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Tackling the wider determinants of health: Health Improvement Domain Andrew Jones Regional Director/ Director of Health Improvement National Policy and Direction in Wales • ‘Designed for Life’ • Commitment to deliver world class healthcare services and a clear focus on tackling health inequalities. • Public Health Strategic Framework • Key Strategic themes/priorities Strategic Management by Domain • National Director • Directors with specified responsibilities – – – – Health Improvement Health Protection Health and Social Care Quality Health Intelligence • Public Health Management Group • Public Health Executive Team • Four Domain Strategic Management Groups NPHS Direction • Business Plan : 2005-2008 – Strategic Goals and Objectives • National and Local work plans – Key tasks for delivery • Agreed with partners/stakeholders Health Improvement Domain “to improve the health and well-being of the population and reduce inequalities.” • Focus on strategic priorities and actions relating to the wider social, economic and environmental determinants of health. • Social model of health • Support national policy and local delivery Health Improvement Domain • Specialist public health advice aimed at supporting partners/stakeholders to work together to: – Address the root causes of poor health, – Promote ‘Investment for Health’ and – Reduce health inequalities. • Link to other Domains as required Domain Management Group • Chaired by Director • Senior staff specialising within the domain • Representation from Local Public Health Directors • Cross representation from other domains • Wider engagement as appropriate Moving from this Environment Public economic strategies Traffic Agriculture & food Education Sex & life together Leisure & culture Social-insurance Eating habits § Illicit drugs Social network Housing Employment ? Alcohol Tobacco Work environment Physical activity Age, sex, heredity Social support Contact children and adults Social assistance Sleep habits Health-& medical care …..to this Haglund, Svanström, KI, revision, Beth Hammarström Domain Structure • 3 Areas to address the broad range of determinants of health • Economic and Physical Environment – housing, transport, waste, economic development, corporate health standard • Influencing Behaviours – tobacco, alcohol, nutrition, physical activity, substance misuse, sexual health • Communities and Families – Focus on children e.g. child poverty, community development, schools, mental health promotion Service Delivery • Local Public Health Directors/Teams • Domain support – ‘Lead’ Consultant in Public health in each of 3 areas – Dedicated practitioner support in each of 3 areas – Defined services – smoking cessation/ workplace health – Use of ‘Advisory’ roles using expertise from LPHTs – Task and Finish Teams/ Networks – Key links to partners e.g. Wales Centre for Health, Local Government Specific Managed Programmes • All Wales Smoking Cessation Service – National public health programme – Community focus – Pre –operative service ( NHS performance target) – Targeted services (maternity, mental health, manual workers) • Corporate Health Standard Some challenges • Task and Finish groups to address: • Economic and Physical Environment – Welsh Backs project – Injury Prevention – Climate change/Sustainable Development Influencing Behaviours – Obesity – Tobacco – Alcohol misuse/Prevention Programmes • Communities and Families – Child Poverty – CEHAPE (Children’s Health Action Plan - European) Economic and Physical Environment Priorities • Health at Work • Economic inactivity • Economic and physical regeneration (spatial plans) • Sustainable Development - climate change, heat wave plan, KWTW • Housing and built environment • Injuries Influencing Behaviours Priorities • Prevention and early intervention – link to chronic disease care pathways • Tobacco – Cessation – Prevention – ASSIST ( and more e.g. social marketing) – Environment ( Tobacco ban in public places) • Obesity – nutrition and physical activity • Alcohol misuse – comprehensive public health programme Communities and Families • Child Poverty • Children and Young People partnerships • Healthy Schools • Settings – next year Prison health Working with Stakeholders • • • • • Welsh Assembly Government Local Health Boards Local Government Wales Centre for Health National partners e.g. Health Protection Agency, Environment Agency • Independent and voluntary sector Research and Development • Link to academic public health • Promote research and evaluation • Contribute to development of public health evidence base • Share best practice Wales and beyond • Work within UK ( other devolved administrations Scotland, Ireland etc) • Europe – Children’s Environmental Health Action Plan (CEHAPE) • International Public Health Added Value • How can we best work together across NPHS to deliver a world class specialist advice service to promote health improvement and address health inequality?