The health inequalities challenge for Wales www.cymru.gov.uk Dr Tony Jewell Chief Medical Officer for Wales Public Health Conference Swalec Stadium 21st September 2011

I will cover... Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Chief Medical Officer for Wales Annual Report 2010 Challenges Inequalities Fairer Health Outcomes for All www.cymru.gov.uk

Chief Medical Officer’s Annual Report Chief Medical Officer for Wales Annual Report 2010 Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Chief Medical Officer’s Annual Report Life expectancy at birth Male life expectancy at birth, 1992 - 2008 Source: WHO, Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Chief Medical Officer’s Annual Report Infant and neonatal mortality 1949-2009 Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Chief Medical Officer’s Annual Report Deaths by gender Deaths by gender, 1971-2009 Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Health in Wales Leading causes of death in Wales, 1971-2009 Source: Statistical Directorate, Welsh Government www.cymru.gov.uk

Chief Medical Officer’s Annual Report Deaths from liver disease and cirrhosis Source: eHealthshow, NWIS Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Challenges

Getting healthier...but? Female life expectancy at birth by deprivation quintile Source: Statistical Directorate. Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Teenage conceptions Teenage Conceptions 15-17 years, 2007-2009 Source: Office for National Statistics www.cymru.gov.uk

Chief Medical Officer’s Annual Report Teenage conceptions Teenage conceptions trends Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Non evidence-based behaviours Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk ©Maciej Dakowicz

The rise of chronic conditions Prevalence of non-communicable diseases (2009-2010) Source: NHS Wales Quality Outcome Framework Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

A healthy retirement? Life expectancy and income deprivation (1999-2003) Source: Office for National Statistics Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Inequalities

Growing gaps Source: Public Health Wales Observatory Spatial inequalities Proportion of adult population obese by BMI, 2009-2010 Source: Welsh Health Survey Growing gaps Source: Public Health Wales Observatory Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Growing gaps Source: Public Health Wales Observatory Growing gaps Comparison of life expectancy, healthy life expectancy and disability-free life expectancy in Wales 2001-2005 and 2005-2009 Source: Public Health Wales Observatory Growing gaps Source: Public Health Wales Observatory Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Males www.cymru.gov.uk SII = Slope Index of Inequality, a measure reflecting socioeconomic dimension to inequalities in health., For more information see A Leyland (2007) Measuring socio-economic inequalities in health, Scotpho (Glasgow)

Male life expectancy Male life expectancy at birth by deprivation quintile, 2007-9 Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Female life expectancy Female life expectancy at birth by deprivation quintile, 2007-9 Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Infant mortality rate Deaths within the first years of life Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Male deaths from heart disease Premature (under 65) male deaths from circulatory disease, 2009 Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Reversal in pattern Adults daily drinking above guidelines Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Smoking Adults who are smokers Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Twice as many die from smoking across gradient Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Twice as many die from smoking across gradient

More than description Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Epidemiologists are good at describing these gradients, and governments are good at ‘being concerned’ about them, because of their consequences for public health. However, each of the inequalities tends to be treated piecemeal, as if they were unrelated to all of the others, and they are generally conceptualised as the consequence of ignorance or error. Nettle, D. (2009). Social class through the evolutionary lens. The Psychologist 22: 934-7 www.cymru.gov.uk

Heard it before? Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Fairer Health Outcomes for All Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Fairer Health Outcomes for All

Our Healthy Future Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

10 Priorities Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Reducing inequities in health Stopping the growing harm from alcohol and drugs Improving people’s mental well-being Reducing the number of teenage pregnancies Improving health in the workplace Reducing the level of smoking Reducing the number of accidents and injuries Increasing physical activity Increasing immunisation rates Reducing unhealthy eating www.cymru.gov.uk

Fairer Health Outcomes for All Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Building health into all policies and all policies into health Giving every child a healthy start Developing health assets in communities Improving health literacy Making health and social services more equitable Improving health at work Strengthening the evidence base. www.cymru.gov.uk

Whole of government approach Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

10 Priorities Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

The 4 E’s Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization

Turning evidence to action: Hypertension interventions Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Turning evidence to action: Road safety interventions Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Improving and reducing inequities Child pedestrian injuries from motor vehicle accidents by deprivation quintile Source: Statistical Directorate, Welsh Government Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Chief Medical Officer’s Annual Report Variation in primary care Percentage of patients with Chronic Obstructive Pulmonary Disease with a record of a breath test (FeV1) recorded in the previous 15 months Source: Primary Care Information Set 2010 Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Data and oratory Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Using his forceful oratory skills and sound data, and recognizing the need to deal with the social and political dimensions of...[health]. Obituary of Jonathan Mann – International expert in AIDS research and management Peter Piot & Daniel Tarantola, Bulletin of the World Health Organization, 1998, 76 (5): iii-v www.cymru.gov.uk

Developing health assets in communities Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Nye J, Kamarck EC (2002). Governance.com: democracy in the information age.Brookings Institute Press. (Washington)

Communities First and Flying Start Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Innovation: Learning from others Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

International approaches to reducing inequality Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization England – inequalities target for infant mortality Gemany – Law 20 on prevention Veneto (Italy) – High Council for immigration Ireland – Building healthy communities programme Tuscany (Italy) – Community Healthy Partnerships Netherlands - a health for all approach to public health Scotland – Whole system approach to health inequalities Norway – national strategy to reduce social inequalities in health Pomurje (Slovenia) – Programme MURA, Investment in health Poland – improving equity of access to healthcare Sweden – public health policy www.cymru.gov.uk S Simpson et al (2010) Putting our own house in order: examples of health system action on socially determined health inequalities. WHO (Venice)

Chief Medical Officer’s Annual Report Reducing smoking 15/16 year olds smoking weekly Source: Health behaviour in school-aged children, 2011 Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Short, mid and long term programmes and outcomes Phased results Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Immunisation Contraception A www.cymru.gov.uk Alcohol programmes Cardiovascular B C Education Health at work 2011 2016 2021 2026

Getting from A to B Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Chief Medical Officer’s Annual Report Global inequality Estimated life expectancy at birth, 2009 Source: Global Health Observatory, WHO Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk

Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Vision without action achieves nothing. Action without vision just passes time. Vision with action can change the world Nelson Mandela

Diolch yn fawr Thank you very much Tony.jewell@wales.gsi.gov.uk http://wales.gov.uk/topics/health/ocmo/?lang=en http://wales.gov.uk/topics/health/ocmo/?lang=cy