Jude Williams

Head of Public Health

Dr. Dan Murphy

Head of Research and Evaluation

Forecasting the future health of the Nation.

3rd July 2008

Research Methods Festival

Overview

• Background to Healthcare Commission• Obesity• Alcohol abuse• Pose some questions

NHS organisations that commission services inc 152 PCTs

170 hospital trusts including 70 foundation trusts

Other NHS trusts including 12 ambulance, 59 mental health andcommunity

2000+ private sector organisations including hospitals and clinics

We regulate

Our role re public health

• In the Act that set up the Healthcare Commission

• PH part of healthcare• Standards for Better Health and Targets

• External Drivers• Wanless – a health service we can afford• Public health challenges such as obesity• Health inequalities• But generally longevity and health improving

Public health targets

• Mental health• GP Body Mass Index (BMI) recording• Suicide prevention• Smoking• Older people• Health inequalities• Sexual health• Long-term conditions

Public health - what we have doneAnnual health check• Standards• Targets

In-depth reviews• Tobacco Control• Obesity (with NAO and Audit Commission)• Unintentional Injury in Children (with the Audit

Commission)• Sexual Health• Are we choosing Health ?

• Positive feedback

OBESITYOBESITY

Tackling child obesity – First stepsFebruary 2006

Indicators for PCTs:2006/7: • GP recording of body mass index (BMI) status

2007/8: • GP BMI recording 16 plus• Childhood obesity data quality (National Childhood Measurement Plan) and data completeness • Compliance with NICE Guidance 43 (PCTs and provider trusts)

2008/09:• Childhood obesity data quality and rate (NCMP) - Data completeness and prevalence measure

Definition

Obesity may be defined as “an excess of body fat frequently resulting in a significant impairment of health and longevity” (H.C.)

or

Body mass index – Weight in kilos divided by height in metres squared

Not perfect measure

Morbidly obese = BMI > 40 Kg/m2

Obese = BMI > 30 Kg/m2

Overweight = BMI > 25-29.9 Kg/m2

Normal = BMI > 18.5-24.9 Kg/m2

Underweight = BMI < 18.5 Kg/m2

Prevalence in England

1980 8% of women Obese 6% of men Obese

1998 21% of women Obese 17% of men Obese

1998 32% of women Overweight 46% of men Overweight

1998 58% of adults Overweight / obese

2003 23% of UK adult Obese population

• Three fold increase in obesity since 1980

Age Overweight + Obesity increase with age

Location

18% of men in London were obese25% of men in Yorkshire and Humber

Prevalence

- About 28% of men 16-24 are overweight / obese- About 27% of women 16-24 are overweight / obese

- But 76% of men aged 55-64 are overweight / obese- But 68% of women aged 55-64 are overweight / obese

Prevalence (2)

Socio-economicdifferences

- More common for women in manual occupations. Less prevalent for men in lower supervisory and routine occupations.

- Quarter of women in unskilled manual occupations have BMI > 30Kg/m2 compared with one in seven in ‘professional’ work.

- Both men and women working in unskilled manual occupations are four times more likely to be morbidly obese.

Where both parents overweight/obese, their children are six times more likely to be overweight/obese compared with children living with parents of healthy weight.

Risks• Diabetes• Hypertension• Cardiovascular diseases• Respiratory problems (asthma)• Muscoskeletal diseases (arthritis)• CHD causes 270,000 heart attacks each year in UK of which

28,000 heart attacks a year are attributable to obesity (BHF)• 6% of all deaths attributable to obesity• Over BMI 25, 10% increase in weight corresponds to approx

30% increase in incidence of heart disease (Framingham heart study)

• Obesity causes a 40 year old man or woman to lose 6-8 years of life.

