1 Living in interesting times: Thoughts for DsPH in the 21 st Century Association of Directors of Public Health Victory Services Club, London 13 th May 2011 Dr Tony Jewell Chief Medical Officer for Wales

Tobacco kills Mortality from lung cancer, Source: World Health Organization Living in interesting times

Tobacco kills Mortality from lung cancer, Source: World Health Organization Male deaths (average) and Source: Office for National Statistics

Tobacco kills Mortality from lung cancer, Source: World Health Organization Significant progress Reports of infectious disease in England and Wales Source: Health Protection Agency

Tobacco kills Mortality from lung cancer, Source: World Health Organization Heart disease is next? Selected causes of death, Wales, Source: World Health Organization

Tobacco kills Mortality from lung cancer, Source: World Health Organization Prevention works Male mortality from lung cancer, Source: World Health Organization

Tobacco kills Mortality from lung cancer, Source: World Health Organization Encourage Enable Engage Exemplify Catalyse High excise taxes Ban marketing practices Address smuggling (nb. Personal incentives) NHS 'stop smoking' treatment Smoke-free policies Quit-lines Pharmaceutical deregulation Social marketing campaigns More graphic warnings Major news media assault Constant revisiting evidence “Denormalisation” Smoke-free policies Clear messages from NHS Consistent package Clear goals Commercial arguments The 4 E’s

Tobacco kills Mortality from lung cancer, Source: World Health Organization Improving quality Great progress in improving health service delivery and quality Still much work to do – learning from the best

Tobacco kills Mortality from lung cancer, Source: World Health Organization Changing times and the end of eras

Tobacco kills Mortality from lung cancer, Source: World Health Organization The impact of poverty, neglect and hopelessness

Tobacco kills Mortality from lung cancer, Source: World Health Organization Non evidence-based behaviour

Tobacco kills Mortality from lung cancer, Source: World Health Organization Responses to human and natural tragedy

Source: NHS SDU At least 15,000 people died prematurely as a result of Europe’s heat wave in 2003 in France 1 1. Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments Jean-François Dhainaut, Yann - Erick Claessens, Christine Ginsburg, and Bruno Riou. Crit Care. 2004; 8(1): 1–2. Published online 2003 December 4. doi: /cc2404. and Bhattacharya, S. (October 2003), ‘European heat wave caused 35,000 deaths’, The New Scientist.

Tobacco kills Mortality from lung cancer, Source: World Health Organization The origins of our trade

Tobacco kills Mortality from lung cancer, Source: World Health Organization Fusing a new model Biomedical model Age Sex Gender Genetics Education Environment Culture Employment Lifestyle Social Determinant model A new approach to Public Health

Tobacco kills Mortality from lung cancer, Source: World Health Organization The centrality of the DPH

Tobacco kills Mortality from lung cancer, Source: World Health Organization Collegial support

Tobacco kills Mortality from lung cancer, Source: World Health Organization Global movements for health

Tobacco kills Mortality from lung cancer, Source: World Health Organization Evidence Evidence is vital as it can be convincing Doesn’t always win the argument Need to close the gap between policy makers and evidence through better communication

Tobacco kills Mortality from lung cancer, Source: World Health Organization Advocacy

Tobacco kills Mortality from lung cancer, Source: World Health Organization Brokerage

Tobacco kills Mortality from lung cancer, Source: World Health Organization Excellence

Tobacco kills Mortality from lung cancer, Source: World Health Organization The future Demonstrate daily the importance of Directors of Public Health Find new and different forms of communication Remember to have a voice

Diolch yn fawr Thank you very much