Food in a Public Health Context

Dr Eugene Milne

Deputy Regional Director of Public Health

Some national reports and policies

• Choosing Health (Nov 2004)

• Tackling Obesity: Foresight Report (2007)

• Healthy Weight, Healthy Lives (Jan 2008)

• Food Matters : Cabinet Office Report (July 2008)

• FSA Strategic Plan 2010- 2015

• Food 2030 (Defra 2010)

• Fair Society, Healthy Lives (2010)

The North East will have the best and fairest health and well-being, andwill be recognised for its outstanding and sustainable quality of life.

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Male all-cause all-age mortality in the North East and England

North East

England

1

1.02

1.04

1.06

1.08

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1.12

1.14

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1.18

1993

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1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

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Cardiovascular mortality for persons in the North East and England

North East

England

1

1.02

1.04

1.06

1.08

1.1

1.12

1.14

1.16

1.18

1.2

1993

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Explaining the fall in coronary heart disease deaths in England & Wales 1981-2000

Risk Factors worse +13%

Risk Factors better

-71%

    

Treatments -42%

20001981

68,230 fewer deathsin 2000

 Unal, Critchley & Capewell Circulation 2004 109(9) 1101

Explaining the fall in coronary heart disease deaths in England & Wales 1981-2000

Risk Factors worse +13% Obesity (increase) +3.5% Diabetes (increase) +4.8% Physical activity (less) +4.4%

Risk Factors better -71%Smoking -41%Cholesterol -9%Population BP fall -9%Deprivation -3%Other factors -8%

    Treatments -42%AMI treatments -8%Secondary prevention -11%Heart failure -12%Angina:CABG & PTCA -4%Angina: Aspirin etc -5%Hypertension therapies -3%

20001981  Unal, Critchley & Capewell Circulation 2004 109(9) 1101

68,230 fewer deathsin 2000

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1992 1994 1996 1998 2000 2002 2004 2006 2008 2010

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All-age cancer mortality for persons in the North East and England

North East

England

• Delivery of BHFH requires falls in CVD and cancer

• Falls in CVD and cancer require not only better treatments but falls in smoking, falls in obesity and increased physical activity

Themes

• Economy, culture and environment

• Mental health, happiness and well-being

• Tobacco

• Obesity, diet and physical activity

• Alcohol

• Prevention, fair and early treatment

• Early life

• Mature and working life

• Later life

• A good death

Vision

• The North East will curtail its increase in average body mass index and increase the proportion of people whose weight is within safe limits, eradicating the differential between social groups.

• The North East population will be the most physically active in the country, both in its activities of daily living and in its recreational choices. The support available for individuals to alter their activity levels will be clearly and fairly defined and will be provided according to individual need.

• Review of BHFH later this year – opportunity to think again about what should be there from the perspective of food.

• Our position at present is not good…

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1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Prop

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NORTH EAST

NORTH WEST

YORKSHIRE AND THE HUMBER

EAST MIDLANDS

WEST MIDLANDS

EAST OF ENGLAND

LONDON

SOUTH EAST

SOUTH WEST

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1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

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NORTH EAST

NORTH WEST

YORKSHIRE AND THE HUMBER

EAST MIDLANDS

WEST MIDLANDS

EAST OF ENGLAND

LONDON

SOUTH EAST

SOUTH WEST

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2001 2002 2003 2004 2005 2006 2007

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NORTH EAST

NORTH WEST

YORKSHIRE AND THE HUMBER

EAST MIDLANDS

WEST MIDLANDS

EAST OF ENGLAND

LONDON

SOUTH EAST

SOUTH WEST

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NORTH EAST

NORTH WEST

YORKSHIRE AND THE HUMBER

EAST MIDLANDS

WEST MIDLANDS

EAST OF ENGLAND

LONDON

SOUTH EAST

SOUTH WEST

• So far we have made progress on CVD through better delivery of treatments and substantial falls in smoking

• Changes in diet and other lifestyle behaviours have lagged behind

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North East SHA

North West SHA

Yorkshire and The Humber

SHA

East Midlands

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West Midlands

SHA

East Of England

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London SHA

South East

Coast SHA

South Central

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South West SHA

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Infant age under 1 year Infant age under 28 days Infant age under 7 days

Identifiable Actions to Reduce the 2002-

200404 Gap in Infant Mortality What would work Impact on the 2002-04 gap What would work

(percentage points)Reducing conceptions in under 18s in the R&M group by 44% to meet the target

Targeted interventions to prevent SUDI by 10% in the R&M group

Reducing the prevalence of obesity in the R&M group to 23%

Increasing the rate of breastfeeding initiation in the R&M group to those of the non-R&M group from 67% to 83%

Immediate actions

Optimising preconception care

Early booking

Access to culturally sensitive healthcare

Reducing maternal and infant infections

Reducing overcrowding in the R&M group, through its effect on SUDI

Reducing the rate of smoking in pregnancy by two percentage points by 2010

Meeting the child poverty strategy

Long-term actions Improving maternal educational attainment

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Key activities:

• Governance

• Research and development, analysis

• Service redesign & funding

• Advertising and social marketing

• Lobbying activity

• Policies and planning

• Performance management of services

The Rose Hypothesis

“... a large number of people exposed to a small risk may generate many more cases than a small number exposed to a high risk”

..therefore…

• Our task should not be to focus on outlier groups but to shift population mean behaviours and to narrow the range across which those behaviours are distributed.

The North East will have the best and fairest health and well-being, andwill be recognised for its outstanding and sustainable quality of life.