Looking at the Bigger Picture Robin Ireland, Chief Executive, Heart - - PowerPoint PPT Presentation

Stobart Stadium, January 2013 Focus on NHS Health Check Programme

Looking at the ‘Bigger Picture’

Robin Ireland, Chief Executive, Heart of Mersey

Thanks for slides from Professor Simon Capewell, Martin Dockrell (ASH), Professor Vilius Grabauskas, Dr Barbara Hjalsted, Professor Torben Jørgensen, World Heart Federation and Heart of Mersey colleagues.

Focus on NHS Health Check Programme The Power of the Third Sector

– Advocacy for heart health policy and regulation; – Working at local level to shape population-level policy and strategy; – Designing, delivering and supporting services A THIRD SECTOR HEALTH GROUP

Based on poem by Joseph Malins ‘The Ambulance Down in the Valley’ (1895). Original Diagram at: “Addressing the Social Determinants of Children’s Health: A Cliff Analogy”, http://www.vdh.virginia.gov/healthpolicy/healthequity/documents/cliff-analogy.pdf

Upstream – Downstream: ‘The Ambulance Down in the Valley’

Moving people away from the cliff edge – represents addressing the social determinants of health The Ambulance – represents acute medical care for people who are sick. The Safety Net – represents secondary prevention for people who are already sick. The Fence – represents primary prevention with a focus on individual risk.

Health promotion Disease prevention Diseases Determinants Risk factors Health-

• riented health

services Upstream approach Comprehensive approach: Comprehensive approach:

• Population

Population-

• level prevention programmes

level prevention programmes

• Targeting high risk individuals

Targeting high risk individuals

• Improved quality and coverage of care

Improved quality and coverage of care

• Systematic reduction of inequalities

Systematic reduction of inequalities Spanning the continuum

Comprehensive and balanced Comprehensive and balanced

Prevention is cost effective!

20 30 40 50 60 70 80 90 Age

difference in mortality maybe at work at work

Expenses

a life with prevention

palliative care a life without prevention

Source: Kaiser Permanente / Hjalsted

So is it the responsibility of the individual to change their behaviour … or of society to provide an environment in which healthier lifestyles are easier? It’s both of course

Integrated prevention strategies

• Should include individual high risk approaches
• and population based approaches

What an individual high risk approach may include

• Targeted health checks
• Social marketing campaigns
• Provision of health education materials
• Counselling lifestyle behaviour change
• Smoking cessation support
• Cookery sessions
• Cycle training
• Walking groups

A population-based approach

Looking at the ‘Bigger Picture’

• A population-based upstream approach to prevention

focuses on making the healthier choice the easier choice by improving social environments.

• Population-based interventions can be achieved through

regulation, legislation, taxation etc.

• Individually-based approaches are also important.
• Making a small change for a lot of people – the population

– makes a big difference overall.

A population-based approach

Looking at the ‘Bigger Picture’

For example:

• Reducing population cardiovascular risk by just 1% would

generate healthcare savings in England and Wales of approximately £260 million a year

• A 3 gram reduction in adults’ average daily salt intake

would lead to around 14-20,000 fewer deaths from CVD

• Following the implementation of smoke free legislation in

2007, there was a decrease of 2.4% in the rate of emergency myocardial infarction hospital admissions in the following 12 months. In the NW, this equates to a reduction of 1,541 bed days and a saving of £1.18 million in acute hospital care

e.g. Focus on Health Education - campaigns may selectively help upper socio-economic groups if they are not targeted effectively

Individual responsibility Changes to the "toxic" environment

Adapted from Puska P, 2001

• Agree comprehensive smokefree legislation;

plain packs

• Progressively adapt towns/cities to favour

pedestrian/cycling as norm

• Nutritional standards for food in all government

facilities/schools; catering on Finnish scale

• Limit/abolish all marketing to children
• Selectively increase costs of high fat/sugary

products; soft drinks

Approaches to chronic disease prevention: Individual and population based Approaches to chronic disease prevention: Individual and population based

Risk factors for disease

Effective interventions are known

% Lifestyle

Geoffrey Rose (1992):

A small shift in the risk of disease across a whole population can lead to greater reduction in disease burden than a large shift among those persons already at risk

Population-level strategy

Healthy Unhealthy

Risk factors

(modifiable through population-based strategies)

Unhealthy diet

High intake of salt, red meat, processed meat, saturated fat, trans-fat, and refined grains and sugar Main problem: HFSS-”food”

Smoking

Both passive smoking and smoking

Physical inactivity

Including sedentarism

Alcohol

Excess amount of alcohol

A quarter-pound cheeseburger, large fries and a 16 oz. soda provide:



1,166 calories



51 g fat



95 mg cholesterol



1,450 mg sodium Ref: Kelly Brownell

Food and nutrition – what can be done locally?

L

• o king at the ‘Bigge r Pic ture ’
• Improving pre-school, school nutrition and the school

‘fringe’

• Improving food in residential homes, hospitals and prisons
• Work with local food business outlets to improve products
• Improve procurement practice to ensure publicly funded

food and drink provision contributes to a healthy, balanced diet

• Improve local planning systems to enable more space for

growing, supporting local producers etc.

• Use bye-laws to regulate the opening hours of take-aways

and other food outlets

• Ensure children and young people are protected from all

forms of marketing, advertising and promotions which encourage an unhealthy diet

• Continuing to advocate for appropriate national and

international (EU) policies and regulation to support local food and nutrition policies

Pushing back

• n secondhand smoke

82% of homes in the North West are smokefree 51% of smokers live in smokefree homes 84% of adults in the North West believe smoking in cars should be banned 22% of smokers believe smoke has little or no effect on a child’s health

Pushing back What can be done locally?

• Protecting health policy from the tobacco

industry

• Protecting children and young people from

smoking

• Work with agencies re: illicit tobacco,

underage sales etc.

• Working with targeted groups such as

COPD patients, mental health services users

• Smokefree Homes
• Smokefree Hospital sites
• Smokefree Play Areas
• Smokefree Squads (with sports stadia)
• Continued advocacy for strong national

policies

adapted from

Promoting Physical Activity

Most people could meet recommended physical activity levels simply by including more walking or cycling in their daily lives.

Estimated share of journeys (trips) made by bicycle European Best Practice 2006 Update – Atkins 2006

Walking and cycling in Europe

Most people could meet recommended physical activity levels simply by including more walking or cycling in their daily lives

So why is there less commissioning of CVD population-based prevention initiatives?

• Emphasis by most agencies on individual behaviour

change

• Potentially much harder to measure population-based

interventions

• Complex geographical footprints
• Short term impact v long term change?
• Less experience and understanding by

commissioners of population-based initiatives

Individual changes to lifestyle without environmental modification? An environment that is conducive to making healthy choices affects the likelihood that people will achieve positive

• utcomes from individual approaches

such as an NHS Health Check, behaviour change, lifestyle interventions and medical interventions

NICE CVD Commissioning Guide, 2012

Stobart Stadium, January 2013

THANK YOU

Focus on NHS Health Check Programme