A presentation for a stakeholder event on how the physical activity and sports sector, and Public Health, in Hertfordshire can work together

1. Better Public Health
Working in Partnership with Sports
and Physical Activity Sector
Jim McManus
Director of Public Health
26th February 2014
Sports and Physical Activity Stakeholder Event
Hertfordshire Sports Village
www.hertsdirect.org

2. AGENDA
• 9.30am
–
Welcome and introduction
Christine Neyndorff Director, Herts Sports Partnership (HSP)
• 9.35am
Herts Public Health Strategy – ‘working in partnership with the sport sector
• Jim McManus Director of Public Health, HCC
• 10.05am
Q&A / discussion
Jim McManus
• 10.50am
•
•
•
•
•
•
Sport & PA case studies – the use of sport and physical activity to promote public
health messages
Fiona Deans, Herts Sports partnership
11.00am
In groups, identify
Fiona Deans
What can the Sport & PA sector do as part of what they do anyway?
What is needed to help this happen?
What would be a priority for new work?
• 11.25am
• 11.30am
Closing remarks
End of session
www.hertsdirect.org
Christine Neyndorff

3. Current challenges facing Hertfordshire
• Avoidable early deaths – over 2,000 pa
• Chronic disease – poor self management, poor
•
•
•
management of sub-clinical risk, could do better on
prevention and early intervention
Some sections of our population at very high risk of
avoidable misery and death
Mental health – haven't tapped the benefits of physical
activity for this
Resilience and Happiness – likewise
www.hertsdirect.org

4. 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
The
Public
Health
Outcomes
Framework
(the national
PHOF will
Help us measure
Our success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUR
RESIDENTS
(our strategic priorities: what we achieve for our County)
Priority 1:
Our
Populatio
n lives
Longer,
Healthier
Lives
Building
Strong
Blocks
Leadership
For the
Public Health Family
Priority 2:
Our
Population
Starts Life
Healthy
and Stays
Healthy
Capable,
Skilled People
www.hertsdirect.org
Priority 3: We
narrow the
gap in life
expectancy
and health
between
most and
least healthy
Co-production
with citizens
Priority 4: We
protect our
communities
from harm
(chemical,
biological,
radiological and
environmental)
Effective
Partnerships
HOW WE WILL WORK TOGETHER
(our strategic priorities: how we do it for
our County)
Priority 5:
We
understand
what’s
needed and
we do what
works
Evidence and
Knowledge
Driven
Plan and
Deliver for
Localism
Priority 6: We
make public
health
everybody’s
business and
work together
Whole
System
Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels

5. www.hertsdirect.org

6. Contributors to overall health outcomes and why elected
councillors are important leaders
Health
Behaviours 30%
Socioeconomic
Factors 40%
Clinical Care
20%
Built Environment
10%
Smoking 10%
Education 10%
Environmental
Quality 5%
Diet/Exercise 10%
Employment
10%
Access to care
10%
Quality of care
10%
Built
Environment 5%
Alcohol use 5%
Poor sexual health
5%
www.hertsdirect.org
Income 10%
Family/Social
Support 5%
Community
Safety 5%
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.

7. Hertfordshire doing very well overall,
but this masks several districts with
Significant inequalities in outcomes
www.hertsdirect.org

8. Underweight
Healthy
Overweight
www.hertsdirect.org
Obese
St
.
ns
sh
i re
ire
Al
ba
rd
sh
e
rd
m
er
ts
tfo
rd
tfo
H
er
tH
er
th
Ea
s
N
or
H
er
fo
30%
40.0%
33.6%
39.5%
38.2%
39.6%
47.0%
35.6%
35.5%
35.6%
44.0%
46.7%
40.9%
41.0%
36.9%
31.5%
39.9%
39.2%
37.1%
41.9%
40.3%
70%
W
at
ld
rs
fie
R
iv
e
H
at
e
W
el
w
yn
Th
re
ag
e
10%
29.2%
50%
or
um
ve
n
37.5%
40.8%
21.5%
23.0%
15.5%
18.7%
19.1%
20.2%
20.9%
21.2%
24.0%
25.2%
25.6%
28.3%
80%
D
ac
St
e
ire
ne
sh
35.0%
20%
ou
r
rd
d
60%
xb
tfo
la
n
90%
Br
o
H
er
En
g
Adult obesity in Hertfordshire 2012
100%
40%
0%
Source: Active People Survey (Sport for England)

9. in and
Out of hospital
Primary
Prevention
www.hertsdirect.org
Secondary
Prevention
Tertiary
Prevention

10. The shift to prevention
Primary
Prevention
www.hertsdirect.org
Secondary
Prevention
Tertiary
Prevention

11. How?
• Self management in primary care and chronic
disease
• Benefits of physical activity
• Behavioural support and change (variety of
techniques)
• Early identification of people with disease and
pathwaying into healthier lifestyles
www.hertsdirect.org

12. •
•
•
•
•
•
•
•
It is not the answer to obesity, it is part of AN answer
It is important in and of itself as a health-giving and
health-protecting exercise (vascular, endocrine,
musculo-skeletal, cognitive, emotional and immune
benefits)
Second nature self-propelled transport
Link up to behavioural pathways in prevention
Balances pharmacological pathways in prevention of
non communicable disease
Supports self care in non communicable disease
Supports tehabilitation
Mental health resilience and coping
www.hertsdirect.org

13. Mental Health and Physical Activity
• Resilience
• Self Management
• Early Intervention
• Physical health challenges
• Unity of person – biopsychosocial approach
• MH Benchmarking exercise
www.hertsdirect.org

