Stephen Palmer presentation WSPCR 2010


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Stephen Palmer presentation WSPCR 2010

  1. 1. Owing to the generosity of Sir WJ Thomas an Institute of Preventive Medicine was built in 1921 for the Department of Public Health and the School of Preventive Medicine.Sir William Osler: “I think we can look forward with hope to the inauguration of a really great School of Preventive Medicine…that will be an example to the world…. …The Professor must have a burning enthusiasm for research.”
  2. 2. Professor Edgar L CollisInaugral Lecture: ‘Finem Respice’ Lancet 1920;i:6-11 •  ‘The task to be accomplished: ‘What is then the task which lies before the Welsh National School of Medicine. It has to train a whole and complete medical service for the Principality so that there may be established throughout Wales a capable and well-equipped band of apostles preaching the gospel of health on hill and dale, in hamlet, village and town.’ ‘I am undertaking a heavy responsibility in that I am the first occupant of the only chair in the country devoted entirely to the subject of preventive medicine. There is no tradition to guide, no precedent to refer to…’
  3. 3. “… I mean the prevention of disease. This side presents apoint of view which centres thought on the positive entity,Health, rather than on the varied manifestations of lack ofhealth which we sum up in the negative term, disease…but each member of the community is only interested inthese matters in a half -hearted way… ”
  4. 4. ResearchEL Collis again… Inaugral Lecture: ‘Finem Respice’ ‘The Institute stands not only for teaching, but also research and the spirit of research….The Institute must be acquainted with the health conditions of Wales and be prepared to direct research to meet the needs of the Welsh nation; it must have knowledge of social conditions with which health is so intimately associated; … it must note variations in sickness and mortality in different districts and be prepared to assist in searching out the causes and finding ways to remove them…. Its scope must, as far as medicine is concerned, be broad… and claim all knowledge for its own.’
  5. 5. 1919 First Professor of Preventive Medicine appointed1921 Institute of Preventive Medicine opened1925: Stevens Committee of Enquiry “You have got these fancy departments these men are (Preventive Medicine and Tuberculosis)… running your place and they have more to say that the men who are doing the real work of the hospital… they are luxuries” Referring to the Institute of Preventive Medicine…. “…the block will be exceedingly useful for other work”
  6. 6. out of
  7. 7. AL Cochrane 1909-1988…the spirit of research…
  8. 8. World Health Organisation and English Department of Health fund work at National1978 Perinatal Epidemiology Unit, Oxford, UK to assemble a register of controlled trials in perinatal medicine Outline plans drafted in Cardiff, Wales, UK for1976 systematic reviews of controlled trials in perinatal medicine Identification of controlled trials in perinatal1974 medicine begins in Cardiff, Wales, UK Publication of Archie Cochranes Effectiveness and Efficiency: random reflections1972 on health services , which drew attention to our collective ignorance about the effects of health care
  9. 9. 2000 UK Parliament Health CommitteePress Notice No. 13 of Session 2000-01, dated 27 March 2000 "Public health" is not a term understood by the majority of the public. It can be variously defined so as to cover trends of disease in a population, the provision of preventive and health improving care, or a range of health-impacting factors including or excluding the NHS. In a key note speech delivered as the annual LSE health lecture on 8 March 2000, the Secretary of State for Health himself drew attention to the problems in defining public health and the implications of those problems and said: "The time has come to take public health out of the ghetto."
  10. 10. House of Commons Select Committee on Health: Second Report, 2001 Leadership in Public Healthpara We agree with the Secretary of State that102 health authorities are not solely responsible for improving health, however we consider that the strategic lead for public health must be clarified. The “plethora of partnerships” make it vital that there is clear strategic of public health at a local level. Whatever arrangements are made, leadership should be strong, explicit and should have clear lines of accountability.
  11. 11. April Public Health Group registered2008Mar Chinese Cochrane Centre registered1999Nov Sexually Transmitted Diseases Group1998 registeredMar HIV/AIDS Group registered1998
  12. 12. The Spirit of Public Health Research in Wales•  a collaborative model ▫  draw together researchers from health sciences, sociology, psychology, engineering, architecture, economics and business studies, geography, informatics and others.•  Build on the successes and strengths of health research in Wales•  Take new opportunities, new partnerships (eg ONS now in Wales), new technology for record linking large routine health datasets for public health studies of the whole Welsh population Wales). ▫  (HIRU/SAIL) and multi-sectoral datasets (WISERD) and Web based epidemiology.
