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A workshop for community and voluntary agencies on public health priorities for Hertfordshire and how we can build people centred public health together
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www.hertsdirect.org
People Centred Public HealthOpportunities for Community Agencies in a Strategic Shift to Prevention
Jim McManus
Director of Public Health
Sept 27th 2013
www.hertsdirect.org
What we want to get to
• Articulate what people centred public health means
• Explain the context• Explain what agencies can do• Suggest some models
www.hertsdirect.org
Healthier Herts: A Public Health Strategy for HertfordshireConsultation Draft
OUR PURPOSEto work together to improve the health and wellbeing of the people of
Hertfordshire, based on best practice and best evidence
OUR VISION:A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
Priority 5: We understand what’s needed and we do what works
Priority 6: We make public health everybody’s business and work together
HOW WE WILL WORK TOGETHER(our strategic priorities: how we do it for
our County)
ThePublicHealthOutcomesFramework(the nationalPHOF willHelp us measureOur success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION
(our strategic priorities: what we achieve for our County)
Priority 1: Our Population lives Longer, Healthier Lives
Priority 2: Our Population Starts Life Healthy and Stays Healthy
Priority 3: We narrow the gap in life expectancy and health between most and least healthy
Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental)
BuildingBlocks For the Public Health Family
Strong Leadership
Capable, Skilled People
Co-production with citizens
Effective Partnerships
Evidence and Knowledge Driven
Plan and Deliver for Localism
Whole System Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels
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1. OUR CHALLENGES
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Hertfordshire
• 1.1m People in 37 Settlements• 10 Districts• 1 County Council• 2 NHS CCGs• 8 NHS Trusts• 1400+ vol orgs• Urban/Rural mix
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Major Disease Shifts
• 1st – Poverty, Living Conditions
– Improvement in incomes, reduction in deaths
• 2nd –Communicable Diseases
– Now on average 6-11% of deaths in UK. Was 85% of deaths before 1900
• 3rd – Non-Communicable Diseases
– Over 60% of deaths due to lifestyle and behaviour
– Poorest fare worst (smoking, diabetes, heart disease)
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Learning the lessons from theNational Audit Office 2010not on course!
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Interface of PH, health inequalities & social care• NHS gone from infectious disease focus in 1948 to LTCs, cancer and
mental health in 21st century • 1 in every 7 GP appointments for LTCs*• 50% of adults with a mental health problem had a MH, behavioural or
emotional problem before the age of 14 yrs• MH biggest spend of NHS than any other health condition• Social determinants AND quality and accessibility of health & social care• Old model of health and social care – deliver to, not with…co-production,
co-creating health, shared decision-making …• Personal budgets… for social care (and health ??)• Shift from one size fits all
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The Big Strategic Challenges for Hertfordshire
Health Improvement
Health Protection
Service Quality
Imms
Vaccs
TB
HCAI
Environment
• Non Communicable Disease
• Public Mental Health
• Development
• Ageing
Health Care QualityPublic Service Outcomes
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2. THE CONTEXT
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Conceptualising wider determinants
Smoking 10%
Diet/Exercise 10%
Alcohol use 5%Poor sexual health
5%
Health Behaviours 30%
Education 10%
Employment 10%
Income 10%
Family/Social Support 5%Community Safety 5%
Socioeconomic Factors 40%
Access to care 10%
Quality of care 10%
Clinical Care 20%
Environmental Quality 5%
Built Environment 5%
Built Environment 10%
Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status
While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.
Contributors to overall health outcomes
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40 years of science/policyon wider determinants
• From Rose to Black to Marmot....
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Systems thinking on wider determinantsGetting everyone on the same systems page
The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!)
The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences)
The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)
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3. WHERE WE WANT TO GET TO
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People Centred Public Health
• Every service understands and owns a public health role
• We skill and motivate people to self-manage their health and wellbeing
• We focus on the person and co-ordinate around them
• Physical, Social, Psychological and Spiritual are all part of the dynamics of health
• Mindset of staff,volunteers, carers and users
www.hertsdirect.org
Healthier Herts: A Public Health Strategy for Hertfordshire
OUR PURPOSEto work together to improve the health and wellbeing of the people of
Hertfordshire, based on best practice and best evidence
OUR VISION:A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
Priority 5: We understand what’s needed and we do what works
Priority 6: We make public health everybody’s business and work together
HOW WE WILL WORK TOGETHER(our strategic priorities: how we do it for
our County)
ThePublicHealthOutcomesFramework(the nationalPHOF willHelp us measureOur success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION
(our strategic priorities: what we achieve for our County)
Priority 1: Our Population lives Longer, Healthier Lives
Priority 2: Our Population Starts Life Healthy and Stays Healthy
Priority 3: We narrow the gap in life expectancy and health between most and least healthy
Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental)
BuildingBlocks For the Public Health Family
Strong Leadership
Capable, Skilled People
Co-production with citizens
Effective Partnerships
Evidence and Knowledge Driven
Plan and Deliver for Localism
Whole System Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels
www.hertsdirect.org
The Opportunity for Herts
• The conditions for everyone to be healthy• The conditions for the poorest and worst off to
be healthier• Public services which put this at the core of their
business• People thriving and prosperous• Healthy workforce, prosperous County
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The Strategy Pyramid1
HWBS
Herts PHS
Local Strategies
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The Strategy Pyramid2
Mission Vision: Where we want
to get to
Strategy: How we want to get to the vision
Implementation Plans : What we need to do in each area of the business and for each topic
Individual Plans: My personal objectives and must dos
Mission:
Why ? Where/What do we want to be?
