1. The Health of our Population Doug Robertson Clinical Champion for Prevention

2. Our people die too soon, too often
These six diagnoses explain more than half of excess years of life lost
Mortality data for the SWBCCG population compared to UK means in

3. Why is this? Deprivations scores in bottom 10 in UK
25% of people smoke
20% drink at high risk
25% of men & women are obese
70% don’t eat 5 fruit/vegetables a day
65% do not meet physical activity levels

4. Do these habits matter? Four Health Behaviours: Non smoker
Survival in 20,244 healthy adults aged by health behaviours
Khaw et al. PLoS Med 2008 Jan 8: 5 (1): e12
EPIC-Norfolk Population study 4 3 2 1
Number of prudent
health behaviours
100 90 80 70
Year of study
% still alive
Four Health Behaviours:
Non smoker
Alcohol <14 units/wk
Not sedentary
Blood vitamin C
>50 mmol/l
(>5 servings fruit &
vegetables daily).
Overall impact:
14 year difference in life expectancy.

5. A large, preventable, excess of death
CMO England report Nov 2012 : top 10 public health concerns
illicit drug use
low fruit and vegetable
occupational risks
poor sexual health
tobacco use
harmful alcohol use
high blood pressure
high cholesterol
overweight and obesity
physical inactivity

6. NHS spends only 2% on prevention

7. SWBH potential for prevention
We have hundreds of thousands of contacts per year
We see patients who are at high risk & often with high motivation to change behaviour
We are a large local employer: impact on community
We can contribute to local health improvement

8. Use our main resource: our staff
Make Every Contact Count (MECC) An NHS programme
To train all staff to give brief health advice for prevention.
Covers smoking, drinking, diet and activity
Makes prevention personal, nudges us to ‘walk the talk’
Will change SWBH culture

9. Problems start young & get worse
Early Death
Making sense of the prevention agenda:
Health & Wellbeing Boards
(Sandwell and Birmingham)
Early Frailty
Loss of independence
Worsening Ill health
Long term conditions
(Diabetes, COPD, Heart failure)
Heavy Users of Services
Clinical Disease
Increased Risk
Early onset disease
(lung, heart, stroke)
Poor Habits
Risky behaviours (smoking, diet etc.)
Poor Employment
Poor life chances
Poor Childhood
Many of our people have a poor start in life which evolve into high health risks,
long term conditions, frailty & early death

10. Need more than just NHS healthcare
Department of Health sponsored review to look at inequalities in health
Conclusions:
Social inequality is the biggest single cause of poor health
Need to tackle causes of deprivation
Reducing health inequalities is vital for the economy.
Reducing health inequalities is ‘fairness and social justice’
 'Fair Society Healthy Lives' (Marmot Review) 2010 

11. SWBH sits in a corridor of deprivation
Wolverhampton
Walsall
Sutton
Coldfield
Sandwell
Birmingham
Dudley
Solihull

12. Things we can do together
Early death
Influence the life course via social causes of health
Councils: Health & Wellbeing Boards
SWBH: Public Health/Community Development
/Equality Board structure
Partners: Primary Care, Voluntary Organisations
Early Frailty
Sick people
Increased Ill-health
Appropriate
Care
Clinical Disease
Risky behaviours
Education
Interventions
Increased Risk
Active support
for self-management
Poor Habits
MECC
Poor Employment
Secondary
Prevention
Poor Start
Improving
Social Determinants
Primary
Prevention

13. SWBH can help reduce premature deaths
Making every contact count
Getting people into jobs
SWBH
Reducing homelessness
We know what works: we just need to apply it.
Living well for longer: DOH 2013

14. Next steps: making it happen
Get involved with Health & Wellbeing Board priorities
Sandwell: Early life, Chronic Disease, Frail elderly, Alcohol
Birmingham: Children, Vulnerable, Homeless, Obesity
Promote a Trust Public Health strategy
Include community and regeneration projects in it
Develop a Trust-wide approach
Use our skills, people and equipment better
Make prevention a core part of what we do
Simply, doing the right thing for our population