1. North East England Health Summit:
Inequalities-Related Stress Event
Policy and PHE Overview: challenges
and opportunities
Gregor Henderson, Public Health England
@Gregorwell

2. Public Health England
‘Protecting and improving the nation’s health
and addressing health inequalities’
A Government Executive Agency - Part of the Department of Health.
Key Functions:
• Health Protection
• Knowledge and Information
• Health Improvement
8 Local Centres, Plus London – ‘Locally Led Public Health System’
Close Working with NHS England, Local Government, and VCS
Advocates, Informs and Challenges Government
2

3. PHE
protects the country from threats to health,
including outbreaks of infectious diseases and
environmental hazards, in the UK and abroad
improves the public’s health and wellbeing
improves population health through sustainable
health and care services
builds capacity and capability of the public health
system
Through supporting Local Systems
3

4. Improving the ‘public’s’ health through…
The application of evidence into practice and influencing
public health policy.
Addressing health inequalities (other underpinning themes)
A place-based approach that engages local communities,
building on their assets and addressing the wider
determinants of health, including the built and natural
environment
A life course approach, promoting a holistic view of an
individual’s total health and wellbeing needs at every
stage of life, seeing public health as one system for
improving health and wellbeing
4 Opportunities for prevention and improving outcomes

5. Health?.......
Socially determined and shaped – more by the way in which our
society is organised, than by our individual ‘merit’ or the quality of
the health care system.
Good health is more than the absence of disease or illness.
There is a ‘social’ gradient.
Need to address the causes of the causes – poverty, isolation,
violence, worklessness, environment and housing, caring……
(takes us into meaning and purpose and what we value)
Key areas are early childhood development, education, work and
working conditions, older people (connected and cared for),
resilient, connected and engaged communities.
Sir Michael Marmot ‘The Health Gap’ 2015
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6. Wellbeing (and mental health)
Wellbeing is a dynamic state, in which the individual is able to
develop their potential, work productively and creatively, build strong
and positive relationships with others, and contribute to their
community. It is enhanced when an individual is able to fulfil their
personal and social goals and achieve a sense of purpose in
society.’ Foresight Report on Mental Capital and Wellbeing (2008)
Government Office for Science
‘Feeling Good and Functioning Well’ FPH (2014)
‘Mental health is defined as a state of well-being in which every
individual realizes his or her own potential, can cope with the normal
stresses of life, can work productively and fruitfully, and is able to
make a contribution to her or his community. Where health is a state
of complete physical, mental and social well-being and not merely
the absence of disease or infirmity.’ WHO 2005
‘6

7. Themes – Stress, health and Inequalities
• Stress impacts on our psychosocial state and way of
being
• Stress is mediated by our social and physical
environment
• Stress as a mediating factor in the link between
inequalities and ill health
• The importance of the social, political and economic
cultural context
• The need for more research and evidence
The role of stress as a key psychosocial determinant of
health and health inequalities.
7 Opportunities for prevention and improving outcomes

8. Challenges
8 Opportunities for prevention and improving outcomes

9. ‘Health’ in Our
CommunitiesOur population is ageing
More people have long term conditions (physical and
mental)
Inequalities persist and in many places are worsening
Expectations of services rising
Financial constraints in all public services
People want more responsive, personalised services
People want more control and influence
Communities are more fluid and in some cases fragmented
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10. Psychological wellbeing
Depression now ranks 1st
as contributor to burden
of disease in high & mid-
income countries
Past decade: use of
prescription drugs to
treat ADHD in children
has increased by 46% in
US, has quadrupled in
UK
Solutions are beyond
illness care and
treatment services

11. Community Vitality
Studies identify community
as one of most
significant determinants
of wellbeing for
individuals & families
(R Putnam, 1993)
Those who feel sense of
belonging lead happier,
healthier lives & create
more stable, supportive
communities
(J Helliwell, 2012)
Yet, in many countries,
seeing widening social
inequalities, breakdown of
social cohesion & trust ...

12. Social relationships: Overall findings from this meta-analysis
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
Social relationships have big impact:
comparative odds of decreased mortality
Social relationships: High vs. low social support contrasted
Social relationships: Complex measures of social integration
Smoking <15 cigarettes daily
Smoking cessation: Cease vs. continue in patients with CHD
Alcohol consumption: Abstinence vs. excessive drinking
Flu vaccine: Pneumococcal vaccination in adults
Cardiac rehabilitation (exercise) for patients with CHD
Physical activity (controlling for adiposty)
BMI: Lean vs. obese
Drug treatment for hypertension in populations > 59 years
Air pollution: low vs. high
Holt-Lunstad J et al. PLoS Med. 2010;7:e1000316
Social relationships have as great an
impact on health outcomes as smoking
cessation, and more than physical activity
and issues to address obesity

