Health Improvement

Everybody’s BusinessGrace Moore

Associate Director of Health Promotion and Equalities

Outline

• Definitions

• The Public Health Workforce

• Planning for Health Improvement

• Programmes and Priorities

• Making sense of a cluttered landscape

• Performance Monitoring/Management

• Summary

Definitions

• Public Health; "The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society”.

• Health Improvement is an outcome, the achievement of which includes the areas of work traditionally described as health promotion, public health and health care[1].

Definitions

• Health Promotion is the process of enabling people to increase control over, and to improve their health[2].

• [1] Public Health Institute of Scotland. The health promotion contribution to health improvement. 2002

• [2] World Health Organisation. Ottawa Charter. 1986

The Public Health Workforce

• Health improvement is pursued by a range of staff through:– wide-ranging health promotion efforts, aimed

at promoting good health and preventing ill-health in the whole population and also in specific target groups

– and through maximising the population health benefits of treatment of ill-health.

The Public Health Workforce

• Specialist – Senior Staff working at consultant level – generally members/fellows of Faculty of Public Health

• (Specialised) Practitioner e.g. Health Promotion Officer and Public Health Practitioners – work to a set of competencies as defined by the FPH

The Public Health Workforce

• Wider Workforce – adopt public health approaches for some of the work they do but will be working to a set of competencies defined by their professional body e.g. doctors, nurses, teachers, community workers, pharmacists, physiotherapists……in fact many people in public bodies

Main areas of public health practice

Health Protection

Health services Health Promotion and disease prevention

Vision for Health

physical mental

social

complete

Well-being

Health and Well-being

• “Health is more than the absence of disease….to be healthy requires individuals to engage in their health as much as it requires healthy and sustainable environments and well trained professionals”

Complex Environment

economic social

physical

employment

Health and social services

housingpollution

povertyculture

Layers of Health Improving Activity

Population-based approaches

Target Groups

Priority Topics

Settings

1 to 1 approaches

Large number of

practitioners

Small number of

practitioners

From Population to the Individual

Tobacco – A Worked Example

TobaccoReduced burden of disease, disability and premature death due to tobacco

GreenerSafer & StrongerHealthierSmarterWealthier & Fairer

· Reduced adult smoking rates· Reduced uptake of smoking by young people

Social norms

HIGH LEVELOUTCOMES

INTERMEDIATEOUTCOMES

SHORT-TERM OUTCOMES

Outcomes related to service delivery

Reduced inequalities in premature mortality due to smoking-related

diseases

Smoke-free environments

Access to SC services

Accessibility of tobacco (YP)

Reduced inequalities inHealthy Life Expectancy

· Reduced adult smoking rates· Reduced uptake of smoking by young people

Social norms

HIGH LEVELOUTCOMES

INTERMEDIATEOUTCOMES

SHORT-TERM OUTCOMES

Outcomes related to service delivery

Reduced inequalities in premature mortality due to smoking-related

diseases

Smoke-free environments

Access to SC services

Accessibility of tobacco (YP)

Reduced inequalities inHealthy Life Expectancy

TobaccoIntermediate Outcomes

Reduced adult smoking rateSustained quit rate (1 year follow-up)

Long term OutcomesImproved mental wellbeing

Reduced inequalities in HLEReduced inequalities in CHD mortality

Reduced tobacoo-related morbidity and mortality

ProcessesWhat the NHS has to do to deliver effective SC services

in key settings

OutputsSmoking cessation services

Short-term OutcomesQuit rate at 1 month follow-up

InputsBudget, trained workforce and data needed

to run and monitor smoking cessation services

Reach (target population)Smokers who want to quit (key sub-groups)

new HEAT target

National indicators

Cross-sector Contributions

Inputs

Activities

Outputs

Reach

Short-term outcomes

Intermediate outcomes

High level outcomes

NHS

Individual Behaviours

Reduce adult smoking rates

Reduce uptake of smoking in children and young people

Increased healthy life expectancy; Reduced inequalities in healthy life expectancy, Reduced inequalities in morbidity and mortality due to smoking related diseases e.g. CHD, Cancer

Physical Environments – Reduced exposure to second hand smoke

Social Environments – Reduced attractiveness of tobacco products Economic Environments

SG,UK govt, EU

Schools, community

Example

Local authorities

Improved compliance with

laws

Local authorities

Anti-smoking messages

Media, school ethos, practices

Young people

Understanding risks, attitudes to

smoking

Smokers

Increased quit rate

Enforcement of smoking ban

Enforcement of laws on under-

age sales

Tobacco Retail Sales

Under 18s

Smoking Cessation Services

Intensive support, brief advice, NRT

Compliance with laws

Increased price,

reduced incentives

Smoke free public places

General Public General Public

Taxation, displays

promotions, advertising Industry

Regulation

Priority Topics

• Mental Health and Well-being

• Obesity

• Tobacco

• Alcohol

Priority Target Groups

• Children and young people

• Pregnant women

• People living in deprivation

• Groups who face particular inequalities e.g. homeless, people who have sensory impairment, people from ethnic minorities

Summary

• Health promotion implemented by a range of staff across a range of sectors

• The specialist function works mainly (but not exclusively) at a strategic and population level

• It provides support to others in their health promotion efforts

• It delivers complex interventions across a range of settings, for a range of target groups on a range of priority topics using a range of methods

Finally….

• “Our staff are the agents of change. We cannot hope to bring about the improvements envisaged unless the people who deliver these improvements are protected in their place of work, recognised and rewarded for their contribution to our success and given the opportunities to develop the skills and experience they require to improve health and reduce health inequalities.”

• (Better Health Better Care: Action Plan)

Sensory Impairment - Partners

NHS • Communications• Disability Awareness• IT• Learning Disabilities• Optometrists/Ophthalmology• Audiologists• Psychological Services • Procurement• Public Health • PFPI• Medical Records• Primary Care• Children’s Services • Occupational Therapy• Nursing• Estates

External • Leisure Services (LA and

Independent)• Social Services• LA Procurement• RNIB• RNID• Visibility• Deafblind Scotland• SISG Ayrshire• Volunteers• Patients/People with Sensory

Impairment• Carers• Healthy Living Centres

Bridge to Vision

Arran Pilot Training Group

CSS Policy

Eyecare Review

Adult’s Sub Group

LD Needs Assessment

Children’s Sub Group

Training Sub Group

Development Group for Equalities and Sensory

Impairment

Needs Assessment

Commissioning an Area Wide Service Sub Group

Deafblind Communicator Pilot

Interpreter Services ContractActive Living & HI Programme

VI Pilot

Centre Sub Group

Audit & Standards Commissioning

Network Management Function

Awareness Raising Pilot

Pfizer Funding

Literature Review

National Procurement Contracts

South Ayrshire Working Group

East Ayrshire Working Group

North Ayrshire Working Group

Key: Yellow Circle = Main Project Group Bracket = Future Work Green Circle = Sub Group Pentagon = Link Function Pink Rectangle = Sub Project GroupsFull Lines = Accountability routes Jade Rectangle = Working Groups Broken lines = Communication links

Sensory Impairment Project