  13. 13. Designed for Life•  A New Policy Context•  The vision which drives this renewal is shaped by the paradigm embraced in the Welsh Assembly Government’s constitution - Sustainable Development.•  “We remain one of the few administrations in the world to have such a statutory duty, and it gives us an opportunity to develop Wales, as a small, smart nation, in ways which contribute sustainably to people’s economic, social and environmental wellbeing, now and in the future”•  “the central organising principle of public service – because public service must be about achieving benefits for the whole of society and for the long term.”
  14. 14. Sustainable Communities– a new paradigm for Public Health! “I want a Wales fit for generations to come … What motivates me is doing my very best to ensure a brighter, sustainable future for [my grandchildren and their grandchildren] and every other child growing up in Wales today … [Therefore], top of the list … of our priorities which will continue to improve the quality of life for people today and in the future … is sustainability” First Minister, 8 February 2008
  15. 15. Implications of “Sustainable Communities” Social This and Economic Environments Future Natural Generations
  16. 16. Preliminary Analysis - Smoking SMOKING STATUS CASES % CONTROLS (n) % (n) Smoked YES 76.9 (70) 48.8 (106) before NO 23.1 (21) 51.2 (111) Pregnancy Smoked YES 70.3 (64) 44.2 (96) during first NO 29.7 (27) 55.8 (121) 12weeksUnadjusted Odds Ratios (95%Confidence Intervals).Smoking before pregnancy : 3.3 (1.82, 6.05)Smoking during first trimester: 2.8 (1.63, 4.98)
  17. 17. Preliminary Results: AlcoholALCOHOL CONSUMPTION CASE % (n) CONTROL% (n)Typical number of 0 22.2 (20) 38.6 (83)units per week in < 14 48.9 (44) 51.2 (110)first trimester >14 28.9 (26) 10.2 (22)Binge drinker (> 6 Yes 51.6 (47) 37.0 (80)units in one sitting/ No 47.3 (43) 62.0 (134)day) Don’t know 1.1 (1) 0.9 (2) Unadjusted Odds Ratio (95%CI) < 14 units per week: 1.6 (0.83, 2.95) > 14 units per week: 4.7 (2.07, 10.71) Binge Drinking: > 6 units in one sitting/day: 1.8 (1.00, 2.97)
  18. 18. Preliminary Analysis: Recreational Drug useDRUG USE STATUS CASES% (n) CONTROLS% (n)Ever used illegal YES 48.4 (44) 30.9 (67)substances No 51.6 (47) 69.1 (150)Used prior to YES 20.9 (19) 7.4 (16)knowledge of pregnancy No 79.1 (72) 92.6 (201)Used during first 12 YES 15.4 (14) 5.1 (11)weeks of pregnancy NO 84.6 (77) 94.9 (206) Unadjusted Odds Ratios (95%Confidence Intervals) Ever used illegal substances: 2.0 (1.15, 3.35) Used illegal substances before pregnancy: 2.9 (1.39, 6.19) Used illegal substances during first trimester: 2.7 (1.17, 6.29)
  19. 19. Towards Evidence Based Public Health RESEARCH EVIDENCE PUBLIC Evaluation Assessment Political ProcessSurveillance SynthesisIMPLEMENTATION POLICY LEGISLATION
  20. 20. RCT Results: 74 intervention homes versus 72 control homes• Improvement in breathing at 6 mths 52% v 2%• Reduction in medication at 6 mths 41% v -17%• Reduction in wheeze affecting act’ 31% v 7%
  21. 21. The proposed functions of the “Institute”•  Evidence Centre•  Coordinate public health knowledge management.•  Identify knowledge gaps and develop research priorities.•  Provide a strategic link between academic public health researchers, PHW, WAG, NHS and LAs.•  Manage the Wales public health research programme and stimulate and where appropriate coordinate multicentre and multidisciplinary research, especially exploiting natural experiments.•  Drive the timely use of national datasets and surveillance systems for maximum public health gain, possibly embracing the Wales Observatory.•  Promote and coordinate use of public health and mathematical modelling to assist decision making.
  22. 22. The proposed functions of the “Institute”•  Public Health Training•  managing the all Wales public health training programme under the direction of the Postgraduate Dean.•  Liaison with academic training centres such as Cardiff University MPH Programme and UWIC/HPA International training Centre for Chemical Hazards.•  Policy and Programmes “Laboratory”•  Create an evidence-policy “space” which would be a forum for debate and development of advice.•  Test new ideas for new prevention policies, programmes and projects.