13. Inequalities- TheSpiritLevel
Inequality matters in how we relate to each other
The quality of our social relations are largely built on
material foundations
‘Need to now shift away from material standards and
economic growth to improving the psychological and
social wellbeing of societies and populations……….’
www.equalitytrust.org.uk

14. GoingBeyondtheIndividual
‘………levels of mental distress among communities
need to be understood less in terms of individual
pathology and more as a response to (poverty)
relative deprivation and social injustice, which erode
the emotional, spiritual and intellectual resources
essential to psychological well-being’
Lynne Friedli, ‘Mental Health, Resilience and
Inequalities.’ WHO 2009

15. Opportunities
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16. Guide & family published Feb
2015
2015/16 Evidence into action
• Embedding across PHE priorities
• Application of family to practice
• Development of knowledge portal
• Asset based approaches
• Communication and dissemination
2014/15 PHE and NHS England project
to draw together and disseminate existing
evidence and learning on working with
communities
System leadership
Good access to evidence and learning
combined with strong collaborations will help
grow and strengthen effective working with
communities
Building confident and connected
communities is an important route to
improve health and reduce the health
gap
16 PHE’s approach to improving the public’s mental health and wellbeing
Communities

17. Community CentredApproaches andAssets Programme
A national collaborative programme for community
centred approaches
Knowledge platform of evidence
• Collect and disseminate case studies of good practice
• Support learning, training and development
• Support Devolution work and local Vanguard sites
• Produce an asset based health profile and asset
mapping tool
• Join up national work and effort (with NHSE)
17 HEMH Outline Strategic Plan 2016/17 Dec4

18. PHE ACTION PLAN calls all partners to take action on:
Applying, and testing, the principles and competencies to
different workforces – Competencies and Capabilities
Workforce and Leadership
18 PHE’s approach to improving the public’s mental health and wellbeing

19. Data and Intelligence
National Mental Health Intelligence Network (NMHIN)
“Turning data and information into timely meaningful health
intelligence for commissioners, policy makers, clinicians
and health professionals to improve services and
outcomes.”
NMHDNIN focuses on the following key areas:
• Common mental health problems,
• Severe mental illness,
• Suicide
• Children and young people,
• Wellbeing,
• Co-existing substance misuse and mental health issues
Web: www.gov.uk/phe
19 PHE’s approach to improving the public’s mental health and wellbeing

20. Embedding
Embedding psycho-social approaches:
• Obesity
• Alcohol
• Smoking
Early days, promising signs, enthusiasm.
Policy advocacy and opportunities
20 Opportunities for prevention and improving outcomes

21. Emerging
21 Opportunities for prevention and improving outcomes

22. Five ways to wellbeing
Evidence-based
actions that are
memorable, easy to
understand and have
a wide variety of
possible applications

23. Shift to Integration - Integrated education,
awareness, social marketing; integrated
services
PHE’s One You Campaign – smoking, drinking,
eating, moving, sleep, stress
‘Modern life makes it hard to be healthy’
Integrated wellness services – holistic attempts to
provide a range of integrated services in one
place.
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24. Psychosocial pathways to health
• Psychosocial factors are an important part of the causal
pathway between social conditions and health
inequalities.
• Psychosocial pathways directly impact our physical and
mental health and also indirectly via health behaviours.
• The influence of psychosocial pathways is not often
explicitly recognised in policy and practice.
PHE is publishing a conceptual framework on Psychosocial Pathways
to Health, produced by the Institute for Health Equity. This will be
followed by work this year on a report on implications for local and
national action.
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25. Key Drivers
Actions outside healthcare
Shifting to wellness
Building on assets / communities
Local devolution
Integrated approaches
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26. Some KeyAreas
• Early Years
• Schools
• Primary care
• Obesity
• Alcohol
• Smoking
26 Opportunities for prevention and improving outcomes

27. InternationalAdvocacy
Social movements responding to health inequities and use
of community-centred approaches. Advocating for
stronger alignment of health promotion and civil society
efforts around social justice issues.
The importance to health of well-connected communities
through social and informal networks, to help build
resilience, belonging and social capital.
Recognition of the psychosocial processes and factors that
help explain how exposure to adverse social conditions
impact directly and indirectly on health outcomes e.g.
control, status, stress, resilience, social networks.
27 Opportunities for prevention and improving outcomes

28. Challenges
• Attention for Prevention
• Continuing austerity
• Making the case for integrated investment
• Having good Intelligence (data, evidence)
• Capacity and Capability (workforce and
leadership)
• Wider Ownership for health and wellbeing
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29. Thank you
gregor.henderson@phe.gov.uk
@Gregorwell