Transcript public health - Society for the Study of Addiction

PUBLIC HEALTH
March 2016
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Understanding and awareness of:
theoretical principles underpinning public health
importance of public health interventions in supply and demand
evaluation of role of public health in prevention of substance
misuse
the legislative framework governing drugs classification,
legislation and licensing
the role of clinicians in public health
the role of health professionals in advising policy makers
politicisation of drugs and alcohol
the role of media in public health messages
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Lobbying for changes in legislation governing control of
supply and demand
Interventions to tackle causes of inequalities and risk factors
Community based interventions eg risk minimisation eg crime
and public disorder, control of blood borne viruses (BBV)
Health promotion
Social marketing
Understanding of cultural context of addiction so as to offer
user-friendly services
Drug misuse cost NHS £488m
 2.8 million adults used illicit drugs
 Drugs cost to Society £15.4bn per annum
 Smoking cost to Society estimated at 12.9bn (England), cost to NHS
in treating diseases caused by smoking £2bn a year
 Estimated 9.4 million UK adult cigarette smokers
 About nine-million adults drink at levels that pose some risk to
their
health with 2.2 million drinking at higher-risk of harm.
 The total annual cost to society of alcohol-related harm is
estimated to be £21bn. The NHS incurs £3.5bn a year in costs
related to alcohol
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Prevent disease, promote health, and prolong life
Aims to focus on populations not individual conditions or
diseases
Focus on total system
3 main public health functions are:
Assessment and monitoring of health of communities at risk
to identify health problems
Formulation of public health policies to solve local and
national health problems
Assure access to appropriate cost effective health care
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Protecting the safety and improving health of communities
through education, policy making and research for disease
and injury prevention
Application of many disciplines: biology, anthropology, public
policy, mathematics, engineering, education, psychology,
computer science, sociology, medicine, business
Roles include laboratory or field research, statistics, work
directly with people, international reach, address or influence
health of communities
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Art and science of promoting and protecting health and well
being, preventing health and prolonging life through
organised efforts of society
Population based
Emphasis on collective responsibility for health, its protection
and prevention
Recognises key role of the state, linked to socioeconomic and
other determinants of health and disease
Emphasis on partnerships with all those who contribute to
the health of the population
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Surveillance & assessment of population’s health and well being
Assess evidence of effectiveness of health & healthcare
interventions
Policy and strategy development and implementation
Strategic leadership and collaborative working
Health improvement
Health protection
Health and social service quality
Academic public health
Public health intelligence
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Monitor health status of a community to identify potential
problems
Diagnose and investigate health problems/hazards in the
community
Inform, educate, empower people about health issues
Mobilise community partnerships to identify and solve health
issues
Develop policies and plans that support individual and
community health efforts
Enforce laws and regulations to protect health and ensure
safety
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Link people to personal health services and ensure health
provision
Ensure a competent public health and personal health care
workforce
Evaluate effectiveness, accessibility, and quality of personal
and population based health services
Research new insights and innovative solutions to health
problems
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Giving all children a health start in life
Creating a lasting legacy from the 2012 Olympic and
Paralympic Games
Reducing drug misuse and dependence
Reducing smoking
Reducing harmful drinking
Reducing obesity and improving diet
Helping more people survive cancer
Planning for health emergencies
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Effectiveness intervention: Reducing the incidence of hepatitis and
HIV/AIDS: introduction of needle and syringe schemes was a
response to the rise of BBV to reduce incidence of sharing and reusing injecting equipment
Evidence not accepted by policy makers: minimum pricing and
alcohol advertising: minimum pricing and ending sports
sponsorship is favoured by public health groups since price is
linked to consumption and advertising influencing children and
young people
A new intervention sparks debate: although e cigarettes helps the
