A presentation from 2015 on how primary prevention of illness and disease should be integrated across systems and practice.

1. Primary prevention
- everybody’s business
Dr Justin Varney
Consultant Public Health Medicine (Adults and Older People’s Health and Wellbeing)
Justin.varney@phe.gov.uk

2. The Big Picture
Non-communicable diseases (NCDs)
and health inequalities in England

3. Significant challenges to public health
• Gap in life expectancy between local of around 9 years
for men and 7 years for women.
• Unsustainable rates of lifestyle-associated disease, e.g.
oOne of the highest obesity rates in the developed world
oSmoking claims around 80,000 lives a year
o1.6 million people are alcohol dependent
oOver 0.5 million new STIs diagnosed a year
• Major health threats persist, ranging from risk of new
pandemics to the potential impact of terrorist incidents.
3 Source: ONS

4. http://www.healthmetricsandevaluation.org;
The Lancet, Early Online Publication, 5 March 2013doi:10.1016/S0140-6736(13)60355-4
Understanding the NCD challenge
Burdenofdiseaseattributableto20leadingriskfactors,expressedaspercentageof
UKDALYS

5. Life expectancy and healthy life expectancy, and premature mortality
rates vary across the country – higher rates strongly linked to
socioeconomic deprivation
The NCD challenge: Health inequalities

6. Turning the tide

7. Prevention Tiers
Primary Prevention
Primary prevention aims to prevent the disease from occurring. So primary prevention reduces
both the incidence and prevalence of a disease, i.e. how many new people are diagnosed with
the disease and the overall proportion of the population living with the disease.
Secondary Prevention
Secondary prevention is used— after the disease has occurred, but before the person notices
that anything is wrong. The goal of secondary prevention is to find and treat disease early. In
many cases, the disease can be cured.
Secondary prevention is also used to describe actions to prevent individuals living with one
disease developing another (co-morbidity).
Tertiary Prevention
Tertiary prevention targets the person who already has symptoms of the disease. The goals of
tertiary prevention is to maximise the potential of the individual, through slow progression and
prevent complications.
7 Primary Prevention – everybody’s business

8. 8 Primary Prevention – everybody’s business
WHO 25 by 25

9. Primary Prevention & Cancer
Several lifestyle risk behaviours have an evidence base for association with cancer:
Tobacco
Cigarette smoking has been established as a cause of cancers of the lung, oral cavity,
oesophagus, bladder, kidney, pancreas, stomach, cervix, and acute myelogenous leukemia.
Physical Activity
There is strong evidence that physical activity is associated with reduced risk of cancers of the
colon and breast. Several studies have also reported links between physical activity and
reduced risk of endometrial (lining of the uterus), lung, and prostate cancers
Obesity
Obesity is associated with increased risks of cancers of the esophagus, breast
(postmenopausal), endometrium (the lining of the uterus), colon and rectum, kidney, pancreas,
thyroid, gallbladder, and possibly other cancer types.
Diet
A healthy diet is associated with reducing the risk for many cancers, there are some specific
diet modifications suggested by research such as a high fibre diet may reduce the risk of
bowel cancer, and a diet high in red processed meat may increase the risk.
Vaccination (HPV), Sun Exposure (Melanoma)
9 Primary Prevention – everybody’s business

10. Primary Prevention & Breast Cancer
Several lifestyle risk behaviours have an evidence base for association with cancer:
Obesity
Based on solid evidence, obesity is associated with an increased breast cancer risk in
postmenopausal women who have not used HT.
Alcohol
Based on solid evidence, alcohol consumption is associated with increased breast cancer risk
in a dose-dependent fashion. It is uncertain whether decreasing alcohol intake by heavy
drinkers reduces the risk
Exercise
Based on solid evidence, exercising strenuously for more than 4 hours per week is associated
with reduced breast cancer risk.
10 Primary Prevention – everybody’s business

11. Supporting Change
Everybody can make a difference, small changes like taking a ten
minute brisk walk every day can have an impact across a life-time.
Growing bank of resources and support on how best to enable behaviour
change:
NICE guidelines on behaviour change
Lots of tools and resources to support people making every day
changes, both big and small:
Eat Well Plate
Change4Life Smart Swaps
Change4Life 10 minute shake up
Change4Life Drink Checker
Couch25K
NHS Weight loss guide
NHS Quit Smoking & Smoke Free Apps
Move More pack for people living with cancer
11 Primary Prevention – everybody’s business

