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The Local Public Health Context

Jackie DavidsonAssociate Director of Public Health

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Objectives

• To provide a local public health context to health promotion in pharmacy

• To identify key public health messages

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Male and Female Life expectancy 2009-2015

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Male Life Expectancy by deprivation quintile

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Causes of the life expectancy gap in Greenwich

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Joint Strategic Needs Assessment 7 x MAIN DISORDERS & CONDITIONS IN GREENWICH

1. Cardiovascular diseases (heart disease & stroke)

2. Cancers (esp. breast, lung and bowel)

3. Respiratory diseases (COPD, emphysema, bronchitis)

4. Mental health (anxiety & depression; dementia)

5. Falls and fractures in older people6. Alcohol related harm (social and

health)7. Diabetes

What are underlying causes?

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Underlying Causes: Smoking

• 17.9% of local population smoke

• Links with JSNA clinical priorities (Cardiovascular, Cancers, Respiratory, Diabetes, Dementia, Osteoporosis)

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Underlying Causes: Physical inactivity

• 10% of adults are physically active, 51.5% of the population is sedentary

• Links with JSNA clinical priorities (Cardiovascular diseases, Diabetes, Cancers, Falls and fractures, Respiratory diseases)

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Underlying Causes-Diet

• 60% Not eating 5 fruit and veg per day

• 86% of adults have excess saturated fat intake

• Links with JSNA clinical priorities (Cardiovascular diseases, Diabetes, Cancers Falls & fractures)

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Underlying Causes: Alcohol

Increasing and high risk drinking (combined) 19.7%, lower than England (22.3%) and London (20.6%)

Links with JSNA clinical priorities (Cardiovascular, Cancers, Mental health, Links with determinants)

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Underlying Causes: Hypertension

• 1 in 5 adults have high blood pressure, but only 58% are diagnosed (Greenwich- 33,500)

• Links with JSNA clinical priorities (Cardiovascular diseases, Mental health,

Diabetes)

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Health Behaviours:• Non smoker• Alcohol <14 units/week• Not inactive• Diet (5 a day, vit C)

Overall impact:• 14 year difference in• life expectancy.

Survival in 20,244 healthy adults aged 40-79 by healthy behaviours

Khaw et al. PLoS Med 2008 Jan 8: 5 (1): e12

4

3

2

10

Number of prudent health behaviours

-2 0 2 4 6 8 10 12

100

90

80

70

Year of study

% s

till a

live

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Making every contact count

Every day staff have millions of contacts with people that could be used to offer appropriate information on staying healthy

We need to make the most of every appropriate opportunity to raise the issue of healthy lifestyle

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Making every contact count is cost effective

• Alcohol brief advice changes drinking behaviour of 1 in 8 people

• For a local area of population of 310,000 cost = £48,000 to deliver IBA to 10,000 increasing risk drinkers

• 1,250 will change drinking behaviour• Resulting in reduced, acute admissions and A&E

attendances • Estimated benefits to NHS = £126,000*• ROI = £2.60 back for every £1 spent.

* Based on DH ready reckoner v5.2

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Some key messages

• Good mental and physical health is a resource that enables people to:– Succeed in childhood socially and academically– Gain and sustain meaningful employment, be economically

productive, contribute to the wider success of the area– Age well, minimising dependence on health and social care

• Not everyone has an equal chance – proportionate universalism

• Promoting health is everyone’s business• Ensuring effective use of health services• Addressing health over the life course is key