Leading Health and Wellbeing: From transition to transformation Professor Kevin A. Fenton National Director, Health and

1. Leading Health and Wellbeing: From transition to transformationProfessor Kevin A. FentonNational Director, Health and Wellbeing 26 June, 2013

2. The new public health system: a recap • Healthy Lives, Healthy People white paper • Published November 2010 to set out a new approach to public health • Responsibility for local health improvement returned to local authorities from 1 April 2013 • Public Health England is the expert national public health agency which fulfils the Secretary of State for Health’s statutory duty to protect health and address inequalities, and executes his power to promote the health and wellbeing of the nation. • Health and Social Care Act 2012 • Set the legislative framework for the changes to the health and care system that led to the creation of Public Health England as an operationally autonomous executive agency of the Department of Health • Received Royal Assent 27 March 2012 2 Leading Health and Wellbeing: From transition to transformation

3. Public health outcomes framework To improve and protect the nation’s health and wellbeing and improve the health of the poorest, fastest Outcome 2) Reduced differences in life expectancy between communities (through greater improvements in more disadvantaged communities) Outcome 1) Increased healthy life expectancy – taking into account health quality as well as length of life 1 Improving the wider determinants of health 2 Health improvement 3 Health protection 4 Healthcare and public health preventing premature mortality • 19 indicators, including: • Children in poverty • People with mental illness or disability in settled accommodation • Sickness absence rate • Statutory homelessness • Fuel poverty • 7 indicators, including: • Air pollution • Population vaccination coverage • People presenting with HIV at a late stage of infection • Treatment completion for tuberculosis • 16 indicators, including: • Infant mortality • Mortality from causes considered preventable • Mortality from cancer • Suicide • Preventable sight loss • Excess winter deaths • 24 indicators, including: • Excess weight • Smoking prevalence • Alcohol-related admissions to hospital • Cancer screening coverage • Recorded diabetes • Self-reported wellbeing 3 Leading Health and Wellbeing: From transition to transformation

4. What is Public Health England? “Public Health England (PHE) is the expert national public health agency which fulfils the Secretary of State for Health’s statutory duty to protect health and address inequalities, and executes his power to promote the health and wellbeing of the nation.” Leading Health and Wellbeing: From transition to transformation

5. Outcome-focused priorities Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives 5 Leading Health and Wellbeing: From transition to transformation

6. Supporting priorities Promoting the development of place-based public health systems Developing our own capacity and capability to provide professional, scientific and delivery expertise to our partners 6 Leading Health and Wellbeing: From transition to transformation

7. Structure – Public Health England Advisory Board Chief Executive Development Advisor Director of Health Protection and Medical Director Director of Health and Wellbeing Chief Knowledge Officer Director of Nursing Director of Communications Director of Strategy Chief of Staff Chief Operating Officer Private Office Secretariat Director of Programmes Regional Directors Microbiology Internal Audit Corporate Governance Centre Directors Finance and Commercial Director Legal Service Director of Human Resources 7 Leading Health and Wellbeing: From transition to transformation

8. Local presence • Four regions, 15 centres • Eight Knowledge and • Intelligence Teams • London • South West • South East • West Midlands • East Midlands • North West • Northern and Yorkshire • East • Other local presence • ten microbiology laboratories • field epidemiology teams • Additional support • Local teams can also draw on national scientific expertise based at Colindale, Porton Down and Chilton 8 Leading Health and Wellbeing: From transition to transformation

9. Place-based approach to public health Non-statutory providers* NHS providers People and communities Health and wellbeing boards NHSE area team PHE centre Local government CCGs • EPPR • Screening and immunisation • Offender public health programmes • Specialised commissioning • Primary care public health programmes and population healthcare Public health advice *Including voluntary and community sector 9 Leading Health and Wellbeing: From transition to transformation

10. Leverage from the public health ring fence DsPH have influence across all local government spend Influence on wider spending in commercial and voluntary sectors Clinical Commissioning Groups And NHS England PHE provides expert advice to local government PHE provides expertise in local area teams Embedding ‘making every contact count’ 10 Leading Health and Wellbeing: From transition to transformation

11. Transforming health and wellbeing We will focus on the major drivers of disease, disability, disadvantage and death and tackle health inequalities. Leading Health and Wellbeing: From transition to transformation

