A common approach to linked avoidable non communicable diseases

Manchester 25 March 2014

Purpose

• Avoidable NCD’s – the huge challenge for the health and social care system and the economy

• Common causes, pathologies and solutions• Ways forward with impact• Implications for the public health system • UK Health Forum raison d’etre• UK Health Forum work and resources

Non communicable diseases

• Grammatical as well as a public health challenge• Nonsense term- “non” , communicable! etc• Unfriendly• Answers on a post card to the UK Health Forum please

Avoidable NCD’s and conditions• CHD and Stroke • Circulatory diseases• Cancers• Respiratory diseases• Liver disease• Type 2 Diabetes• Kidney disease• Obesity• Vascular Dementia

PowerPoint presentations as major risk factor

Population level determinants of risks to health

• Social• Environmental• Economic• Cultural• Commercial and market• Global/EU• Civic• POLITICAL

NCDs – a major global burden• Globally – almost two-thirds of all deaths in 2008

from NCDs (36 million)• WHO European Region - 86% of deaths and 77%

of the disease burden• United Kingdom - the leading cause of death in

2008 (518,400)

UN High Level meeting on NCD’s 2011

• Second ever UN high level meeting on health• Political Declaration- 191 countries• WHO Global action plan 2013• UN Agencies• MDG review links

Macroeconomics• Estimated at $47 trillion over the next two decades. • Approximately 75% of the 2010 global gross domestic

product (GDP). Source: World Economic Forum / Harvard School of Public Health. 2011

• Diseases that “break the bank “• Lancet – 2% reduction per annum, 36 million lives saved,

$9 billion• Austerity• No new global fund

Non Communicable Diseases - The Big Challenge

• Major causes of avoidable mortality, morbidity and disability and inequalities

• Common risk factors and wider determinants • Linked chronic conditions- many manifestations • That’s Life!• Risk factors and protective factors• Decades lag period throughout the life course• Genotype and phenotype interactions

Non Communicable Diseases- The Big Challenge• Industrial epidemics- commercial determinants• Major risks from consumption of tobacco, alcohol and ultra

processed foods• Habitual and addictive behaviours• Social and environmental patterning of behaviour• Dose and duration• Changing intergenerational risks • Avoidable or delayable components of morbidity,

disability and ageing• Solutions predisposed to have considerable ideological bias

Comorbidities: Our current understanding • Comorbidity is expected to;

• grow in prevalence (1.9 to 2.9million 2008-2018)

• grow in cost (currently £8-13billion/year in England)

• Because of;• an ageing population and younger cohorts• increasing health inequalities • Poor management of the physical health of people

with mental illness• Poor management of the mental health of people

with LTCs• Fragmented disease driven not people centred

system, services and guidelines etc

NCD’s are a cause and manifestation of health inequalities in current and future generations

An integrated model of the relationships and levels of intervention

Health improvement & protection

Tertiary prevention

Secondary prevention

Behavioural risk factors

Poor diet Low intake of vegetables, fruit,

nuts, pulses, whole grains & fish High intake of dairy products, red

& processed meat, processed foods, snacks and confectionery

High intake of salt, saturated fat & sugar

Physicalinactivity

Smoking Alcohol

Unhealthy food, Tobacco & Alcohol and their affordability, accessibility, availability, marketing

Agriculture & food production Walking, cycling & public transport

infrastructure

Blood Pressure

Cholesterol

Obesity

Diabetes

Asymptomatic (Sub-clinical disease)

Symptoms & disability

Stroke Some cancers & other NCDs

Dementia & Cognitive

loss

Avoidable death

Intermediate clinical risk

factors

Clinical end-points

(single or co-morbidities)

Social & Environmental determinants (protective &

harmful factors)

Heart disease

Depression & anxiety

Primary

prevention

Physical & built environment Poverty, income, employment status Education & lifelong learning Parenting, social capital & networks Access to health & social services

Humans are

endowed with an

ANCIENT

PHYSIOLOGY

moulded by

famine ...

… especially when we do so little!

.... and ill equipped to

handle our modern food

environment ….

Tackle environmental factors

Agenda for the Long Term• Threats posed by business as usual• Generated most of the externalities• Existing structure bestows a higher premium on

immediate returns on investment• What is owed to future generations?• Revalue the future• Invest in younger generations• Establish a common platform of understanding

Tackle the “Inverse (Public) Health Law”• Poor utilisation of evidence of impact• Avoidance of high impact upstream public health

measures• Poor absolute and relative investments in health

improvement especially primary prevention• Underutilisation of the third sector- civic and civil society• Commercial freedoms of health damaging industries

trump human rights, especially protection of the young and vulnerable

Public health organisations– sectors of operation

Leadership

Everything you wanted to know about the UK Health Forum and more

UKHF strategic focus- avoidable chronic diseases (NCD’s)

• Upstream- international, national and local• High impact• Systemic and sustainable change• Take account of equity, inequalities, social justice

and sustainable development

How we work

Business areas

1. The Forum

2. Interdependent policy focused business areas:• Policy development and research• Modelling and forecasting• Research and information services• Global health

The UKHF’s information niche

web-based resource

Information services

Prevention Information and Evidence eLibrary (P.I.E) UKHF websiteukhealthforum.org.uk

NHS, local authority/gov, VCS, government, international organisations, academia

Prevention of NCDs: risk factors, determinants &

inequalities

Collection and dissemination of quality assessed news

(media), policy reports, case studies etc.

Searchable P.I.E elibrary, subscription briefing service

Obesity Learning Centre – Knowledge and

innovation networkobesitylearningcentre.org.uk

NHS, local authority/gov, VCS, government, international organisations, academia, schools, industry, weight

management orgs.

Obesity, physical activity and nutrition

Collection and dissemination of quality assessed news

(media), policy reports, case studies and tools.

Discussion boards, membership and resources

directory, national networks, content geared to specific

roles (e.g. local gov.), legacy, elearning

Healthy Places – Wellbeing in the local

environmenthealthyplaces.org.uk

Public health, local authorities, city/transport planners, VCS

Access to healthy food, local alcohol control, active

communities, active travel, healthy housing

Regulatory and case law, soft policy (e.g. government

scheme for local fuel poverty)

Case studies, plain language case law, regulatory options,

cross-sector links, PDF maker

Ncdlinks.org Community of Practicencdlinks.org

Global policy, government, health and care practitioners

Physical activity & nutrition (Panacealink), Tobacco

(Globalink), Alcohol (Caribapan for the Caribbean; new Alcohol and Health Link).

Feeds through topic specific news and content from P.I.E

The closed networks function independently, knowledge and

information sharing in discussion boards,

membership directories

Audience

Topics

Content

Functionality

Websites, information & knowledge products

Strategic Partners Portal

The Voluntary Sector Health and Care Strategic Partners Portal website was launched on the 17 October 2013.• Hosted by the UK Health

Forum. • This will be the first site to

show the logos of the Department of Health, Public Health England and NHS England together in one place.

• The site will be used to promote the works of the Strategic Partners to the public and a closed area for Partners to share information.

www.voluntarysectorhealthcare.org.uk

Concluding threads• NCD’s major continuing cause of health inequalities -between

population groups, countries and generations• Individual, social, economic disasters• Consider an integrated approach to NCD’s, their common risk

factors ,determinants and distribution – including co- morbidities

• Address the “Inverse PH Law” – tackle -structural inequalities• A difference will only be achieved by smart investment in

publically supported upstream measures especially on the commercial determinants

The end!