A workshop for community and voluntary agencies on public health priorities for Hertfordshire and how we can build people centred public health together
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People Centred Public Health: Community/Vol Agency Stakeholders Workshop
1. www.hertsdirect.org
People Centred Public Health
Opportunities for Community Agencies in a Strategic
Shift to Prevention
Jim McManus
Director of Public Health
Sept 27th 2013
2. www.hertsdirect.org
What we want to get to
• Articulate what people centred public health
means
• Explain the context
• Explain what agencies can do
• Suggest some models
3. www.hertsdirect.org
Healthier Herts: A Public Health Strategy for Hertfordshire
Consultation Draft OUR PURPOSE
to work together to improve the health and wellbeing of the people of
Hertfordshire, based on best practice and best evidence
OUR VISION:
A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy
and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
Priority 5:
We
understand
what’s
needed and
we do what
works
Priority 6: We
make public
health
everybody’s
business and
work together
HOW WE WILL WORK TOGETHER
(our strategic priorities: how we do it for
our County)
The
Public
Health
Outcomes
Framework
(the national
PHOF will
Help us measure
Our success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT
POPULATION
(our strategic priorities: what we achieve for our County)
Priority 1:
Our
Populatio
n lives
Longer, H
ealthier
Lives
Priority 2:
Our
Population
Starts Life
Healthy
and Stays
Healthy
Priority 3: We
narrow the
gap in life
expectancy
and health
between
most and
least healthy
Priority 4: We
protect our
communities
from harm
(chemical, biolo
gical, radiologic
al and
environmental)
Building
Blocks
For the
Public Health Family
Strong
Leadership
Capable,
Skilled People
Co-production
with citizens
Effective
Partnerships
Evidence and
Knowledge
Driven
Plan and
Deliver for
Localism
Whole
System
Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels
6. www.hertsdirect.org
Major Disease Shifts
• 1st – Poverty, Living Conditions
– Improvement in incomes, reduction in deaths
• 2nd –Communicable Diseases
– Now on average 6-11% of deaths in UK. Was 85% of deaths
before 1900
• 3rd – Non-Communicable Diseases
– Over 60% of deaths due to lifestyle and behaviour
– Poorest fare worst (smoking, diabetes, heart disease)
9. www.hertsdirect.org
Interface of PH, health inequalities & social care
• NHS gone from infectious disease focus in 1948 to LTCs, cancer and
mental health in 21st century
• 1 in every 7 GP appointments for LTCs*
• 50% of adults with a mental health problem had a MH, behavioural or
emotional problem before the age of 14 yrs
• MH biggest spend of NHS than any other health condition
• Social determinants AND quality and accessibility of health & social care
• Old model of health and social care – deliver to, not with…co-production,
co-creating health, shared decision-making …
• Personal budgets… for social care (and health ??)
• Shift from one size fits all
10. www.hertsdirect.org
The Big Strategic Challenges for Hertfordshire
Health
Improvement
Health
Protection
Service Quality
Imms
Vaccs
TB
HCAI
Environment
•Non
Communicable
Disease
•Public Mental
Health
•Development
•Ageing
Health Care Quality
Public Service Outcomes
12. www.hertsdirect.org
Conceptualising wider determinants
Smoking 10%
Diet/Exercise 10%
Alcohol use 5%
Poor sexual health
5%
Health
Behaviours 30%
Education 10%
Employment
10%
Income 10%
Family/Social
Support 5%
Community
Safety 5%
Socioeconomic
Factors 40%
Access to care
10%
Quality of care
10%
Clinical Care
20%
Environmental
Quality 5%
Built
Environment 5%
Built Environment
10%
Source: Robert Wood Johnson Foundation and University
of Wisconsin Population Health Institute. Used in US to
rank counties by health status
While this is from a US context it does have significant
resonance with UK Evidence, though I would want to
increase the contribution of housing to health outcomes
from a UK perspective.
Contributors to overall health outcomes
14. www.hertsdirect.org
Systems thinking on wider determinants
Getting everyone on the same systems page
The wider determinants of Health and Local Government functions
(Must adopt a Lifecourse approach!)