12. Physical Activity:
a challenge and a solution

13. Physical activity –ANational priority
13 Graph: Lee I-M et al. (2012)
Fourth greatest risk factor for
poor health in England
Contributes to almost 1 in 10
premature deaths, equal to
smoking
Greater cause of death in UK
than in comparable
countries
PopulationAttributableFractionof
mortalityduetophysicalactivity

14. Physical activity –Alocal priority
• Health costs – e.g. almost 1 in 2 women and 1 in 3 men not
active enough for good health
• Social costs – e.g. decline in number of walked trips (including
journeys to school), impact on economic regeneration
• Economic costs – estimated £10bn annual cost to
communities (nationally)
• Inequalities – by socioeconomics, age, disability, race, sex and
sexual orientation
14

15. Physical activity and wellbeing
15
Individual
Becoming
More
Active
Fun
Personal
development
Travel
Social
inclusion
Health

16. PHE
PhysicalActivity
Vision & Goals
16
Creating a social
movement
Activating
professionals
Industrial-scale
implementation
EVERYONE
ACTIVE,
EVERY
DAY
Creating environments
for active lives

17. The National PhysicalActivity
Implementation Framework
Will support local leaders to reframe, refocus and
provide leadership on:
Cross-sector partnership
Industrial scale action across the whole system
Focus on addressing inactivity and achieving health
enhancing levels of activity in physically active
Will consolidate evidence of need and ‘what works’,
with recommendations for People, Places and
Communities
Will provide a single coherent perspective across
national and local levels in October 2014

18. Lessons from previous national programmes
Transport has a role to play
Community interventions have
potential
Local authorities are key
Longer term vision needed
18
Date Programme
1996 Active for Life
2000 Walking the Way to Health
2003 Local Exercise Action Pilots
2003 London congestion charge
(plus cycle infrastructure)
2004 Sustainable travel towns
2006 Cycling Demonstration Towns
2008 Healthy Towns
2012 2012 Olympics
Ref: Cavil N (2014) Presentation to Westminster Forum. May 2014.

19. Recent national developments
Moving More, Living More
Cross-Government commitment to physical activity legacy of
2012 Olympic and Paralympic Games
Celebrates work already underway, highlights areas more
could be done & reiterates National Ambition
All-Party Commission on Physical Activity
Chaired by four cross-party chairs
Recommendations:
1. A national action plan
2. Getting the message out
3. Designing physical activity back into everyday life
4. Making physical activity a lifelong habit
5. Proving success
19
Refs: HMG (2014) Moving More , Living More. https://www.gov.uk/government/publications/moving-more-living-more-olympic-
and-paralympic-games-legacy / All Party Commission on Physical Activity (2014) http://activitycommission.com/

20. Conceptual Model
Children &
Families
Young
People
Working Age
Adults
Older Adults
Schools
Outdoor spaces
Workplaces
Built environment and transport
Health and social care services

21. MM,LM
published
CMO letter to RC
Virtual engagement
Conference engagement
Timeline
JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC
FRAMEWORK
PUBLICATION
Case Study/Emerging
Practice collection
Framework Concept Engagement
PHE
Launch
event
Regional
events
Topic Roundtables
Regional
Embedding
events
Evidence Collation
Rapid topic
overviews Consolidated ROI paper
APCOPA
report
BMJ
Learning/PH
PA eLearning
Workplace
topic guide
on Physical
Activity
Brain Age
Tool

22. Engagement activities (so far!)
• Virtual engagement
o PhysicalActivity@phe.gov.uk mailbox (~100 professional
and public submissions)
o ‘Good’ and ‘promising’ practice collation (>750
submissions)
• Direct engagement
o Cross-sector launch (>200 senior leaders)
o Sector-specific presentations / workshops
o Regional MMLM fora (>700 people)
o Bilateral meetings
o Expert roundtables
o Cross-Government Moving More Living More work
o All Party Commission on Physical Activity
22

23. Let’s get everyone
active everyday!
PhysicalActivity@phe.gov.uk