A presentation I gave in 2014 to a senior delegation of officials from Iraq on our approach in England to addressing the challenge of non-communicable disease

1. Addressing the challenge
of non-communicable
disease
Dr Justin Varney MBBS FFPH
NationalLeadforAdultHealthandWellbeing
Iraq Health Delegation
November, 2014

2. Content
1. The Challenge: NCDs and Health Inequalities
2. The Health and Wellbeing Directorate
3. Responding at Scale: Everybody Active, Every
Day
2

3. The Challenge
Non-communicable diseases and health
inequalities in England

4. Context of non-communicable disease
• Cancer, circulatory disease, respiratory disease and liver disease account
for almost 80% of deaths among under 75yrs olds in England, 67% of
deaths are preventable or amenable to prevention.
• Significant inequalities across the country: socio-economic, demographic.
• Although life expectancy is improving, disability free life expectancy lags
behind.
• International comparison shows potential for improvement, especially
around areas such as diet, physical activity and mental health resilience.
4 Presentation title - edit in Header and Footer

5. Significant challenges to public health
• In 2008-10, the gap between areas with the highest and lowest life
expectancy was around 12 years
• England has one of the highest rates of obesity in the developed
world.
• Two thirds of adults are overweight or obese, a leading cause of
type 2 diabetes and heart disease
• Smoking claims c80,000 lives a year.
• 1.6 million people are dependent on alcohol.
• Over half a million new STIs were diagnosed in 2010
• Major health threats persist, ranging from risk of new pandemics to
the potential impact of terrorist incidents.
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6. 6
The Challenge: Burdenofdiseaseattributable to20leadingrisk
factors, expressedaspercentageofUKDALYS

7. Wicked Problems:
The leading risk factors
Tobacco
smoke
1
High blood
pressure
2
High BMI
3
Physical
inactivity
4
Alcohol
5
Lack of
fruit
6
High
cholesterol
7
Lack of nuts
and seeds
8
Diabetes
9
Salt
10

8. The Challenge: Burden of disease -disability
8 Our Visions and Priorities: A National Perspective

9. Wicked Problems:
The leading diseases
Cardoivascular
and circulatory
diseases
1
Cancer
2
Chronic
respiratory
diseases
3
Diabetes
4
Musculoskeletal
disorders
5
Neurological
disorders
6
Mental and
behavourial
disorders
7
Digestive
diseases
8
Cirrhosis
9
HIV/AIDS and
tuberculosis
10

10. A new approach that brings together
• appreciation of wider health determinants
• promoting wellbeing, prevention and early intervention
A new vision and transformed approach
1
3
2 A new approach that relies on
• evidence-base for what works
• collaboration and cross-sector leadership
• adapting to local needs
A renewed focus on driving healthy behaviour
• promoting healthy behaviour (campaigns)
• informing personal choice
• providing local data for improving health
10 – Source: A Framework for Sexual Health Improvement in England

11. The Health &
Wellbeing
Directorate

12. • Better physical health
• Less health-damaging
behaviour
• Greater educational
achievement
• Improved productivity
• Higher income
• Reduced absenteeism
• Less crime
• More participation in
community life
• Improved overall
functioning
• Reduced mortality
“A dynamic state, in which the individual is able to develop
their potential, work productively and creatively, build strong
and positive relationships with others, and contribute to
their community. It is enhanced when an individual is able to
fulfil their personal and social goals and achieve a sense of
purpose in society” (Foresight, 2008)
What is wellbeing?
Improved wellbeing can lead to:

13. Health and Wellbeing in Public Health
England
• Health and Wellbeing Directorate takes the lead in
promoting healthier lifestyles, delivering chronic disease
prevention programmes, national health marketing and
health equity programmes.
• Good health outcomes rely on more than hospitals and
medicine. PHE will lead on healthier lifestyles by
promoting better nutrition, more exercise and lower rates
of alcohol, tobacco and drug use and risky sexual
behaviour.
13 Our Visions and Priorities: A National Perspective

14. Drugs,
Alcohol &
Tobacco
Healthcare
Public
Health
Healthy
People
Healthy
Places
Health
marketing
and public
engagement
Science and
strategic
information
Health impact priorities
Wellbeing and mental health
Alcohol and drugs
Tobacco control and smoking cessation
Obesity, nutrition, exercise
HIV, sexual and reproductive health
Divisions

