www.hertsdirect.orgJim McManusDirector of Public HealthPublic HealthMapping out a new offerfor Hertfordshire
www.hertsdirect.orgLaunching this year...• A dedicated web portal for elected members ofall authorities covering public health issues youneed to know about• An e-learning portal for district and countycouncils and voluntary groups on public health• A public web portal on public health
www.hertsdirect.orgIn the meantime...Why public health matters to you
www.hertsdirect.orgMajor 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 deathsbefore 1900• 3rd – Non-Communicable Diseases– Over 60% of deaths due to lifestyle and behaviour– Poorest fare worst (smoking, diabetes, heart disease)
www.hertsdirect.orgContributors to overall health outcomes and why electedcouncillors are important leadersSmoking 10%Diet/Exercise 10%Alcohol use 5%Poor sexual health5%HealthBehaviours 30%Education 10%Employment10%Income 10%Family/SocialSupport 5%CommunitySafety 5%SocioeconomicFactors 40%Access to care10%Quality of care10%Clinical Care20%EnvironmentalQuality 5%BuiltEnvironment 5%Built Environment10%Source: Robert Wood Johnson Foundation and Universityof Wisconsin Population Health Institute. Used in US torank counties by health statusWhile this is from a US context it does have significantresonance with UK Evidence, though I would want toincrease the contribution of housing to health outcomesfrom a UK perspective.
www.hertsdirect.orgThree key points• Unique role of local authorities able to work on70% of determinants of health• The importance of a lifecourse approach• The new strategic role of local government
www.hertsdirect.orgOttawa Charter, 1986• Underpins strategic role of local government• "The goal of a healthy public policy is health promotion, i.e., toenable 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
www.hertsdirect.orgLifecourse approach• Conception to death• Protective and vulnerability factors (e.g. obesogenicor energy balanced environment)• Healthy outcome in one age is cumulative impact ofearlier ages• Poor outcome in one age may be risk factor foranother (low birth weight and CVD)• Early investment, early prevention (lifetime mental illhealth and under 13s)• Data, Evidence, Implementation key
www.hertsdirect.orgThe Public Health Family 2013Environmental Health& Regulatory Services NHSPolice, Fire,Community Safety Third Sector andCommunity BodiesPublic HealthEnglandSpecialist Public Health Agencies with Major Public Health RolesHCC Public HealthCounty CouncilDistrict Councils
www.hertsdirect.orgThe Domains of Public HealthHealthImprovementHealthProtectionService QualityThen &NowSanitationHousingNowEnvironmentThen & NowSmokingHeart DiseaseNowCare which keepsPeople healthy andindependent
www.hertsdirect.orgThe Opportunity for Herts• The conditions for everyone to be healthy• The conditions for the poorest and worst off tobe healthier• Public services which put this at the core of theirbusiness• People thriving and prosperous• Healthy workforce, prosperous County
www.hertsdirect.orgYou cannot change health overnightSome things happen faster thanothers.....
www.hertsdirect.orgTimeframes of impact/yieldYears0 1 5 10 15PlanningEducationVitaminSupplementsAir PollutionDecentHomesJobsPrimaryCare20CVDEventsSelf CareVitamin D and TBRicketsCVD EventsAcute Bronchitis AdmissionsRespiratoryMental Health overcrowding educationalattainmentLife ExpectancyHealthier space use Changing culture of activityLife ExpectancyMental Health
www.hertsdirect.orgThe public health mindset in local governmentmeans working across different dimensions oftime 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 andCommunity Sector working together
www.hertsdirect.orgThe Tasks Now1. Understand the context set by our populationand the differences between it and England2. Understand the big ticket issues we need towork on3. Use specialist public health to impact on the£4bn +, not commission the £55m –4. Stronger role for behavioural sciences
www.hertsdirect.orgWhat public health can do for HertfordshireCrosscuttingSupport JSNA, Health and Wellbeing Strategy, Public Health Board, PublicHealth Networks of Practice, the PH Workforce and Skills agendaThe domains of what public health will doChunk 1Servicesmandatedby theSecretaryof StateChunk 2Healthcarepublichealthsupportto CCGsChunk 3HealthProtection andresiliencerole (stillbeingdefined)Chunk 4Applyingpublichealthskills tolocalauthorities and thepublicsectorChunk 5Joiningthings upbetweenandacrossagencies(e.g.Obesity)Chunk 6DeliveringhealthandwellbeingBoardpriorities
www.hertsdirect.orgService Start Well Develop Well Age WellHealth andCommunityServicesParents in familieswith complexproblems accessingappropriate servicesTransition sorted outbetween servicesOlder Peoples’ offerfrom prevention tovery high needHousing Decent HomesstandardDecent HomesStandardAccess, Trips,Falls, ExtremeWeather,AdaptabilityLocalEconomicPartnershipBack to workpackagesDigital inclusionBack to workpackages for parentsDigital InclusionVolunteering andwork packagesDigital InclusionNHS CCGs Infant MortalityConceptionChild health pathway Frail ElderlyExamples
www.hertsdirect.orgPhased 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. Wideengagement of team and staff etc• Phase 2b – to March 2013 – Transformational – the vision andstrategy of what Public Health is offering Hertfordshire• Phase 3 – march 2013 to March 2014 – Embedding thetransformation and new way of working• Phase 4 – 2014 onwards – the hard long term work of makingHertfordshire a public health county.
www.hertsdirect.orgMechanisms• Health and Wellbeing Board• County Council Cabinet Panel• LSPs• Hertfordshire Forward• JSNA• Health and Wellbeing Strategy• And....
www.hertsdirect.orgNew Hertfordshire Mechanisms• The Public Health Board – every district council withthe County, NHS, Police and Crime Commissioner. Sub-Board of Health and Wellbeing Board and Joint HertsCEOs Forum• The Public Health Partnerships Fund...funding fromthe Director of Public Health for district councils to workwith local communities on health issues• The Herts Public Health Skills Framework – adeveloping plan to spread capacity and capability forpublic health across all agencies in the County