Focus on NHS Health Check Programme Stobart Stadium, January 2013 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 A THIRD SECTOR HEALTH GROUP – Advocacy for heart health policy and regulation; – Working at local level to shape population-level policy and strategy; – Designing, delivering and supporting services
Upstream – Downstream: ‘The Ambulance Down in the Valley ’ 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 – Moving people away represents primary from the cliff edge – prevention with a represents addressing focus on individual the social determinants of risk. health 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
Comprehensive and balanced Comprehensive and balanced Upstream approach Disease Health- Health prevention oriented health promotion services Spanning the continuum Determinants Risk factors Diseases Comprehensive approach: Comprehensive approach: ● ● Population- -level prevention programmes level prevention programmes Population ● ● 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
Prevention is cost effective! a life without Expenses palliative prevention care a life with prevention 20 30 40 50 60 70 80 90 at work maybe at work difference in mortality Age 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 • 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. Looking at the ‘Bigger Picture’
A population-based approach 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 Looking at the ‘Bigger Picture’
Approaches to Individual responsibility Approaches to chronic disease chronic disease e.g. Focus on Health Education - prevention: prevention: campaigns may selectively help Individual and upper socio-economic groups if they Individual and are not targeted effectively population based population based Changes to the "toxic" environment 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 Adapted from Puska P, 2001
Risk factors for disease
Effective interventions are known
Population-level strategy 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 Unhealthy Healthy Lifestyle
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? • 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 L o o king at the ‘Bigge r Pic ture ’
Pushing back on 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 22% of smokers believe smoking in cars smoke has little or no should be banned 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 Most people could meet recommended physical activity levels simply by including more walking or cycling in their daily lives. more walking or cycling in their daily lives Walking and cycling in Europe Estimated share of journeys (trips) made by bicycle European Best Practice 2006 Update – Atkins 2006
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 outcomes from individual approaches such as an NHS Health Check, behaviour change, lifestyle interventions and medical interventions NICE CVD Commissioning Guide, 2012
Focus on NHS Health Check Programme Stobart Stadium, January 2013 THANK YOU
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