12. Focusing our effort Overall, the three risk factors that account for the most disease burden in the United Kingdom are dietary risks, tobacco smoking, and high blood pressure. The leading risk factor for both children under 5 and adults aged 15-49 years was tobacco smoking in 2010. Tobacco smoking as a risk factor for children is due to second-hand smoke exposure. http://www.healthmetricsandevaluation.org; The Lancet, Early Online Publication, 5 March 2013doi:10.1016/S0140-6736(13)60355-4

13. Mental disorder accounts for largest burden (23%) of diseases in England and affects >1 in 4 of the population at any time Mental wellbeing assoc with improved outcomes in health, education, employment, reduced crime and antisocial behaviour Public mental health: Better assessment; interventions; prioritization Well being and Mental Health Health Impact PrioritiesThe health and wellbeing contribution to our corporate priorities Diet, Obesity, and Physical Exercise All major causes of CVD and cancer. Poor diet accounts for one third of deaths from cancer and CVD. Low levels of physical activity increases the risk CVD, colorectal and breast cancer by 20-35%. Obesity increases risk of type II diabetes (5-13 times), hypertension (2-3 times) and colorectal cancer (3 times) in men. Health and Wellbeing Directorate Health Impact Priorities Tobacco Control and Smoking Cessation Accounts for 20% of new cases of cancer (23%M and16%F) Tobacco causes nearly 1 in 5 deaths in England annually For each death, 20 more suffer tobacco-related illnesses Comprehensive cessation programs; excise tax increases; 100% smoke-free policies; media campaigns; cessation access; advertising restrictions work. Alcohol Moderation and Drug Recovery Much of the cost of drug and alcohol misuse occurs to the criminal justice system. The main costs to society from drug an alcohol is from related crime. This is different to other lifestyle health related areas and needs a different public health response. While supporting and ensuring progress against the PHOF, the Directorate will provide enhanced focus on the major drivers of mortality and morbidity in England where further gains may be made by scaling known, effective strategies By the end of 2012 likely more than 100,000 PLWHA in the UK Late diagnosis a major problem with 50% diagnosed with CD4<350 Millions of STD diagnosed annually, esp. among youth, MSM, minorities HIV/STD screening, early treatment, partner notification, social marketing campaigns, condom access, and policy to address stigma and discrimination are key interventions HIV and Sexual health

14. Healthy Infants, Children, and Young Adults A focus on improving health and health outcomes for mothers and infants, children, teens and young adults. Life course perspective All people, and especially those at greater risk of health disparities, will achieve their optimal lifespan with the best possible quality of health, including mental health, in every stage of life. Healthy Adults and Older Adults Support sound decision-making and policy change within the NHS to deliver, scale up, evaluate and improve effective clinical preventive services that drive population health. Healthcare Public Health Expert advisors will assist PHE technical leads to develop, implement and monitor population health, and health and wellness across the lifespan in five domains. They will also assist PHE in promoting the value and impact of this approach to our partners and stakeholders. Ensuring that the places where people live, work, learn, and play will protect and promote their health, especially those people at greater risk of health disparities. Healthy People in Healthy Places Inform and support DH and other government partners in sound decision-making and policy change at all levels to deliver and evaluate programmes and address social determinants of health. Health in All Policies Leading Health and Wellbeing: From transition to transformation

15. The challenges we will tackle togetherAn example: The national Child Measurement Programme One in five children in Reception is overweight or obese (boys 23.5%, girls 21.6%) One in three children in Year 6 is overweight or obese (boys 35.4%, girls 32.4%) Child overweight (including obesity)/ excess weight: BMI ≥ 85th centile of the UK90 growth reference Leading Health and Wellbeing: From transition to transformation

16. The challenges we will tackle togetherAn example: The national Child Measurement Programme Child obesity: BMI ≥ 95th centile of the UK90 growth reference Leading Health and Wellbeing: From transition to transformation

17. The challenges we will tackle togetherInforming personal choiceInforming individual choice Leading Health and Wellbeing: From transition to transformation

18. QuestionsProfessor Kevin A. FentonNational Director, Health and Wellbeing kevin.fenton@phe.gov.uk www.gov.uk/phe Follow Public Health England on Twitter at  @PHE_uk