"Practical Public Health for the Geriatrician".

"Practical Public Health for the Geriatrician".

Paul JohnstonePHERegional Director North of England

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What is Public Health?

Facts and figures

Older people focus

How is PH organised?

How to get involved and work on Dementia

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What is public health?The Faculty defines public health as:

The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.

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Public health:is population based not patient individual base

emphasises collective responsibility for health, its protection and disease prevention

recognises the key role of the state, linked to a concern for the underlying socio-economic and wider determinants of health, as well as disease

emphasises partnerships with all those who contribute to the health of the population.

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Determinants of Health

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Three domains of public health practice:Health Improvement

Inequalities, Education, Housing, EmploymentFamily/communityLifestylesSurveillance and monitoring of specific diseases and risk factors

Improving servicesClinical effectiveness, EfficiencyService planningAudit and evaluation, Clinical governanceEquity

Health ProtectionInfectious diseasesChemicals and poisons, RadiationEmergency responseEnvironmental health hazards

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Public health and healthcare success stories

7 A tale of two populations- 26th Sept 2013

Data Source: Mortality in England and Wales Average Life Span, December 2012

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Data Source HSE 2011 Volume 1 HSCI

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Greatest reduction in

CVD

Data source Avoidable Mortality in England and wales 2011 ONS may2013

Public health working with healthcare professionals- reducing stillbirths.

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Unfinished business- inequalities

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Source: ONS Statistical bulletin Life expectancy at birth and at age 65 for local areas in England and Wales, 2009-11

Data source: ONS Inequalities in LE and DFLE , 2001-2004 to 2007-2010

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Increasing retirement age will not increase tax revenue if people are too ill to work

By the time retirement age

reaches 68, only the richest 10% of people

will reach retirement

without disability

Years of disability and dependency

Source: ONS 2007

Figure 4: Variation in estimated years of male disability and poor health at birth in Yorkshire and the Humber (based on 2001 Census data)

0 10 20 30 40 50 60 70 80 90

Barnsley

Harrogate

Ryedale

Life expectancy Healthy life expectancy Diability free life expectancy

Age in years

Source: ONS 2007

Figure 5: Variation in estimated years of female disability and poor health at birth in Yorkshire and the Humber (based on 2001 Census data)

0 10 20 30 40 50 60 70 80 90

Barnsley

Harrogate

Ryedale

Life expectancy Healthy life expectancy Disability free life expectancy

Age in years

Obese

930,000Obese

930,000

Morbidly obese

83,000

Healthy weight

1.65 m Over-weight

1.45 m

2009 2015Morbidly obese

96,000

Obese

1.45 mOver-weight

1.48 m

Healthy weight

870,000

Unfinished business- obesity

Unfinished business- primary care

Unfinished Business- primary care prevention

Immediate causes of disease burden

16 Strategic Review

Ed AM, Monika

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Top causes of under 75 mortality – 2010 Top causes of under 75 mortality – 2010

Raised blood pressure accounts

for 50% of all heart disease

Raised blood pressure accounts

for 50% of all heart disease

Around 86% of lung cancer

deaths in the UK are caused by

tobacco smoking

Around 86% of lung cancer

deaths in the UK are caused by

tobacco smoking

…leading to the major killers.

Causes of long term disability

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http://www.wmpho.org.uk/olderpeopleatlas/Atlas/atlas.html

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What is Public Health?

Facts and figures

Older people focus

How is PH organised?

How to get involved and work on Dementia

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Public Health England

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“Public Health England exists to serve the system, a

system led locally by elected members”

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PHE’s National PrioritiesREDUCING PREVENTABLE DEATHS

Helping people to live longer by reducing preventable deaths fromconditions such as heart disease, stroke, cancer and liver disease

REDUCING THE BURDEN OF DISEASE Increasing healthy life expectancy by tackling conditions which place a

burden on many lives, such as anxiety, depression and back pain

PROTECTING THE COUNTRY’S HEALTHProtecting the population from infectious diseases and environmental hazards,including emerging risks and the growing problem of antimicrobial resistance

GIVING CHILDREN AND YOUNG PEOPLE THE BEST POSSIBLE STARTSupporting families to give children the best start in life, through working with

health visitors, Family Nurse Partnerships and the Troubled Families Programme

IMPROVING HEALTH IN THE WORKPLACEHelping employers to facilitate and encourage their staff to make healthy choices

PHE’s local presence

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– Four regions, fifteen centres

– Centres in North:

–Cumbria and Lancs

–Cheshire and Mersey

–Greater Manchester

–Yorkshire and Humber

–North East

– Knowledge Intelligence Teams–North West–Northern and Yorkshire

– Other local presence–microbiology laboratories–field epidemiology teams–Centre for Radiation, Chemicals and Environmental Hazards units

Place-based approach to public health

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Public health advice

Health and wellbeing boardsHealth and wellbeing boards

Local governmentLocal government CCGsCCGsPHEcentre

NHSE area team

• EPPR• Screening and immunisation• Offender public health programmes• Specialised commissioning• Primary care public health programmes

and population healthcare

NHS providers

Non-statutory

providers*People and communities

*Including voluntary and community sector

What is Public Health?

Facts and figures

Older people focus

How is PH organised?

How to get involved?

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http://www.makingeverycontactcount.co.uk/

Cross-government narrative on health26

Political

27 Strategic Review

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LondonNorth East

North West

Yorkshire and the Humber

West Midlands

East Midlands

East of England

South West

South East

Spending power cut per dwelling 2010/11 to 2015/16

Source: Association for North East Councils: Response to DCLG’s consultation on the provisional local government finance settlement 2014/15 Annex A

-544 -467 -417 -357 -339 -238 -146 -146 -105

-£600

-£500

-£400

-£300

-£200

-£100

£0

England

Local Govt Funding and Social Care

Dementia

National Executive Meeting 18 February 2014

Why is dementia an area of focus?

Health Impact • Dementia is the 3rd leading cause of disability for the over 70s, and the 10 th leading cause of premature mortality for all ages (GBD – UK figures)

• c.25% of hospital beds are occupied by people with dementia, with increased length of stay• c.21m people in England know a close friend or family member with dementia

Health Inequalities

• Higher vascular risk in certain BAME communities and socioeconomic groups• Particularly challenging cultural norms in many BAME communities• Women more likely to develop dementia and to be carers

Unique System Leadership

• All major dementias have a vascular component (eg 80% in Alzheimer’s)• Opportunity to build on successful primary prevention approaches for eg heart disease and

stroke• PHE expertise in social marketing and national corporate partnerships

Effective Interventions

• The evidence on prevention is growing - particular benefits in midlife• Opportunity to build on existing Dementia Friends and Dementia Friendly Communities

programmes with new social marketing approaches

Responsiveness

• Numbers of people with dementia are expected to rise as population ages – need to get ahead of the curve as well as improving support for people now.

• DPHs require data, intelligence, and best practice interventions

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Dementia Friends Movement in Partnership with Alzheimer's Society in

2014/15

: