André Pinto Regeneration and Social Determinants of Health Specialist Public health in Newham - Local health needs of the Borough 1

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In context… 3

Index of Multiple Deprivation by LSOA

5 ….within Newham…

Trend of life expectancy at birth for males and females in Newham, London and England, to Slide 6 Source: The NHS Information Centre for health and social care

Dahlgren and Whitehead (M Benzeval, K. Judge and M. Whitehead (ed.s) Tackling Inequalities In Health: An Agenda For Action. Kings Fund.) 7

Slide 9 Local Authorities in London compared to the Strategic Health Authority average Source: Health Profiles 2011, Public Health Observatories The scale of the challenge

Significant worse than England average PHOF Indicators for Newham DeprivationChildren in povertyGCSEs achievedViolent crimeLong term unemploymentPhysically active adults Hospital stays for alcohol related hard Drug misusePeople diagnosed with diabetesNew cases of tuberculosisLife expectancy – maleLife expectancy – femaleDeaths from smoking Early deaths: heart disease and stroke 10 JSNA Pharmaceutical Needs Assessment

Pharmacies delivering Public Health – Track record Stop SmokingMedicines Use ReviewMinor ailments serviceEmergency Hormonal Contraception ServiceCondom Distribution ServiceChlamydia Screening ServiceNeedle Exchange Service and Supervised Consumption ServiceTuberculosis Treatment Supervision SchemeNHS Health ChecksNew cases of tuberculosisFlu vaccination 11

Pharmacies delivering Public Health in Newham – scope for improvement Stop Smoking – make process easier. Medicines Use Review – develop further. Address concerns regarding quality. Encourage uptake. Minor ailments service – Provide additional primary care capacity. NHS Health Checks – Encourage uptake. Extend existing scope? (atrial fibrillation, hypertension, weight management and lifestyle interventions. Flu vaccination – increase uptake and training. Widen the scope (target groups)?HIV Point of Care testing – consider expanding pilot Anticoagulant Monitoring Service – Therapy initiated in the hospital but then monitored in community setting. Self Care – Promote community ownership of health outcomes and disease management (diabetes). Overcome resistance and access EMIS as a standard. Integrate pharmacy in care pathway. Communications Strategy 12

Health Inequalities Different Gestation Times for Interventions A B C For example supporting individuals to reduce risk of mortality in people with established disease such as CVD, cancer, diabetes For example supporting individuals through lifestyle and behavioural change such as stopping smoking, reducing alcohol related harm and weight management to reduce mortality in the medium term For example intervening to modify the social determinants of health such as worklessness, poor housing, poverty and poor education attainment to impact on mortality in the long term

Population Level Interventions Intervention Through Communities Intervention Through Services Partnership, Vision and Strategy, Leadership and Engagement Systematic and scaled interventions through services Systematic community engagement Service engagement with the community Producing Percentage Change at Population LevelC. Bentley 2007

Achieving Percentage Change in Population Outcomes Programme characteristics will include being :- –Evidence based – concentrate on interventions where research findings and professional consensus are strongest –Outcomes orientated – with measurements locally relevant and locally owned –Systematically applied – not depending on exceptional circumstances and exceptional champions –Scaled up appropriately – “industrial scale” processes require different thinking to small “ bench experiments” –Appropriately resourced – refocus on core budgets and services rather than short bursts of project funding –Persistent – continue for the long haul, capitalising on, but not dependant on fads, fashion and policy priorities

Making every contact count