1. Tackling the wider determinants of health: Health Improvement Domain
Andrew Jones
Regional Director/ Director of Health Improvement

2. National Policy and Direction in Wales
‘Designed for Life’
Commitment to deliver world class healthcare services and a clear focus on tackling health inequalities.
Public Health Strategic Framework
Key Strategic themes/priorities

4. Strategic Management by Domain
National Director
Directors with specified responsibilities
Health Improvement
Health Protection
Health and Social Care Quality
Health Intelligence
Public Health Management Group
Public Health Executive Team
Four Domain Strategic Management Groups

5. NPHS Direction Business Plan : 2005-2008 National and Local work plans
Strategic Goals and Objectives
National and Local work plans
Key tasks for delivery
Agreed with partners/stakeholders

6. Health Improvement Domain
“to improve the health and well-being of the population and reduce inequalities.”
Focus on strategic priorities and actions relating to the wider social, economic and environmental determinants of health.
Social model of health
Support national policy and local delivery

7. Health Improvement Domain
Specialist public health advice aimed at supporting partners/stakeholders to work together to:
Address the root causes of poor health,
Promote ‘Investment for Health’ and
Reduce health inequalities.
Link to other Domains as required

8. Domain Management Group
Chaired by Director
Senior staff specialising within the domain
Representation from Local Public Health Directors
Cross representation from other domains
Wider engagement as appropriate

9. Moving from this

10. …..to this Traffic Illicit drugs Environment Public economic
strategies
Tobacco
Eating habits
Age, sex,
heredity
Sleep
habits
Physical
activity
Education
Sex &
life together
Housing
Illicit drugs
Contact
children
and adults
Agri-
culture
& food
Traffic
Work
environment
Alcohol
Leisure &
Social
network
Health-&
medical care
support
assistance
Social-insurance
Employ-
ment
…..to this
Haglund, Svanström, KI, revision, Beth Hammarström

11. Domain Structure
3 Areas to address the broad range of determinants of health
Economic and Physical Environment
housing, transport, waste, economic development, corporate health standard
Influencing Behaviours
tobacco, alcohol, nutrition, physical activity, substance misuse, sexual health
Communities and Families
Focus on children e.g. child poverty, community development, schools, mental health promotion

12. Service Delivery Local Public Health Directors/Teams Domain support
‘Lead’ Consultant in Public health in each of 3 areas
Dedicated practitioner support in each of 3 areas
Defined services – smoking cessation/ workplace health
Use of ‘Advisory’ roles using expertise from LPHTs
Task and Finish Teams/ Networks
Key links to partners e.g. Wales Centre for Health, Local Government

13. Specific Managed Programmes
All Wales Smoking Cessation Service
National public health programme
Community focus
Pre –operative service ( NHS performance target)
Targeted services (maternity, mental health, manual workers)
Corporate Health Standard

14. Some challenges Task and Finish groups to address:
Economic and Physical Environment
Welsh Backs project
Injury Prevention
Climate change/Sustainable Development
Influencing Behaviours
Obesity
Tobacco
Alcohol misuse/Prevention Programmes
Communities and Families
Child Poverty
CEHAPE (Children’s Health Action Plan - European)

15. Economic and Physical Environment Priorities
Health at Work
Economic inactivity
Economic and physical regeneration (spatial plans)
Sustainable Development - climate change, heat wave plan, KWTW
Housing and built environment
Injuries

16. Influencing Behaviours Priorities
Prevention and early intervention – link to chronic disease care pathways
Tobacco
Cessation
Prevention – ASSIST ( and more e.g. social marketing)
Environment ( Tobacco ban in public places)
Obesity
nutrition and physical activity
Alcohol misuse – comprehensive public health programme

17. Communities and Families
Child Poverty
Children and Young People partnerships
Healthy Schools
Settings – next year Prison health

18. Working with Stakeholders
Welsh Assembly Government
Local Health Boards
Local Government
Wales Centre for Health
National partners e.g. Health Protection Agency, Environment Agency
Independent and voluntary sector

19. Research and Development
Link to academic public health
Promote research and evaluation
Contribute to development of public health evidence base
Share best practice

20. Wales and beyond
Work within UK ( other devolved administrations Scotland, Ireland etc)
Europe – Children’s Environmental Health Action Plan (CEHAPE)
International Public Health

21. Added Value
How can we best work together across NPHS to deliver a world class specialist advice service to promote health improvement and address health inequality?