The Lives people lead and whether LA functions help or
hinder healthy lifestyles (policy, service
quality, access, behavioural economics, behavioural
sciences)
The services people access such as primary care
(high quality, easy access, good follow
up, behavioural and lifestyle pathways wrap
around)
16. www.hertsdirect.org
People Centred Public Health
• Every service understands and owns a public
health role
• We skill and motivate people to self-manage
their health and wellbeing
• We focus on the person and co-ordinate around
them
• Physical, Social, Psychological and Spiritual are
all part of the dynamics of health
• Mindset of staff,volunteers, carers and users
17. www.hertsdirect.org
Healthier Herts: A Public Health Strategy for Hertfordshire
OUR PURPOSE
to work together to improve the health and wellbeing of the people of
Hertfordshire, based on best practice and best evidence
OUR VISION:
A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy
and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
Priority 5:
We
understand
what’s
needed and
we do what
works
Priority 6: We
make public
health
everybody’s
business and
work together
HOW WE WILL WORK TOGETHER
(our strategic priorities: how we do it for
our County)
The
Public
Health
Outcomes
Framework
(the national
PHOF will
Help us measure
Our success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT
POPULATION
(our strategic priorities: what we achieve for our County)
Priority 1:
Our
Populatio
n lives
Longer, H
ealthier
Lives
Priority 2:
Our
Population
Starts Life
Healthy
and Stays
Healthy
Priority 3: We
narrow the
gap in life
expectancy
and health
between
most and
least healthy
Priority 4: We
protect our
communities
from harm
(chemical,
biological,
radiological and
environmental)
Building
Blocks
For the
Public Health Family
Strong
Leadership
Capable, Skille
d People
Co-production
with citizens
Effective
Partnerships
Evidence and
Knowledge
Driven
Plan and
Deliver for
Localism
Whole
System
Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels
18. www.hertsdirect.org
The Opportunity for Herts
• The conditions for everyone to be healthy
• The conditions for the poorest and worst off to
be healthier
• Public services which put this at the core of their
business
• People thriving and prosperous
• Healthy workforce, prosperous County
20. www.hertsdirect.org
The Strategy Pyramid
2
Missio
nVision: Where we want
to get to
Strategy: How we want to get to the
vision
Implementation Plans : What we need to do in each area
of the business and for each topic
Individual Plans: My personal objectives and must dos
Mission:
Why ?
Where/What do
we want to be?
Why do we
Exist ?
How we want to
get there?
What we
need to do!
What I
need to
do!
Values, what’s
important to us ?
{
21. www.hertsdirect.org
A Lifecourse approach
• Conception to death
• Protective and vulnerability factors (e.g. obesogenic
or energy balanced environment)
• Healthy outcome in one age is cumulative impact of
earlier ages
• Poor outcome in one age may be risk factor for
another (low birth weight and CVD)
• Early investment, early prevention (lifetime mental ill
health and under 13s)
• Data, Evidence, Implementation key
22. www.hertsdirect.org
Mission
• Our mission is to work together to improve
the health and wellbeing of the people of
Hertfordshire, based on best practice and
best evidence*
•
• *Best evidence means not just effectiveness
but cost-effectiveness
24. www.hertsdirect.org
Timeframes of impact/yield
Years
0 1 5 10 15
Planning
Education
Vitamin
Supplements
Air Pollution
Decent
Homes
Jobs
Primary
Care
20
CVD
Events
Self Care
Vitamin D and TB
Rickets
CVD Events
Acute Bronchitis Admissions
Respiratory
Mental Health overcrowding educational
attainment
Life Expectancy
Healthier space use Changing culture of activity
Life ExpectancyMental Health
26. www.hertsdirect.org
What it means for public health
• Design pathways around people
• Whole life approach
• Whole school approach to health
• Whole place approach to health
• Commission preventive services which join up
with clinical services
• Build protective factors
27. www.hertsdirect.org
What it means for NHS Services, for example
• Preventive services in every patient pathway
• Preventive services in clinical services link up to
community services (referral for leisure and
behavioural interventions)
• Making Every Contact Count
• Commissioning for self-management in chronic
disease
28. www.hertsdirect.org
What it means for community agencies
• Identify need and be part of needs assessment
process
• Co-design public health services with public
health commissioners
• Embed public health skills across your services
• Build resilience in users and communities
• Motivate people to self-manage
• Become health promoting in all you do
31. www.hertsdirect.org
Values - Ottawa Charter, 1986
• Underpins strategic role of local government
• "The goal of a healthy public policy is health promotion, i.e., to
enable people to increase control over and improve their health.
• It is also essential to
– create supportive environments,
– strengthen community action,
– develop personal skills and
– reorient health services.
All of these are areas for elected member leadership
32. www.hertsdirect.org
The public health mindset means working
across different dimensions of time and
responsibility
•Think through what we can do short term
•Start work on the medium term
•Set the policy framework for the long term
•Build this understanding among partners
•Get started and realise
•County, District, Parish, NHS, Business and
Community Sector working together
33. www.hertsdirect.org
HERTFORDSHIRE LOCAL PUBLIC HEALTH MODEL (For Place or for People Settings)
Development of a local plan for each area and agency between partners with use of existing
community networks
2. WORK ON THE COMMON RISK
FACTORS FOR BIG KILLERS
Neighbourhood interventions for
Diet, Physical
Activity, Smoking, Alcohol,
3a. IMPROVE LOCAL
NEIGHBOURHOOD QUALITY
Physical Environment, Green
Space, Crime/ASB. INCREASE
SOCIAL CONTACT BETWEEN
NEIGHBOURS
4. INCREASE UPTAKE OF PREVENTIVE HEALTH PROGRAMMES
Immunisation, Screening, This may differ from area to area depending on issues
1. Complete a Basic health profile – identification of health issues salient for the
neighbourhood or service user group by checking the basic basic profile from
JSNA or other source
5. Skilling people for their own health– develop and deliver basic personal health
skills training. (Physical and mental health)
So…towards a model
explicitly designed to be as easy as possible for non-health specialists
can implement it
3b. IMPROVE SALIENT HEALTH OUTCOMES
Address issues specific to your population e.g. Coping and resilience for carers
34. www.hertsdirect.org
So
• Does this make sense?
• Is it doable?
• What do you think can make it better?
• How do we improve?
• Where do we go from here?
• What can you do?
• What do we need to do to helpyou?