PPMA Annual Seminar 2014 - Public Health is everyone's business - better outcomes for...

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Population Health is everyone’s businessbetter outcomes for Communities and Workforces

Jim McManus, CPsychol, CSci, AFBPsS, FFPH, FRSPH, MCIPD, FCIEH

Director of Public Health, Hertfordshire County CouncilRepresenting the Association of Directors of Public Health

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Coverage• Public health - one year on

– From closing brothels to changing places• Shared ownership of community outcomes• Applying public health skills across local government• Common ground between public health and people

managers for the future? • Workforce wellbeing - keeping people healthy and

resilient

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Public Health – one year on

Opportunity

•The Big epidemiological challenges ahead•PH Skillsets adding value•Mainstreaming public health work

Challenge

•workforce challenges– Leadership– Market– Person-Organisation Fit– Redesigning roles and

jobs

•Service challenges

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Crucial Situational Factors • Leadership doesn’t happen in isolation• Multiple environment and collaborative (Getha-

Taylor,2013)

The factors determining

which style you need for which Public Health

challenge

The Personality of the Leader

The issue itselfPandemic or health improvement?

Organizational Culture

Strategic andPartnership Environments

Team andOrganization

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Crucial Situational Factors • Leadership doesn’t happen in isolation• Multiple environment and collaborative (Getha-

Taylor,2013)

The factors determining

which style you need for which Public Health

challenge

The Personality of the Leader

The issue itselfPandemic or health improvement?

Organizational Culture

Strategic andPartnership Environments

Team andOrganization

www.hertsdirect.org

Crucial Situational Factors • Leadership doesn’t happen in isolation• Multiple environment and collaborative (Getha-

Taylor,2013)

The factors determining

which style you need for which Public Health

challenge

The Personality of the Leader

The issue itselfPandemic or health improvement?

Organizational Culture

Strategic andPartnership Environments

Team andOrganization

www.hertsdirect.org

What does that mean for Public Health? The variety of challenges1. The Strategic Challenge across our agency and geography2. The distributed Challenge across agencies and

stakeholders 3. The Professional challenge across domains of PH practice4. The practice challenge to remain competent and practice

well5. The protective challenge of planning and responding to

health protection incidents6. The managerial challenge of tasks and resources7. The personal challenge of resilience during this

Agile Leadership Styles!

See for example Lutz Allan et al, 2013

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Work still to do – finding the new sewage?What is high impact public health today?

• Transformation not transition• Multi-Dimensional public health

– Phasing across the lifecourse– Layering across the real world

• Colonising local government• Using PH as a babel fish • New applications for public health

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The Challenges

• Misery and Pain due to avoidable disease and poor resilience/happiness

• What kills most people early is diseases of lifestyle

• Seeing the wood for the trees in the midst of clinical detail

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The Challenges – Living in a System

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The challenges - busting the economy

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The Challenges - the Lifecourse

• Phasing across the lifecourse and layering across time Working age

AccumulationOf risk inLate workingage

Good early Years outcomesFor lifetimeMental health

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Core Public Health Skill Sets – ppma can help unlock this

• The population mindset • Problem Definition• Needs Assessment • Evidence of What Works• Generation of Outcomes and Priorities• Generation of Interventions• Testing and refining

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Health Improvement

Health Protection

Commissioning priorities, Evidence, acting when evidence is silent, making it work, supporting implementation

Protecting people from threats and hazards

Long term, medium term, short term impacts

Take any example and use the three domains model

Service Improvement& Quality

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Applications

• Housing• Leisure• Social Care• Workforce • Behaviour Change – from driving behaviour to

council tax payments and channel shift

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Health Improvement

Health Protection

Commissioning priorities, Evidence, acting when evidence is silent, making it work, supporting implementation

Protecting the workforce from hazards and threats

Long term, medium term, short term impacts

Applications in H R Terms – Phasing and Layering

Service Quality/Improvement

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Common ground – our workforce health

• Increasing non-communicable disease– Smoking, obesity

• Increasing mental ill health• Increasing sickness absence• Increasing loss to business productivity and

performance from sick pay• Avoidable cost of managing and replacing sick

and absent staff

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Early and avoidable deaths• Most of them preventable• Problems start in working age life with sickness absence• Common causes: inactivity, MSK problems, diet,

alcohol, smoking• Significant avoidable stress and mental health costs• The human side of resource depreciation because it isn’t

looked after• WE REALLY MUST DO SOMETHING! BUT WHAT?

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Mental Health• Biggest single cause of sickness absence• Mostly avoidable or remediable at early stages• Significant cause of ET claims and workplace

disputes• Area most employers feel least prepared for• 1 in 4 of population have in lifetime• 1 in 3 of workforce report sickness absence around it• Behavioural sciences relatively under-utilised

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What is the root issue?

• There is a flow from low risk to high risk to disease for the working age population

• This leads to:• Diseases of lifestyle• More risk, more absence• Compound risk, compound absence• Low productivity

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What does this mean for you as employers?• Chronic disease related deaths account for 56% of all deaths in the

working-age population in the world (World Health Organization).

• High prevalence of major modifiable health risks contributes to the epidemic of chronic disease.

– Elevated BMI (BMI ≥25kg/m2) Obesity (BMI ≥ 30 kg/m2)– Inactivity Smoking– Stress Elevated blood pressure– Elevated cholesterol High blood sugar– Alcohol

• Places an increasing burden on employers: decreased productivity, increased absenteeism, increased health and worker’s compensation claims.

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Productivity Decreases with Number of Health Risks

Excess

Productivity LossProductivity Loss (%)

Base Cost

Number of Health Risks

(Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))

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Absenteeism Increases with Number of Health Risks

Number of Health Risks

(Journal of Occupational and Environmental Medicine 2005;47:769-77 (n = 28,375))

Base work loss days/yr

Excess Work Loss days/yr

work loss days/yr

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Root causesOne of the root causes of unsustainable increases

in costs is natural flow of individuals from

low risk → high risk →disease →higher employer costs

natural flow estimated at 2% - 4% per year. • (Edington et al, 2009).

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What can be done

• An effective Workplace Wellness strategy is to stop migration of people to higher risk and keep low risk people at low risk.

• • Employers costs go up as people age, regardless of their

health risk status and as health risk status gets worse, costs go up regardless of age.

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Three Examples

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Our Offer1. Workplace health champions (North Herts College)2. Mental Health First Aid (Bourne Leisure)3. Health Checks and Mini-MOTs (HCC)4. Physical Activity (ServiceLine)5. Weight Management6. Stop Smoking7. Alcohol and Drugs8. Active Travel

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A common Agenda1. A Healthy, resilient population is a workforce

sustainability outcome and a public health outcome2. The Psychological Contract and Happiness3. Public Health skills embedding across our

agencies can help us understand new challenges4. Public Health being effective in new world is a key

shared outcome for us

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Thank you!

Jim.McManus@hertfordshire.gov.uk

www.adph.org.uk