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Partnerships and Health Inequalities in Hertfordshire

This comprehensive document outlines key priorities and action plans for addressing health inequalities in Hertfordshire, focusing on areas such as smoking, childhood obesity, alcohol misuse, sexual health, screening, and immunization. Strategies include social marketing techniques, tobacco control measures, obesity clinics, personalized support services, and initiatives targeting various vulnerable groups. From smoking cessation to falls prevention, the plan emphasizes collaboration with diverse stakeholders to promote health equity across the county.

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Partnerships and Health Inequalities in Hertfordshire

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  1. Item 4 Partnerships and Health Inequalities in Hertfordshire Raymond Jankowski

  2. Top priorities • Tackling health inequalities • Smoking • Childhood obesity • Alcohol consumption • Sexual health • Screening • Immunisation

  3. Health promotion and disease prevention in adults:challenges in Hertfordshire

  4. 10 major enablers for health inequalities Bentley, June 2008

  5. Health inequalities action plan • Initial plan approved by boards in July 2008 • Update to board in January 2009 • Top 30 key areas (includes 16% most deprived wards) • Also specifies vulnerable groups such migrant workers, gypsy and travellers, ethnic minorities • Making links with housing, education and domestic violence • Focusing on smoking cessation, obesity and immunisation • Need to use social marketing techniques

  6. Importance of broader tobacco control measures • 10-20% fall in prevalence due to NHS smoking cessation services • 80-90% fall to broader tobacco control measures, including: • Taxation • Action to reduce illegal (cheaper) supplies • Environmental controls and enforcement (smoke –free) • Restrictions of tobacco advertising • Population-based health promotion campaigns • Local initiatives to discourage starting • Brief advice re quitting/self-motivated quitting

  7. Future actions to reduce smoking levels

  8. Key priorities for tobacco control (2009/10) • County wide strategy group established CSF, Trading Standards, PCT commissioners, stop smoking service, environmental health, links to district/borough council CEOs • Main priorities established • Improved community profiling/ targetting • Focus on workplaces / routine & manual • Increase resource – co-ordination of work, smoking cessation team • Strengthen joint working including tobacco alliance networks • Increase capacity in quitting support services

  9. Obesity in Hertfordshire • Second biggest lifestyle issue in Hertfordshire after smoking • Estimated to cost £400M of £1.4B NHS budget • Large obesity monitoring project for children, not case for adults • 20% + of adults obese • Five a day programmes • LAA for adults physical activity programmes – challenging • Obesity clinics with PBCs ? • Community agent projects (LAA funded ?) • Targeting parents at 50+ children centres ?

  10. Childhood obesity: of obese/overweight children * *Survey of over 85% of schools in 2007/8

  11. Action on childhood obesity Prevention • Supporting antenatal women • Promoting breast feeding • Healthy schools: five a day programme • Increase regular exercise by children • Increase healthy school meal options • Improve user friendliness of parks and open spaces Personalised support • Local clinical pathways for management of overweight/obesity • Ensure health visitor/school nurse capacity to manage need • Pilot antenatal dietician scheme to support obese women • Evaluate and extend anti-obesity programmes e.g. MEND, Fun schemes

  12. Alcohol misuse • Binge drinking and hospital admission data • Underage drinking, selling of alcohol • Those drinking more than recommended limits at home • Perception of difficulty of NHS access for drinking addiction ?

  13. Alcohol misuse: actions • National drinkwise campaign targeting all drinkers (units) • Hertfordshire Alcohol Harm Reduction • Closer working with DAAT • CDRP partnerships • New data sharing –e.g. incidence data collection form A&E departments • Development of Brief interventions for alcohol misuse in primary care • Drugs Education Forum working with healthy schools initiative • Working with Young Persons Substance Misuse Commissioning Group • Working with Herts Foundation Partnership Trust to target dual diagnosis patients

  14. Sexual health • Increasing in GUM attendances in Hertfordshire • Increase in young people • Increase in those over 50 years old • Teenage pregnancy rates • Varies across county • Some district rates are above national average

  15. Sexual health: action • Integration of services • Sexual health clinical network • Holistic model: 5 levels of service • Development of GP based service • Contraception services for teenagers • Screening for HIV/chlamydia • Increase education and prevention • Teenage pregnancy strategy with partners • Specific services for looked after children, six form and 16-24 years • Condom availability, C- card scheme • Increase awareness • To inform about services and how to access • Specific messages to young people, young parents, parents, carers and professionals • Teenage pregnancy strategy

  16. Screening programmes • Antenatal • Down’s syndrome • Sickle cell and thalassaemia • Newborn • Hearing • Blood spot • Cancer • Bowel • Breast • Cervical • Adult • Heart disease • Aortic aneurysm • Diabetic retinopathy

  17. Immunisation • MMR • HPV • Seasonal flu

  18. Falls prevention • Commonest cause in older people of: • Serious injury • Injury-related hospital attendance • Precipitating care home admission • Reducing confidence and independence • 30% fall aged over 65 years in a year • 50% fall aged over 85 years in a year

  19. The epidemiology of falls in Hertfordshire: in one year 45-50 deaths from falls 942 hip fractures 4,141 hospital admissions 9,000 A&E attendances 18,000 ambulance 999 calls 52,000 falls in >65 year olds

  20. Action for Falls prevention • Nottingham tool for identification • Effectiveness in NICE guidance • Improve balance, gait, mobility • Environmental factors • 15-30% reduction in falls – financial savings • At least £2.65M per annum savings in Hertfordshire (hospital admissions) • 7,800 fewer older falling – less residential/nursing home care • Importance of exercise in prevention • Impact on intermediate care ?

  21. Future focus • Agreeing priorities with 12 PBCs, LAAs, 10 LSPs • Making links across LAA groups • Reinforcing links with LAs and voluntary sector • Opportunities within world class commissioning e.g. intermediate care • Consideration to continue second year of £100,000 to the 10 LSPs

  22. Key documents • Health inequalities action plan July 2008 • Health inequalities action plan update January 2009 • PCTs’ 5 year strategy In draft • Sexual Health strategy 2007

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