Why do we Exist ?
How we want to get there?
What we need to do!
What I need to do!
Values, what’s important to us ? {
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A Lifecourse approach
• Conception to death• Protective and vulnerability factors (e.g. obesogenic or
energy balanced environment)• Healthy outcome in one age is cumulative impact of
earlier ages• Poor outcome in one age may be risk factor for another
(low birth weight and CVD)• Early investment, early prevention (lifetime mental ill
health and under 13s)• Data, Evidence, Implementation key
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Mission
• Our mission is to work together to improve the health and wellbeing of the people of Hertfordshire, based on best practice and best evidence*
• • *Best evidence means not just effectiveness
but cost-effectiveness
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Vision
• Healthy, Happy Hertfordshire: Our vision is that everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives.
www.hertsdirect.org
Timeframes of impact/yield
Years
0 1 5 10 15
Planning
Education
Vitamin Supplements
Air Pollution
Decent Homes
Jobs
Primary Care
20
CVD Events
Self Care
Vitamin D and TBRickets
CVD Events
Acute Bronchitis Admissions
RespiratoryMental Health overcrowding educational attainment
Life Expectancy
Healthier space use Changing culture of activity
Life ExpectancyMental Health
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4. WHAT WE NEED TO DO
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What it means for public health
• Design pathways around people• Whole life approach• Whole school approach to health• Whole place approach to health• Commission preventive services which join up
with clinical services• Build protective factors
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What it means for NHS Services, for example
• Preventive services in every patient pathway• Preventive services in clinical services link up to
community services (referral for leisure and behavioural interventions)
• Making Every Contact Count• Commissioning for self-management in chronic
disease
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What it means for community agencies
• Identify need and be part of needs assessment process
• Co-design public health services with public health commissioners
• Embed public health skills across your services• Build resilience in users and communities• Motivate people to self-manage• Become health promoting in all you do
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Health Improvement
Health Protection
Commissioning priorities, Evidence, acting when evidence is silent, making it work, supporting implementation
Ensuring we have the right frameworks in place
Long term, medium term, short term impacts
Let’s assume you run a day centre.....
FALLS PREVENTION?
Service Quality andImprovement
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What Outcomes can I contribute to?
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Values - Ottawa Charter, 1986• Underpins strategic role of local government
• "The goal of a healthy public policy is health promotion, i.e., to enable people to increase control over and improve their health.
• It is also essential to
– create supportive environments,
– strengthen community action,
– develop personal skills and
– reorient health services.
All of these are areas for elected member leadership
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The public health mindset means working across different dimensions of time and responsibility
•Think through what we can do short term
•Start work on the medium term
•Set the policy framework for the long term
•Build this understanding among partners
•Get started and realise
•County, District, Parish, NHS, Business and Community Sector working together
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HERTFORDSHIRE LOCAL PUBLIC HEALTH MODEL (For Place or for People Settings)Development of a local plan for each area and agency between partners with use of existing
community networks
2. WORK ON THE COMMON RISK FACTORS FOR BIG KILLERS
Neighbourhood interventions forDiet, Physical Activity, Smoking,
Alcohol,
3a. IMPROVE LOCAL NEIGHBOURHOOD QUALITY
Physical Environment, Green Space, Crime/ASB. INCREASE SOCIAL CONTACT BETWEEN NEIGHBOURS
4. INCREASE UPTAKE OF PREVENTIVE HEALTH PROGRAMMESImmunisation, Screening, This may differ from area to area depending on
issues
1. Complete a Basic health profile – identification of health issues salient for the neighbourhood or service user group by checking the basic basic profile from JSNA or other source
5. Skilling people for their own health– develop and deliver basic personal health skills training. (Physical and mental health)
So…towards a modelexplicitly designed to be as easy as possible for non-health specialists can implement it
3b. IMPROVE SALIENT HEALTH OUTCOMESAddress issues specific to your population e.g. Coping and resilience for carers
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So
• Does this make sense?• Is it doable?• What do you think can make it better?• How do we improve?• Where do we go from here?• What can you do?• What do we need to do to helpyou?