1. The science of creating wellness Prof Carol Tannahill, Director, Glasgow Centre for Population Health

3. Scotland & other Western European countries

4. Not always the ‘Sick Man of Europe’

5. Comparison to WE Mean (Males)

6. Proportionate Contribution by Cause - Males

7. Coronary heart disease mortality Men aged 15-74 years Age-standardised mortality per 100,000

8. Healthy Life Expectancy

9. Percentage of adults aged 16 and over with a long-standing illness, disability or health problem by SIMD quintile, 2007/08 (Scottish Household Survey)

10. Percentage of adults aged 16 and over with a long-standing illness, disability or health problem by SIMD quintile, 2007/08 (Scottish Household Survey) 2001 Census figures. Scotland: 20%; NHSGGC range from 16% - 30%

11. A whistlestop tour around some concepts 1.Prevention Reduce the incidence of health problems (primary prevention) Reduce the progression of health problems (secondary prevention) Reduce the impacts of disease (tertiary prevention) Reduce unnecessary health interventions (quarternary prevention) BUT…

12. A whistlestop tour around some concepts 1.Prevention Reduce the incidence of health problems (primary prevention) health problems only? Reduce the progression of health problems (secondary prevention) Reduce the impacts of disease (tertiary prevention) Reduce unnecessary health interventions (quarternary prevention)

13. A whistlestop tour around some concepts 1.Prevention Reduce the incidence of health problems (primary prevention) health problems only? Reduce the progression of health problems (secondary prevention) covers almost all of health care activity Reduce the impacts of disease (tertiary prevention) Reduce unnecessary health interventions (quarternary prevention)

14. A whistlestop tour around some concepts 1.Prevention Reduce the incidence of health problems (primary prevention) health problems only? Reduce the progression of health problems (secondary prevention) covers almost all of health care activity Reduce the impacts of disease (tertiary prevention) covers almost all of social care activity Reduce unnecessary health interventions (quarternary prevention)

15. A whistlestop tour around some concepts An alternative 1.Prevention of the onset or first manifestation of a disease process, or some other first occurrence, through risk reduction 2.Prevention of the progression of a disease process or other unwanted state, through early detection when this favourably affects outcome 3.Prevention of avoidable complications of a health problem or other unwanted state 4.Prevention of the recurrence of an illness or other unwanted phenomenon.

16. A whistlestop tour around some concepts Preventative spend Spending now that is expected to reduce public spending demands in the future by reducing avoidable health and social problems Must increase healthy lifespan/compress morbidity Wanless: requirement for ‘fully engaged’ scenario

17. A whistlestop tour around some concepts Wellness Aaron Antonovsky Sir Harry Burns

18. “.....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement." Sense of coherence....

19. For the creation of health........the social and physical environment must be: ComprehensibleComprehensible ManageableManageable MeaningfulMeaningful......or the individual would experience chronic stress......or the individual would experience chronic stress

21. Summary Scotland’s health ranking is a relatively recent phenomenon, and reflects a slower rate of improvement than other countries The outcomes for (young) working age men and women are particularly concerning For many causes of death, Scotland’s improvement is in line with other countries But ‘social dis-eases’ are increasing Inequalities are also increasing There is a lot of evidence (and more emerging all the time) that traditional explanations of socio-economic deprivation (underpinned by effects of post-industrial decline) are not sufficient.

22. How do we respond?

23. 1. Programmatically on individual issues? The most common response Evidence-based and often with a clear method Positive outcomes for (a proportion of) participants Tends to increase inequality Rarely achieves population-level impact Need to respond to each new issue afresh

26. 2. Through national policy on individual issues? Smoking in public places Alcohol minimum pricing Screening and immunisation programmes Housing quality standards Social protection School meal standards Less likely to increase inequality More likely to achieve population-level impact But still need to respond to each new issue afresh

27. 3. On the cross-cutting determinants operating at individual & community levels? Fundamental influences that perpetuate poorer health outcomes, regardless of the issue –Power distribution –Knowledge –Social networks –Access to (financial and other) resources Asset-based working

28. Creating wellbeing Sense of coherence Seeing the world as: Structured Predictable Feeling that it is: Manageable Meaningful Wanting to engage Sense of coherence Seeing the world as: Structured Predictable Feeling that it is: Manageable Meaningful Wanting to engage Generalised resistance resources Family Nurture Intelligence Work Material resource Identity Cultural stability Optimism Stable set of answers Generalised resistance resources Family Nurture Intelligence Work Material resource Identity Cultural stability Optimism Stable set of answers Events Stress Tension Resolution Wellbeing Events Stress Tension Resolution Wellbeing Antonovsky. Health, stress and coping. 1979

30. Inflammation in plaques Inflammatory cells MMPs, IL-6, IL-15, IL-18, CRP Lumen Core Cap Thin Fibrous Cap InflammatoryCells SMCapoptosis Degradedmatrix Unstable cytokinesMMP

31. Choice reaction time Choice reaction time p<0.001 milliseconds Age (years)

32. Environmental determinants of inflammatory status CRP (median) mg/dl affluent deprived

33. Implementing at scale…. can it be done?

34. The Early Years Collaborative - Aims reduction of 15% in the rates of stillbirths 1. To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015). 85% of all children have reached all of the expected developmental milestones child’s 27-30 month child health review, by end-2016. 2. To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016. 90% of all children reached all of the expected developmental milestones at the time the child starts primary school, by end-2017 3. To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.

35. Lochrin Nursery Grassmarket changes introduced. Books available at collection time. Research information handed to parents. weekly average displayed for parents

36. 90% of children at Grassmarket nursery school will receive a bedtime story at least 3 times a week. Family garden party A very hot weekend

37. Alfie ‘I like my bedtime story because it helps me to dream ’ ‘I like my bedtime story because it helps me to dream ’

39. Do one brave thing today….then run like hell!