Transcript Public Health in Scotland 2016

Public Health in
Scotland 2016
Early Clinical Career Fellowship
Masterclass
31/08/2016
Pauline Craig
Head of Population Health
Outline
• Nursing to public health
– a career pathway (or crazy paving?)
• What IS public health?
– Theory, practice and priorities
• The public health workforce in Scotland
– Where does nursing fit?
– What does it mean to me?
Our vision and mission
Our Strategy 2012-17:
“A FAIRER HEALTHIER SCOTLAND”
NHS Health Scotland
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Small national Health Board (c. 280 employees) working with public,
third and private sectors to reduce health inequalities and improve
health http://www.healthscotland.com/
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Our main focus is on knowledge into action for influencing and
implementing policy, planning and practice. We are also known for
public facing health information (eg screening, Ready, Steady Baby,
smoking cessation etc)
•
We are developing a new strategy for 2017-2022, building on AFHS
and human rights, and within the context of the recent public health
review
NHS Health Scotland
Chief Execs Office
Gerry McLaughlin
Public Health
Sciences
Health Equity
Health and Work
Strategy
George Dodds
Steve Bell
Cath Denholm
- Population Health
- Fit For Work
- Evaluation
- Place and Equity
-Evidence for Action
- Learning and
Improvement
- Healthy Living
Award
Andrew Fraser
- Public Health
Observatory
(ScotPHO)
- ScotPHN
- Knowledge Services
- Marketing and
Digital Services
- Employee Health,
safety and wellbeing
- Strategy and
Communications
- Performance,
People and
Planning
What is public health?
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‘the science and art of preventing disease, prolonging life and
promoting health through the organised efforts of society’(Acheson
1988)
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Population based, multidisciplinary
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Collective responsibility across the state, ie beyond healthcare
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Determinants of health as well as disease: health and well being, more
than absence of disease
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Key figures from C19 UK history: Edwin Chadwick (Poor Laws and
sanitation reform); John Snow (Broad Street Pump); Florence
Nightingale (social causes of death, hospital reforms)
Faculty of Public Health (FPH) three
key domains
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Health improvement: population surveillance, housing and education
etc, lifestyles, health inequalities (NHS Health Scotland)
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Improving services: need, efficiency, audit, governance, equity (NHS
Boards, Scottish Public Health Network, Information Services Division)
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Health protection: infectious diseases, environmental health,
emergency responses (Health Protection Scotland; Information
Services Division)
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Underpinned by workforce: Standards, education, training,
development (Faculty of Public Health, NHS Education Scotland, NHS
Health Scotland; Professional Organisations – RCN, ReHIS)
FPH standards based on nine key
areas
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Surveillance and assessment of the population's health and wellbeing
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
Science and art
• Epidemiology: biomedical science, incidence and distribution of
disease and factors relating to health
• Needs-based, effective and high standard services
• Environmental health: communicable diseases, chemicals, air
quality
• Social determinants: poverty and income inequality, power and
disadvantage, housing, education, green space, food, culture
• Curiosity, influencing, advocacy, driving change, leadership,
vision
Examples from health improvement
practice
• Developing new knowledge and understanding
• Knowledge into action
• Social change
Determinants of health
Age-standardised suicide mortality (15-44y)
Source: Mok PLH, Kapur N, Windfuhr K, et al. Trends in national suicide rates for Scotland and for England &
Wales, 1960-2008. British Journal of Psychiatry 2012; 245: 245-51.
All cause death rates, men 0-64y, 2001
Glasgow City
Inverclyde
West Dunbartonshire
Dundee City
Eilean Siar
Renfrewshire
North Ayrshire
North Lanarkshire
Source: Alastair H Leyland, Ruth Dundas, Philip McLoone & F Andrew Boddy. Inequalities in mortality in Scotland 1981-2001.
Glasgow, MRC SPHSU, 2007.
Males - 75.8y
Females - 83.1y
Hillhead
Jordanhil
l
Hyndland
Partick
Exhibitio
n Centre
St
George’s
Cross
Buchanan
Street
Charin
g Cross
Anderston
QUEEN
STREET
Argyll St.
Govan
Ibro
x
Cessnoc
k
CENTRA
L
Bridgeton
St Enoch
Males - 61.9y
Females 74.6y
Life expectancy data refers to 2001-05 and was extracted from the Glasgow Centre for Population Health community health
and wellbeing profiles. Adapted from the Strathclyde Partnership for Transport travel map.