• Risk factors greater than smoking or excessive drinking• Severely obese individuals are likely to die on average 11 years

earlier than those with a healthy weight

Risks (2)

• 10% of all cancer deaths among non smokers are related to obesity

• Risk of coronary artery disease is increased 3.6 times for each unit BMI (eg from BMI 26 to BMI 27)

• 85% of hypertension is associated with a BMI greater than 25

• Risk of developing type 2 diabetes is about 20 times greater for people who are very obese (BMI 35+) compared to individuals with BMI between 18 and 25

• Time lag between onset of obesity and related disorders suggests risk in UK is only just being realised and being stored for the future

Causes

“we live in an environment that has been dubbed ‘obesogenic’, full of stimuli that encourage us to eat, to take less exercise, and to, above all consume”

• Many and vary by country• Deterioration in eating patterns• Larger portions• Fast / take away food with high fat and salt content• Fewer meals prepared at home• Too little fruit and vegetable

• Favourite vegetable named by UK adolescent :• As a country we were healthier during WW2 with rationing• Less and less physical activity – 2/3rds world children not active enough• Watching TV and computer games• More cars – less walking

CHIPS

Costs

• Direct and indirect costs (loss of earning due to sickness and premature mortality) estimate at: £3.3 to 3.7 Billion (Hoc Health Committee 2004)

• Direct cost to NHS is at least £ 0.9 billion PA• 80% of this from CHD, hypertension + type 2 diabetes• 18,000 sick days a year lost due to obesity (NAO)• Normal Lamb, MP, surveyed Trusts about specialist

equipment eg. Bigger beds, reinforced ambulances, extra-strong hoists, reinforced stretchers costing around £ 10 million PA

International comparisons

• 3% of population of Korea and Japan obese (2001)

• Around 10% of Denmark, Sweden, Norway, France, Italy, Netherlands and Switzerland obese (but rising)

• > 20% of Australian adults obese (1999)

• 23% of UK adults obese (2003) same as USA 10 years ago

• 24% of adult Mexicans are obese

• USA 30% + of adults are obese – highest in OECD (2003)

* USA, UK, Australia based on actual measures, rest self-report

Trends

• Obesity in children in England has ‘doubled’ in a decade

• From 1995 to 2004, obesity among boys aged 11-15 rose from 14% to 24% and girls from 15% to 26%.

• About a third of children aged 2 to15 were estimated to be overweight or obese in 2006.

• Individuals get heavier as they age, as UK population gets older, and survives longer, there will be an underlying trend toward more overweight

• If prevalence continues to rise at the current rate, more than one in four adults will be obese by 2010

• By 2050, levels of obesity will rise to: 60% in men 50% in women 25% in children, with a further 35% adults, and nearly 40% of children overweight.

(Healthy weight, healthy lives)

ALCOHOL ALCOHOL ABUSEABUSE

Alcohol

• In 2007, alcohol misuse and related harm estimated to have cost English economy £ 1.4 - £ 1.7 Billions pa.

• Between 15,000 and 22,000 alcohol related deaths every year in England.

Deaths associated with alcohol consumption have risen

1991 - 9.1 deaths per thousands men

- 5.0 deaths per thousands women

2006 -18.3 deaths per thousands men (double)

- 8.8 deaths per thousands women (80% increase)

Deaths associated with alcohol consumption

• Each man dying in this group loses 20 years of life compared

with the average• Each woman dying loses 15 years

• Total contribution that alcohol makes is to reduced life

expectancy on average :

-9.9 months for men

-4.4 months for women

• Estimated 6.3 million people in England in 2005 drinking at hazardous levels (between 20-50 units per week for men, and 15-35 units for women)

• Estimated 1.55 million people in England in 2005 drinking at harmful levels (over 50 units for men per week, 35 for women)

• Alcohol-related hospital admissions have more than doubled in the last 10 years

• 1995/1996 – 93,459 adults over 16 admitted with primary or secondary diagnosis related to alcohol

• By 2006/2007 – 207,788 admitted

• Increase true for all regions but greater in more deprived areas.

• Between 2001 and 2007, alcohol-related deaths increased by 19%.

• Rate of admission to hospital in North West for alcohol-specific conditions was over twice as high as East of England.

And in Scotland

The alcohol-related death rates for males and females were around double the rate for the UK as a whole (2002-2004)

Two questions:

What will be the other public health challenges over the next twenty years ?

What would you do about the growing problems of obesity and alcohol abuse ?

Aim

Better health and better healthcare

for everyone