15. Health in All Policies
Accelerating Health Impact
Reduce the level and impact of Smoking2
Issue
World-leading prevention and early diagnosis programme
Actions
1. Continue to invest in stop-smoking campaign
2. Support local stop-smoking services
3. Provide evidence that informs policy
4. Support people with mental issues, pregnant mothers, etc, who want to quit
Outcomes
• Keep smoking prevalence low, in line with national tobacco plan
• Reduce smoking prevalence disparities between richest and poorest areas
• Reduce exposure to second-hand smoke in homes and cars
Potential impact
• Current decline in smoking is reducing rate of deaths by 800-1600 per year

16. Responding at
scale:
EverybodyActive, Every Day – an
evidence based approach to physical
activity

17. Whole system approach
• Health does not exist in isolation
• Need whole system approaches at local and national levels which
connect policy, encourage collaboration and deliver coherent and
connected pathways of care
• Without a whole system approach the scale of the challenge
continues to rise and the solutions are temporary and short term.
• Whole system approaches require leadership, communication,
clear accountability and coordination.
17

18. Inactivity is killing us
Inactivity is the fourth greatest cause of
disease and disability in the UK
o1 in 6 UK deaths
oUp to 40% of many long-term conditions
Decreasing activity levels since 1960s:
oOver 20% less physically active
oEstimated 35%↓ by 2030?
• Estimated £7.4 billion annual cost
18
Sources: Ng SW, Popkin B (2012); Lee I-M, et al. (2012); Wen CP, Wu X (2012); WHO (2010); Ossa D & Hutton J
(2002); Murray et al. (2013)

19. Everybody needs to be more
active every day
19
Source: Health Survey for England 2012 (HSE); Active People Survey 8, April 2103-April 2014 (APS); National Travel
Survey July 2014 (NTS)

20. The lazy man of the western world?
20
Source: Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U, for the Lancet Physical Activity Series Working
Group (2012) Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet; published online July 18.
International comparison of physical inactivity (at ages 15 and over)
Note: Comparator = Not meeting any of the following per week: (a) 5 x 30 mins moderate-intensity activity; (b) 3 x
20 mins vigorous-intensity activity; (c) equivalent combination achieving 600 metabolic equivalent-min.

21. Responding to the
challenge
Embedding evidence-based characteristics
for effective national action:
oPersistence over time
oCollaboration across sectors and levels
Learning from other countries, e.g. Finland:
oSince 1980, nationwide campaign for change
oFocus on grassroots interventions & key groups
oIncreases in leisure time seen across all age
groups
21
Sources: Bull F et al. (2014) Turning the Tide: national policy approaches to increasing physical activity in seven
European countries. British Journal of Sports Medicine. Vuori I et al. (2004) Physical activity policy and program
development: The experience in Finland. Public Health Reports 119: 331-345.

22. EAED co-production process
Engagement activities (>1,000 people)
o Cross-sector launch workshops
o PhysicalActivity@phe.gov.uk mailbox submissions
o Nine expert roundtables
o Five regional fora
o Cross-Government Moving More Living More policy
o All Party Commission on Physical Activity
o Sector-specific presentations / workshops
o Bilateral meetings
Commissioned work
o Nine expert rapid topic overviews
o Collation & review of promising practice in communities
o Review of Return on Investment data
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23. Domains for actions
23

24. Measuring impact
Key = Public Health Outcomes Framework outcomes
o % adults inactive (primary outcome)
o % adults physically active (secondary)
Surveys provide detail at national and local level:
o Health Survey for England
o Active People Survey
o National Travel Survey
o Labour Force Survey
Improving evaluation of local interventions
Exploring potential for self-measurement
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25. Evidence for implementation
Synthesis of existing evidence base (e.g. NICE)
Settings:
oPhysical environment
oSocial environment
oCommunity-wide interventions
oGroup interventions
oOne-to-one interventions
Life-course:
oStarting well
oLiving well
oAgeing well
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26. Options forAction
Evidence-based across four domains for national, local and
organisational action across public health system
Includes five key steps for local areas
1. Teach every child to have and enjoy the skills to be active every day
2. Create safe and attractive environments where everyone can walk or
cycle, regardless of age or disability
3. Make every contact count for professionals and volunteers to
encourage active lives
4. Lead by example in every public sector workspace
5. Evaluate and share the findings so the learning of what works can
grow
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27. PHE actions to support
implementation
Toolkit for MPs and elected members
Free BMJ e-Learning modules
Identifying ‘what works’ for local physical inactivity
interventions
Topic overviews on physical activity in specific groups
Definitive review of return on investment data
Next round of regional Moving More Living More
events
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28. Thank you
DrJustinVarney
NationalLeadforAdultHealthandWellbeing
Email: Justin.Varney@phe.gov.uk