1. Public Health challenges in Hertfordshire Raymond Jankowski Deputy Director of Public Health

2. Public Health The art and science of prolonging life, preventing disease and promoting health through the organised efforts of society

3. 3 domains of Public health Health improvement Health protection Health care

5. Commissioning Health and Wellbeing for Hertfordshire

6. Public Health Challenges Tobacco control Obesity Alcohol misuse Children and young people realising their full potential Mental health and wellbeing Supporting older people to live independent lives Health inequalities Quality Innovation Productivity Prevention (QiPP) Climate change Lifelong learning

8. Tobacco control: the challenge Increase referrals to Hertfordshire smoking cessation services Reduce number of people starting smoking Effective communication and social marketing Reduce supply of cheap and illicit tobacco Reduce health inequalities

9. Smoking prevalence in Hertfordshire by age Girls 9-11 yrs Boys 9-11 yrs Girls 15 yrs Boys 15 yrs AdultsPregnancy 2%6%21%15%19.5%10.5% National target 2015 - - 12% 12% 18.5%11%

10. KeyIMD 3 to 8.9 9 to 14.9 15 to 20.9 21 to 26.9 27 and over Hertfordshire IMD 2010 by MSOA with district averages

11. KeyRange 0 to 10.9 11 to 12.9 13 to 14.9 15 to 16.9 17 to 18.9 19 and over GP-recorded Smoking prevalence by MSOA 2010-11

12. Estimated NHS and wider economy costs of tobacco control in Hertfordshire NHS - £54M Wider economy -£275M – Cleaning up cigarette butts - £5.8M – Smoke related fires - £8.7M

13. Summary Build on a strong Hertfordshire Tobacco Control Alliance, to reduce smoking prevalence by: Supporting smokers in priority groups to quit Continuing to support actions to reduce supply of illicit tobacco Reducing the uptake of smoking among young people

14. Obesity in Hertfordshire: challenges Prevalence % 4-5 year olds 10-11 year olds Adults 8-9%14-16%21.4%

15. Estimated NHS and economic costs in Hertfordshire NHSWider economy 2007£84M£320M 2050£174M£1000M

16. KeyIMD 3 to 8.9 9 to 14.9 15 to 20.9 21 to 26.9 27 and over Hertfordshire IMD 2010 by MSOA with district averages

17. Prevalence of obesity in school age children (Year 6 aged 10-11 years) in MSOAs in Hertfordshire for 2009-10 KeyPrevalence of obesity 0 to 8.9% 9% to 13.9% 14% to 18.9% 19% to 23.9% 24% and over

18. Reducing Obesogenic environment Individuals, Families, Communities  Physical activity  Healthy eating and sensible drinking Motivation Self esteem Cost and availability of leisure facilities Availability of green space Cycle lanes Pedestrian friendly Community safety Healthy workplace Motivation Self esteem Cost of healthy eating Shopping skills Cooking skills Availability of fresh produce Advertising Healthy workplace

19. NHSWider economy % NHS/wider economy Tobacco control £54M£275M20% Obesity£84M£320M26% Alcohol£54M£400M13.5% NHS versus wider economy costs in Hertfordshire

21. Challenges in older age Falls Dementia Social isolation Intermediate care End of Life Influenza Fuel poverty