Food in a Public Health Context Dr Eugene Milne Deputy Regional Director of Public Health

Some national reports and policies Choosing Health (Nov 2004) Tackling Obesity: Foresight Report (2007) Healthy Weight, Healthy Lives (Jan 2008) Food Matters : Cabinet Office Report (July 2008) FSA Strategic Plan Food 2030 (Defra 2010) Fair Society, Healthy Lives (2010)

The North East will have the best and fairest health and well-being, and will be recognised for its outstanding and sustainable quality of life.

Explaining the fall in coronary heart disease deaths in England & Wales Risk Factors worse +13% Risk Factors better -71% Treatments -42% ,230 fewer deaths in 2000  Unal, Critchley & Capewell Circulation (9) 1101

Explaining the fall in coronary heart disease deaths in England & Wales Risk Factors worse +13% Obesity (increase) +3.5% Diabetes (increase) +4.8% Physical activity (less) +4.4% Risk Factors better -71% Smoking -41% Cholesterol -9% Population BP fall -9% Deprivation -3% Other factors -8% Treatments -42% AMI treatments -8% Secondary prevention -11% Heart failure -12% Angina:CABG & PTCA -4% Angina: Aspirin etc -5% Hypertension therapies -3% Unal, Critchley & Capewell Circulation (9) ,230 fewer deaths in 2000 

Delivery of BHFH requires falls in CVD and cancer Falls in CVD and cancer require not only better treatments but falls in smoking, falls in obesity and increased physical activity

Themes Economy, culture and environment Mental health, happiness and well-being Tobacco Obesity, diet and physical activity Alcohol Prevention, fair and early treatment Early life Mature and working life Later life A good death

Vision The North East will curtail its increase in average body mass index and increase the proportion of people whose weight is within safe limits, eradicating the differential between social groups. The North East population will be the most physically active in the country, both in its activities of daily living and in its recreational choices. The support available for individuals to alter their activity levels will be clearly and fairly defined and will be provided according to individual need.

Review of BHFH later this year – opportunity to think again about what should be there from the perspective of food. Our position at present is not good…

So far we have made progress on CVD through better delivery of treatments and substantial falls in smoking Changes in diet and other lifestyle behaviours have lagged behind

Identifiable Actions to Reduce the Gap in Infant Mortality What would work Impact on the gap What would work (percentage points) Reducing conceptions in under 18s in the R&M group by 44% to meet the target Targeted interventions to prevent SUDI by 10% in the R&M group Reducing the prevalence of obesity in the R&M group to 23% Increasing the rate of breastfeeding initiation in the R&M group to those of the non-R&M group from 67% to 83% Immediate actions Optimising preconception care Early booking Access to culturally sensitive healthcare Reducing maternal and infant infections Reducing overcrowding in the R&M group, through its effect on SUDI Reducing the rate of smoking in pregnancy by two percentage points by 2010 Meeting the child poverty strategy Long-term actions Improving maternal educational attainment

Key activities: Governance Research and development, analysis Service redesign & funding Advertising and social marketing Lobbying activity Policies and planning Performance management of services

The Rose Hypothesis “... a large number of people exposed to a small risk may generate many more cases than a small number exposed to a high risk”

..therefore… Our task should not be to focus on outlier groups but to shift population mean behaviours and to narrow the range across which those behaviours are distributed.

The North East will have the best and fairest health and well-being, and will be recognised for its outstanding and sustainable quality of life.