1. 1 www.cymru.gov.uk Living in interesting times: Thoughts for DsPH in the 21 st Century Association of Directors of Public Health Victory Services Club, London 13 th May 2011 Dr Tony Jewell Chief Medical Officer for Wales

2. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Living in interesting times

3. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Male deaths 1848-1871 (average) and 2009 1848 - 1871 2009 Source: Office for National Statistics

4. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Significant progress Reports of infectious disease in England and Wales Source: Health Protection Agency

5. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Heart disease is next? Selected causes of death, Wales, 1969 - 2009 Source: World Health Organization

6. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Prevention works Male mortality from lung cancer, 1970 - 2006 Source: World Health Organization

7. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Encourage Enable Engage Exemplify Catalyse High excise taxes Ban marketing practices Address smuggling (nb. Personal incentives) NHS 'stop smoking' treatment Smoke-free policies Quit-lines Pharmaceutical deregulation Social marketing campaigns More graphic warnings Major news media assault Constant revisiting evidence “Denormalisation” Smoke-free policies Clear messages from NHS Consistent package Clear goals Commercial arguments The 4 E’s

8. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Improving quality Great progress in improving health service delivery and quality Still much work to do – learning from the best

9. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Changing times and the end of eras

10. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk The impact of poverty, neglect and hopelessness

11. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Non evidence-based behaviour

12. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Responses to human and natural tragedy

13. Source: NHS SDU At least 15,000 people died prematurely as a result of Europe’s heat wave in 2003 in France 1 1. Unprecedented heat-related deaths during the 2003 heat wave in Paris: consequences on emergency departments Jean-François Dhainaut, Yann - Erick Claessens, Christine Ginsburg, and Bruno Riou. Crit Care. 2004; 8(1): 1–2. Published online 2003 December 4. doi: 10.1186/cc2404. and Bhattacharya, S. (October 2003), ‘European heat wave caused 35,000 deaths’, The New Scientist. http://www.newscientist.com/article/dn4259

14. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization The origins of our trade

15. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Fusing a new model Biomedical model Age Sex Gender Genetics Education Environment Culture Employment Lifestyle Social Determinant model A new approach to Public Health

16. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk The centrality of the DPH

17. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk Collegial support

18. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Global movements for health

19. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Evidence Evidence is vital as it can be convincing Doesn’t always win the argument Need to close the gap between policy makers and evidence through better communication

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

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

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

23. Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www.cymru.gov.uk The future Demonstrate daily the importance of Directors of Public Health Find new and different forms of communication Remember to have a voice

24. Diolch yn fawr Thank you very much Tony.jewell@wales.gsi.gov.ukony.jewell@wales.gsi.gov.uk http://wales.gov.uk/topics/health/ocmo/?lang=en http://wales.gov.uk/topics/health/ocmo/?lang=cy