The Health of our Population Doug Robertson Clinical Champion for Prevention

Our people die too soon, too often These six diagnoses explain more than half of excess years of life lost Mortality data for the SWBCCG population compared to UK means in 2006-10

Why is this? Deprivations scores in bottom 10 in UK 25% of people smoke 20% drink at high risk 25% of men & women are obese 70% don’t eat 5 fruit/vegetables a day 65% do not meet physical activity levels

Do these habits matter? Four Health Behaviours: Non smoker Survival in 20,244 healthy adults aged 40-79 by health behaviours Khaw et al. PLoS Med 2008 Jan 8: 5 (1): e12 EPIC-Norfolk Population study 4 3 2 1 Number of prudent health behaviours -2 0 2 4 6 8 10 12 100 90 80 70 Year of study % still alive Four Health Behaviours: Non smoker Alcohol <14 units/wk Not sedentary Blood vitamin C >50 mmol/l (>5 servings fruit & vegetables daily). Overall impact: 14 year difference in life expectancy.

A large, preventable, excess of death CMO England report Nov 2012 : top 10 public health concerns illicit drug use low fruit and vegetable occupational risks poor sexual health tobacco use harmful alcohol use high blood pressure high cholesterol overweight and obesity physical inactivity

NHS spends only 2% on prevention

SWBH potential for prevention We have hundreds of thousands of contacts per year We see patients who are at high risk & often with high motivation to change behaviour We are a large local employer: impact on community We can contribute to local health improvement

Use our main resource: our staff Make Every Contact Count (MECC) An NHS programme To train all staff to give brief health advice for prevention. Covers smoking, drinking, diet and activity Makes prevention personal, nudges us to ‘walk the talk’ Will change SWBH culture

Problems start young & get worse Early Death Making sense of the prevention agenda: Health & Wellbeing Boards (Sandwell and Birmingham) Early Frailty Loss of independence Worsening Ill health Long term conditions (Diabetes, COPD, Heart failure) Heavy Users of Services Clinical Disease Increased Risk Early onset disease (lung, heart, stroke) Poor Habits Risky behaviours (smoking, diet etc.) Poor Employment Poor life chances Poor Childhood Many of our people have a poor start in life which evolve into high health risks, long term conditions, frailty & early death

Need more than just NHS healthcare Department of Health sponsored review to look at inequalities in health Conclusions: Social inequality is the biggest single cause of poor health Need to tackle causes of deprivation Reducing health inequalities is vital for the economy. Reducing health inequalities is ‘fairness and social justice’  'Fair Society Healthy Lives' (Marmot Review) 2010 

SWBH sits in a corridor of deprivation Wolverhampton Walsall Sutton Coldfield Sandwell Birmingham Dudley Solihull

Things we can do together Early death Influence the life course via social causes of health Councils: Health & Wellbeing Boards SWBH: Public Health/Community Development /Equality Board structure Partners: Primary Care, Voluntary Organisations Early Frailty Sick people Increased Ill-health Appropriate Care Clinical Disease Risky behaviours Education Interventions Increased Risk Active support for self-management Poor Habits MECC Poor Employment Secondary Prevention Poor Start Improving Social Determinants Primary Prevention

SWBH can help reduce premature deaths Making every contact count Getting people into jobs SWBH Reducing homelessness We know what works: we just need to apply it. Living well for longer: DOH 2013

Next steps: making it happen Get involved with Health & Wellbeing Board priorities Sandwell: Early life, Chronic Disease, Frail elderly, Alcohol Birmingham: Children, Vulnerable, Homeless, Obesity Promote a Trust Public Health strategy Include community and regeneration projects in it Develop a Trust-wide approach Use our skills, people and equipment better Make prevention a core part of what we do Simply, doing the right thing for our population