Health Improvement

1. Health Improvement Everybody’s Business Grace Moore Associate Director of Health Promotion and Equalities

2. Outline • Definitions • The Public Health Workforce • Planning for Health Improvement • Programmes and Priorities • Making sense of a cluttered landscape • Performance Monitoring/Management • Summary

3. Definitions • Public Health; "The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society”. • Health Improvement is an outcome, the achievement of which includes the areas of work traditionally described as health promotion, public health and health care[1].

4. Definitions • Health Promotion is the process of enabling people to increase control over, and to improve their health[2]. • [1] Public Health Institute of Scotland. The health promotion contribution to health improvement. 2002 • [2] World Health Organisation. Ottawa Charter. 1986

5. The Public Health Workforce • Health improvement is pursued by a range of staff through: • wide-ranging health promotion efforts, aimed at promoting good health and preventing ill-health in the whole population and also in specific target groups • and through maximising the population health benefits of treatment of ill-health.

6. The Public Health Workforce • Specialist – Senior Staff working at consultant level – generally members/fellows of Faculty of Public Health • (Specialised) Practitioner e.g. Health Promotion Officer and Public Health Practitioners – work to a set of competencies as defined by the FPH

7. The Public Health Workforce • Wider Workforce – adopt public health approaches for some of the work they do but will be working to a set of competencies defined by their professional body e.g. doctors, nurses, teachers, community workers, pharmacists, physiotherapists……in fact many people in public bodies

8. Main areas of public health practice

9. Vision for Health complete physical mental social Well-being

10. Health and Well-being • “Health is more than the absence of disease….to be healthy requires individuals to engage in their health as much as it requires healthy and sustainable environments and well trained professionals”

11. Complex Environment Health and social services employment economic social culture poverty physical housing pollution

12. From Population to the Individual

13. Tobacco – A Worked Example

14. new HEAT target Long term Outcomes Improved mental wellbeing Reduced inequalities in HLE Reduced inequalities in CHD mortality Reduced tobacoo-related morbidity and mortality Tobacco National indicators Intermediate Outcomes Reduced adult smoking rate Sustained quit rate (1 year follow-up) Short-term Outcomes Quit rate at 1 month follow-up Reach (target population) Smokers who want to quit (key sub-groups) Outputs Smoking cessation services Processes What the NHS has to do to deliver effective SC services in key settings Inputs Budget, trained workforce and data needed to run and monitor smoking cessation services

15. Example High level outcomes Intermediate outcomes Short-term outcomes Reach Outputs Activities Inputs Cross-sector Contributions Increased healthy life expectancy; Reduced inequalities in healthy life expectancy, Reduced inequalities in morbidity and mortality due to smoking related diseases e.g. CHD, Cancer Physical Environments – Reduced exposure to second hand smoke Social Environments – Reduced attractiveness of tobacco products Economic Environments Individual Behaviours Reduce adult smoking rates Reduce uptake of smoking in children and young people Increased quit rate Understanding risks, attitudes to smoking Improved compliance with laws Compliance with laws Increased price, reduced incentives Smokers Young people Under 18s General Public General Public Smoking Cessation Services Anti-smoking messages Tobacco Retail Sales Smoke free public places Taxation, displays promotions, advertising Intensive support, brief advice, NRT Media, school ethos, practices Enforcement of laws on under-age sales Enforcement of smoking ban Industry Regulation Schools, community Local authorities NHS Local authorities SG,UK govt, EU

16. Priority Topics • Mental Health and Well-being • Obesity • Tobacco • Alcohol

17. Priority Target Groups • Children and young people • Pregnant women • People living in deprivation • Groups who face particular inequalities e.g. homeless, people who have sensory impairment, people from ethnic minorities

18. Summary • Health promotion implemented by a range of staff across a range of sectors • The specialist function works mainly (but not exclusively) at a strategic and population level • It provides support to others in their health promotion efforts • It delivers complex interventions across a range of settings, for a range of target groups on a range of priority topics using a range of methods

19. Finally…. • “Our staff are the agents of change. We cannot hope to bring about the improvements envisaged unless the people who deliver these improvements are protected in their place of work, recognised and rewarded for their contribution to our success and given the opportunities to develop the skills and experience they require to improve health and reduce health inequalities.” • (Better Health Better Care: Action Plan)

20. Sensory Impairment - Partners NHS External Communications Disability Awareness IT Learning Disabilities Optometrists/Ophthalmology Audiologists Psychological Services Procurement Public Health PFPI Medical Records Primary Care Children’s Services Occupational Therapy Nursing Estates Leisure Services (LA and Independent) Social Services LA Procurement RNIB RNID Visibility Deafblind Scotland SISG Ayrshire Volunteers Patients/People with Sensory Impairment Carers Healthy Living Centres

21. Sensory Impairment Project VI Pilot Arran Pilot Training Group National Procurement Contracts Active Living & HI Programme CSS Policy Interpreter Services Contract Deafblind Communicator Pilot Pfizer Funding Audit & Standards Commissioning Centre Sub Group Literature Review Commissioning an Area Wide Service Sub Group Development Group for Equalities and Sensory Impairment Network Management Function Needs Assessment Training Sub Group Eyecare Review Bridge to Vision Adult’s Sub Group Awareness Raising Pilot Children’s Sub Group LD Needs Assessment North Ayrshire Working Group South Ayrshire Working Group East Ayrshire Working Group Key: Yellow Circle = Main Project Group Bracket = Future Work Green Circle = Sub Group Pentagon = Link Function Pink Rectangle = Sub Project Groups Full Lines = Accountability routes Jade Rectangle = Working Groups Broken lines = Communication links