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"Practical Public Health for the
Geriatrician".
Paul Johnstone
PHE
Regional Director North of England
1
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 socioeconomic 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, Employment
Family/community
Lifestyles
Surveillance and monitoring of specific diseases and risk factors
Improving services
Clinical effectiveness, Efficiency
Service planning
Audit and evaluation, Clinical governance
Equity
Health Protection
Infectious diseases
Chemicals and poisons, Radiation
Emergency response
Environmental health hazards
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Public health and healthcare success stories
Data Source: Mortality in England and Wales Average Life Span, December 2012
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A tale of two populations- 26th Sept 2013
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
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Public health working with healthcare
professionals- reducing stillbirths.
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Unfinished business- inequalities
Data source: ONS Inequalities in LE
and DFLE , 2001-2004 to 20072010
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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
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
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Years of disability and dependency
Figure 4: Variation in estimated years of male disability and poor health at birth in Yorkshire and the
Humber (based on 2001 Census data)
Life expectancy
Healthy life expectancy
Diability free life expectancy
Ryedale
Harrogate
Barnsley
0
10
20
30
40
50
60
70
80
90
Age in years
Figure 5: Variation in estimated years of female disability and poor health at birth in Yorkshire and the
Humber (based on 2001 Census data)
Source: ONS 2007
Life expectancy
Healthy life expectancy
Disability free life expectancy
Ryedale
Harrogate
Barnsley
0
Source: ONS 2007
10
20
30
40
50
Age in years
60
70
80
90
Unfinished business- obesity
Morbidly obese
2009
83,000
Morbidly obese
2015
96,000
Obese
Healthy
weight
1.65 m
Obese
930,000
Over-weight
1.45 m
930,000
Healthy
weight
870,000
Over-weight
1.48 m
Obese
1.45
m
Unfinished Business- primary care prevention
Unfinished business- primary care
Immediate causes of disease burden
Ed AM, Monika
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Strategic Review
…leading to the major killers.
Top causes of under 75 mortality – 2010
0
5
10
15
20
25
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Ischaemic heart disease
Lung cancer
Stroke
COPD
Colorectal cancer
Breast cancer
Cirrhosis
Around 86% of
lung cancer deaths
in the UK are
caused by tobacco
smoking
Lower Respiratory Infection
Pacreatic cancer
other cardio
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Raised blood
pressure accounts
for 50% of all heart
disease
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
“Public Health England
exists to serve the system, a
system led locally by
elected members”
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PHE’s National Priorities
REDUCING PREVENTABLE DEATHS
Helping people to live longer by reducing preventable deaths from
conditions 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 HEALTH
Protecting 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 START
Supporting 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 WORKPLACE
Helping employers to facilitate and encourage their staff to make healthy choices
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PHE’s local presence
– 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
Nonstatutory
providers*
People and communities
NHS
providers
Health and wellbeing boards
PHE
centre
Public health advice
Local government
•
•
•
•
•
CCGs
NHSE
area team
EPPR
Screening and immunisation
Offender public health programmes
Specialised commissioning
Primary care public health programmes and
population healthcare
*Including voluntary and community sector
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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 health
Political
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Strategic Review
Spending power cut per dwelling 2010/11 to 2015/16
London
North
East
North
West
-544
-467
-417
Yorkshire
and the
West
East
East of
Humber Midlands Midlands England
South
West
South
East
-146
-105
£0
-357
-339
-238
-146
-£100
-£200
-£300
England
-£400
-£500
-£600
Source: Association for North East Councils: Response to DCLG’s consultation on the
provisional local government finance settlement 2014/15 Annex A
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Dementia
National Executive Meeting 18 February 2014
Why is dementia an area of focus?
•
•
•
Dementia is the 3rd leading cause of disability for the over 70s, and the 10th 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
Health Impact
•
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
•
Dementia Friends Movement in Partnership
with Alzheimer's Society in 2014/15
:
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