Putting the Public back in Public Health –
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Transcript of Putting the Public back in Public Health –
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Putting the Public back in Public Health –
New Approaches to improving Health & wellbeing for the 21st
century.
Wendy MeredithDirector of Public HealthBolton Council11-04-2014
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The presentation will cover: •Reflection on features of public health in 21st century •Discussion of emerging trends •Outline possible approaches to new and old problems
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Public Health in 21st century
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A powerful case for change
We face significant challenges to the public’s health:
•Two out of three adults are overweight or obese•Smoking costs the NHS £2.7 billion per year. And there are wider economic and social costs from preventable ill-health:•drug use and smoking cost over £10 billion per year •Major health threats, ranging from the risk of new pandemics to the potential impact of terrorist incidents •Inequalities in health remain: in 2008-2010, the gap between local authorities with the highest and lowest life expectancy was nearly 12 years for males and just under 11 years for females.
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Life expectancy
Internal gap 12 years
Gap with England – bigger than ever
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Bolton Health & Wellbeing Survey 2010
• Self perceived general health has slightly worsened• Increases in backache and joint pain• Diabetes has continued to increase (BBHC)• Mental health worsened• Obesity has increased further• More people experiencing financial difficulties• More negative perceptions of neighbourhood
• Smoking has continued to fall• Regular dental check ups continue to increase
Key changes since 2007 survey
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Lifestyle factors & risk factors• Smoking has reduced but still 1 in 3 adults admit to smoking in some
deprived areas• Alcohol - 30% adults binge at least once a week, 24% drink over the
recommended wkly level, 12% have just 0-1 alcohol free day a week
Alcohol consumption is greatest in least deprived areas but the reverse is seen related mortality rates
• Obesity – 20-25% adults are obese
9% Reception aged children, 21% by Year 6 are obese• Physical activity – 17% adults leading a sedentary lifestyle, 43% do 5
sessions• Substance misuse – estimates of 2272 opiate and or crack users –
‘traditional’ drug user profile is changing• Sexual health & teenage pregnancy – significant improvement in TP in
recent years but still above national average• Infectious disease - HIV prevalence and TB incidence increasing
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However good the NHS gets, until we get better at dealing with public health, poverty, housing, job-less-ness, education and giving kids a sure start in life, we were running
up the down escalator.
Roy Lilly, NHS Commentator
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‘Three Horizons’ Model Of Innovation
(Adapted by Duggan and Marsh 2008)
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How to Read a Change of Age
increasing synchronous
failure
Innovation to try and keep things
going
Radically new ideas
with better fit to new
environment new context for
useful old ways
less
disruptive change
new paradigm fits and takes off
innovation
shifts allegiance
TIME
THE TURBULENT TRANSITION
HORIZON 1
HORIZON 2
HORIZON 3
VIABILITY
radically different operating
environment
NOW
www.internationalfuturesforum.com
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An effective public health system
•Accounts for the changing nature, assets and strengths of the population – is vigilant for new health threats
•Ensures economic development creates health and well being
•Advocates wise use of environmental resources
•Promotes individual and community well being
•Helps people limit behaviours damaging to their health.
•Secures equitable access to good quality health and social care, with prevention incorporated into all contacts.
•Systematically works to reduce health inequalities and embeds health and well being in all policies.
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Essential Public Health system
1.Monitor health status to identify community problems
2.Diagnose and investigate health problems and health hazards in the community
3.Inform and educate people about health issues and empower them to deal with the issues 4.Mobilise community partnerships to identify and solve health problems
5.Develop policies and plans that support individual and community efforts
6.Enforce laws and regulations that protect health and ensure safety
7.Link people to needed personal health services and ensure the provision of health care when otherwise unavailable 8.Ensure a competent public health and personal care workforce
9.Evaluate effectiveness, accessibility and quality of personal and population based health services 10.Research for new insights and innovative solutions to health problems
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Emerging trends
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Strategic shift from healthier habits to wellbeing
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The Wellbeing Shift
Illness Wellness
Proximal Distal determinants (the root causes)
Deficits/ problems
Assets/ goals
What you are doing
Why you are doing it
Passive recipient Active,
empowered citizen
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PeoplePlacesPower
Health Inequalities
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Protecting health and improving wellbeing throughout life 1.Empowering local government and communities 2.Tackling health inequalities 3.Coherent approach to different stages of life 4.Giving every child the best start in life 5.Making it pay to work 6.Designing communities for active ageing and sustainability
7.Protecting communities from threats 8.Working collaboratively with business and voluntary sector
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Possible approaches to new and old problems
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What could be different?
•Five ways to well-being – Large scale change •Asset based working •Community resilience and coproduction •Community oriented primary care •Integrated Wellness Services •Investment for Health – “Health in all policies”
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Five Ways To Well-being Action that individuals can take ……. 1.Connect - with family, friends, colleagues, neighbours
2.Be active - walk, run, garden, dance 3.Take notice - be curious, reflect on experiences 4.Keep learning - try something new
5.Give - doing something for others
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• Improved use of wellness based prevention services
• Prevention incorporated into every care contact
What could be different? - Better preventive services
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•Better access to public health information •Extensive use of internet based communication and services - www.health2works.com Web 2.0
What could be different? – access to information
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JSNAJSNA
Filled with public
service provision
Community
Traditional Approach Asset Based Approach
Areas where support may be required
POPULATION NEED
Specialist interventions
Community assets and capacity
What could be different? - JSNA or JSAA?
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“You can’t know what you need until you know what you have”
“Look in your back yard before you go to the store”
John McKnightInstitute for Asset-Based Community Development
Northwestern University, Chicago
What could be different? – Community involvement
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• Everyone has gifts• Relationships build a community• Leaders involve others as active members of the community• People care about something• Motivation to act must be identified• A listening conversation• Ask, Ask, And Ask• Asking questions rather than giving answers invites stronger
participation• A citizen centred ‘inside-out’ organisation is the key to
community engagement• Institutions have reached their limits in problem solving• The institution as servants
The 12 Principles of ABCD Community Involvement
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Policies •Local policy decisions made whilst knowing their possible health impacts •Health in All Policies
What could be different? – Health in all polices
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Conclusion
• Now seeing limitations of risk theory of disease and lifestyle approach
• Shift from Illness to Wellness
• Putting “public” back in public health
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http://www.idea.gov.uk/idk/aio/26995259 Joint Strategic Needs Assessment: a springboard for actionhttp://www.idea.gov.uk/idk/aio/18410498 A Glass Half Full: How an asset approach can improve community health and wellbeinghttp://www.nwph.net/hawa/writedir/2fa6The%20Asset%20Approach%20to%20Living%20Well.pdf The Asset Approach to Living Wellhttp://www.nwph.net/hawa/writedir/da0dNW%20JSAA.pdf Development of a Method for Asset-Based Workinghttp://www.abcdinstitute.org/ ABCD Institute, Northwestern University, IL, USAhttp://www.youtube.com/watch?v=NhZOLLaLNDY
References
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Putting the Public back in Public Health
Wendy MeredithDirector of Public HealthBolton Council11-04-2014