majority of smokers quit completely, but there is controversy as to
whether it will initiate novice smokers into tobacco use
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Public health interventions are proactive and reactive
Proactive policies aim to reduce substance misuse related harm
prior to initiation eg limit supply by classifying a new substance
Reactive policies respond quickly to ‘epidemics’ of substance use
eg educational campaigns provide early advice eg needle exchange
Harm reduction by minimising harms associated with substance
use
Public health interventions can improve health outcomes & save
money
Improvement in education/employment and reduce deprivation
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Media and advertising promoting alcohol use
Health and social care practitioners insufficiently trained to
address public health issues
Evidence policies not always accepted by policy makers and
not widely disseminated
Developing partnership across a range of agencies eg health,
social and criminal justice agencies, service users and carers
Social marketing for communication of messages NOT SURE
IF THIS IS A CHALLENGE OR SHOULD GO SOMEWHERE ELSE
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Societal: alcohol licensing laws, taxation, legal age for alcohol
consumption, alcohol control zones, driving legislation
Community: Risk minimisation through education/ prevention
eg ‘know your limits’
Individual: Screening and brief interventions or referral to
primary or secondary care
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Societal: tobacco licensing laws, taxation, legal age for
consumption and enforcement, smoking in public places bans
Individual: Risk minimisation and smoking cessation services
Population: Education/prevention of educational campaigns,
health messages on cigarette packers, charity educational
campaigns
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Societal: Misuse of Drugs Act, Drugs Classification, Drug
Strategy, International narcotics control, Regulation of
Medicines
Risk minimisation: Needle exchange, maintenance opiate
treatment to reduce crime, health harms, impact on families
Education/prevention: Internet and telephone advice services,
drop in centres, advice in eg nightclubs, education in schools
and youth services
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Better evidence for effectiveness of smoking interventions:
taxation, mass media campaigns
Alcohol: taxation, drink driving, advertising
Drugs: risk minimisation beneficial in terms of reducing
spread of BBV
Awareness of the need for international responses that
harmonise
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Action on Smoking (2015) ASH Facts at a glance – smoking statistics
http://www.ash.org.uk/files/documents/ASH_93.pdf
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Action on Smoking (2014) Secondhand Smoke the impact on children
http://ash.org.uk/files/documents/ASH_596.pdf
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Atusingwize E, Lewis S, Langley T (2014)Review: Economic evaluations of tobacco control mass media
campaigns: a systematic review Tob Control 2015;24:4 320-327
http://tobaccocontrol.bmj.com/content/24/4/320.full
Bala, M., Strzeszynski, L., and Cahill, K. (2008) Mass media interventions for smoking cessation in adults.
Cochrane Database Syst Rev, CD004704.
Campbell, R., Starkey, F., Holliday, J. et al. (2008) An informal school based peer-led intervention for
smoking prevention in adolescence (ASSIST): a cluster randomised trial. Lancet, 371: 1595-602.
Dahlgren ,G., and Whitehead M ( 2006) European strategies for tackling social inequities in health:
Levelling up Part 2. World Health Organisation.
http://www.euro.who.int/__data/assets/pdf_file/0018/103824/E89384.pdf
Dawkins, L., Turner, J., Roberts, A. and Soar, K. (2013), ‘Vaping’ profiles and preferences: an online
survey of electronic cigarette users. Addiction, 108: 1115–1125. doi: 10.1111/add.12150
Home Office (2015) Drug Misuse: Findings from the 2014/15 Crime Survey for England and Wales
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/462885/drug-misuse1415.pdf
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Lefebvre, C., and Flora, J. A. (1998). “Social Marketing and Public Health Intervention.” Health Education
Quarterly 15(3):299–315.
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Marmot review (2011) Fair Society Health Lives. http://www.instituteofhealthequity.org/projects/fairsociety-healthy-lives-the-marmot-review
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McKeganey, N. & Russell C (2015) Tobacco plain packaging: Evidence based policy or public health
advocacy? International Journal of Drug Policy, 26 (6) 560-8 doi:10.1016/j.drugpo.2015.03.004
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NICE (2010) Alcohol-use disorders - preventing harmful drinking (NICE public health guideline, PH24)
http://guidance.nice.org.uk/PH24
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West R et al (2015) Health-care interventions to promote and assist tobacco cessation: a review of
efficacy, effectiveness and affordability for use in national guideline development. Addiction,110, 13881403