Empowering the Public for Better Health and Health Outcomes Dr. Patrick Doorley

1. Empowering the Public for Better Health and Health Outcomes Dr. Patrick Doorley National Director of Population Health, HSE

2. The Vision • A health system that supports and encourages you and your family to achieve your full health potential - Quality and Fairness 2001 Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

3. How the public can be empowered for better health and health outcomes • Self Mangement of Chronic Disease • Health Promotion • Planning for better health outcomes • Health Public Policy Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

4. Community Action • Ottawa Charter, 1986 • Identified the need for strengthening community action – recognised that communities will achieve better health status themselves Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

5. The Health Strategy Recommended in Relation to Travellers • The development in consultation with Traveller groups of health education programmes specifically for Travellers • The development of models of Traveller participation in health promotion and prevention • That health boards make special arrangements to encourage Traveller use of health services Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

6. MHB Objectives for Travellers Health • To assess possible Travellers Health needs • To enable Travellers to have more control over factors which influence their health • To promote healthy lifestyles • To promote the best healthcare and uptake of important preventive services by Travellers • To act as advocates for improvement in • Travellers accommodation • Their general physical environment • Other services which effect Travellers’ Health Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

7. MHB Pilot Primary Health Care Project for Travellers • A joint 4 year pilot project between the MHB and Tullamore Travellers Movement to develop competent Traveller health workers who would be leaders in their own community in promoting health Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

8. Capacity Building • Pre-training phase for Traveller healthcare workers – supported by FÁS • Building on existing skills • Personal development • Health training • Increasing awareness of Travellers Health • Facilitation and Presentation Training • Developing planning skills • Evaluation and review Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

9. Outcome • 7 Traveller health workers funded by HSE Midland • Improved knowledge among travellers of health services available • Health promotion programmes – child safety, smoking cessation, diabetes, cardiovascular health • Improvement in uptake of preventive services – eg. dental, immunisation • Travellers assessing own health needs and discussing with managers Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

10. Other applications of Peer Led approach • Asylum seekers • Migrants health • Older people • Childhood adolesent health • Community Development Projects Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

11. Self Management ( 1 ) Hospital Care Primary, Community and Continuing Care Public Health Self Management Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

12. Self Management ( 2 ) Public Health Self Management Primary, Community and Continuing Care Hospital Care Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

13. Self Management ( 3 ) Programmes improve health status, health care utilisation • Arthritis • Back pain • Chronic disease Lorig, K, Holman Halsted Stanford University Patent Education Centre Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

14. Self Management ( 4 ) Diabetes Self Management • UK National Service Framework for Diabetes • US National Standards for Diabetes Self Management Education Programme established criteria • Self Management programmes improve control, decrease amputation rate, reduce costs and hospitalisation National Standards for Diabetes Self Management Education Programme ( Lecture Review ) Revised 2002 Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

15. Outcome (5yr Survival) Hospital Cancer Care • Centralisation • Specialisation • Multidisciplinary Teams • Audit • Volume Outcome Relationship Cancer Care • Breast • Colon • Rectal • Breast • Testicular • Pancreas • Oesophagus Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

16. Breast Cancer: Experience in Ireland • Policy document 2000 • Minimum 100 new cases per unit year • Minimum 50 new cases per surgeon per annum • 2005 – 60% surgeons do less than 10 procedures per year • Poliferation of small units • Political • Public • Professional Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

17. How Might Health Reforms Help • Unitary System • Better evidence, better info for the public • Regional health offices – political and public interface provide opportunity for dialogue • Health Information and QualityAuthority Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

18. Public Health Tobacco Acts (2002, 2004) • Enlosed workplaces smoke-free offices, shops, factories, bars, restaurants, other enclosed workplaces smoke-free • Aim: • To protect workers and the public from health consequences of passive smoking Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

19. Public were given facts – also some untruths • Prolonged comprehensive debate • Mobilised public opinion – including smokers • Public support for ban increased over time including smoker support Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

20. Allright Report • Exposure to second hand smoke causes • Cancer • Heart Disease • Repiratory Disease • Other illnesses Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

21. OTC Review of Smoking Ban • 93% think law is good idea including 80% smokers • 96% believe law is successful including 89% smokers • 98% believe workplaces are healthier • Air quality has improved • Levels of CO have decreased in non-smoking bar workers • 96% indoor workers report working in smoke free environment • 94% workplaces inspected are smoke-free • National New Year’s Poll - smoke free law voted No. 1 “high” of 2004 Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

22. Conclusions • Overwhelming public support • Public are empowered • Evidence of health benefit • Public clearly know their rights • Public can be assured that their rights will be vindicated • Public are making smoking ban work Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005

23. Other Public Health Policies Which Might Be Empowering • Sales of cigarettes to minors • Obesity – parents feel disempowered because of advertising of junk food, vending machines in schools • Alcohol – implementing a public health approach to alcohol (Strategic Task Force on Alcohol 2002, Revised 2004 ) • Speed Limits Empowering the Public for Better Health and Health Outcomes, Dr. Patrick Doorley, 19th May 2005