From Strategy to Practice A perspective from the Institute of Public Health 5 November 2015

1. UKPHR Consultative Forum From Strategy to Practice A perspective from the Institute of Public Health 5 November 2015 Owen Metcalfe, FFPH Chief Executive, IPH

2. “However beautiful the strategy, you should occasionally look at the results”. • Sir Winston Churchill • “A strategy, even a great one, doesn’t implement • itself”. • Anon

3. Institute of Public Health in Ireland • Research – Prevalence of Long Standing Conditions • Policy – Obesity, Smoking, Sexual Health • Capacity Building – HIA Training, Open Conference • Ageing Research & Development – Keeping Active for Better Ageing www.publichealth.ie

4. IPH Work Programme Health Information Health Well

5. Established to Promote Cooperation for Public Health • Why is cooperation necessary?

7. UK Faculty of Public Health • 3 key domains of public health: • Health improvement • Improving health services • Health protection

8. UK Faculty of Public Health • 9 key areas for practice: • Surveillance and assessment of the populations health and well being • Assessing the evidence of effectiveness of health and healthcare interventions, programmes and services • Policy and strategy development and implementation • Strategic leadership and collaborative working for health • Health improvement • Health protection • Health and social service quality • Public health intelligence • Academic public health

9. IPH • A focus on health inequalities • Fairness and justice

10. Life Expectancy of Men in Northern Ireland Ranked by Deprivation (2009-11) Source: Making Life Better

11. Life Expectancy of Women in Northern Ireland Ranked by Deprivation (2009-11) Source: Making Life Better

12. Life Expectancy and Disability-Free Expectancy (DFLE) at birth, Persons by neighborhood income level, England, 1999 - 2003

13. Inequality Gaps • Inequality gaps between deprived areas and NI overall were in: • Alcohol-related deaths – 121% higher • Drug-related deaths – 113% higher • Admissions for self-harm – 94% higher • Teenage births – 80% higher • Suicide – 73% higher • Respiratory death rates – 66% higher • Lung cancer incidence – 65% higher • NI Health & Social Care Inequalities Monitoring Systems 2009

14. Strategy – Making Life Better • The Gradient Approach • In order to achieve the aims of better health and wellbeing for everyone and reduced inequalities in health, the overriding approach must be to take account of the need for greater intensity of action for those with greater social, economic and health disadvantage. This applies right across the social gradient, as recognised by Marmot, and require action to improve universal services as well as more targeted services for those in greater need. • Making Life Better, DHSSPS 2014

15. Strategy – Healthy Ireland • Goal 2: Reduce Health Inequalities • Health and wellbeing are not evenly distributed across Irish society. This goal requires not only interventions to target particular health risks, but also a broad focus on addressing the wider social determinants of health – the circumstances in which people are born, grow, live, work and age – to create economic, social, cultural and physical environments that foster healthy living. • Healthy Ireland, DoH 2013

16. WHO Health 2020 • “Reducing health inequalities and improving governance for health and health equity”. • European Commission and Health Equity • “Solidarity in health – reducing health inequalities in the EU”.

17. Public Health Policies supporting MLB & HI • On specific issues: • Tobacco • Alcohol • Sexual health • Obesity • With references to health inequalities.

18. Other Countries • Spain • Moving forward equity: a proposal for policies and interventions to reduce social inequalities in health in Spain 2011 • Norway • Norwegian strategy to reduce social inequalities in health 2007 • Slovenia • Health inequalities in Slovenia 2011 • Finland • Health inequalities in Finland 2009 • England • Public Health England – health inequalities division

19. Developing a Comprehensive Approach and Action Plan • Secure political commitment and cooperation from many sectors • Assess the extent of the problem, consider points for intervention along with barriers to action • Put in place organisational arrangements and financial requirements. Allocate responsibility and resources • Draw up action plans – what? who? how much? outcome? • The Equity Action Spectrum: taking a comprehensive approach, WHO 2014

20. Progress • Increasing references to health inequalities • Marmot work leading to increased knowledge • UK and Irelands collaboration on health inequalities • NI health and social care inequalities monitoring system • HSE health inequalities action plan

21. Work To Do • Dedicated policy • Accountability mechanisms • Resources • Personnel • Finance • Maintain an intersectoral health in all policies approach

22. Closing the Gap • Lynch Pins • Improve daily living conditions • Tackle the inequitable distribution of power, money and resources • Measure and understand the problem and assess the impact of action • Train the workforce in the social determinants of health • Raise public awareness about the social determinants of health • Closing the Gap in a Generation, WHO 2008