1. The health inequalities challenge for Wales
Dr Tony Jewell
Chief Medical Officer for Wales
Public Health Conference
Swalec Stadium
21st September 2011

2. I will cover...
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Chief Medical Officer for Wales Annual Report 2010
Challenges
Inequalities
Fairer Health Outcomes for All

3. Chief Medical Officer’s Annual Report
Chief Medical Officer for Wales Annual Report 2010
Tobacco kills Mortality from lung cancer, Source: World Health Organization

4. Chief Medical Officer’s Annual Report
Life expectancy at birth
Male life expectancy at birth, Source: WHO, Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

5. Chief Medical Officer’s Annual Report
Infant and neonatal mortality Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

6. Chief Medical Officer’s Annual Report
Deaths by gender Deaths by gender, Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

7. Health in Wales Leading causes of death in Wales, Source: Statistical Directorate, Welsh Government

8. Chief Medical Officer’s Annual Report
Deaths from liver disease and cirrhosis Source: eHealthshow, NWIS
Tobacco kills Mortality from lung cancer, Source: World Health Organization

9. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization
Challenges

10. Getting healthier...but? Female life expectancy at birth by deprivation quintile Source: Statistical Directorate. Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

11. Teenage conceptions Teenage Conceptions years, Source: Office for National Statistics

12. Chief Medical Officer’s Annual Report
Teenage conceptions Teenage conceptions trends Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

13. Non evidence-based behaviours
Tobacco kills Mortality from lung cancer, Source: World Health Organization
©Maciej Dakowicz

14. The rise of chronic conditions Prevalence of non-communicable diseases ( ) Source: NHS Wales Quality Outcome Framework
Tobacco kills Mortality from lung cancer, Source: World Health Organization

15. A healthy retirement? Life expectancy and income deprivation ( ) Source: Office for National Statistics
Tobacco kills Mortality from lung cancer, Source: World Health Organization

16. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization
Inequalities

17. Growing gaps Source: Public Health Wales Observatory
Spatial inequalities Proportion of adult population obese by BMI,
Source: Welsh Health Survey
Growing gaps Source: Public Health Wales Observatory
Tobacco kills Mortality from lung cancer, Source: World Health Organization

18. Growing gaps Source: Public Health Wales Observatory
Growing gaps Comparison of life expectancy, healthy life expectancy and disability-free life expectancy in Wales and
Source: Public Health Wales Observatory
Growing gaps Source: Public Health Wales Observatory
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Males
SII = Slope Index of Inequality, a measure reflecting socioeconomic dimension to inequalities in health., For more information see A Leyland (2007) Measuring socio-economic inequalities in health, Scotpho (Glasgow)

19. Male life expectancy Male life expectancy at birth by deprivation quintile, Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

20. Female life expectancy Female life expectancy at birth by deprivation quintile, Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

21. Infant mortality rate Deaths within the first years of life
Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

22. Male deaths from heart disease Premature (under 65) male deaths from circulatory disease, 2009
Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

23. Reversal in pattern Adults daily drinking above guidelines
Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

24. Smoking
Adults who are smokers
Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

25. Twice as many die from smoking across gradient
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Twice as many die from smoking across gradient

26. More than description
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Epidemiologists are good at describing these gradients, and governments are good at ‘being concerned’ about them, because of their consequences for public health. However, each of the inequalities tends to be treated piecemeal, as if they were unrelated to all of the others, and they are generally conceptualised as the consequence of ignorance or error.
Nettle, D. (2009). Social class through the evolutionary lens. The Psychologist 22: 934-7

27. Heard it before?
Tobacco kills Mortality from lung cancer, Source: World Health Organization

28. Fairer Health Outcomes for All
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Fairer Health Outcomes for All

29. Our Healthy Future
Tobacco kills Mortality from lung cancer, Source: World Health Organization

30. 10 Priorities
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Reducing inequities in health
Stopping the growing harm from alcohol and drugs
Improving people’s mental well-being
Reducing the number of teenage pregnancies
Improving health in the workplace
Reducing the level of smoking
Reducing the number of accidents and injuries
Increasing physical activity
Increasing immunisation rates
Reducing unhealthy eating

31. Fairer Health Outcomes for All
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Building health into all policies and all policies into health
Giving every child a healthy start
Developing health assets in communities
Improving health literacy
Making health and social services more equitable
Improving health at work
Strengthening the evidence base.

