Tackling the wider determinants of health: Health Improvement Domain Andrew Jones Regional Director/ Director of Health Improvement

National Policy and Direction in Wales ‘Designed for Life’ Commitment to deliver world class healthcare services and a clear focus on tackling health inequalities. Public Health Strategic Framework Key Strategic themes/priorities

Strategic Management by Domain National Director Directors with specified responsibilities Health Improvement Health Protection Health and Social Care Quality Health Intelligence Public Health Management Group Public Health Executive Team Four Domain Strategic Management Groups

NPHS Direction Business Plan : 2005-2008 National and Local work plans Strategic Goals and Objectives National and Local work plans Key tasks for delivery Agreed with partners/stakeholders

Health Improvement Domain “to improve the health and well-being of the population and reduce inequalities.” Focus on strategic priorities and actions relating to the wider social, economic and environmental determinants of health. Social model of health Support national policy and local delivery

Health Improvement Domain Specialist public health advice aimed at supporting partners/stakeholders to work together to: Address the root causes of poor health, Promote ‘Investment for Health’ and Reduce health inequalities. Link to other Domains as required

Domain Management Group Chaired by Director Senior staff specialising within the domain Representation from Local Public Health Directors Cross representation from other domains Wider engagement as appropriate

Moving from this

…..to this Traffic Illicit drugs Environment Public economic strategies Tobacco Eating habits Age, sex, heredity Sleep habits Physical activity Education Sex & life together Housing Illicit drugs Contact children and adults Agri- culture & food Traffic Work environment Alcohol Leisure & Social network Health-& medical care support assistance Social-insurance Employ- ment …..to this Haglund, Svanström, KI, revision, Beth Hammarström

Domain Structure 3 Areas to address the broad range of determinants of health Economic and Physical Environment housing, transport, waste, economic development, corporate health standard Influencing Behaviours tobacco, alcohol, nutrition, physical activity, substance misuse, sexual health Communities and Families Focus on children e.g. child poverty, community development, schools, mental health promotion

Service Delivery Local Public Health Directors/Teams Domain support ‘Lead’ Consultant in Public health in each of 3 areas Dedicated practitioner support in each of 3 areas Defined services – smoking cessation/ workplace health Use of ‘Advisory’ roles using expertise from LPHTs Task and Finish Teams/ Networks Key links to partners e.g. Wales Centre for Health, Local Government

Specific Managed Programmes All Wales Smoking Cessation Service National public health programme Community focus Pre –operative service ( NHS performance target) Targeted services (maternity, mental health, manual workers) Corporate Health Standard

Some challenges Task and Finish groups to address: Economic and Physical Environment Welsh Backs project Injury Prevention Climate change/Sustainable Development Influencing Behaviours Obesity Tobacco Alcohol misuse/Prevention Programmes Communities and Families Child Poverty CEHAPE (Children’s Health Action Plan - European)

Economic and Physical Environment Priorities Health at Work Economic inactivity Economic and physical regeneration (spatial plans) Sustainable Development - climate change, heat wave plan, KWTW Housing and built environment Injuries

Influencing Behaviours Priorities Prevention and early intervention – link to chronic disease care pathways Tobacco Cessation Prevention – ASSIST ( and more e.g. social marketing) Environment ( Tobacco ban in public places) Obesity nutrition and physical activity Alcohol misuse – comprehensive public health programme

Communities and Families Child Poverty Children and Young People partnerships Healthy Schools Settings – next year Prison health

Working with Stakeholders Welsh Assembly Government Local Health Boards Local Government Wales Centre for Health National partners e.g. Health Protection Agency, Environment Agency Independent and voluntary sector

Research and Development Link to academic public health Promote research and evaluation Contribute to development of public health evidence base Share best practice

Wales and beyond Work within UK ( other devolved administrations Scotland, Ireland etc) Europe – Children’s Environmental Health Action Plan (CEHAPE) International Public Health

Added Value How can we best work together across NPHS to deliver a world class specialist advice service to promote health improvement and address health inequality?