Sport and physical activity public health stakeholder event

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Jim McManus

Director of Public Health

26th February 2014

Sports and Physical Activity Stakeholder Event

Hertfordshire Sports Village

Better Public HealthWorking in Partnership with Sports and Physical Activity Sector

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AGENDA• 9.30am             Welcome and introduction

– Christine Neyndorff Director, Herts Sports Partnership (HSP)

• 9.35am             Herts Public Health Strategy – ‘working in partnership with the sport sector• Jim McManus Director of Public Health, HCC

• 10.05am           Q&A / discussion Jim McManus

• 10.50am           Sport & PA case studies – the use of sport and physical activity to promote public health messages

• Fiona Deans, Herts Sports partnership

• 11.00am In groups, identify Fiona Deans•• What can the Sport & PA sector do as part of what they do anyway?• What is needed to help this happen?• What would be a priority for new work?

• 11.25am           Closing remarks Christine Neyndorff• 11.30am           End of session

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Current challenges facing Hertfordshire

• Avoidable early deaths – over 2,000 pa• Chronic disease – poor self management, poor

management of sub-clinical risk, could do better on prevention and early intervention

• Some sections of our population at very high risk of avoidable misery and death

• Mental health – haven't tapped the benefits of physical activity for this

• Resilience and Happiness – likewise

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Healthier Herts: A Public Health Strategy for Hertfordshire

OUR PURPOSEto work together to improve the health and wellbeing of the people of

Hertfordshire, based on best practice and best evidence

OUR VISION:A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well

against Hertfordshire

Priority 5: We understand what’s needed and we do what works

Priority 6: We make public health everybody’s business and work together

HOW WE WILL WORK TOGETHER(our strategic priorities: how we do it for

our County)

ThePublicHealthOutcomesFramework(the nationalPHOF willHelp us measureOur success)

WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUR RESIDENTS

(our strategic priorities: what we achieve for our County)

Priority 1: Our Population lives Longer, Healthier Lives

Priority 2: Our Population Starts Life Healthy and Stays Healthy

Priority 3: We narrow the gap in life expectancy and health between most and least healthy

Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental)

BuildingBlocks For the Public Health Family

Strong Leadership

Capable, Skilled People

Co-production with citizens

Effective Partnerships

Evidence and Knowledge Driven

Plan and Deliver for Localism

Whole System Approaches

Making better use of behavioural sciences at individual, interpersonal, community and service levels

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Contributors to overall health outcomes and why elected councillors are important leaders

Smoking 10%

Diet/Exercise 10%

Alcohol use 5%Poor sexual health

5%

Health Behaviours 30%

Education 10%

Employment 10%

Income 10%

Family/Social Support 5%Community Safety 5%

Socioeconomic Factors 40%

Access to care 10%

Quality of care 10%

Clinical Care 20%

Environmental Quality 5%

Built Environment 5%

Built Environment 10%

Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status

While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.

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Background of Health Outcomes

Hertfordshire doing very well overall, but this masks several districts with Significant inequalities in outcomes

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Adult obesity in Hertfordshire 2012

35.0

%

37.5

%

29.2

% 35.6

%

35.5

%

35.6

% 47.0

%

39.6

%

38.2

%

39.5

%

33.6

%

40.0

%

40

.8%

40

.3%

41

.9% 37

.1%

39

.2%

39

.9% 3

1.5

%

36

.9%

41

.0%

40

.9%

46

.7%

44

.0%

23

.0%

21

.5%

28

.3%

25

.6%

25

.2%

24

.0%

21

.2%

20

.9%

20

.2%

19

.1%

18

.7%

15

.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Underweight Healthy Overweight ObeseSource: Active People Survey (Sport for England)

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Investing in the Right Things Our Burden of Disease is not the right way round

PrimaryPrevention

SecondaryPrevention

TertiaryPrevention

in andOut of hospital

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Health and Care: Our Burden of Disease is not the right way round

PrimaryPrevention

SecondaryPrevention

TertiaryPrevention

The shift to prevention

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How?

• Self management in primary care and chronic disease

• Benefits of physical activity• Behavioural support and change (variety of

techniques)• Early identification of people with disease and

pathwaying into healthier lifestyles

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Role of Physical Activity• It is not the answer to obesity, it is part of AN answer• It is important in and of itself as a health-giving and

health-protecting exercise (vascular, endocrine, musculo-skeletal, cognitive, emotional and immune benefits)

• Second nature self-propelled transport• Link up to behavioural pathways in prevention• Balances pharmacological pathways in prevention of

non communicable disease• Supports self care in non communicable disease• Supports tehabilitation • Mental health resilience and coping

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Mental Health and Physical Activity

• Resilience • Self Management• Early Intervention• Physical health challenges• Unity of person – biopsychosocial approach• MH Benchmarking exercise

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Average BMI

Underweight

Healthy weight

Overweight

Obese

Average BMI

Underweight

Healthy weight

Overweight

Obese

Fewer overweight Fewer obese

Reduce average BMI

Fewer underweight

Maximise proportion at a healthy weight

Minimise proportion at an unhealthy

weight

a new approach is needed, focus on shifting weight distribution in the population

Make more people a healthy weight, not just fewer people obese

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Systems thinking on wider determinantsGetting everyone on the same systems page

The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!)

