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Jim McManus

Director of Public Health

Public HealthMapping out a new offer for Hertfordshire

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Launching this year...

• A dedicated web portal for elected members of all authorities covering public health issues you need to know about

• An e-learning portal for district and county councils and voluntary groups on public health

• A public web portal on public health

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In the meantime...

Why public health matters to you

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Major Disease Shifts

• 1st – Poverty, Living Conditions

– Improvement in incomes, reduction in deaths

• 2nd –Communicable Diseases

– Now on average 6-11% of deaths in UK. Was 85% of deaths before 1900

• 3rd – Non-Communicable Diseases

– Over 60% of deaths due to lifestyle and behaviour

– Poorest fare worst (smoking, diabetes, heart disease)

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Contributors to overall health outcomes and why elected councillors are important leaders

Smoking 10%

Diet/Exercise 10%

Alcohol use 5%Poor sexual health

5%

Health Behaviours 30%

Education 10%

Employment 10%

Income 10%

Family/Social Support 5%Community Safety 5%

Socioeconomic Factors 40%

Access to care 10%

Quality of care 10%

Clinical Care 20%

Environmental Quality 5%

Built Environment 5%

Built Environment 10%

Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status

While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.

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Three key points

• Unique role of local authorities able to work on 70% of determinants of health

• The importance of a lifecourse approach

• The new strategic role of local government

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Ottawa Charter, 1986• Underpins strategic role of local government

• "The goal of a healthy public policy is health promotion, i.e., to enable people to increase control over and improve their health.

• It is also essential to

– create supportive environments,

– strengthen community action,

– develop personal skills and

– reorient health services.

All of these are areas for elected member leadership

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Lifecourse approach

• Conception to death• Protective and vulnerability factors (e.g. obesogenic or

energy balanced environment)• Healthy outcome in one age is cumulative impact of

earlier ages• Poor outcome in one age may be risk factor for another

(low birth weight and CVD)• Early investment, early prevention (lifetime mental ill

health and under 13s)• Data, Evidence, Implementation key

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The Public Health Family 2013

Environmental Health& Regulatory Services NHS

Police, Fire, Community Safety Third Sector and

Community Bodies

Public Health England

Specialist Public Health Agencies with Major Public Health Roles

HCC Public Health

County CouncilDistrict Councils

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The Domains of Public Health

Health Improvement

Health Protection

Service Quality

Then & Now

Sanitation

Housing

NowEnvironment

Then & Now

Smoking

Heart Disease

NowCare which keepsPeople healthy andindependent

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The Opportunity for Herts

• The conditions for everyone to be healthy• The conditions for the poorest and worst off to

be healthier• Public services which put this at the core of their

business• People thriving and prosperous• Healthy workforce, prosperous County

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You cannot change health overnight

Some things happen faster than others.....

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Timeframes of impact/yield

Years

0 1 5 10 15

Planning

Education

Vitamin Supplements

Air Pollution

Decent Homes

Jobs

Primary Care

20

CVD Events

Self Care

Vitamin D and TBRickets

CVD Events

Acute Bronchitis Admissions

RespiratoryMental Health overcrowding educational attainment

Life Expectancy

Healthier space use Changing culture of activity

Life ExpectancyMental Health

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The public health mindset in local government means working across different dimensions of time and responsibility

•Think through what we can do short term

•Start work on the medium term

•Set the policy framework for the long term

•Build this understanding among partners

•Get started and realise

•County, District, Parish, NHS, Business and Community Sector working together

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The Tasks Now

1. Understand the context set by our population and the differences between it and England

2. Understand the big ticket issues we need to work on

3. Use specialist public health to impact on the £4bn +, not commission the £55m –

4. Stronger role for behavioural sciences

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What public health can do for Hertfordshire

Crosscutting

Support JSNA, Health and Wellbeing Strategy, Public Health Board, Public Health Networks of Practice, the PH Workforce and Skills agenda

The domains of what public health will do

Chunk 1Services

mandated by the Secretary of State

Chunk 2Healthcare

public health support to CCGs

Chunk 3Health

Protection and resilience role (still being defined)

Chunk 4Applying

public health skills to local authorities and the public sector

Chunk 5Joining

things up between and across agencies (e.g. Obesity)

Chunk 6Delivering

health and wellbeing Board priorities

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Service Start Well Develop Well Age Well

Health and Community Services

Parents in families with complex problems accessing appropriate services

Transition sorted out between services

Older Peoples’ offer from prevention to very high need

Housing Decent Homes standard

Decent Homes Standard

Access, Trips, Falls, Extreme Weather, Adaptability

Local Economic Partnership

Back to work packagesDigital inclusion

Back to work packages for parentsDigital Inclusion

Volunteering and work packagesDigital Inclusion

NHS CCGs Infant MortalityConception

Child health pathway Frail Elderly

Examples

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Phased Approach to transition

• Phase 1 – to Sept 2012. Focus on transactional issues, accommodation, co-location, scoping further work

• Phase 2a – to March 2013 – moving into transformational. Wide engagement of team and staff etc

• Phase 2b – to March 2013 – Transformational – the vision and strategy of what Public Health is offering Hertfordshire

• Phase 3 – march 2013 to March 2014 – Embedding the transformation and new way of working

• Phase 4 – 2014 onwards – the hard long term work of making Hertfordshire a public health county.

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Mechanisms

• Health and Wellbeing Board• County Council Cabinet Panel• LSPs• Hertfordshire Forward• JSNA• Health and Wellbeing Strategy

• And....

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New Hertfordshire Mechanisms

• The Public Health Board – every district council with the County, NHS, Police and Crime Commissioner. Sub-Board of Health and Wellbeing Board and Joint Herts CEOs Forum

• The Public Health Partnerships Fund...funding from the Director of Public Health for district councils to work with local communities on health issues

• The Herts Public Health Skills Framework – a developing plan to spread capacity and capability for public health across all agencies in the County

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Thank you!

Jim.mcmanus@hertfordshire.gov.uk