Health Improvement Everybody’s Business Grace Moore Associate Director of Health Promotion and Equalities

Outline Definitions The Public Health Workforce Planning for Health Improvement Programmes and Priorities Making sense of a cluttered landscape Performance Monitoring/Management Summary

Definitions Public Health; "The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society”. Health Improvement is an outcome, the achievement of which includes the areas of work traditionally described as health promotion, public health and health care[1].[1]

Definitions Health Promotion is the process of enabling people to increase control over, and to improve their health[2].[2] [1] Public Health Institute of Scotland. The health promotion contribution to health improvement. 2002[1] [2] World Health Organisation. Ottawa Charter. 1986[2]

The Public Health Workforce Health improvement is pursued by a range of staff through: –wide-ranging health promotion efforts, aimed at promoting good health and preventing ill- health in the whole population and also in specific target groups –and through maximising the population health benefits of treatment of ill-health.

The Public Health Workforce Specialist – Senior Staff working at consultant level – generally members/fellows of Faculty of Public Health (Specialised) Practitioner e.g. Health Promotion Officer and Public Health Practitioners – work to a set of competencies as defined by the FPH

The Public Health Workforce Wider Workforce – adopt public health approaches for some of the work they do but will be working to a set of competencies defined by their professional body e.g. doctors, nurses, teachers, community workers, pharmacists, physiotherapists……in fact many people in public bodies

Main areas of public health practice Health Protection Health services Health Promotion and disease prevention

Vision for Health physicalmental social complete Well-being

Health and Well-being “Health is more than the absence of disease….to be healthy requires individuals to engage in their health as much as it requires healthy and sustainable environments and well trained professionals”

Complex Environment economicsocial physical employment Health and social services housing pollution poverty culture

From Population to the Individual

Tobacco – A Worked Example

Tobacco Intermediate Outcomes Reduced adult smoking rate Sustained quit rate (1 year follow-up) Long term Outcomes Improved mental wellbeing Reduced inequalities in HLE Reduced inequalities in CHD mortality Reduced tobacoo-related morbidity and mortality Processes What the NHS has to do to deliver effective SC services in key settings Outputs Smoking cessation services Short-term Outcomes Quit rate at 1 month follow-up Inputs Budget, trained workforce and data needed to run and monitor smoking cessation services Reach (target population) Smokers who want to quit (key sub-groups) new HEAT target National indicators

Cross-sector Contributions Inputs Activities Outputs Reach Short-term outcomes Intermediate outcomes High level outcomes NHS Individual Behaviours Reduce adult smoking rates Reduce uptake of smoking in children and young people Increased healthy life expectancy; Reduced inequalities in healthy life expectancy, Reduced inequalities in morbidity and mortality due to smoking related diseases e.g. CHD, Cancer Physical Environments – Reduced exposure to second hand smoke Social Environments – Reduced attractiveness of tobacco products Economic Environments SG,UK govt, EU Schools, community Example Local authorities Improved compliance with laws Local authorities Anti-smoking messages Media, school ethos, practices Young people Understanding risks, attitudes to smoking Smokers Increased quit rate Enforcement of smoking ban Enforcement of laws on under- age sales Tobacco Retail Sales Under 18s Smoking Cessation Services Intensive support, brief advice, NRT Compliance with laws Increased price, reduced incentives Smoke free public places General Public Taxation, displays promotions, advertising Industry Regulation

Priority Topics Mental Health and Well-being Obesity Tobacco Alcohol

Priority Target Groups Children and young people Pregnant women People living in deprivation Groups who face particular inequalities e.g. homeless, people who have sensory impairment, people from ethnic minorities

Summary Health promotion implemented by a range of staff across a range of sectors The specialist function works mainly (but not exclusively) at a strategic and population level It provides support to others in their health promotion efforts It delivers complex interventions across a range of settings, for a range of target groups on a range of priority topics using a range of methods

Finally…. “Our staff are the agents of change. We cannot hope to bring about the improvements envisaged unless the people who deliver these improvements are protected in their place of work, recognised and rewarded for their contribution to our success and given the opportunities to develop the skills and experience they require to improve health and reduce health inequalities.” (Better Health Better Care: Action Plan)

Sensory Impairment - Partners NHS Communications Disability Awareness IT Learning Disabilities Optometrists/Ophthalmology Audiologists Psychological Services Procurement Public Health PFPI Medical Records Primary Care Children’s Services Occupational Therapy Nursing Estates External Leisure Services (LA and Independent) Social Services LA Procurement RNIB RNID Visibility Deafblind Scotland SISG Ayrshire Volunteers Patients/People with Sensory Impairment Carers Healthy Living Centres

Bridge to Vision Arran Pilot Training Group CSS Policy Eyecare Review Adult’s Sub Group LD Needs Assessment Children’s Sub Group Training Sub Group Development Group for Equalities and Sensory Impairment Needs Assessment Commissioning an Area Wide Service Sub Group Deafblind Communicator Pilot Interpreter Services Contract Active Living & HI Programme VI Pilot Centre Sub Group Audit & Standards Commissioning Network Management Function Awareness Raising Pilot Pfizer Funding Literature Review National Procurement Contracts South Ayrshire Working Group East Ayrshire Working Group North Ayrshire Working Group Key: Yellow Circle = Main Project GroupBracket = Future Work Green Circle = Sub GroupPentagon = Link Function Pink Rectangle = Sub Project GroupsFull Lines = Accountability routes Jade Rectangle = Working Groups Broken lines = Communication links Sensory Impairment Project