The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences)

The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)

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Some parameters – yes please to

• Physical activity population wide as an important public health intervention

• Targeted and tailored interventions for populations– Health walks– Cardiac rehabilitation phases 1 – 4– Secondary prevention– Post surgery rehabilitatipn– Better access for disabled people

• Range of benefits – physical and psychological – “Everybody more active, more of the time”– Everyone working out their role and contribution

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Some parameters

• No to assuming physical activity is “the solution” to obesity (because it simply isn’t)

• Need to work out the role of elite sports and our sports clubs in public health challenges

– Suggestion – their public health role is about• doing what they do already• Increasing participation at all levels• Helping create a culture of physical activity• They are a part of an answer, not the answer

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Values for sports and physical activity sector - Ottawa Charter, 1986• "The goal of a healthy public policy is health promotion, i.e., to

enable people to increase control over and improve their health.

• It is also essential to

– create supportive environments,

– strengthen community action,

– develop personal skills and

– reorient health services.

All of these are area where sports and physical activity can help

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The upshot of the Ottawaw Charter for sport and physical activity

• Regular physical activity available for ALL as routine part of life

• Physical activity providers as part of public health pathway

• Making every contact count• Physical Activity Plus +• Sport from entrant to elite – social norms

reinforcing activity and health

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What it means for NHS Services, for example

• Preventive services in every patient pathway• Preventive services in clinical services link up to

community services (referral for leisure and behavioural interventions)

• Making Every Contact Count• Commissioning for self-management in chronic

disease

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Physical Activity Plus+

• Referral from GPs and services• Physical activity more widely on referral• Staff have health goal assessment, motivation

and behaviour change skills• Inclusion of people who face barriers to access

(cost, disability, etc)

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What it means for physical activity agencies

• Mainstream an ethos of public health in your service

• Co-design public health services with public health commissioners

• Embed public health skills across your services• Build resilience in users and communities• Motivate people to self-manage• Become health promoting in all you do

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Phasing and Layering across public health

•Think through what we can do short term•Start work on the medium term •Set the policy framework for the long term•Build this understanding among partners•Get started and realise •County, District, Parish, NHS, Business and Community Sector working together

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A Lifecourse approach to physical activity

• Everyone active from early years to older age• Tailored menu of what can be done• School, community, workplace, care setting

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15 Actions being taken so far (more will be done)

1. New weight management service already commissioned and reached 1st 1,000 referrals in three months, more will be commissioned

2. Obesity pathway in place for tiers 1 -3 obesity care. Revision late 2014

3. New lifestyle partnership launched with lifestyle offer for Herts residents to be ready by Easter for phased roll out

4. New online lifestyle service launched in February

5. Workplace physical activity challenge funded and running (Herts Sports Partnership)

6. Workplace Health improvement programme running (Business in the Community)

7. 93% of GPs in Herts now doing NHS HealthChecks

1. Obesity Plan approval by Cabinet due March 2014

2. New child weight management service to be commissioned in 2014

3. Broxbourne whole area obesity pilot underway with Borough and County Council, schools and NHS

4. Fast food takeaway restrictions

5. Countryside walks scheme

6. Year of Cycling launching May 2014

7. Funding for District Councils to work on health improvement agreed and each District working out its plans

8. Continue child weight measurement programme

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Where next

• Getting the benefit from the new lifestyle partnership• Building a behaviour pathway into physical activity• “Public healthing” physical activity and leisure/sport

– Pathways

– Behavioural support, motivation, assessment

– Whole healthy life packages, not silos

– Training

– Commissioning specific interventions

– Large scale

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Behaviour Change Pathway Approaches

2nd Line – Behaviour Change 3rd Line - Activity 4th Line – Specialist1st Line – Brief Intervention

Opportunistic brief advice by GP, pharmacist or practice nurse

1 Identify health issue of concern (and follow appropriate pathway for that, e.g. obesity)

2 Assess motivation to change

3 If motivated, refer on4 If not motivated,

Raise awareness of risks.

Offer written information on healthy eating and physical activity.

Raise again in 3 months.

Offer information prescription

Smoking is primary, main or only goal

If fall into 1st or subsequent line category of advice within Obesity Care Pathway refer to Lifestyle Programme, provided there are no contraindications and if co-morbidities or person has BMI over 30, GP has assessed and supports referral. Check this ….

Discuss primary or main goal then refer appropriately For patients with co-

morbidites

Patients who are diabetic or have coronary heart disease or a history of heart problems must have referral from appropriate primary care team or secondary care to participate in programme.

Behaviour change programme to be developed in partnership with specialist services

The evidence base for changing health behaviour is developing quickly. Brief interventions in primary care (by practice nurses and GPs) can motivate people to change, providing referral onwards is speedy. This pathway

Refer to smoking cessation service

Weight loss, healthy living or CVD risk is main or primary goal

Refer to ifestyle Service Patients with highly complex psychological or emotional

issues (e.g. depression or eating disorder.)

If not already in contact with such services, refer to IAPT programme psychology or primary care mental health team

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Thank you!

www.hertspublichealth.co.uk

• [email protected]