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Prevention

October 2013 Presenter: Peter Bradley Twitter @ pbradleyphw

With research support from Rhiannon Tudor Edwards, Jo Charles and Huw Lloyd-Williams Centre for Health Economics and Medicines Evaluation, Bangor University

Inequality gap very wide in healthy life expectancy in Wales

61.2 60.8 65.3 64.7 81.4 80.4 59.1 58.7 63.5 62.8 77.0 75.9 8.6 9.2 18.4 18.9

14.6 14.8 6.5 7.1 17.4 17.8 12.3 12.5

2001-05 2005-09 Life expectancy Healthy life expectancy Disability-free life expectancy Life expectancy Healthy life expectancy Disability-free life expectancy Males Females Life expectancy with 95% confidence interval Inequality gap (SII in years)

2

y

Produced by Public Health Wales Observatory using data from ADDE/MYE (ONS) and WHS/WIMD (WG).

Why aren’t our efforts working?

Prevention

Wanless Review

Wanless Review 2002

Appleby‟s 2009 King‟s Fund reports projections of future healthcare spending in UK (next 50 years). If current trends continue 17% GDP

• n health by 2060.

Healthcare Spending

Slide based on work by Prof Rhiannon Tudor- Edwards, Bangor University

British Social Attitudes Survey (Appleby and Lee 2012).

• Reduction from 83% in 2000 to 68% in 2011

who see health as main priority.

• May come a point where the public‟s perception
• n spending on health would be overtaken by
• ther priorities
• Could lead to a „flat line‟ of health spending.

Public Perception

2

Slide based on work by Prof Rhiannon Tudor- Edwards, Bangor University

Winning the debate

• Science
• Public support
• Political support
• System
• Scale and
• Sustainability

Prevention

Advocacy: our voice

Recent examples

• Plain packaging
• Minimum Unit Price for alcohol
• E-cigarettes
• Graduated driving licences

What about....

• Sugar, domestic violence,

tobacco control, gambling

• Impact of benefit reforms,

austerity measures.........

Prevention

Food banks

• Some charities reporting big

increases in use

• Largest charity Trussel Trust reports

170% increase in emergency food given out in last 12 months

Trussel Trust Aug 2013 www.trusseltrust.org/stats

Outcome focus and large- scale change

• Innovation in service delivery and

approach AND

• All sectors involved – common goals and

capacity

What are we trying to acheive? Time perspective – early wins, late gains

Prevention

"Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”

William A Foster 1941

Barriers

Manaña

Moral offset

(not now, too difficult, do it later) Pecking order

Cognitive dissonance

(important, but not as important as ... Nothing to do with me, not my job)

Prevention

FRESH (tobacco control NE)

• Aiming for smoke-free NE and social norm change
• Smoking Childhood addiction that kills 50% of long-

term users

• Multi-faceted campaign inc.

– Media campaigns based on real people – Enforcement through trading standards and police

• Smoking prevalence markedly down (compared to rest
• f UK)
• Good outcomes led to apparent reduction in CVD

www.freshne.com

Co-production and tailoring approaches

• Community based, looking at assets

and building on them

• Have to find solutions that are

attractive, fit into people‟s lives and motivate them to change (social marketing)

Prevention

Ottawa Charter 1986

Innovation

• Stop drink driving:

http://www.scooterman.co.uk/

• Flip flops

http://www.bbc.co.uk/news/uk- england-merseyside-16761353

• Sub 21 http://vimeo.com/15477986

Prevention

• Obesity costs the U.K. NHS £5.1 billion per

year (cost year 2007/08). In Wales the cost is £73m (Welsh Government)

• Physical Inactivity costs the U.K. NHS £0.9

billion per year (cost year 2007/08).

• Ill Health Related to Poor Diet costs the U.K.

NHS £5.8 billion per year (cost year 2007/08).

Obesity, Physical Inactivity and Poor Diet

4 3 3 3

Slide by Prof Rhiannon Tudor-Edwards, Bangor University

• Smoking costs the U.K. NHS £3.3 billion per

year (cost year 2007/08). In Wales smoking cost the NHS £386m in 2007.

• Smoking during pregnancy costs the U.K. NHS £8-

£64 m per year (cost year 2005/06).

• These costs can be attributed to maternal increased

risk of spontaneous abortion, ectopic pregnancy, placenta previa, abruptio placenta, preterm premature rupture of membranes and decreased risk of pre-eclampsia.

Smoking and Smoking During Pregnancy

3 5 6 3

Slide by Prof Rhiannon Tudor-Edwards, Bangor University

• Alcohol Misuse costs the U.K. NHS £3.3 billion per

year (cost year 2007/08). In Wales the cost of excessive alcohol consumption is between £69.9m and £73.3m

• Alcohol related harm costs the NHS in England £2.9

billion per year. Costs of crime and antisocial behaviour linked to alcohol are £8 billion per year and the costs of employee absenteeism related to alcohol-use disorders are £1.7 billion per year (estimates for England only and cost year 2008/09).

Alcohol Misuse

3 4 8

Slide by Prof Rhiannon Tudor-Edwards, Bangor University

• The productivity loss to the U.K. economy is estimated at £10

million per day. Youth unemployment and inactivity costs the state about £20 million per week in Job-Seeker‟s Allowance (cost year 2004/05). The corresponding figure for Wales was £0.98 million per day.

• The estimated total cost of youth crime for Great Britain was in

excess of £1 billion (cost year 2004/05).

• Educational underachievement is estimated to cost the U.K.

economy £18 billion, as this may lead to youth unemployment or youth crime (cost year 2004/05). In Wales the figure is £227 million.

Youth Unemployment, Crime and Educational Underachievement

Slide by Prof Rhiannon Tudor- Edwards, Bangor University

Cost burden of lifestyle

Cost to UK NHS per year

• Poor diet, £5.8 billion
• Obesity, £5.1 billion
• Smoking, £3.3 billion
• Alcohol, £3.3 billion
• Physical activity, £0.9 billion
• Unplanned pregnancy,

£194k

• Mental health, substance

misuse........ Figures by Jo Charles/Rhiannon Tudor Edwards University of Bangor.

Return on investment (examples)

Topic ROI (approx)+ Smoking in pregnancy 9 to 1 Suicide prevention 2-4 to 1 Adult obesity 3 to 1 Workplace health promotion 2 to 1 Conduct disorders children 84 to 1 Young people drinking Saving

• Examples only
• Figures dependent
• n sectors consider
• Full report from

Bangor University in November

• Based on US

research

• NICE also has on-

going work

Figures based on those by Prof Tudor- Edwards, Bangor University, 2013

Obesity/physical activity

Welsh Health Survey data (prepared by Public Health Wales Observatory) Dr Peter Bradley

Example: Obesity

• 25% higher health costs than person of normal

weight per year.

• Earn up to 18% less
• x3 more likely to receive disability pension (N

Europe).

• comprehensive prevention strategy would

avoid approx 4375 deaths in Wales/year

• The annual cost of such a strategy would be

about £12 per head.

Prevention

Lancet physical activity series 2012

Transforming Health Improvement in Wales

“Health improvement review” Opportunity to review what we do and what impact it is making Prevention

Transforming Health Improvement in Wales

• Focus: reducing health inequalities
• Targeted resources to high impact

areas across lifespan

• Be proactive, flexible, innovative
• Enhance role of NHS, primary care
• Communication, evaluation,

research vital

Prevention

Transforming Health Improvement in Wales

• Prepare for future health needs
• Integrated solutions (all sectors)
• Act on wider causes of ill health
• Work more closely with local people/

communities (sustainability)

• Shared plans/budgets

Prevention