1

www.cymru.gov.uk

Living in interesting times: Thoughts for DsPH in the 21st Century

Association of Directors of Public HealthVictory Services Club, London

13th May 2011

Dr Tony JewellChief Medical Officer for Wales

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

Living in interesting times

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

Male deaths 1848-1871 (average) and 2009

1848 - 1871 2009

Source: Office for National Statistics

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

Significant progressReports of infectious disease in England and WalesSource: Health Protection Agency

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

Heart disease is next?Selected causes of death, Wales, 1969 - 2009Source: World Health Organization

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Prevention worksMale mortality from lung cancer, 1970 - 2006 Source: World Health Organization

0

20

40

60

80

100

120

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

2000

2003

2006

Euro

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dis

ed r

ate p

er

100,0

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France

Sweden

UK

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

Encourage

Enable

Engage

Exemplify

Catalyse

High excise taxesBan marketing practices

Address smuggling

(nb. Personal incentives)

NHS 'stop smoking' treatmentSmoke-free policies

Quit-linesPharmaceutical deregulation

Social marketing campaignsMore graphic warnings

Major news media assaultConstant revisiting evidence

“Denormalisation”

Smoke-free policiesClear messages from NHS

Consistent packageClear goals

Commercial arguments

The 4 E’s

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

Improving quality

• Great progress in improving health service delivery and quality

• Still much work to do – learning from the best

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Changing times and the end of eras

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

The impact of poverty, neglect and hopelessness

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Non evidence-based behaviour

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Responses to human and natural tragedy

Source: NHS SDU

At least 15,000 people died prematurely as a result of Europe’s heat wave in 2003 in France1

1. Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments

Jean-François Dhainaut, Yann - Erick Claessens, Christine Ginsburg, and Bruno Riou.

Crit Care. 2004; 8(1): 1–2.

Published online 2003 December 4. doi: 10.1186/cc2404.

and Bhattacharya, S. (October 2003), ‘European heat wave caused 35,000 deaths’, The New Scientist. http://www.newscientist.com/article/dn4259

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

The origins of our trade

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

Fusing a new model

Biomedical model

AgeSexGenderGenetics

EducationEnvironmentCultureEmploymentLifestyle

Social Determinant model

A new approach to Public Health

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

The centrality of the DPH

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

Collegial support

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Global movements for health

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Evidence

• Evidence is vital as it can be convincing

• Doesn’t always win the argument

• Need to close the gap between policy makers and evidence through better communication

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Advocacy

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Brokerage

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

Excellence

Tobacco killsMortality from lung cancer, 1991 - 2008 Source: World Health Organization

www.cymru.gov.uk

The future

• Demonstrate daily the importance of Directors of Public Health

• Find new and different forms of communication

• Remember to have a voice

Diolch yn fawrThank you very much

Tony.jewell@wales.gsi.gov.uk http://wales.gov.uk/topics/health/ocmo/?lang=enhttp://wales.gov.uk/topics/health/ocmo/?lang=cy