www.publichealth.ie

From Strategy to PracticeA perspective from the Institute of Public Health

5 November 2015

Owen Metcalfe, FFPH Chief Executive, IPH

UKPHR Consultative Forum

“However beautiful the strategy, you should occasionally look at the results”. Sir Winston Churchill

“A strategy, even a great one, doesn’t implement itself”.

Anon

Institute of Public Health in Ireland

• Research – Prevalence of Long Standing Conditions

• Policy – Obesity, Smoking, Sexual Health

• Capacity Building – HIA Training, Open Conference

• Ageing Research & Development – Keeping Active for Better Ageing

www.publichealth.ie

IPH Work Programme

Health Information

Health Well

Established to Promote Cooperation

for Public Health

Why is cooperation necessary?

UK Faculty of Public Health

3 key domains of public health:

•Health improvement

•Improving health services

•Health protection

UK Faculty of Public Health

9 key areas for practice:•Surveillance and assessment of the populations health and well being•Assessing the evidence of effectiveness of health and healthcare interventions, programmes and services•Policy and strategy development and implementation•Strategic leadership and collaborative working for health•Health improvement•Health protection•Health and social service quality•Public health intelligence•Academic public health

IPH

• A focus on health inequalities

• Fairness and justice

Life Expectancy of Men in Northern Ireland Ranked by Deprivation (2009-11)

Source: Making Life Better

Life Expectancy of Women in Northern Ireland Ranked by Deprivation (2009-11)

Source: Making Life Better

Life Expectancy and Disability-Free Expectancy (DFLE) at birth, Persons by neighborhood income

level, England, 1999 - 2003

Inequality Gaps

Inequality gaps between deprived areas and NI overall were in:•Alcohol-related deaths – 121% higher•Drug-related deaths – 113% higher•Admissions for self-harm – 94% higher•Teenage births – 80% higher•Suicide – 73% higher•Respiratory death rates – 66% higher•Lung cancer incidence – 65% higher

NI Health & Social Care Inequalities Monitoring Systems 2009

Strategy – Making Life Better

The Gradient Approach

In order to achieve the aims of better health and wellbeing for everyone and reduced inequalities in health, the overriding approach must be to take account of the need for greater intensity of action for those with greater social, economic and health disadvantage. This applies right across the social gradient, as recognised by Marmot, and require action to improve universal services as well as more targeted services for those in greater need.Making Life Better, DHSSPS 2014

Strategy – Healthy Ireland

Goal 2: Reduce Health Inequalities

Health and wellbeing are not evenly distributed across Irish society. This goal requires not only interventions to target particular health risks, but also a broad focus on addressing the wider social determinants of health – the circumstances in which people are born, grow, live, work and age – to create economic, social, cultural and physical environments that foster healthy living.

Healthy Ireland, DoH 2013

WHO Health 2020•“Reducing health inequalities and improving governance for health and health equity”.

European Commission and Health Equity•“Solidarity in health – reducing health inequalities in the EU”.

Public Health Policies supporting MLB & HI

On specific issues:

• Tobacco• Alcohol• Sexual health• Obesity

With references to health inequalities.

Other Countries

SpainMoving forward equity: a proposal for policies and interventions

to reduce social inequalities in health in Spain 2011NorwayNorwegian strategy to reduce social inequalities in health 2007SloveniaHealth inequalities in Slovenia 2011FinlandHealth inequalities in Finland 2009EnglandPublic Health England – health inequalities division

Developing a Comprehensive Approach and Action Plan

• Secure political commitment and cooperation from many sectors

• Assess the extent of the problem, consider points for intervention along with barriers to action

• Put in place organisational arrangements and financial requirements. Allocate responsibility and resources

• Draw up action plans – what? who? how much? outcome?

The Equity Action Spectrum: taking a comprehensive approach, WHO 2014

Progress

• Increasing references to health inequalities

• Marmot work leading to increased knowledge

• UK and Irelands collaboration on health inequalities

• NI health and social care inequalities monitoring system

• HSE health inequalities action plan

Work To Do

• Dedicated policy• Accountability mechanisms• Resources

‒ Personnel‒ Finance

• Maintain an intersectoral health in all policies approach

Closing the Gap

Lynch Pins• Improve daily living conditions• Tackle the inequitable distribution of power, money

and resources• Measure and understand the problem and assess

the impact of action• Train the workforce in the social determinants of

health• Raise public awareness about the social

determinants of healthClosing the Gap in a Generation, WHO 2008