bevan HB
95% confidence interval
Proportion of adults who reported eating five portions of fruit and
vegetables the previous day, age-standardised, persons, aged
16+, Wales health boards, 2009-2010
Produced by Public Health Wales Observatory, using Welsh Health Survey (WG)
% eating five portions of fruit and vegetables the previous day,
2009-2010
Age-standardised, persons aged 16+, Wales health boards

19. 12.5% of children aged 4-5
are obese
9.4
11.4
13.2 13.5 14.3
Least
deprived
fifth
Next least
deprived
Middle
deprived
Next most
deprived
Most
deprived
fifth
Wales= 12.5%
Percentage of children aged 4-5 years who are obese,
Welsh Index of Multiple Deprivation fifths, Child
Measurement Programme for Wales, 2011/12
Produced by Public Health Wales Observatory, using CMP data (NWIS), WIMD
2011 (WG)

20. … and more than half of adults are
overweight or obese
55
56
58
58
54
62
59
Wales = 57
Betsi Cadwaladr UHB
Powys THB
Hywel Dda HB
ABM UHB
Cardif f & Vale UHB
Cwm Taf HB
Aneurin Bevan HB
95% conf idence interval
Proportion of adults who reported being obese or overweight
(Body Mass Index >= 25), age-standardised, persons, aged 16+,
Wales health boards, 2009-2010
Produced by Public Health Wales Observatory, using Welsh Health Survey (WG)
% obese or overweight (BMI*>=25), 2009-2010
Age-standardised, persons aged 16+, Wales health boards

21. LIVING WITH ILLNESS

22. Large numbers of people
live with illness
48% of adults are being treated for a
chronic illness
– 19% for high blood pressure
– 14% for respiratory illness
– 14% for arthritis
– 10% for mental illness
– 9% for a heart condition
– 6% for diabetes

23. CANCER

24. Bowel cancer now has the highest
incidence, but lung cancer kills
more people

25. Mortality is falling slowly

26. … but there are inequalities
everywhere
Incidence Survival Mortality

27. EMERGENCY ADMISSIONS,
INJURIES AND INFANT
MORTALITY

28. More inequality…
77.6
85.3
97.1
107.6
127.1
Wales =101.9
Least deprived
Next least deprived
Middle
Next most deprived
Most deprived
Emergency hospital admissions* by deprivation fifth, persons
aged 0-24, Wales, EASR per 1,000, 2011
*Patients are counted more than once if they had multiple admissions
during 2011
Emergency admissions* by deprivation fifth,
persons aged 0-24, Wales, EASR per 1,000, 2011
15.1
20.9
28.8
38.8
51.0
Wales = 31.7
Least deprived
Next least deprived
Middle
Next most deprived
Most deprived
Admissions for pedestrian injuries by fifth of deprivation,
children aged 5-14, Wales, rate per 100,000, 2006-2010
Producedby PublicHealth WalesObservatory,using WDS, PEDW(NWIS) &
WIMD 2011 (WG)
Admissions for pedestrian injuries by fifth of
deprivation, children aged 5-14, Wales, rate
per 100,000, 2006-2010
3.8
3.8
4.1
4.3
5.6
Least deprived
Next least deprived
Middle
Next most deprived
Most deprived
Infant mortality by fifth of deprivation, Wales, rate per 1,000
births, 2006-2010
Produced by Public Health Wales Observatory, using ADDE & ADBE (ONS),
Wales = 4.4
Infant mortality by fifth of deprivation, Wales, rate per 1,000 births, 2006-2010

29. We must deliver a more preventative
approach for our public’s health that has
maximum impact to reduce inequalities
and keep people healthier for longer

30. Prudent Healthcare
‘Healthcare which is conceived, managed and
delivered in a cautious, safe and wise way
characterised by forethought, vigilance and
careful budgeting which achieves tangible
benefits and quality outcomes for patients’
Bevan Commission, 2013

31. Provisional Principles
1. Treating greatest clinical need first
2. Do no harm – achieve measurable good
3. Do the minimum appropriate intervention to achieve
the desired outcomes
4. Choose the most Prudent Care, openly together with
the patient
5. Consistently and appropriately apply evidence based
medicine in practice
6. Co-produce health with the public, patients and
partners

32. HOW DO WE CHANGE
DESTINY?

33. New Focus for the Future
Design and transform a health service to be fit,
effective, efficient and viable to meet population needs
today and tomorrow
Embed an emphasis on 1’ and 2’ prevention through
lens of reducing absolute inequalities
Use the interventions we know work
Creating a healthier destiny for our young and
keeping people healthier for longer:
- early years focus (from preconception)
- realigned role of ‘primary’ and ‘community’ care
- better skilled workforce and capacity for older age
- optimising all public services and third sector
- engaging with people to enable positive choices
Aligning social policy to drive transformation

34. Systems Approach to
Health Improvement

35. Optimising our Assets
National,
regional, town
or county
Communities
Workplaces
Children’s
settings
Healthy
schools
Healthy
pre-
schools
Healthy Working Wales
Health of the Valleys project
Training,
award
schemes
Network
initiation
NHS
LA’s
Housing
Police

36. Aligning Policy, Settings and People
People
• Making every contact
count
• Training and education
• Multi-interventionalists
• Smoking, obesity and
alcohol tailored support
• Ensure workplace policies
tackle well-being
• Become public health
advocates
• All public servants,
voluntary organisations
• Connecting with local
community leaders and
role models
Specific Settings
• Schools
• Further Education
Establishments
• Hospitals/ Health
Centres
• Public Sector
Workplace
• Custodial settings
• Private Sector
workplaces
• Cinemas/Theatres/En
tertainment venues
• Retail establishments
• Fast Food shops
• Local communities
Public Policy
• Taxation – sugar, soft
drinks
• Planning – restriction of
outlets, designed for health
• Bans- promotions,
sponsorship, products
• Licensing – what can be
sold and where
• Restrictions – on sales to
children, on marketing on
access to health care
• Parenting Orders
• Profiling for obesity at birth
• Raising public awareness
away from personal
responsibility to coping with
environment

37. Working Together for a
Healthier Future
Focus on reducing absolute inequalities,
primary prevention and early years
Building a social movement – transforming
societal policy and approach
Working together for tangible change
Boundaryless approach at local level
Working closely with partners and communities
Well-being of Future Generations Bill

38. If we are ever in doubt about what to
do, it is a good rule to ask ourselves
what we shall wish on the morrow that
we had done.
John Lubbock