Transcript Public Health Matters - Imperial College London

Public Health Matters:
Priorities for Primary Care
Mauritius November 2007
Dr. Catherine Brogan
Public Health Matters
• What is Public Health?
• ‘Choosing Health’ in England
• What are the priorities for primary care
• Involving the community
Public Health Matters
• Public health is the art & science of
prolonging life, promoting
health,reducing illness and inequalities
through the organised efforts of society.
Acheson 1988
Public Health Matters
• Public Health Consultants have a full medical
training, at least three years clinical
experience, followed by a five year specialist
training in epidemiology, statistics, infectious
disease control, health economics, research
methodologies, sociology etc
Public Health Matters
• The CMO in England is a Public Health Consultant
• All regions and districts have a Director of Public
Health (DPH) who is effectively the CMO for that
area.
• Each DPH has a team of public health consultants
and specialists.
• Their responsibility is to protect and improve the
health of the local population and reduce health
inequalities.
Public Health Matters
Identified population health needs are tackled
through three areas of public health expertise
Health Promotion
Health Care
Health Protection
John Snow
(1813 - 1858)
John Snow was a British
physician who is
considered one of the
founders of epidemiology
for his work identifying the
source of the London
cholera outbreak in 1854.
The year was 1854; the scene was the Soho District of west
London. During the stifling beat of August, there had been a
handful of deaths from the dreaded disease cholera. Not
unusual, in itself.
But on August 31, the situation exploded: In a single
evening, within a radius of only blocks, doctors reported 56
new cholera cases. By the next evening there were 143, and
the death toll had reached 70 and was climbing. Residents
started fleeing the district in panic. Medical authorities
debated but couldn't settle on a plan of action…
Snow went to the Register of
Deaths and made a list of the
cholera fatalities.
He drew up a report & a
statistical map of the area which
he presented to the Board of
Guardians of St. James Parish.
They were convinced, and
disabled the pump by removing
its handle.
Immediately, new cases of
cholera started to dwindle, and
then disappeared.
A founding principle for the NHS in 1948 was
that it should improve health and prevent
disease, not just provide treatment for those
who are ill.
Public Health Matters
Setting health priorities
• Sanitation and safe water saved many lives
• Immunisation
• Maternal and child health programmes saved lives
• Clean Air Act reduced respiratory diseases
• Health and safety at work reduced accidents
• Seat belt in cars legislation
• So what are the next big killers?
Public Health Matters
Assessing public health needs….
• How healthy is UK compared to Europe?
• How healthy are different regions of UK?
• Do men fare better or worse than women?
• What difference does social class make?
• What difference does ethnicity make?
Death rates from Heart Disease
in Western Europe
Unequal risk of Heart Disease Death
at different levels in the public sector
Relative mortality from CHD by ethnic origin
South Asia
151
146
130
Scotland
120
120
Ireland
Women
124
105
East Africa
131
Men
71
Caribbean
46
62
West Africa
56
0
England & Wales 1989-92
50
100
150
Standardised Mortality Ratio
200
Public Health Matters
Health Promotion Policy
• 1998 Independent inquiry into inequalities in health (Acheson)
• 1999 Saving lives: our healthier nation
• 2002 Government’s cross cutting review: tackling health inequalities
• 2003 Tackling health inequalities: a programme for action
• 2003 Securing our future health: taking a long-term view (Wanless)
• 2004 Securing good health for the whole population (Wanless)
• 2005 Choosing health: making healthy choices easier
Where does the money go?
Level 3: Highly complex patients who
need case management.
80% of resources).
Level 2: High risk patients who
need disease management
support e.g. diabetes.
20% of
resources
Level 1: with right support,
many people can
look after
.
themselves.
Health Promotion
Predicted UK expenditure on health care
13
12
11
10
%
GDP
9
8
7
6
5
1977-78 1982-83 1987-88 1992-93 1997-98 2002-03 2007-08 2012-13 2017-18 2022-23
Wanless Health care scenarios
slow uptake
solid progress
fully engaged
Changing National Sickness Service to National Health Service
“.. a step change is needed in
the way we address health
issues & tackle health
inequalities…..
We need new thinking &
practical action.”
Sir Derek Wanless, Securing good health for the population
HMSO, February 2004
Public Health Mattters
Empowering everyone to achieve better health:
• creating better informed demand for health
• creating an environment where health is an
easier choice
• developing the right framework for change
• dynamising the system
Smoking
Obesity
Sexual health
Alcohol misuse
Mental Health
Public Health Matters
Priorities for action
•
•
•
•
•
•
Health inequalities
Reduce no. of smokers
Reduce obesity
Sensible drinking
Improve sexual health
Improve mental health
and well-being
Public Health Matters
Primary care clinicians can advise people to…
• Lead healthy lifestyles
» to prevent chronic diseases
» to reduce complications of diabetes & CVD
• Prescribe smoking cessation- nicotine patches
• Prescribe exercise
• Organise health campaigns & events
Public Health Matters
Primary care clinicians…
• To create more time in clinics and reduce
duplication
»Increase roles of nurses and pharmacists
»Pilot patient held records
»Plan team events to value staff and plan
health promotion events
Making Policy decisions
The Community’s
Circumstances
Shared
Public Health Policy
Decision Making
The Evidence
The Community’s
wishes and
priorities
Public Health Matters
Community services…
•
•
•
•
•
•
Training health leaders in community
Five a day fruit
Smoking cessation services
Sure Start
Children’s Traffic Club
Organise health campaigns & events such as
Safer sex
Community support workers facilitating a young
mothers group
Public Health Matters
Community Involvement…
•
•
•
•
Hard to reach groups
Work with the community to hear their ideas
Work with other agencies
Pilot and evaluate initiatives
Public Health Matters
Do these interventions work?
• There is good evidence that many health
promoting interventions are successful, such
as immunisation, smoking cessation…
• Research is very important in this area
»What helps people change?
»Which programmes work for which groups?
»You can audit, pilot and evaluate initiatives
which can lead on to larger research
programmes
Public Health Matters
In conclusion…
• Every country is facing the triple challenge of
rising public expectations, demographic
change and rising costs.
• Public health and primary care working in
partnership have the potential to take action
to improve the health of their communities.
• Ongoing research is essential to identify the
most cost-effective interventions to improve
health.