The role of Public Health in Tackling Health Inequalities in Salford Basis Thursday 19 th March 2015 Ian Ashworth Consultant in Public Health [email protected].

The role of Public Health in Tackling Health Inequalities in Salford

Basis Thursday 19th March 2015

Ian AshworthConsultant in Public [email protected]

1948 Medical Officer for Health Dr Lance Burn – “to make health attractive and help people to live healthier lives”.

Salford first city in GB to – wipe out diptheria, – one of the first to use mass X Rays to tackle TB– put the Clean Air act into use.– led the country in helping people with mental health issues to live in the

community rather than institutions.– life expectancy was 66 years for men / 70 years for women (78 & 80)– main causes of death: heart disease and cancer– infant mortality fell from 61 to 42 per 1000 live births (1947-48) today’s

rate 5.5/1000

160 years of Salford Public Health

So what is Public Health?• Focus on the health and wellbeing of a society and most effective

means of protecting and improving it.

• http://www.youtube.com/watch?v=oy1CAMObRzc

• Preventing illness / disease and promoting health and wellbeing.

• Addresses inequalities, injustices and denials of human rights

• Works through partnerships that cut across professional and organisational boundaries

• Relies on evidence, judgment and skills and promotes the participation of the populations

Main areas of responsibility• Health Improvement

- Commissioning for Public Health

• Health Intelligence – Advice to CCG on population “Healthcare Public Health”

• Health Protection– Prevention– Preparedness

Local Authority Public Health commissioning responsibilities

• Tobacco control and smoking cessation• Alcohol and drug misuse• Seasonal mortality excess deaths • National Child Measurement Programme*• Local nutrition initiatives• Increasing physical activity• NHS Health Check assessments*• Public mental health services• Dental public health services• Accidental injury prevention• Population level interventions to prevent

birth defects• Behavioural and lifestyle campaigns to

prevent cancer and long term conditions• Workplace health

• Review and challenge of screening, immunisation

• Sexual health services* (outside of GP contract and HIV)

• Public health services for children and young people 5-19 (and by 2015 public health services for children and young people)

• Health protection incidents, outbreaks and emergencies*, impacts of environmental risks

• Public health aspects of community safety, violence prevention, and response, social exclusion

Source: Public health in Local Government Commissioning Responsibilities Factsheet 2012

Some Headlines: Salford Residents Die Earlier

Source: Health and Social Care Information Centre (HSCIC)https://indicators.ic.nhs.uk/webview/ (accessed 01/08/14)

70

72

74

76

78

80

82

84

1991-93 1993-95 1995-97 1997-99 1999-01 2001-03 2003-05 2005-07 2007-09 2009-11

Life

Exp

ecta

ncy

(yea

rs)

Female Life Expectancy at birth, Salford, 1991/93 to 2010/12England Salford

70

72

74

76

78

80

82

84

1991-93 1993-95 1995-97 1997-99 1999-01 2001-03 2003-05 2005-07 2007-09 2009-11

Life

Exp

ecta

ncy

(yea

rs)

Male Life Expectancy at birth, Salford, 1991/93 to 2010/12

England Salford

Reasons for Life Expectancy Gaps

Salford residents face health challengesSignificantly Better Than England Average

Significantly Worse Than the England Average

Recorded Diabetes DeprivationExcess winter deaths (3 years) Children in poverty Killed/seriously injured on roads Statutory homelessness

GCSE achieved Long term unemployment Smoking at time of delivery Starting breast feeding Obese Children (Year 6) Alcohol-specific hospital stays u18 Under 18 conceptions Adults smoking Physically active adults Hospital stays for self-harmHospital stays, alcohol related harm Drug misuse Acute STIs Hip Fractures Life expectancy – male Life expectancy – female Smoking related deaths Mortality rate CVD Mortality rate cancer

.

Salford has significant deprivation

The poorest areas have worst health

• The number of bars and takeaways along the main routes and in town centres serving less deprived populations such as Worsley, Claremont and Cadishead is far less

1993-1995

Males Females© Crown copyright and database rights 2012 Ordnance Survey

100020290Adult obesity: BMI ≥ 30kg/m2

2008-2010

Males Females© Crown copyright and database rights 2012 Ordnance Survey

100020290Adult obesity: BMI ≥ 30kg/m2

What this means for Salford ChildrenIn 2012:

Approximately 250 4-5 year olds are obese

Approximately 500 10-11 year olds are obese

Nearly 13,000 children under the age of 16 are an unhealthy weight

Data from Salford child weight measurement programme

The impact of obesity on children• Type 2 diabetes strongly associated with obesity

- obese women 12 times more likely to develop type 2 diabetes• Type 2 diabetes (disease of adults) is now seen in obese schoolchildren

- likely to develop heart disease at age 30 - 40• Research estimates diabetes will occur in 1 in 3 children born in 2000• Mental health impact

- children experience stigmatisation, discrimination and prejudice

- obesity linked to low self-image, low self confidence and depression in children

- in one study in USA obese children rated their quality of life as low as those of

young cancer patients on chemotherapy

Ultimately, obesity reduces life expectancy by up to 11 years

Source: Dahlgren and Whitehead (1991)

Examples of Local Health Improvement Commissioning

• City Council Health Improvement Service delivering: Stop Smoking Support and Family Weight Management Programme

• Community Leisure Trust: Active Lifestyles, cardiac and pulmonary rehabilitation

• Salford Schools Sports Partnership

• Way2Wellbeing portal• Community Asset Network

• Being Well Salford: Wellbeing Coaches

• Healthy Living Centres• Health Trainer Service• Healthy Communities

Collaborative: Be clear on cancer campaigns

• Drug and Alcohol recovery Service

• Sexual Health promotion services

Tackling Inequalities• Joint Health and Wellbeing Board and Strategy• Targeted and collaborative commissioning•Community assets and the vital role of VCSE•Integrated Care Programmes•Salford’s National Health Inequality Tool•National Demonstrator site for Preventing Diabetes•Policy and Licensing opportunities•GM Devolution