14. a new approach is needed, focus on shifting
weight distribution in the population
Underweight
Healthy weight
Overweight
Obese
Average BMI
Maximise proportion
at a healthy weight
Minimise proportion
at an unhealthy
weight
Fewer overweight
Fewer underweight
Fewer obese
www.hertsdirect.org
Average BMI
Reduce average BMI
Underweight
Healthy weight
Overweight
Obese
Make more people a
healthy weight,
not just fewer
people obese

15. 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)
www.hertsdirect.org

16. Some parameters – yes please to
• Physical activity population wide as an important public
•
•
health intervention
Targeted and tailored interventions for populations
– Health walks
– Cardiac rehabilitation phases 1 – 4
– Secondary prevention
– Post surgery rehabilitatipn
– Better access for disabled people
Range of benefits – physical and psychological
– “Everybody more active, more of the time”
– Everyone working out their role and contribution
www.hertsdirect.org

17. Some parameters
• No to assuming physical activity is “the solution”
•
to obesity (because it simply isn’t)
Need to work out the role of elite sports and our
sports clubs in public health challenges
– Suggestion – their public health role is about
• doing what they do already
• Increasing participation at all levels
• Helping create a culture of physical activity
• They are a part of an answer, not the answer
www.hertsdirect.org

18. Values for sports and physical activity sector Ottawa Charter, 1986
• "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 area where sports and physical activity can help
www.hertsdirect.org

19. The upshot of the Ottawaw Charter for sport and
physical activity
• Regular physical activity available for ALL as
routine part of life
• Physical activity providers as part of public
health pathway
• Making every contact count
• Physical Activity Plus +
• Sport from entrant to elite – social norms
reinforcing activity and health
www.hertsdirect.org

20. 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
www.hertsdirect.org

21. Physical Activity Plus+
• Referral from GPs and services
• Physical activity more widely on referral
• Staff have health goal assessment, motivation
and behaviour change skills
• Inclusion of people who face barriers to access
(cost, disability, etc)
www.hertsdirect.org

22. What it means for physical activity agencies
• Mainstream an ethos of public health in your
service
• 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
www.hertsdirect.org

23. Phasing and Layering across public health
•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
www.hertsdirect.org

24. A Lifecourse approach to physical activity
• Everyone active from early years to older age
• Tailored menu of what can be done
• School, community, workplace, care setting
www.hertsdirect.org

25. 15 Actions being taken so far (more will be done)
1. New weight management service already
1st
2.
3.
4.
5.
6.
7.
commissioned and reached
1,000
referrals in three months, more will be
commissioned
Obesity pathway in place for tiers 1 -3
obesity care. Revision late 2014
New lifestyle partnership launched with
lifestyle offer for Herts residents to be ready
by Easter for phased roll out
New online lifestyle service launched in
February
Workplace physical activity challenge
funded and running (Herts Sports
Partnership)
Workplace Health improvement programme
running (Business in the Community)
93% of GPs in Herts now doing NHS
HealthChecks
www.hertsdirect.org
1. Obesity Plan approval by Cabinet due
March 2014
2. New child weight management service to
be commissioned in 2014
3. Broxbourne whole area obesity pilot
underway with Borough and County
Council, schools and NHS
4. Fast food takeaway restrictions
5. Countryside walks scheme
6. Year of Cycling launching May 2014
7. Funding for District Councils to work on
health improvement agreed and each
District working out its plans
8. Continue child weight measurement
programme

26. Where next
• Getting the benefit from the new lifestyle partnership
• Building a behaviour pathway into physical activity
• “Public healthing” physical activity and leisure/sport
– Pathways
– Behavioural support, motivation, assessment
–
–
–
–
Whole healthy life packages, not silos
Training
Commissioning specific interventions
Large scale
www.hertsdirect.org

27. Behaviour Change Pathway Approaches
The evidence base for changing health behaviour is developing quickly. Brief interventions in primary care (by practice nurses and
GPs) can motivate people to change, providing referral onwards is speedy. This pathway
1st Line – Brief Intervention
Opportunistic brief advice by
GP, pharmacist or practice
nurse
1Identify health issue of
concern (and follow
appropriate pathway for
that, e.g. obesity)
2Assess motivation to
change
3If motivated, refer on
4If not motivated,
Raise awareness
of risks.
Offer written
information on
healthy eating and
physical activity.
Raise again in 3
months.
Offer information
prescription
2nd Line – Behaviour Change
Discuss primary or main goal
then refer appropriately
Smoking
is primary,
main or
only goal
Refer to
smoking
cessation
service
www.hertsdirect.org
Weight
loss,
healthy
living or
CVD risk
is main or
primary
goal
Refer to
ifestyle
Service
3rd Line - Activity
4th Line – Specialist
If fall into 1st or
subsequent line category
of advice within Obesity
Care Pathway refer to
Lifestyle Programme,
provided there are no
contraindications and if
co-morbidities or person
has BMI over 30, GP has
assessed and supports
referral. Check this ….
For patients with comorbidites
Patients who are diabetic or
have coronary heart
disease or a history of heart
problems must have referral
from appropriate primary
care team or secondary
care to participate in
programme.
Behaviour change
programme to be developed
in partnership with specialist
services
Patients with highly complex psychological or emotional
issues (e.g. depression or eating disorder.)
If not already in contact with such services, refer to IAPT
programme psychology or primary care mental health team

28. Thank you!
www.hertspublichealth.co.uk
• Jim.mcmanus@hertfordshire.gov.uk
www.hertsdirect.org