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Collaborating to Improve our Public’s Health

Healthier, Happier and Fairer Wales

Health ImprovementHealthcare ImprovementHealth ProtectionScreening ServicesMicrobiology ServicesPolicy advice

DEMOGRAPHIC CHALLENGES

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

OECD EU27 Japan Korea USA World Brazil China

Global Population Aged over 80 years

Source: OECD Labour Force and Demographic Database, 2010

Young Children and Older People as a Percentage of GlobalPopulation: 1950-2050

Source: United Nations. World Population Prospects: The 2010 Revision.

Increasing Ageing Population in Wales

A higher proportion of the Welsh population is 65+ compared to rest of UK

WIDER DETERMINANTS AND LIFE EXPECTANCY

22% of children in Wales live in poverty

In some areas 55-68% of children live in poverty

19.013.419.623.724.026.624.1

Wales= 22.2%Betsi Cadwaladr

PowysHywel Dda

ABMCardiff & Vale

Cwm TafAneurin Bevan

Life expectancy is related to socio-economic deprivation

THE BIG KILLERS

Circulatory disease and cancer are the biggest killers

Circulatory33% all ages25% <75 years

Neoplasms28% all ages40% <75 years

THE MAIN CAUSES

Nearly a quarter of adults still smoke

% currently smoking, 2009-2010Age-standardised percentage, persons aged 16+, Wales Health Boards

0

5

10

15

20

25

30

35

% Men 16+

Women 16+

All

Smoking Deaths

“ Smoking continues to be the greatest single cause of avoidable mortality in Wales. In people aged 35 and over, smoking causes nearly one in five of all deaths and around one third of the inequality in mortality between the most and least deprived areas.”

5,450

Nearly half of young people report drinking too much

% of persons aged 16-24 who reported drinking above the recommended guidelines on at least one day in the previous week, 2008-2011

43.046.044.946.848.245.144.9

Wales = 45.5Betsi Cadwaladr

PowysHywel Dda

ABMCardiff & Vale

Cwm TafAneurin Bevan

Alcohol is killing an estimated 1,500 per year

Produced by Public Health Wales Observatory, using ADDE, MYE (ONS), fractions (PHE)

More deaths in areas of high deprivation

Alcohol-attributable mortality rate, males, all ages, Wales, 2003-05 to 2010-12

Too few people eat a healthy diet

36

37

40

35

37

30

32

Wales = 35

Betsi Cadwaladr UHB

Powys THB

Hywel Dda HB

ABM UHB

Cardiff & Vale UHB

Cwm Taf HB

Aneurin Bevan HB

95% confidence interval

% eating five portions of fruit and vegetables the previous day, 2009-2010 Age-standardised, persons aged 16+, Wales health boards

12.5% of children aged 4-5 are obese

9.411.4

13.2 13.5 14.3

Least deprived

f ifth

Next least deprived

Middle deprived

Next most deprived

Most deprived

f ifth

Wales= 12.5%

… and more than half of adults are overweight or obese

55

56

58

58

54

62

59

Wales = 57

Betsi Cadwaladr UHB

Powys THB

Hywel Dda HB

ABM UHB

Cardiff & Vale UHB

Cwm Taf HB

Aneurin Bevan HB

95% confidence interval

% obese or overweight (BMI*>=25), 2009-2010 Age-standardised, persons aged 16+, Wales health boards

0

10

20

30

40

50

60

70

2003

/04

2004

/05

2005

/06

2007

(a)

2008

2009

2010

2011

2012

2013

% Men 16+

Women 16+

All

LIVING WITH ILLNESS

Large numbers of people live with illness

48% of adults are being treated for a chronic illness–19% for high blood pressure–14% for respiratory illness–14% for arthritis–10% for mental illness–9% for a heart condition–6% for diabetes

CANCER

Bowel cancer now has the highest incidence, but lung cancer kills

more people

Mortality is falling slowly

… but there are inequalities everywhere

Incidence Survival Mortality

EMERGENCY ADMISSIONS, INJURIES AND INFANT

MORTALITY

More inequality…

77.685.397.1107.6127.1

Wales = 101.9Least deprived

Next least deprivedMiddle

Next most deprivedMost deprived

Emergency admissions* by deprivation fifth, persons aged 0-24, Wales, EASR per 1,000, 2011

15.120.928.838.851.0

Wales = 31.7Least deprived

Next least deprivedMiddle

Next most deprivedMost deprived

Admissions for pedestrian injuries by fifth of deprivation, children aged 5-14, Wales, rate per 100,000, 2006-2010

3.83.84.14.35.6

Least deprivedNext least deprived

MiddleNext most deprived

Most deprived

y y g ( )

Wales = 4.4

Infant mortality by fifth of deprivation, Wales, rate per 1,000 births, 2006-2010

We must deliver a more preventative approach for our public’s health that has maximum impact to reduce inequalities

and keep people healthier for longer

Prudent Healthcare

‘Healthcare which is conceived, managed and delivered in a cautious, safe and wise way characterised by forethought, vigilance and careful budgeting which achieves tangible benefits and quality outcomes for patients’

Bevan Commission, 2013

Provisional Principles

1. Treating greatest clinical need first2. Do no harm – achieve measurable good3. Do the minimum appropriate intervention to achieve

the desired outcomes4. Choose the most Prudent Care, openly together with

the patient5. Consistently and appropriately apply evidence based

medicine in practice6. Co-produce health with the public, patients and

partners

HOW DO WE CHANGE DESTINY?

Keeping people healthier for longer

Shifting the equilibrium of health, wellbeing and care

New Focus for the Future

Focus on reducing absolute inequalities, primary prevention and early yearsPrudent Healthcare Building a social movement – transforming societal policy and approachWorking together for tangible changeBoundaryless approach at local levelWorking closely with partners and communitiesWell-being of Future Generations Bill

New Focus for the Future

Untapped potential for housing and public health to work togetherJoint ventures and new models of supported housing supporting people at home Opportunities to maximise capital and assetsHousing included as part of care pathways and budget planningAddress barriers/incentives to support innovation together

If we are ever in doubt about what to do, it is a good rule to ask ourselves

what we shall wish on the morrow that we had done.

John Lubbock