Public HealthFrom Chadwick To Cameron Pete Hill & Sarah James
Public Health From Chadwick To Cameron• Back in Time to 1842….• What is Public Health?• JSNA – What’s One of Those Then?• Data – Lies Damned Lies & Statistics?• Health – The Makeover• Public Health Outcomes Framework• Need v Demand• Conclusions
Origins of Public Health“That the various forms of epidemic, endemic, and other disease caused, or aggravated,or propagated chiefly amongst the labouring classes by atmospheric impurities producedby decomposing animal and vegetable substances, by damp and filth, and close andovercrowded dwellings prevail amongst the population in every part of the kingdom,whether dwelling in separate houses, in rural villages, in small towns, in the larger towns— as they have been found to prevail in the lowest districts of the metropolis.”“That such disease, wherever its attacks are frequent, is always found in connexion withthe physical circumstances above specified, and that where those circumstances areremoved by drainage, proper cleansing, better ventilation, and other means ofdiminishing atmospheric impurity, the frequency and intensity of such disease is abated;and where the removal of the noxious agencies appears to be complete, such diseasealmost entirely disappears.”Edwin Chadwick Report...from the Poor Law Commissioners on an Inquiry into the SanitaryConditions of the Labouring Population of Great Britain [online source]. London, 1842, pp. 369-372.]
“That the younger population, bred up under noxious physical agencies, is inferior inphysical organization and general health to a population preserved from thepresence of such agencies.”“That the population so exposed is less susceptible of moral influences, and theeffects of education are more transient than with a healthy population.”“That these adverse circumstances tend to produce an adult population short-lived,improvident, reckless, and intemperate, and with habitual avidity for sensualgratifications.”
Step Up John SnowThe Broad Street Pump – 1854Golden Square choleraepidemic500 deathsFirst mapping to indicateextent and local ofoutbreak - mappedincidence and checkedfacts
Health and its determinants“Health is as a positive conceptthat emphasises social andpersonal resources, as well asphysical capabilities. It involvesthe capacity of individuals tofunction and to cope with theirsocial and physicalenvironment, as well as withspecific illnesses and with lifein general” (WHO, 1984; Baggott,1994).
JSNA What’s One of Those Then?Our health, our care, our say white paper:• identified the need for directors of:• public health• adult social services• children’s servicesto undertake regular strategic needs assessments ofthe health and wellbeing status of their populations• Need for joint planning and understanding
JSNA What’s One of Those Then? “JSNA is a process that will identify the current and future health and wellbeing needs of a local population… leading to agreed commissioning priorities that will improve outcomes and reduce health inequalities.” Department of Health (2007) Guidance on Joint Strategic Needs Assessment
JSNA What’s One of Those Then?Describes a process that identifies currentand future health and wellbeing needs inlight of existing services, and informs futureservice planning taking into accountevidence of effectiveness.• Identifies the “big picture” in terms of thehealth and wellbeing needs andinequalities of a local population.• Assists commissioning services andinterventions that will achieve better healthand wellbeing outcomes and reduceinequalitiesThe Local Government and Public Involvement in Health Act 2007 Section 116 specifies that local authoritiesand Primary Care Trusts (PCTs) produce a Joint Strategic Needs Assessment (JSNA) of the health andwellbeing of the local community
“The Department of Health expects local authorities to commission on an ‘any willing provider’ basis and they will work to ensure that voluntary, community and social enterprise organisations are supported to play a full part in providing services.”Healthy Lives Healthy People December 2010
JSNA Data Inventory• People receiving housing benefit• Number and proportion of households in fuel poverty• Noise and vibration levels monitored by environmental health• Information on food poisoning outbreaks – type, location and number of people affected• Level of flooding risk• Proposed developments in the area that might affect population health and wellbeing• Houses in multiple occupation• Housing condition (private sector)• Overcrowding• Number of unfit dwellings• Number of Gypsy and Traveler sites and estimated populations• Performance and other indicators on local social housing providers• Perceptions of antisocial behavior
Other Contributing Data• Environmental Quality• Air Quality• Contaminated Land• Private Water Supplies• IPPC Permits• Smoking• Health & Safety at Work• Accident data• Young Persons at Work• Cold and Hot Weather Risk Assessment• Public Health• Accumulations• Filthy & Verminous Premises• Nuisance Complaints
NHS Timeline 1950 New 19525th July 1948 NHS hits PrescriptionNHS Formed budget charges problems introduced 1980 Black Report 1962 Enoch1987 Whitehead finds health Powell’sreport continues inequalities Hospital PlanBlacks work between social introduces groups Local Health Authorities1990 Community 1992 NHS Trusts 1998 AchesonCare Act Health Formed Report on Healthservices now Inequalitiescommissionedfrom NHS
Funding Department of Health Public NHS Health BUDGET Budget £100 £5 billion billion Specific Public Health ServicesPublic Health NHS CommissionersEngland GP’s Ring Fenced Providers Grant Local Health & Wellbeing Boards Authorities
Public Health Outcomes Framework Main Aims Increased healthy life expectancy. Reduced differences in life expectancy and healthy life expectancy between communities Four Domains of Indicators 1. Improving the wider determinants of health 2. Health improvement 3. Health protection 4. Healthcare public health and preventing premature mortality Framework will operate from April 2013
An example There is an eight year gap in male life expectancy between St Pancras and Somers Town wards and Hampstead 3.5 miles!
