Angela Mawle Chief Executive. Our priorities Combating health inequalities –Working for a fairer, more equitable and healthier society Promoting sustainable.

Angela MawleChief Executive

Our priorities

• Combating health inequalities– Working for a fairer, more equitable and

healthier society

• Promoting sustainable development – ensuring healthy environments for future

generations

• Challenging anti-health forces– Promoting health-sustaining production,

consumption and employment

Sustainable Development in the 20th Century

• 1987 - Dr Gro Harlem Brundtland (the World Commission on Environment and Development) Developed the broad political concept of sustainable development, published its report ‘Our Common Future’ in April 1987.

• 1992 - UN Conference on Environment and Development (RIO Earth Summit) produced Agenda 21 a 40 chapter blueprint for sustainable development

• 1995 - WHO re-launched the global health policy ‘Health For All’ in response to accelerated global change and to ensure that individuals, countries and organisations are prepared to meet the challenges of the 21st Century.

Definition of Sustainable Development

"Sustainable development is economic development which actively promotes social equity and social justice and which protects and enhances the natural environment"

A Sustainable community would be one where there is:

• Good local employment• Pedestrian bicycle and public transport

networks• A pedestrian dominated public realm• A rich and diverse natural environment• Local facilities and resources• Locally produced good wholesome food• A rich and diverse cultural heritage• Vibrantly textured social networks• Informed and empowered individuals

The widening mortality gap between the social classes

(Tackling Health Inequalities – A Programme for Action –DOH June 2003)

• In 1999/2001, the difference between areas with the highest (North Dorset) and lowest (Manchester) life expectancy at birth was 9.5 years for boys and 6.9 years for girls.

• The highest life expectancy for girls was in West Somerset and the lowest was in Manchester.

(Tackling Health Inequalities – A Programme for Action –DOH June 2003)

Health in the 21st Century

Donald Acheson• The Acheson Report concluded that the "weight of scientific evidence

supports a socio-economic explanation of health inequalities."

• 'Poverty, low wages and occupational stress, unemployment, poor housing, environmental pollution, poor education, limited access to transport and shops, crime and disorder, and a lack of recreational facilities all have had an impact on people's health'

(Acheson 1998a)

Wanless findings 2004

• Numerous policy statements and initiatives in the field of public health have not resulted on a rebalancing of policy away from health care (a “national sickness service”) to health (a “national health service”).

• There must be a realignment of incentives in the system to focus on reducing the burden of disease and tackling the key lifestyle and environmental risks.

• Recognising the NHS is only one contributor to delivering the public health agenda, there needs to be an alignment of targets between the Planning and Priorities Framework for the NHS and the Comprehensive Performance Assessment for local government.

“Securing Good health for the Whole Population” D Wanless Feb 2004

What’s the Evidence?Attributable risk for CHD

37%

46%

19%13%

6%

Physical inactivity

Blood Cholesterol >5.2 mmol/l

Blood Pressure >140/90mmHg

Smoking

Obesity

Source: William Bird

Numbers needed to treat (NNT) to prevent a death over the next 5 years

Exercise

Walking (<1 mile vs >2 miles) NNT = 11

Cholesterol Lowering (all trials)

Primary Prevention NNT= 107

Secondary Prevention NNT= 20

Source - William Bird

Cost of Saving a Life

1036

190

0

50

100

150

200

£'000

Exercise Secondary Primary

Exercise Vs Lipid Lowering. Cost to save one life

Source - William Bird

– challenge existing services– coordinate actions and to engage different voices in

decision making– understand that partnerships operate within settings

dominated by hierarchies and markets– Acknowledge that seating different people around a

table without understanding these other pressures on their behaviour does not necessarily constitute a new way of working.

Without such changes“partnerships represent little more than the key players suppressing mutual loathing in the interests of mutual greed.”

MIKE ROWE & CAROL DEVANNE , Partnership and the governance of regeneration, Critical Social Policy, Vol. 23, No. 3, 375-397 (2003)

To realise the potential in partnership working there is a need to:

The Concordat

Strategic Interest GroupDeveloping partnerships

• Learning from grassroots development

• Representing what is possible to others

• Producing policy recommendations

• Building upon presence and work year by year

Angela MawleChief Executive