Putting the Public back in Public Health –

1. Putting the Public back in Public Health – NewApproaches to improving Health & wellbeing for the 21st century. Wendy Meredith Director of Public Health Bolton Council 11-04-2014

2. The presentation will cover: •Reflection on features of public health in 21st century •Discussion of emerging trends •Outline possible approaches to new and old problems

3. Public Health in 21st century

5. A powerful case for change We face significant challenges to the public’s health: • Two out of three adults are overweight or obese • Smoking costs the NHS £2.7 billion per year. And there are wider economic and social costs from preventable ill-health: • drug use and smoking cost over £10 billion per year • Major health threats, ranging from the risk of new pandemics to the potential impact of terrorist incidents • Inequalities in health remain: in 2008-2010, the gap between local authorities with the highest and lowest life expectancy was nearly 12 years for males and just under 11 years for females.

6. Life expectancy Internal gap 12 years Gap with England – bigger than ever

7. Bolton Health & Wellbeing Survey 2010 Key changes since 2007 survey • Self perceived general health has slightly worsened • Increases in backache and joint pain • Diabetes has continued to increase (BBHC) • Mental health worsened • Obesity has increased further • More people experiencing financial difficulties • More negative perceptions of neighbourhood • Smoking has continued to fall • Regular dental check ups continue to increase

8. Lifestyle factors & risk factors • Smoking has reduced but still 1 in 3 adults admit to smoking in some deprived areas • Alcohol - 30% adults binge at least once a week, 24% drink over the recommended wkly level, 12% have just 0-1 alcohol free day a week Alcohol consumption is greatest in least deprived areas but the reverse is seen related mortality rates • Obesity – 20-25% adults are obese 9% Reception aged children, 21% by Year 6 are obese • Physical activity – 17% adults leading a sedentary lifestyle, 43% do 5 sessions • Substance misuse – estimates of 2272 opiate and or crack users – ‘traditional’ drug user profile is changing • Sexual health & teenage pregnancy – significant improvement in TP in recent years but still above national average • Infectious disease - HIV prevalence and TB incidence increasing

9. However good the NHS gets, until we get better at dealing with public health, poverty, housing, job-less-ness, education and giving kids a sure start in life, we were running up the down escalator. Roy Lilly, NHS Commentator

10. ‘Three Horizons’ Model Of Innovation (Adapted by Duggan and Marsh 2008)

11. THE TURBULENT TRANSITION How to Read a Change of Age VIABILITY radically different operating environment new paradigm fits and takes off increasing synchronous failure innovation shifts allegiance HORIZON 1 less disruptive change Innovation to try and keep things going Radically new ideas with better fit to new environment HORIZON 2 new context for useful old ways HORIZON 3 NOW www.internationalfuturesforum.com TIME

12. An effective public health system •Accounts for the changing nature, assets and strengths of the population – is vigilant for new health threats •Ensures economic development creates health and well being •Advocates wise use of environmental resources •Promotes individual and community well being •Helps people limit behaviours damaging to their health. •Secures equitable access to good quality health and social care, with prevention incorporated into all contacts. •Systematically works to reduce health inequalities and embeds health and well being in all policies.

13. Essential Public Health system 1.Monitor health status to identify community problems 2.Diagnose and investigate health problems and health hazards in the community 3.Inform and educate people about health issues and empower them to deal with the issues 4.Mobilise community partnerships to identify and solve health problems 5.Develop policies and plans that support individual and community efforts 6.Enforce laws and regulations that protect health and ensure safety 7.Link people to needed personal health services and ensure the provision of health care when otherwise unavailable 8.Ensure a competent public health and personal care workforce 9.Evaluate effectiveness, accessibility and quality of personal and population based health services 10.Research for new insights and innovative solutions to health problems

14. Emerging trends

15. Strategic shift from healthier habits to wellbeing

17. The Wellbeing Shift Illness Wellness Proximal Distal determinants (the root causes) Deficits/ problems Assets/ goals What you are doing Why you are doing it Passive recipient Active, empowered citizen

18. Health Inequalities People Places Power

19. Protecting health and improving wellbeing throughout life 1.Empowering local government and communities 2.Tackling health inequalities 3.Coherent approach to different stages of life 4.Giving every child the best start in life 5.Making it pay to work 6.Designing communities for active ageing and sustainability 7.Protecting communities from threats 8.Working collaboratively with business and voluntary sector

20. Possible approaches to new and old problems

21. What could be different? •Five ways to well-being – Large scale change •Asset based working •Community resilience and coproduction •Community oriented primary care •Integrated Wellness Services •Investment for Health – “Health in all policies”

22. Five Ways To Well-being Action that individuals can take ……. 1.Connect - with family, friends, colleagues, neighbours 2.Be active - walk, run, garden, dance 3.Take notice - be curious, reflect on experiences 4.Keep learning - try something new 5.Give - doing something for others

23. What could be different? - Better preventive services • Improved use of wellness based prevention services • Prevention incorporated into every care contact

24. What could be different? – access to information •Better access to public health information •Extensive use of internet based communication and services - www.health2works.com Web 2.0

25. What could be different? - JSNA or JSAA?

26. What could be different? – Community involvement “You can’t know what you need until you know what you have” “Look in your back yard before you go to the store” John McKnight Institute for Asset-Based Community Development Northwestern University, Chicago

27. The 12 Principles of ABCD Community Involvement • Everyone has gifts • Relationships build a community • Leaders involve others as active members of the community • People care about something • Motivation to act must be identified • A listening conversation • Ask, Ask, And Ask • Asking questions rather than giving answers invites stronger participation • A citizen centred ‘inside-out’ organisation is the key to community engagement • Institutions have reached their limits in problem solving • The institution as servants

28. What could be different? – Health in all polices Policies • Local policy decisions made whilst knowing their possible health impacts • Health in All Policies

29. Conclusion • Now seeing limitations of risk theory of disease and lifestyle approach • Shift from Illness to Wellness • Putting “public” back in public health

30. References http://www.idea.gov.uk/idk/aio/26995259 Joint Strategic Needs Assessment: a springboard for action http://www.idea.gov.uk/idk/aio/18410498 A Glass Half Full: How an asset approach can improve community health and wellbeing http://www.nwph.net/hawa/writedir/2fa6The%20Asset%20Approach%20to%20Living%20Well.pdf The Asset Approach to Living Well http://www.nwph.net/hawa/writedir/da0dNW%20JSAA.pdf Development of a Method for Asset-Based Working http://www.abcdinstitute.org/ ABCD Institute, Northwestern University, IL, USA http://www.youtube.com/watch?v=NhZOLLaLNDY

31. Putting the Public back in Public Health Wendy Meredith Director of Public Health Bolton Council 11-04-2014