Public Health Challenges and Opportunities in the West Midlands

1. Public Health Challenges and Opportunities in the West Midlands Local Government’s New Public Health Role – 12th July 2012 Karen Saunders, Senior Public Health Manager, Department of Health, West Midlands

2. Overview • What we mean by ‘Public Health’ • Challenges and health inequalities in the West Midlands • Opportunities for action • National context • ‘Old and New’ Public Health • The Role of Councillors

3. Definition of Public Health • ‘Public Health is the science and art of promoting and protecting healthand well-being, preventing ill-health and prolonging life through the organised efforts of society.’ (Source: Faculty of Public Health, adapted from Acheson Report 1988)

4. Challenges

6. (Source: ONS (2011) Life expectancy at birth by local area in the UK, 2004-06 to 2008-10)

7. (Source: ONS (2011) Life expectancy at birth by local area in the UK, 2004-06 to 2008-10)

8. Standardised Mortality Ratio for all causes in people aged under 75 2005-9 by MSOA - Coventry Source: APHO

9. Charles Baby Born to affluent parents – will live 10 years longer than Mark Aged 10 Enjoying a good life, lots of opportunity to play sport Aged 20 At university with 10 x A* at GCSE. Plays rugby and eats a healthy diet Aged 45 Fit and healthy businessman, manages stress by playing squash Aged 60 Retired early to spend time with his grand-children and travel Mark Baby One of teenage conceptions. Will live 10 years less than Charles Aged 10 Growing up in poverty Aged 20 Left school with no qualifications, casual labourer, drinks, smokes and takes drugs Aged 45 Weighs 18 stone, has high cholesterol, type 2 diabetes Aged 60 Died from massive stroke Inequalities begin from birth Source: NHS North West SHA

10. Child Poverty There are health inequalities within the West Midlands which are closely associated with deprivation and child poverty: • Deprivation: 27.4% of WM people live in 20% most deprived areas in England (England average 19.9%) • Child Poverty: 24.8% of WM children live in families receiving means-tested benefits (England average 22.4%) (Source: Health Profile 2010)

11. (Source: Health Profile 2010)

12. Costs • Large and escalating burden of disease not just from the public health perspective but also from an economic one • Cardiovascular disease, diabetes, cancer and respiratory diseases • Social burdens include • prolonged disability • diminished resources within families • reduced productivity • tremendous demands on health systems Source: UN High-Level Meeting on NCDs 23 September 2011

13. Smoking • Smoking accounts for over 50% of health inequalities across different groups • Direct Cost to NHS £5.2bn pa • Approx 5% of total NHS expenditure • Healthcare costs for smokers up to 40% higher than for non-smokers • Smoking in the West Midlands has decreased from 40% to 22% over 30 years, however challenges remain • Routine and manual workers • Pregnant women • Second hand smoke

14. Alcohol • Alcohol related hospital admissions increased in the West Midlands - more than doubled in period 2002/3 to 2009/10 • 46,616 to 113,205 • Direct cost to NHS of alcohol harm reduction estimated at £1.7bn per year • Costs to society, approx £20 bn per year

15. Equity from the Start

17. Infant Mortality – Key Actions • Reduce smoking in pregnancy • Reduce child poverty • Increase breast feeding initiation • Improve housing and reduce overcrowding • Reduce obesity • Reduce teenage pregnancy • Reduce unexpected deaths in infancy Equity from the Start

18. Opportunities

19. Healthy Lives, Healthy People: our strategy for public health in England • Aims to: • empower local leadership to strengthen health and wellbeing • support self esteem, increased confidence and personal responsibility • promote healthier behaviour and lifestyles • change the environment to support healthier choices • protect the public from threats to health. Following extensive consultation, further details published in July 2011’s Update and Way Forward December 2011: continuing to finalise key elements of the design of the new public health system

20. Local Government’s “New” Functions New duty to improve the health of the population: • some of most important levers for improving health and wellbeing - planning, transport, leisure, education - are instruments of local government • health and wellbeing boards will integrate commissioning approaches (JSNA; JHWS) • working with Clinical Commissioning Groups • collaborating with the voluntary sector • providing population healthcare advice to the NHS • working with national bodies – PH England; NHS Commissioning Board Local political leadership critical to making this work and ensuring a ‘safe landing’ of public health functions.