Source: McCartney G. Illustrating Glasgow’s health inequalities. JECH 2010; doi 10.1136/jech.2010.120451 .
Alcohol-related mortality* rates per 100,000
population, 1950-2006
Men aged 45-64 years
80
Age standardised mortality rate per 100,000
80
70
60
Scotland
Other European
countries
Women aged 45-64 years
70
60
50
50
40
40
Scotland
30
30
20
20
England
and Wales
10
0
1950
1960
1970
1980
1990
2000
Other European
countries
10
0
1950
England
and Wales
1960
1970
80
Source: Updated from Leon & McCambridge (2006) *as indicated by liver cirrhosis
70
60
50
1980
1990
2000
Upstream
Downstream
Alcohol Brief
Interventions
Minimum Unit
Pricing
Multi-buy discount
ban
Improved labelling
Public Health
objective
Duty rises/falls
National indicator /
SOA
Increased
investment for
T&C
The Framework for Action
• Recognition that alcohol
misuse was a population
problem
• Move towards outcomesbased approach to formulate
evidence-informed policy
• Whole population approach
to reducing alcohol
consumption and related
harms
• Importance of price and
availability recognised
• Move towards better data
collation
Source: Scottish Schools’ Adolescent Lifestyle and Substance Use Survey (SALSUS, 2013)
Defining the Problem
Recorded Crime in Scotland
16000
14000
Number of Crimes
12000
10000
Non Sexual Crimes of Violence
8000
6000
4000
2000
0
Handling an offensive weapon
Sexual offences
Adverse Childhood Experiences
Troubled Families - Average 9 problems. 40% had 3 or more children
Aged 18 to 69 (n = 3,885)
Bellis et al, BMC Medicine, 2014
Successes and challenges for public
health in Scotland
We can build on success – these have been life changing
improvements over the last 50 years.
These 4 ‘waves’ - lots of success in Scotland
For example we have seen:
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Roll out of successful immunisation and screening
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Reductions in premature mortality from CHD, respiratory disease, stroke
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Improved cancer survival rates
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Marked reduction in tobacco use
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Recent reduction in suicide rate
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Recent reduction in risk behaviours among young people
The most pressing challenges of the next decade
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Focusing upstream on prevention to reduce high levels of preventable mortality and multimorbidity in the future.
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Helping everyone stay well for as long as possible whatever their current state of health. In
particular, ensuring the best start in life and increasing the number of years in good health for
our poorest citizens.
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Addressing recent trends in over-consumption, inactivity and obesity which have the potential
to overturn recent gains in life expectancy and healthy life expectancy.
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Giving attention to mental health and wellbeing which can affect life chances and often
coexist with physical health problems.
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Continuing to address Scotland’s challenge with harmful alcohol consumption and continuing
our efforts on tobacco control to reduce smoking further.
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Ensuring collective, cross-government and cross-sector effort focussed on prevention.
People in public health
Public health structure in Scotland
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NHS based specialist function: 14 regional Boards, each with a DPH,
handful of consultants and sometimes a few public health specialists and
health protection nurses. Management or connection with health
promotion/health improvement. Four of the eight national Boards have or
include a public health function: HS, NSS, NES, HIS
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Core workforce in NHS eg information specialists and analysts, PH
pharmacists, health improvement, research and evaluation etc; also local
authority and voluntary sector staff eg physical activity, food etc, also
practitioners with PH roles eg HVs. Could be in local services or
partnership structures, with and without a professional home (eg HVs vs
analysts)
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Wider workforce in NHS: GPs, nurses, midwives, AHPs; other public
sector, third sector, academics, scientists, lawyers, police, fire and rescue
etc
Scottish Public Health Workforce
• PH workforce includes (arguably):
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Directors, consultants and specialists in PH
Scottish Government health policy staff
PH in titles (eg PH nurses, specialists etc)
PH in day jobs but not in titles (eg HVs, Health
promotion/improvement officers, programme managers in
special boards, researchers, multiple skills required for rural
areas etc)
– ‘wider PH workforce’ eg nurses, midwives, teachers, social
workers, Board chairs, community volunteers
Findings
Directors of public health,
Intelligence and knowledge
consultants, specialists and specialist professionals
trainees
370-660
189
Directors of Public Health
[18]
Health Visitors
2,185
Public Health academics
360
School nurses
500
Public health managers and
practitioners
970
Public Health nurses (TB, inf control
etc)
640
Public health academics
360
Environmental health professionals
980
What does all this mean to me?
• In current role
• As a contributor to the public’s health
• Something to find out more about
• Something to leave to others