An example a seven year gap in In Most Authorities female life expectancy between Hampstead and There is at least a 7 Kentish Town. year gap between the 2 miles!most and least deprived Wards!
EH Indicators Air pollution Fuel poverty Diet Excess winter deaths The percentage of the population affected by noiseSmoking prevalence – adult (over 18s) Smoking prevalence – 15 year oldsMortality from communicable diseases Falls and injuries in the over 65sPublic sector organisations with board Comprehensive, agreed inter-agencyapproved sustainable development plans for responding to public healthmanagement plan incidents
Housing & Health• HHSRS• Decent Homes Standards• House Condition Survey• HMO Licensing
Healthcare Community Costs Stability Drugs/ Alcohol Loneliness Depression Suicide Stress Falls Sleep Unemployment DeprivationIsolation Access Problems Dangerous Access to Low Educational Stairs Burglars AchievementLack of StressMoney X Cold Overcrowding Worry Trip Damp & Rubbish Hazards Mould Pneumonia/ Heart Colds Attacks Asthma Anti Social Work Behaviour Absence Bullying Graffiti Death Truancy Crime & Environmental Environmental Disorder Costs Clean Up Costs targets CO2
EHP’s Need To Be…..“Give me a smart idiot over a stupid genius any day.” –Samuel Goldwyn
“A business that makes nothing but money is a poor business.” - Henry Ford
Cost Analysis Expected Number of Estimated Total Expected Hazard Incidences Causing Costs to Mitigate Annual Saving to Harm within the Stock NHS Damp & 70 £775,250 £28,113 Mould Excess 417 £2,082,081 £7,101,366 ColdFalling on Level 626 £241,072 £1,660,965Surfaces etcFalling on 4589 £1,551,082 £11,295,269Stairs etcCrowding 0 £0 £0 & Space Entry by 417 £436,182 £182,238Intruders Totals £5,085,667 £20,267,951
Where Does Your Service Fit In The Health Jigsaw?
Need v DemandKnow your population• How many people at risk?• What is the structure of the population at risk?: Are You in a Position to• Age Say No?• Sex• Ethnicity• What is the deprivation statusof those at risk?
In Conclusion - JSNA •Identifies the most important needs within a population for the wider determinants of health E.g. housing quality is more of a priority than stroke •Measures need (not demand!) . •Measures, understands and articulates the needs of individuals, groups and populations relating to the wider determinants of health and wellbeing. • Sets priorities for partners to work together to addressAnd God said, Let there be light and there was light, but the Electricity Board said He would haveto wait until Thursday to be connected. – Spike Milligan
“The price of a good sanitary environment and the control of pestilence iseternal vigilance on the part of the medical officer of health. The promotion ofhealth in a community -in the home, at work, and at play - demands hisconstant attention, in co-operation with the sociologist; and education in healthneeds for its fulfilment a completely new approach, with teacher, psychologist,and health officer in joint harness.”“In fact, when the prospects of a true health service, relieved of the burden ofthe medical care of the sick, are properly examined, one is amazed andenchanted by the gleaming horizon”. Nye Bevan’s Speech:16 September 1948, to the Society of Medical Officers of Health
Public Health From Chadwick To CameronPete Hill Sarah JamesCorporate Special Projects Officer Chartered Environmental HealthWelwyn Hatfield Borough Council Practitioner01707-357404 Watford Borough CouncilP.Hill@Welhat.gov.uk 01923 278582 Sarah.James@Watford.gov.uk