Hampshire County Council Public Health

Dr Ruth Milton – Director of Public HealthSimon Bryant – Consultant in Public Health

Introduction

• Definition• The county’s responsibilities• The issues for the public’s health• Opportunities for Basingstoke & Deane

Must dos in legislation:

– Sexual health clinical services– National child measurement programme– NHS healthchecks– Health protection– Professional advice to NHS commissioners– (Alcohol licensing)

Supporting public health responsibilities:

• Healthy child programme for 5-19 including school nursing ( 0-5 in 2015)

• Tobacco control – local activity including stop smoking services, prevention, enforcement & communications

• Public mental health – health promotion illness prevention & suicide prevention

• Public health intelligence• Workplace health – local initiatives• Population interventions to reduce birth

defects• Alcohol & drug misuse services,

prevention & treatment • Dental public health – epidemiology,

dental screening & oral health improvement including water fluoridation

• Physical activity – local programmes to promote activity

• Obesity – local programmes to prevent & address obesity

• Locally led nutrition initiatives• Local initiatives to reduce accidental

injuries for all age groups• Prevention and lifestyle campaigns to

prevent long term conditions• Local interventions to reduce excess

deaths from seasonal mortality• Supporting, reviewing and challenging

NHS commissioned public health services

• Public health aspects of community safety, domestic violence

Population

Population change

Lifestyles

Predictions of good health for children…. Infant Mortality Rate & Low Birth WeightThere is a clear link between high levels of infant mortality, deprivation and poor health outcomes. It is therefore often used as a comparative measure of a nation’s health as well as to predict where there will be significant health inequalities.

Low birth weight is strongly associated with poorer health and poorer life chances and is an important predictor of future infant, child and adult health. The reason for this is that babies who have a low birth weight are at greater risk of dying in their first year compared to babies with more average birth weights.

Starting Well

Childhood obesity

Teenage Conceptions

Under 18 conception rate per 1000 females aged 15-17 years by district council in England & Wales (2013)

24.3 24.5

15.4

21.0

Basingstoke & Deane in RED (24.5). England (24.3) and CIPFA nearest neighbours (from right to left in green):Dacorum 21.0; Wycombe 20.5; Chelmsford 15.8; Maidstone 15.6; Huntingdonshire 15.4

Smoking in Pregnancy

Education attainment

Staying Well• Conditions that cause increasing disability are not necessarily those that cause mortality -

however, improving lifestyles particularly around physical activity can improve outcomes• In Basingstoke and Deane in January 2015, there were 465 people claiming PIP, for the

following reasons, Malignancy (15%), Mental illness (severe) (28%), Neurological disease (including Stroke, MS, Parkinson’s and epilepsy) (11%), Musculoskeletal Disorders/disease (32%), Respiratory disease (5%). This is a slightly different profile compared with regional figures where there is marginal more claimants with musculoskeletal conditions, and slightly fewer people with Mental Health conditions (not significant)

• Conditions affecting health in adults and older peopleCCG CHD recorded

prevalenceCHD Estimated prevalence

Diabetes recorded prevalence

Diabetes Estimated Prevalence

Hyper-tension recorded Prevalence

Hyper-tension Estimated Prevalence 

North East Hants and Farnham

2.6%(1 in 38)

3.5%(1 in 29)

5.2%(1 in 19) 

6.3%(1 in 16) 

12.8%(1 in 8)

22.7%(1 in 5) 

North Hampshire 2.6%(1 in 38) 

3.6%(1 in 28)

5.7%(1 in 18)

6.2%(1 in 16) 

12.3%(1 in 8)

22.9%(1 in 5) 

West Hampshire 3.4%(1 in 29 )

4.6%(1 in 22)

5.3%(1 in 19)

7.0%(1 in 14) 

14.5%(1 in 7)

26.2%(1 in 4) 

South Eastern Hampshire

3.8%(1 in 26)

5.3%(1 in 19)

6.2%(1 in 16 ) 

7.5%(1 in 13 )

15.4%(1 in 6)

27.2%(1 in 4) 

Fareham & Gosport

3.6%(1 in 28)

4.5%(1 in 22)

6.2%(1 in 16 ) 

6.8%(1 in 15)

15.5%(1 in 6)

26.0%(1 in 4) 

National 3.3% 4.7% 6.2% - 13.7% 24.7%

Employment• Being in good employment is generally protective to health, and

people who are employed have lower rates of limiting long term illness, cardiovascular disease and health problems. (good news)

Economic inactivity (Jan 2014-Dec 2014)

