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www.hertsdirect.org
Jim McManusDirector of Public Health
Public HealthBuilding a culture, delivering change
Elected Member
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This presentation
• What does public health do?• What does it look like in Hertfordshire?• What are key public health concepts?• What early thinking is happening?
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Big Public Health challenges in Hertfordshire
• Health Inequalities – least affluent die 7 years earlier than most affluent
• Avoidable non-communicable disease– Tobacco, alcohol, inactivity, obesity, poor diet
• Obesity in children• Mental health• Healthy ageing• Sexual Health including late HIV diagnosis• Drug and alcohol use• Health problems accumulating across the lifecourse
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Four key points to remember while the new systems embed
• Unique role of local authorities able to work on 80% of determinants of health
• The importance of a lifecourse approach
• The new strategic role of local government
• Proportionate Universalism….Eh???
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The Domains of Public Health
Health Improvement
Health Protection
Service Quality
Then & Now
Sanitation
Housing
NowEnvironment
Then & Now
Smoking
Heart Disease
NowCare which keepsPeople healthy andindependent
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From 1st April 2013: Public Health in Local Government
• Local Authorities responsible for most of the public health worker formerly in the NHS
• Some bits have gone to Public Health England, some to NHS England (Immunisation, Screening, Health Visitors)
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The New World 1
• DPH recruited and team in Local Govt (early – Sept 2012) with duties across the system
• District Councils still retain their 1984 Act duties• HCC appoints portfolio holder for Public Health &
Localism (other LA’s looking very closely!)• Financial austerity climate• Skills gaps and skills needs• Creating a whole new system, where some of the
guidance doesn’t work• Public Health England
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The New World 2 – the law and the Herts structure
• Director of Public Health– Commissions mandated services– Commissions other services– Statutory duty to advise NHS CCGs– Duty to assure on health protection– Range of other stuff
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Health protection Information &Intelligence
Commissioning
Strategy, Partnerships
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What do we do?• School nurses• Sexual health• Chlamydia• Tobacco• Drugs and alcohol• Health checks• Obesity• Weight management• Contraception• Health promotion
• Infection control• Child weight measurement• Advising NHS on priorities,
funding, commissioning• Individual Funding Requests• Prior approval• Health protection• Information and intelligence• Evidence for interventions• Suicide and self harm
2014 – new medical examiner system2015 – health visitors
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Organisation
• Senior team of consultants and registered specialists in public health
• Programmes team – tobacco control, obesity, alcohol etc
• Provider team – smoking cessation and chlamydia screening
• HBS host the health promotion logistics team• Falls Team – now passed to Ambulance Service
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New World 3 – the opportunity for the system
• Strong political leadership on public health• Strong robust officer cohort across County and
Districts with skills and knowledge appropriate to them
• Strong relationship with NHS colleagues• Strong voluntary and community sector• Distributed Leadership
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New World 4 -The Opportunity for Herts People
• 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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Public Health
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The Public Health Family 2013
Environmental Health& Regulatory Services NHS
Police, Community Safety Third Sector and
Community Bodies
Public Health England
Specialist Public Health Agencies with Major Public Health Roles
HCC Public Health
County Council including
Fire
District Councils
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Contributors to overall health outcomes and why elected councillors are important leaders
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.
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A Hertfordshire Approach
• Lifecourse Heath: conception to death– Lifestyle and preventable disease
• Adopt the best evidence• Proportionate Universalism• Work across all tiers of local government• Strong Member Leadership with strong officer
expertise
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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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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 EventsAcute Bronchitis Admissions
RespiratoryMental Health overcrowding educational attainment
Life Expectancy
Healthier space use Changing culture of activity
Life ExpectancyMental Health
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The Game Plan..making sense of all this
• 2013-14– Get established, get contracts ready, internal
systems and culture right– Get our strategy together
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The public health mindset in local government 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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New Hertfordshire Mechanisms • Health and Wellbeing Board – still bedding in• Public Health & Localism Panel – a major opportunity• The Public Health Board –Officer sub Board of Health
and Wellbeing Board and Joint Herts CEOs Forum• The Public Health Partnerships Fund...funding from
the Director of Public Health for district councils to work with local communities on health issues
• WILL BE WORKING ON SKILLS
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Some things to look out for in the next 9 months
• For Members– A Leaders’ and CEOs
Summit on Public Health
– A conference on public health specifically for elected members across all tiers
• For Officers– A toolkit and common
approach to public health
– Skills development– A conference
For everyone: the Herts Public Health Conference 2013
