Choosing Health: Tackling Inequalities and Promoting Well-being in England

1. Implementing Choosing Health– Sian Griffiths

2. Choosing Health – the context • Health in England has improved dramatically over the last century • New challenges have emerged which must be tackled • Unfair inequalities in health persist • Traditional methods of improving health are becoming outdated • A new approach to public health is required, responding to the needs and wishes of citizensas individuals

3. Priorities for action • Tackling health inequalities • Reduce the numbers of people who smoke – building on current progress • Tackling Obesity – new action with a focus on children • Increase physical activity – more opportunities • Support sensible drinking • Improve sexual health – new campaigns and services • Improve mental health and well being – crucial to good physical health

4. Principles • Informed choice for all • Personalized support • Working in partnership –everybody’s business

5. The wider determinants of health

6. The widening mortality gap between social classes Log scale 160 125 1.2 times greater Social class 100 80 V - Unskilled 2.9 times greater 63 50 Average for working age men 40 30 I - Professional 25 1949-53 1970-72 1979-83* 1930-32 1959-63 1991-93 Years *1979-83 excludes 1981 England and Wales. Men of working age (varies according to year, either aged 15 or 20 to age 64 or 65) Note: These comparisons are based on social classes I & V only. Source: Office for National Statistics

7. Differences in Life Expectancy within a small area in London Travelling east from Westminster, each tube stop represents nearly one year of life expectancy lost Canning Town Westminster Canary Wharf London Bridge North Greenwich Canada Water River Thames Bermondsey Waterloo Southwark Boroughs just a few miles apart geographically have life expectancy spans varying by years. For instance, there are eight stops between Westminster and Canning Town on the Jubilee Line – so as one travels east, each stop, on average, marks nearly a year of shortened lifespan. 1 London Underground Jubilee Line 1 Source: London Health Observatory based on Office for National Statistics data

8. LDP monitoring lines for inequalities • Smoking during pregnancy • Breast feeding initiation • Teenage conception • CVD mortality rates under 75 • Practice based registers of CHD • Blood pressure readings • Cholesterol levels • Cancer mortality rates <75 • Implementation of NICE guidance on cancer

9. Smoking

11. Prevalence of smoking before and throughout pregnancyby mother’s social classification England, 2000 Percentage Examples of occupations for each social classification 1 Doctors,Lawyers, Managers 2 Secretarial, IT Support, Accounts clerk 3 Sales personnel, Customer Service 1 2 3 Social classification Smoked before pregnancy, but gave up Source: Infant Feeding Survey, 2000 (Table 4.9) Note - Using National Statistics Socio-Economic Classification (NS-SEC) Smoked throughout pregnancy

12. Brief advice from a health professional ‘The best thing you can do for your health is to stop smoking, and I advise you to stop as soon as possible. The sooner you stop the better. How do you feel about your smoking? How do you feel about tackling your smoking now?' • causes 2-3% of smokers to quit • probably the most cost-effective intervention in medicine

14. LDP lines and Big Wins • Smoking quitters at 4 week follow up stage • Smoking status among 15 to 75 year olds • Reduced exposure to second hand smoke • Enforcement of regulations • Targeted support- services and campaigns

17. Consequences of Childhood Obesity • Social and psychological • Increased risk factors for heart disease (raised blood pressure, blood cholesterol and blood sugar) • Type 2 diabetes • Persistence into adulthood

20. Children and Young PeopleStarting on the right path • Better information and support for parents, children and young people • Integrated services brought together in one place to meet the needs of parents, users, children and young people • Co-ordinated whole school approach to health, focusing on diet and physical activity • Strengthen action to manage risk associated with underage smoking and sexual activity

21. Healthier Vending Machines Healthier Tuck Shops Breakfast Clubs Water Provision Dining Room Environment Growing Clubs Healthier Lunch Boxes Cookery Clubs Promoting healthy eating in schools

22. NHS Plan: A life course approach Partners Life Welfare Foods Other government Pregnant women departments & agencies & FSA, DfES, DEFRA, under 5 Breastfeeding & HDA, DTLR, DCMS Infant feeding Food industry - National School producers, retailers, Fruit Scheme caterers Children Food in Schools Consumer, health & education Five-a-day programme organisations - Reduce fat, sugar, salt Consumer council, Whole population Hospital nutrition BDA, NAHT etc. Tackle obesity & PA

23. Cross Government action DCMS: Activity Co-ordination Team (ACT) • Target to increase mass participation • 58 key recommendations - PA & sport • ACT - co-ordinate & lead development • Joint lead DH/DCMS DfES: PE and school sport • Joint PSA target with DCMS DfT: travel plans • 111 bursaries for Travel Plan co-ordinators over 3 years

24. Examples of Activities in Five-a-day Community Initiatives • engage primary care staff • free voucher scheme • provision in corner-shops • initiatives in workplace and schools canteens • food co-ops and community cafés • food blender loan scheme • food mapping work • local media campaigns

25. Local communities leading for health • Local authorities providing leadership to local partnerships for health • Investment and new initiatives in disadvantaged communities • Promoting partnership working between public and voluntary sectors • Action on second-hand smoke

26. LDP lines and Big wins • Childhood obesity to be measured • Obesity status in GP populations to be measured • Free school fruit for all 4-6 year olds • School travel plans by 2010 • Increased physical activity opportunities • 5 a day promotion • Healthy schools • Restrict food promotion to children

28. WHAT THE WHITE PAPERMEANS FOR LOCAL AUTHORITIES • Shift to local target setting by PCTs from 2005-6, new driver for partnership with LAs • New Focus on communities • Local health information reports • Community Collaboratives extended • Communities for Health • Network of Health Champions • Local initiatives on sport, exercise, transport and nutrition • Smoke free workplaces and enclosed public places, with limited exemptions

29. A health promoting NHS • Help to plan and deliver effective action to tackle inequalities and improve health • Turn NHS patient encounters into opportunities for healthy choices • Training for NHS staff to embed health improvement into day-to-day patient care • Drive for modernisation to benefit health improvement and prevention services

32. Health as a way of life • Advice and support for people to turngood intentions into sustained action • NHS Health Trainers – accredited professionals drawn from local communities to provide practical advice and connections • Personal Health Guides – support for people to help them take more control over their health • Shifting from ‘advice from on high’ to ‘support from next door’ • Health Direct

33. Develop the workforce • Increased capacity and capability : • Across wider workforce, esp primary care • As ph practitioners • As ph specialists • In leadership organisations • National Workforce Strategy group • Health trainers • School nurses