March 2016 PUBLIC HEALTH

 Understanding and awareness of:  theoretical principles underpinning public health  importance of public health interventions in supply and demand  evaluation of role of public health in prevention of substance misuse  the legislative framework governing drugs classification, legislation and licensing  the role of clinicians in public health  the role of health professionals in advising policy makers  politicisation of drugs and alcohol  the role of media in public health messages

 Lobbying for changes in legislation governing control of supply and demand  Interventions to tackle causes of inequalities and risk factors  Community based interventions eg risk minimisation eg crime and public disorder, control of blood borne viruses (BBV)  Health promotion  Social marketing  Understanding of cultural context of addiction so as to offer user-friendly services

 Drug misuse cost NHS £488m  2.8 million adults used illicit drugs  Drugs cost to Society £15.4bn per annum  Smoking cost to Society estimated at 12.9bn (England), cost to NHS in treating diseases caused by smoking £2bn a year  Estimated 9.4 million UK adult cigarette smokers  About nine-million adults drink at levels that pose some risk to their health with 2.2 million drinking at higher-risk of harm.  The total annual cost to society of alcohol-related harm is estimated to be £21bn. The NHS incurs £3.5bn a year in costs related to alcohol

 Prevent disease, promote health, and prolong life  Aims to focus on populations not individual conditions or diseases  Focus on total system  3 main public health functions are:  Assessment and monitoring of health of communities at risk to identify health problems  Formulation of public health policies to solve local and national health problems  Assure access to appropriate cost effective health care

 Protecting the safety and improving health of communities through education, policy making and research for disease and injury prevention  Application of many disciplines: biology, anthropology, public policy, mathematics, engineering, education, psychology, computer science, sociology, medicine, business  Roles include laboratory or field research, statistics, work directly with people, international reach, address or influence health of communities

 Art and science of promoting and protecting health and well being, preventing health and prolonging life through organised efforts of society  Population based  Emphasis on collective responsibility for health, its protection and prevention  Recognises key role of the state, linked to socioeconomic and other determinants of health and disease  Emphasis on partnerships with all those who contribute to the health of the population

 Surveillance & assessment of population’s health and well being  Assess evidence of effectiveness of health & healthcare interventions  Policy and strategy development and implementation  Strategic leadership and collaborative working  Health improvement  Health protection  Health and social service quality  Academic public health  Public health intelligence

 Monitor health status of a community to identify potential problems  Diagnose and investigate health problems/hazards in the community  Inform, educate, empower people about health issues  Mobilise community partnerships to identify and solve health issues  Develop policies and plans that support individual and community health efforts  Enforce laws and regulations to protect health and ensure safety

 Link people to personal health services and ensure health provision  Ensure a competent public health and personal health care workforce  Evaluate effectiveness, accessibility, and quality of personal and population based health services  Research new insights and innovative solutions to health problems

 Giving all children a health start in life  Creating a lasting legacy from the 2012 Olympic and Paralympic Games  Reducing drug misuse and dependence  Reducing smoking  Reducing harmful drinking  Reducing obesity and improving diet  Helping more people survive cancer  Planning for health emergencies

 Effectiveness intervention: Reducing the incidence of hepatitis and HIV/AIDS: introduction of needle and syringe schemes was a response to the rise of BBV to reduce incidence of sharing and re- using injecting equipment  Evidence not accepted by policy makers: minimum pricing and alcohol advertising: minimum pricing and ending sports sponsorship is favoured by public health groups since price is linked to consumption and advertising influencing children and young people  A new intervention sparks debate: although e cigarettes helps the majority of smokers quit completely, but there is controversy as to whether it will initiate novice smokers into tobacco use

 Public health interventions are proactive and reactive  Proactive policies aim to reduce substance misuse related harm prior to initiation eg limit supply by classifying a new substance  Reactive policies respond quickly to ‘epidemics’ of substance use eg educational campaigns provide early advice eg needle exchange  Harm reduction by minimising harms associated with substance use  Public health interventions can improve health outcomes & save money  Improvement in education/employment and reduce deprivation

 Media and advertising promoting alcohol use  Health and social care practitioners insufficiently trained to address public health issues  Evidence policies not always accepted by policy makers and not widely disseminated  Developing partnership across a range of agencies eg health, social and criminal justice agencies, service users and carers  Social marketing for communication of messages NOT SURE IF THIS IS A CHALLENGE OR SHOULD GO SOMEWHERE ELSE

 Societal: alcohol licensing laws, taxation, legal age for alcohol consumption, alcohol control zones, driving legislation  Community: Risk minimisation through education/ prevention eg ‘know your limits’  Individual: Screening and brief interventions or referral to primary or secondary care

 Societal: tobacco licensing laws, taxation, legal age for consumption and enforcement, smoking in public places bans  Individual: Risk minimisation and smoking cessation services  Population: Education/prevention of educational campaigns, health messages on cigarette packers, charity educational campaigns

 Societal: Misuse of Drugs Act, Drugs Classification, Drug Strategy, International narcotics control, Regulation of Medicines  Risk minimisation: Needle exchange, maintenance opiate treatment to reduce crime, health harms, impact on families  Education/prevention: Internet and telephone advice services, drop in centres, advice in eg nightclubs, education in schools and youth services

 Better evidence for effectiveness of smoking interventions: taxation, mass media campaigns  Alcohol: taxation, drink driving, advertising  Drugs: risk minimisation beneficial in terms of reducing spread of BBV  Awareness of the need for international responses that harmonise

 Action on Smoking (2015) ASH Facts at a glance – smoking statistics  Action on Smoking (2014) Secondhand Smoke the impact on children  Atusingwize E, Lewis S, Langley T (2014)Review: Economic evaluations of tobacco control mass media campaigns: a systematic review Tob Control 2015;24:  Bala, M., Strzeszynski, L., and Cahill, K. (2008) Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev, CD  Campbell, R., Starkey, F., Holliday, J. et al. (2008) An informal school based peer-led intervention for smoking prevention in adolescence (ASSIST): a cluster randomised trial. Lancet, 371:  Dahlgren,G., and Whitehead M ( 2006) European strategies for tackling social inequities in health: Levelling up Part 2. World Health Organisation.  Dawkins, L., Turner, J., Roberts, A. and Soar, K. (2013), ‘Vaping’ profiles and preferences: an online survey of electronic cigarette users. Addiction, 108: 1115–1125. doi: /add.12150

 Home Office (2015) Drug Misuse: Findings from the 2014/15 Crime Survey for England and Wales pdf  Lefebvre, C., and Flora, J. A. (1998). “Social Marketing and Public Health Intervention.” Health Education Quarterly 15(3):299–315.  Marmot review (2011) Fair Society Health Lives. society-healthy-lives-the-marmot-reviewhttp:// society-healthy-lives-the-marmot-review  McKeganey, N. & Russell C (2015) Tobacco plain packaging: Evidence based policy or public health advocacy? International Journal of Drug Policy, 26 (6) doi: /j.drugpo Tobacco plain packaging: Evidence based policy or public health advocacy?  NICE (2010) Alcohol-use disorders - preventing harmful drinking (NICE public health guideline, PH24) disorders - preventing harmful drinking  West R et al (2015) Health-care interventions to promote and assist tobacco cessation: a review of efficacy, effectiveness and affordability for use in national guideline development. Addiction,110, 