2. 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)
3. www.hertsdirect.org
Contributors to overall health outcomes and why elected
councillors are important leaders
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.
4. www.hertsdirect.org
Three key points
• Unique role of local authorities able to work on
70% of determinants of health
• The importance of a lifecourse approach
• The new strategic role of local government
5. www.hertsdirect.org
The Domains of Public Health
Health
Improvement
Health
Protection
Service Quality
Then &
Now
Sanitation
Housing
Now
Environment
Then & Now
Smoking
Heart Disease
Now
Care which keeps
People healthy and
independent
6. 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
8. 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 ?
{
9. 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
10. www.hertsdirect.org
Values - 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
11. www.hertsdirect.org
Values – A Public Health Family 2013
Environmental Health
& Regulatory Services NHS
Police, Fire,
Community Safety Third Sector and
Community Bodies
Public Health
England
Specialist Public Health Agencies with Major Public Health Roles
HCC Public Health
County Council
District Councils
12. 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
14. 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
15. www.hertsdirect.org
Vision
• Healthy, Happy Hertfordshire: Our vision is
that everyone in Hertfordshire is born
healthy, and lives full, healthy and happy
lives.
• ALTERNATIVE
• Our vision is that by 2026 everyone in
Hertfordshire starts and stays as healthy as
possible across their whole life
16. www.hertsdirect.org
Priorities
1. Longer Healthier Lives
2. Start Healthy, Stay Healthy
3. Closing the Gap
4. Understand what’s needed and do what works
5. Partnership: Making PH everybody’s business
6. Protecting our communities from harm
17. 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
18. www.hertsdirect.org
The public health mindset in local government
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
19. www.hertsdirect.org
The Tasks Now
1. Understand the context set by our population
and the differences between it and England
2. Understand the big ticket issues we need to
work on
3. Use specialist public health to impact on the
£4bn +, not commission the £55m –
4. Stronger role for behavioural sciences
20. www.hertsdirect.org
Phased Approach to transition
• Phase 1 – to Sept 2012. Focus on transactional issues,
accommodation, co-location, scoping further work
• Phase 2a – to March 2013 – moving into transformational. Wide
engagement of team and staff etc
• Phase 2b – to March 2013 – Transformational – the vision and
strategy of what Public Health is offering Hertfordshire
• Phase 3 – march 2013 to March 2014 – Embedding the
transformation and new way of working
• Phase 4 – 2014 onwards – the hard long term work of making
Hertfordshire a public health county.