21. “New” Duty to Ensure Plans in Place to Protect the Health of the Population • Nothing new for local authorities - have had health protection responsibilities since the 19th century and currently have major powers and responsibilities under existing legislation including Environmental Protection and Public Health Control of Diseases Acts • Councils will have a new responsibility for ensuring adequate and appropriate health protection plans • Most health protection incidents are contained locally • The DPH will routinely assess intelligence on all incidents, and will lead the local response working with PHE and the NHS • This will include outbreak management, infection prevention and control, and non-infectious environmental hazards • System management still emerging......................

22. Local authority commissioning responsibilities: leadership role in tackling the causes of ill health; reducing health inequalities; promoting and protecting health; promoting social justice and safer communities * = mandated • Tobacco control & smoking cessation • Alcohol and drug misuse • Services for children 5-19 • National Child Measurement Programme* • Obesity and weight management • Local nutrition services • Increasing physical activity • NHS Health Checks* • Public mental health services • Dental public health services • Injury prevention • Birth defect prevention • Behavioural and lifestyle campaigns to prevent LTCs • Local initiatives on workplace health • Support and challenge of NHS services (immunisation and screening) • Public health advice to NHS* • Sexual health services* • Seasonal mortality initiatives • Local role in health protection incidents* • Community safety • Social exclusion * Indicates mandated services

24. FAIR SOCIETY,HEALTHY LIVES CONCEPTUAL FRAMEWORK. REDUCE HEALTH INEQUALITIES AND IMPROVE HEALTH AND WELLBEING FOR ALL. Create an enabling society that maximises individual and community potential. Ensure social justice, health and sustainability are at heart of policies. Policy objectives A. Give every child the best start in life. C. Create fair employment and good work for all. E. Create and develop healthy and sustainable places and communities. B. Enable all children, young people and adults to maximise their capabilities and have control over their lives. D. Ensure healthy standard of living for all. F. Strengthen the role and impact of ill health prevention. Policy mechanisms EQUALITY AND HEALTH EQUITY IN ALL POLICIES. EFFECTIVE EVIDENCE BASED DELIVERY SYSTEMS

25. Principles • Social justice • Material, psychosocial, political empowerment • Creating the conditions for people to have control of their lives • Connects people, places and prospects

26. New approach to Public Health Protect and improve the public’s health, improving the health of the poorest fastest Reach Out and Reach Across Address root causes and reach those who most need support Representative Owned by communities and shaped by their needs Resourced Ring-fenced funding and incentives to improve Rigorous Professionally and politically led, evidenced, efficient and effective Resilient Sustainability and protecting health Source: Healthy Lives, Healthy People, Update and Way Forward, 2011

27. Moving from the old to the new Deficit Process Disease Knowledge Medical Professional led Do to Asset Outcomes Wellbeing Action Social People led Do with

28. Councillors as champions for their communities

29. Local Government Focus on needs of local population Capacity to orchestrate action to address the social determinants of health Whole system leadership • Increasing participation and empowering communities in coproducing local issues and solutions • Local democratic accountability

30. Opportunities for Councillors • Leadership and Advocacy for Improving health and Reducing Health Inequalities • Maximise opportunities for delivery of the new public health function and prevention services • Enable wider understanding of how all Local Authority portfolios can deliver improved health (housing, education, economy, regeneration, planning, social care, children’s services ..) • Champion for improved public health through existing local government powers (e.g. using licensing in controlling cheap alcohol; fast food outlets) • Leadership on population behaviour change programmes (e.g. Change 4 Life; improved physical activity, increased walking and cycling for health, etc.) • Communicating with and in touch with local people (the power of social media) • Challenge poor outcomes through the Health and Wellbeing Board/Healthwatch/Scrutiny • Use of local health data and evidence base of what works with support from the Director of Public Health and service users through local Healthwatch • Develop new/strengthen existing local/national partnerships and alliances • Clinical Commissioning Groups • PH England • VCS

31. More Information? • Karen.saunders@dh.gsi.gov.uk • The new public health system factsheets are available at http://healthandcare.dh.gov.uk/publichealth • Sign-up to the national Transforming Public Health bulletin http://phbulletin.dh.gov.uk/ • Contact the DH Public Health England transition team PublicHealthEngagement@dh.gsi.gov.uk • West Midlands PH Transition website http://www.wmpho.org.uk/lfph/phtransition.aspx • West Midlands Councils www.wmcouncils.gov.uk/