health improvement everybody’s business grace moore associate director of health promotion and...
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Health Improvement
Everybody’s BusinessGrace Moore
Associate Director of Health Promotion and Equalities
Outline
• Definitions
• The Public Health Workforce
• Planning for Health Improvement
• Programmes and Priorities
• Making sense of a cluttered landscape
• Performance Monitoring/Management
• Summary
Definitions
• Public Health; "The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society”.
• Health Improvement is an outcome, the achievement of which includes the areas of work traditionally described as health promotion, public health and health care[1].
Definitions
• Health Promotion is the process of enabling people to increase control over, and to improve their health[2].
• [1] Public Health Institute of Scotland. The health promotion contribution to health improvement. 2002
• [2] World Health Organisation. Ottawa Charter. 1986
The Public Health Workforce
• Health improvement is pursued by a range of staff through:– wide-ranging health promotion efforts, aimed
at promoting good health and preventing ill-health in the whole population and also in specific target groups
– and through maximising the population health benefits of treatment of ill-health.
The Public Health Workforce
• Specialist – Senior Staff working at consultant level – generally members/fellows of Faculty of Public Health
• (Specialised) Practitioner e.g. Health Promotion Officer and Public Health Practitioners – work to a set of competencies as defined by the FPH
The Public Health Workforce
• Wider Workforce – adopt public health approaches for some of the work they do but will be working to a set of competencies defined by their professional body e.g. doctors, nurses, teachers, community workers, pharmacists, physiotherapists……in fact many people in public bodies
Main areas of public health practice
Health Protection
Health services Health Promotion and disease prevention
Health and Well-being
• “Health is more than the absence of disease….to be healthy requires individuals to engage in their health as much as it requires healthy and sustainable environments and well trained professionals”
Complex Environment
economic social
physical
employment
Health and social services
housingpollution
povertyculture
Layers of Health Improving Activity
Population-based approaches
Target Groups
Priority Topics
Settings
1 to 1 approaches
Large number of
practitioners
Small number of
practitioners
From Population to the Individual
Tobacco – A Worked Example
TobaccoReduced burden of disease, disability and premature death due to tobacco
GreenerSafer & StrongerHealthierSmarterWealthier & Fairer
· Reduced adult smoking rates· Reduced uptake of smoking by young people
Social norms
HIGH LEVELOUTCOMES
INTERMEDIATEOUTCOMES
SHORT-TERM OUTCOMES
Outcomes related to service delivery
Reduced inequalities in premature mortality due to smoking-related
diseases
Smoke-free environments
Access to SC services
Accessibility of tobacco (YP)
Reduced inequalities inHealthy Life Expectancy
· Reduced adult smoking rates· Reduced uptake of smoking by young people
Social norms
HIGH LEVELOUTCOMES
INTERMEDIATEOUTCOMES
SHORT-TERM OUTCOMES
Outcomes related to service delivery
Reduced inequalities in premature mortality due to smoking-related
diseases
Smoke-free environments
Access to SC services
Accessibility of tobacco (YP)
Reduced inequalities inHealthy Life Expectancy
TobaccoIntermediate Outcomes
Reduced adult smoking rateSustained quit rate (1 year follow-up)
Long term OutcomesImproved mental wellbeing
Reduced inequalities in HLEReduced inequalities in CHD mortality
Reduced tobacoo-related morbidity and mortality
ProcessesWhat the NHS has to do to deliver effective SC services
in key settings
OutputsSmoking cessation services
Short-term OutcomesQuit rate at 1 month follow-up
InputsBudget, trained workforce and data needed
to run and monitor smoking cessation services
Reach (target population)Smokers who want to quit (key sub-groups)
new HEAT target
National indicators
Cross-sector Contributions
Inputs
Activities
Outputs
Reach
Short-term outcomes
Intermediate outcomes
High level outcomes
NHS
Individual Behaviours
Reduce adult smoking rates
Reduce uptake of smoking in children and young people
Increased healthy life expectancy; Reduced inequalities in healthy life expectancy, Reduced inequalities in morbidity and mortality due to smoking related diseases e.g. CHD, Cancer
Physical Environments – Reduced exposure to second hand smoke
Social Environments – Reduced attractiveness of tobacco products Economic Environments
SG,UK govt, EU
Schools, community
Example
Local authorities
Improved compliance with
laws
Local authorities
Anti-smoking messages
Media, school ethos, practices
Young people
Understanding risks, attitudes to
smoking
Smokers
Increased quit rate
Enforcement of smoking ban
Enforcement of laws on under-
age sales
Tobacco Retail Sales
Under 18s
Smoking Cessation Services
Intensive support, brief advice, NRT
Compliance with laws
Increased price,
reduced incentives
Smoke free public places
General Public General Public
Taxation, displays
promotions, advertising Industry
Regulation
Priority Target Groups
• Children and young people
• Pregnant women
• People living in deprivation
• Groups who face particular inequalities e.g. homeless, people who have sensory impairment, people from ethnic minorities
Summary
• Health promotion implemented by a range of staff across a range of sectors
• The specialist function works mainly (but not exclusively) at a strategic and population level
• It provides support to others in their health promotion efforts
• It delivers complex interventions across a range of settings, for a range of target groups on a range of priority topics using a range of methods
Finally….
• “Our staff are the agents of change. We cannot hope to bring about the improvements envisaged unless the people who deliver these improvements are protected in their place of work, recognised and rewarded for their contribution to our success and given the opportunities to develop the skills and experience they require to improve health and reduce health inequalities.”
• (Better Health Better Care: Action Plan)
Sensory Impairment - Partners
NHS • Communications• Disability Awareness• IT• Learning Disabilities• Optometrists/Ophthalmology• Audiologists• Psychological Services • Procurement• Public Health • PFPI• Medical Records• Primary Care• Children’s Services • Occupational Therapy• Nursing• Estates
External • Leisure Services (LA and
Independent)• Social Services• LA Procurement• RNIB• RNID• Visibility• Deafblind Scotland• SISG Ayrshire• Volunteers• Patients/People with Sensory
Impairment• Carers• Healthy Living Centres
Bridge to Vision
Arran Pilot Training Group
CSS Policy
Eyecare Review
Adult’s Sub Group
LD Needs Assessment
Children’s Sub Group
Training Sub Group
Development Group for Equalities and Sensory
Impairment
Needs Assessment
Commissioning an Area Wide Service Sub Group
Deafblind Communicator Pilot
Interpreter Services ContractActive Living & HI Programme
VI Pilot
Centre Sub Group
Audit & Standards Commissioning
Network Management Function
Awareness Raising Pilot
Pfizer Funding
Literature Review
National Procurement Contracts
South Ayrshire Working Group
East Ayrshire Working Group
North Ayrshire Working Group
Key: Yellow Circle = Main Project Group Bracket = Future Work Green Circle = Sub Group Pentagon = Link Function Pink Rectangle = Sub Project GroupsFull Lines = Accountability routes Jade Rectangle = Working Groups Broken lines = Communication links
Sensory Impairment Project