 Basingstoke and Deane Basingstoke and Deane South East Great Britain

(level) (%) (%) (%)

All people

Total 18,800 16.8 20.3 22.7

Employment and unemployment (Jan 2014-Dec 2014)

 Basingstoke and Deane Basingstoke and Deane South East Great Britain(numbers) (%) (%) (%)

All people

Economically active† 98,000 83.2 79.7 77.3

Life Expectancy at 65 years

2000

-02

2001

-03

2002

-04

2003

-05

2004

-06

2005

-07

2006

-08

2007

-09

2008

-10

2009

-11

2010

-12

2011

-13

-

5.0

10.0

15.0

20.0

25.0

Male and female life expectancy at age 65+ for Basingstoke and Deane

MaleFemale

Period

Life

exp

ecta

ncy

(yea

rs)

Source: Office for National Statistics via Public Health England.

Life expectancy at 65 years for Basingstoke and Deane is 18.9 years for men and 20.7 years for women – although the gap is narrowing the LE in B&D is below the Hampshire average of 19.2 years for Men and 21.8 years for women

Aging Well

Key issues for older people

• Falls– About one in three people over 65 years and half of people over 80 years fall at least

once a year. – A hip fracture is the most immediate consequence of falls and pre-existing

osteoporosis among older people affecting Independence, mobility, confidence and increasing isolation

• Excess winter deaths/Fuel poverty– The UK has one of the highest Excess Winter Death (EWD) rates in Europe and

affects people of all ages – Older people tend to take fewer precautions (such as wearing warmer protective

clothing) in cold weather; compared to those living in countries with cold winters

• Loneliness/Isolation– The influence of social relationships on the risk of death is comparable with risk

factors for mortality such as smoking and alcohol consumption and exceed the influence of physical activity and obesity

Years lived with Disability by cause and age (2010)

Cost of determinants for health• Aside from the costs of care and treatment, the

cumulative impacts of behaviours that increase risks to health also result in reduced productivity, increased absenteeism and welfare costs.

• For example, estimated costs to the country as a whole include:

• inactivity: Estimated to cost £200 per inhabitant/ year – Violence: costs the economy £40 billion/ year in the UK– Environmental health: air pollution costs England about

£10 billion/ year Sources: * Department of Health Chief Medical Officer Annual Report 2009; ** Estimates by The King’s Fund based on Department of Health, Chief Medical Officer Annual Report 2009

Issues of greatest significance for Hampshire • An ageing population that may be experiencing a smaller

proportion of its life in good health with significant ill health and dependency attributable to:– Mental ill health;– Musculoskeletal problems which in turn are linked to how we

live our lives, how active we are, our educational attainment and resilience and

– The significance of the impact of inequalities on individuals, their need for support, so hence the use of our resources

– Dementia.

Opportunities to improve the public’s health

Focus on getting really Active

support active commuting and school travelsupport children and young people to be physically active

Engaged communities: Continue to encourage volunteering

Outdoor space: consider mechanisms for increased access to country parks and installation of fitness zones

A good start in life: post-natal depression identification and intervention parenting programme & family support projects reducing conduct disorder with Social Emotional Literacy

Secure and prepared: GP Domestic Violence identification and referral Road traffic accident prevention

Healthy work: individual and group exercise for back pain mental health promotion in work workplace obesity interventionworkplace ‘flu vaccination & infection control

Mental Well-being: Cognitive Behaviour Therapy for young people, prevention of depression in later life

Positive behaviours: youth tobacco control GP alcohol brief interventions healthy nutrition and physical activity public awareness

Enabled elderly: warm homes psycho-social group therapy for lonely elderly exercise class for older people & falls prevention pathways

People centred services: Vascular disease health checks & diabetes prevention GP high blood pressure diagnosis

Public health services: public health information, health protection, health improvement, healthcare prevention, specialist capacity, alignment and capability

Social and health care: support for people with mental illness coordinated end of life support and information

Simple things we can do to make a real difference:• A sustainable approach to maintaining our countryside• Supporting residents to live in resilient communities • Risk reduction for the avoidable causes if ill health, disability and

dependency - CVD, Cancers and dementias• Support residents to maximize their life chances & the wellbeing of

the local area by – being physically active throughout life from the earliest years– children growing up in conditions to acquire mental resilience & achieve

to be employable– maintain good health for residents of all ages, particularly focusing on

the workplace• Road safety and accident reduction• Valuing and furthering the coordination of the last years of our lives

Examples of local work

• Dementia Friendly settings• Physical Activity programmes• Community Development work• Smoking programmes

– Smokefree settings– Fitness for surgery