Our Lives, Our Health Health and Wellbeing Strategy 2018-2023

The Health of Derbyshire The population of 785,760 is expected to increase by 10% over the next 20 years Average life expectancy at birth = 79.1 for men 82.8 for women Healthy life expectancy = 63.9 for men 63.5 for women Big variation in healthy life expectancy between least and most deprived communities = 13.7 for men 13.5 for women The population is older on average, than England. Average life expectancy at birth is 79.1 years for men and 82.8 years for women; significantly lower than the England average. Healthy life expectancy – how long a person is expected to live in good health – is 63.9 years for men and 63.5 years for women; significantly lower than the England average for women. There is a large difference in healthy life expectancy between men and women living in our most and least deprived communities. A man living in one of the least deprived communities can expected to live 13.7 more years in good health than a man living in one of the most deprived communities. For women the difference is 13.5 years.

The Health of Derbyshire In Derbyshire we have higher levels of a range of mental and physical health conditions than average. We are also significantly worse than average for a range of underlying determinants of health, for example: Mothers smoking at the time of delivery Adult obesity Breastfeeding at 6-8 weeks Households living in fuel poverty Teenagers achieving 5 A*-C grades (incl. English and Maths) at GCSE  In Derbyshire we have significantly higher levels of a range of mental and physical health conditions in Derbyshire. For example, in adults the prevalence of dementia, depression, diabetes, coronary heart disease and stroke are all significantly higher than the England average. Further, the rate of hospital admissions for self-harm at all ages is significantly higher than the England average, as is the hospital admission rate for alcoholic liver disease. The Population Knowledge and Intelligence Team have complied a series of Bite Size reports on health in Derbyshire and the wider determinants of health. These are available on the Derbyshire Observatory if you’d like to explore the data in more detail.

Our Lives, Our Health: Vision “To reduce health inequalities and improve health and wellbeing across all stages of life by working in partnership with our communities.” Category 1 hazard – falls?

A Population Level Approach Our Lives, Our Health focuses on the social, cultural and economic environments in which we all live, work and play; known as the ‘Social’ or ‘Wider’ Determinants of Health (see Figure). The majority – estimated between 60% and 85% - of modifiable health outcomes are due to the wider determinants of health and lifestyle. In Derbyshire this means that a substantial proportion of ill health and premature mortality could be prevented by improving living and working conditions, and making healthy choices easier.   The roots of a healthy life begin in infancy and continue through childhood and into adulthood. The Health and Wellbeing Board is in an excellent position to lead organisations in Derbyshire to address these Wider Determinants of Health, for example with initiatives that influence education, employment, housing and transport positively for health across the life course. We can also work together to influence the creation of environments in which making healthy choices is the easy choice across a range of health behaviours such as smoking, diet, and alcohol consumption. Dahlgren and Whitehead, 1991

Priorities Enable people in Derbyshire to live healthy lives Work to lower levels of air pollution Build mental health and wellbeing across the life course Support our vulnerable populations to live in well-planned and healthy homes Strengthen opportunities for good quality employment and lifelong learning Why this is a priority for Derbyshire What we want to achieve How we will achieve our ambitions? How will we know if we have been successful?

We will achieve our ambitions by: Building on our assets - supporting and enhancing existing strategic groups working across our agenda Providing systems leadership - identifying opportunities for linking across different parts of the system and facilitating working together in partnership Culture shift - engendering a culture of sharing successes and challenges and working together to remove barriers to progress Understanding what works - evaluating so that we know what is working well and what we may need to change within and across the system These priorities are ambitious and no one organisation can deliver health improvements at scale by working alone. For example the Air Quality and the Towards and Active Derbyshire Working Groups.

Measuring Success To understand our progress towards achieving key targets across the 5 priority areas we will track a number of indicators over time using a Health and Wellbeing Strategy Dashboard. A wide range of indicators will be available through the dashboard. An example for the priority ‘Work to lower levels of air pollution’ is shown here.