32. Whole of government approach
Tobacco kills Mortality from lung cancer, Source: World Health Organization

33. 10 Priorities
Tobacco kills Mortality from lung cancer, Source: World Health Organization

34. The 4 E’s
Tobacco kills Mortality from lung cancer, Source: World Health Organization

35. Turning evidence to action: Hypertension interventions
Tobacco kills Mortality from lung cancer, Source: World Health Organization

36. Turning evidence to action: Road safety interventions
Tobacco kills Mortality from lung cancer, Source: World Health Organization

37. Improving and reducing inequities
Child pedestrian injuries from motor vehicle
accidents by deprivation quintile
Source: Statistical Directorate, Welsh Government
Tobacco kills Mortality from lung cancer, Source: World Health Organization

38. Chief Medical Officer’s Annual Report
Variation in primary care Percentage of patients with Chronic Obstructive Pulmonary Disease with a record of a breath test (FeV1) recorded in the previous 15 months
Source: Primary Care Information Set 2010
Tobacco kills Mortality from lung cancer, Source: World Health Organization

39. Data and oratory
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Using his forceful oratory skills and sound data, and recognizing the need to deal with the social and political dimensions of...[health].
Obituary of Jonathan Mann – International expert in AIDS research and management
Peter Piot & Daniel Tarantola, Bulletin of the World Health Organization, 1998, 76 (5): iii-v

40. Developing health assets in communities
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Nye J, Kamarck EC (2002). Governance.com: democracy in the information age.Brookings Institute Press. (Washington)

41. Communities First and Flying Start
Tobacco kills Mortality from lung cancer, Source: World Health Organization

42. Innovation: Learning from others
Tobacco kills Mortality from lung cancer, Source: World Health Organization

43. International approaches to reducing inequality
Tobacco kills Mortality from lung cancer, Source: World Health Organization
England – inequalities target for infant mortality
Gemany – Law 20 on prevention
Veneto (Italy) – High Council for immigration
Ireland – Building healthy communities programme
Tuscany (Italy) – Community Healthy Partnerships
Netherlands - a health for all approach to public health
Scotland – Whole system approach to health inequalities
Norway – national strategy to reduce social inequalities in health
Pomurje (Slovenia) – Programme MURA, Investment in health
Poland – improving equity of access to healthcare
Sweden – public health policy
S Simpson et al (2010) Putting our own house in order: examples of health system action on socially determined health inequalities. WHO (Venice)

44. Chief Medical Officer’s Annual Report
Reducing smoking 15/16 year olds smoking weekly Source: Health behaviour in school-aged children, 2011
Tobacco kills Mortality from lung cancer, Source: World Health Organization

45. Short, mid and long term programmes and outcomes
Phased results
Tobacco kills Mortality from lung cancer, Source: World Health Organization
Immunisation
Contraception A
Alcohol programmes
Cardiovascular B C
Education
Health at work
2011
2016
2021
2026

46. Getting from A to B
Tobacco kills Mortality from lung cancer, Source: World Health Organization

47. Chief Medical Officer’s Annual Report
Global inequality Estimated life expectancy at birth, 2009 Source: Global Health Observatory, WHO
Tobacco kills Mortality from lung cancer, Source: World Health Organization

48. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization
Vision without action achieves nothing.
Action without vision just passes time.
Vision with action can change the world
Nelson Mandela

49. Diolch yn fawr Thank you very much