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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 2 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. 3 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. 4 Determinants of Health 5 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 6 Public health and healthcare success stories Data Source: Mortality in England and Wales Average Life Span, December 2012 7 A tale of two populations- 26th Sept 2013 Data Source HSE 2011 Volume 1 HSCI 8 Presentation title - edit in Header and Footer Greatest reduction in CVD Data source Avoidable Mortality in England and wales 2011 ONS may2013 9 Presentation title - edit in Header and Footer Public health working with healthcare professionals- reducing stillbirths. 10 Unfinished business- inequalities Data source: ONS Inequalities in LE and DFLE , 2001-2004 to 20072010 11 Presentation title - edit in Header and Footer 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 12 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 16 Strategic Review …leading to the major killers. Top causes of under 75 mortality – 2010 0 5 10 15 20 25 30 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 17 Raised blood pressure accounts for 50% of all heart disease Causes of long term disability 18 http://www.wmpho.org.uk/olderpeopleatlas/Atlas/atlas.html 19 What is Public Health? Facts and figures Older people focus How is PH organised? How to get involved and work on Dementia 20 Public Health England “Public Health England exists to serve the system, a system led locally by elected members” 21 Presentation title - edit in Header and Footer 22 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 23 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 24 What is Public Health? Facts and figures Older people focus How is PH organised? How to get involved? 25 26 http://www.makingeverycontactcount.co.uk/ Cross-government narrative on health Political 27 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 28 Presentation title - edit in Header and Footer 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 : 31