Impact Across the System: an example High Blood Pressure Cancer Obesity Type 2 Diabetes Type 2 Diabetes Osteoarthritis Let’s look at the kinds of impacts we would expect to see across the health and care system, as well as broader benefits (e.g. to the economy) if we turn the curve in our priority areas. If we take obesity as one example from our healthy lives priority, here are just a few of the main health impacts of obesity. We can’t look at the all here (in the time available) so let’s just focus on Type 2 diabetes. Coronary Heart Disease Stroke

Impact Across the System: an example Treatment Costs (e.g. primary care, prescriptions, screening, lifestyle interventions, etc… Economy (e.g. absenteeism, presenteeism, early retirement…) Type 2 Diabetes Diabetes Complications (e.g. MI, blindness, excess inpatient days, ulcers and amputations, stroke… Social Care (e.g. residential care, nursing care, home care…) When we look at type 2 diabetes there are a number of different impacts – there are the direct treatment costs (e.g. primary care management, medication, etc) as well as costs to the economy from, for example absenteeism and Presenteeism (not working at full productivity). There are also the costs of diabetes complications – of which there are many – including MI, blindness, amputations, ulcers, etc… as well as social care costs for example in home care. It is important to note that these are not all the impacts, but are just highlighted to give a sense of the wide range of costs associated (across the system) with type 2 diabetes.

Obesity Attributable Type 2 Diabetes in Derbyshire 41,275 people with Type 2 diabetes 24,760 cases attributable to obesity Reduce obesity by 5% by 2023= 250 fewer cases of Type 2 Diabetes each year In Derbyshire we know that just over 41k people have type 2 diabetes and over half of these are attributable to obesity. If we could reduce obesity in Derbyshire by 5% then this would mean 250 fewer new cases of diabetes in Derbyshire each year. So what impact would this have on the system?

Impact across the system: Primary Care Each person with Type 2 diabetes has on average 11 consultations per year 250 fewer cases attributable to obesity would mean: 2,750 fewer consultations £85K in Nurse and GP consultation costs for Derbyshire every year

Impact across the system: Community Prescribing £15 million spend across Derbyshire in 2017 on Drugs Used in Diabetes* 250 fewer cases attributable to obesity would mean: 5,100 fewer items prescribed £91k saved on drug costs for Derbyshire every year *BNF Chapter 6.1 including Insulin, Antidiabetic drugs, Treatment of Hypoglycaemia, Diabetic Diagnostic & Monitoring Agents)

Impact across the system: Diabetic Footcare 1 diabetes admission with ulceration for every 33 people with diabetes at a cost of £5m 58 lower limb amputations in 2017/18, 671 bed days, £450k 250 fewer cases attributable to obesity would mean: £36k saved in admission costs 1 person saved from a lower limb amputation and ongoing costs of £400 p.a. for Derbyshire every year

Impact across the system: Productivity Loss Estimated costs to UK due to Type 2 Diabetes Absenteeism = £850 million Presenteeism = £2.9 billion Average 3 days lost per person 250 fewer cases attributable to obesity would mean: 750 working days gained £405k saved in productivity costs for Derbyshire every year

Impact across the system: Total for 1 disease Based on 4 impacts only: Estimated savings of £617,000 every year for Type 2 diabetes attributable to obesity Other diseases attributable to obesity… All Cancers: 276 new cases each year Hypertension: 44,000 people currently diagnosed Acute MI: 250 admissions per year Dementia: 188 deaths per year

Key Contacts Enable people in Derbyshire to live healthy lives Physical Activity and Nutrition: Jackie Wagstaffe - Jackie.Wagstaffe@derbyshire.gov.uk Alcohol, Drugs and Tobacco: Rosalie Weetman - Rosalie.Weetman@derbyshire.gov.uk Sexual Health: Mary Hague - Mary.Hague@derbyshire.gov.uk Work to lower levels of air pollution Jane Careless - Jane.Careless@derbyshire.gov.uk Build mental health and wellbeing across the life course James Creaghan - James.Creaghan@derbyshire.gov.uk Support our vulnerable populations to live in well-planned and healthy homes Vicky Smyth - Vicky.Smyth@derbyshire.gov.uk Strengthen opportunities for good quality employment and lifelong learning

Our Lives, Our Health Available at: https://www.derbyshire.gov.uk/social-health/health-and- wellbeing/about-public-health/health-and-wellbeing- board/health-and-wellbeing-strategy/health-and- wellbeing-strategy.aspx