This document outlines plans to launch new public health initiatives in Hertfordshire, including a dedicated web portal for elected officials, an e-learning portal, and a public web portal on public health. It discusses how major diseases have shifted from poverty-related to communicable to non-communicable diseases like heart disease and diabetes. It also outlines the various social and economic determinants that influence health outcomes and the role of local authorities in addressing factors like smoking, diet, income, and housing. The document advocates for a lifecourse approach to public health and emphasizes partnership across agencies to improve population health.

1. www.hertsdirect.org
Jim McManus
Director of Public Health
Public Health
Mapping out a new offer
for Hertfordshire

2. www.hertsdirect.org
Launching this year...
• A dedicated web portal for elected members of
all authorities covering public health issues you
need to know about
• An e-learning portal for district and county
councils and voluntary groups on public health
• A public web portal on public health

3. www.hertsdirect.org
In the meantime...
Why public health matters to you

4. www.hertsdirect.org
Major Disease Shifts
• 1st – Poverty, Living Conditions
– Improvement in incomes, reduction in deaths
• 2nd –Communicable Diseases
– Now on average 6-11% of deaths in UK. Was 85% of deaths
before 1900
• 3rd – Non-Communicable Diseases
– Over 60% of deaths due to lifestyle and behaviour
– Poorest fare worst (smoking, diabetes, heart disease)

5. www.hertsdirect.org
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.

6. www.hertsdirect.org
Three key points
• Unique role of local authorities able to work on
70% of determinants of health
• The importance of a lifecourse approach
• The new strategic role of local government

7. www.hertsdirect.org
Ottawa Charter, 1986
• Underpins strategic role of local government
• "The goal of a healthy public policy is health promotion, i.e., to
enable people to increase control over and improve their health.
• It is also essential to
– create supportive environments,
– strengthen community action,
– develop personal skills and
– reorient health services.
All of these are areas for elected member leadership

8. www.hertsdirect.org
Lifecourse approach
• Conception to death
• Protective and vulnerability factors (e.g. obesogenic
or energy balanced environment)
• Healthy outcome in one age is cumulative impact of
earlier ages
• Poor outcome in one age may be risk factor for
another (low birth weight and CVD)
• Early investment, early prevention (lifetime mental ill
health and under 13s)
• Data, Evidence, Implementation key

9. www.hertsdirect.org
The Public Health Family 2013
Environmental Health
& Regulatory Services NHS
Police, Fire,
Community Safety Third Sector and
Community Bodies
Public Health
England
Specialist Public Health Agencies with Major Public Health Roles
HCC Public Health
County Council
District Councils

10. www.hertsdirect.org
The Domains of Public Health
Health
Improvement
Health
Protection
Service Quality
Then &
Now
Sanitation
Housing
Now
Environment
Then & Now
Smoking
Heart Disease
Now
Care which keeps
People healthy and
independent

11. www.hertsdirect.org
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

12. www.hertsdirect.org
You cannot change health overnight
Some things happen faster than
others.....

13. www.hertsdirect.org
Timeframes of impact/yield
Years
0 1 5 10 15
Planning
Education
Vitamin
Supplements
Air Pollution
Decent
Homes
Jobs
Primary
Care
20
CVD
Events
Self Care
Vitamin D and TB
Rickets
CVD Events
Acute Bronchitis Admissions
Respiratory
Mental Health overcrowding educational
attainment
Life Expectancy
Healthier space use Changing culture of activity
Life ExpectancyMental Health

14. www.hertsdirect.org
The public health mindset in local government
means working across different dimensions of
time and responsibility
•Think through what we can do short term
•Start work on the medium term
•Set the policy framework for the long term
•Build this understanding among partners
•Get started and realise
•County, District, Parish, NHS, Business and
Community Sector working together

15. www.hertsdirect.org
The Tasks Now
1. Understand the context set by our population
and the differences between it and England
2. Understand the big ticket issues we need to
work on
3. Use specialist public health to impact on the
£4bn +, not commission the £55m –
4. Stronger role for behavioural sciences

16. www.hertsdirect.org
What public health can do for Hertfordshire
Crosscutting
Support JSNA, Health and Wellbeing Strategy, Public Health Board, Public
Health Networks of Practice, the PH Workforce and Skills agenda
The domains of what public health will do
Chunk 1
Services
mandated
by the
Secretary
of State
Chunk 2
Healthcare
public
health
support
to CCGs
Chunk 3
Health
Protectio
n and
resilience
role (still
being
defined)
Chunk 4
Applying
public
health
skills to
local
authoritie
s and the
public
sector
Chunk 5
Joining
things up
between
and
across
agencies
(e.g.
Obesity)
Chunk 6
Delivering
health
and
wellbeing
Board
priorities

17. www.hertsdirect.org
Service Start Well Develop Well Age Well
Health and
Community
Services
Parents in families
with complex
problems accessing
appropriate services
Transition sorted out
between services
Older Peoples’ offer
from prevention to
very high need
Housing Decent Homes
standard
Decent Homes
Standard
Access, Trips,
Falls, Extreme
Weather,
Adaptability
Local
Economic
Partnership
Back to work
packages
Digital inclusion
Back to work
packages for parents
Digital Inclusion
Volunteering and
work packages
Digital Inclusion
NHS CCGs Infant Mortality
Conception
Child health pathway Frail Elderly
Examples

18. www.hertsdirect.org
Phased Approach to transition
• 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.

19. www.hertsdirect.org
Mechanisms
• Health and Wellbeing Board
• County Council Cabinet Panel
• LSPs
• Hertfordshire Forward
• JSNA
• Health and Wellbeing Strategy
• And....

20. www.hertsdirect.org
New Hertfordshire Mechanisms
• The Public Health Board – every district council with
the County, NHS, Police and Crime Commissioner. Sub-
Board of Health and Wellbeing Board and Joint Herts
CEOs Forum
• The Public Health Partnerships Fund...funding from
the Director of Public Health for district councils to work
with local communities on health issues
• The Herts Public Health Skills Framework – a
developing plan to spread capacity and capability for
public health across all agencies in the County

21. www.hertsdirect.org
Thank you!
Jim.mcmanus@hertfordshire.gov.uk