With research support from October 2013 Rhiannon Tudor Edwards, Jo Charles and Huw Lloyd-Williams Prevention Centre for Health Economics and Medicines Evaluation, Bangor University Presenter: Peter Bradley Twitter @ pbradleyphw Insert name of presentation on Master Slide
Inequality gap very wide in healthy life expectancy in Wales y Life expectancy with 95% Inequality gap 2001-05 2005-09 2 confidence interval (SII in years) Males 75.9 8.6 Life expectancy 77.0 9.2 62.8 18.4 Healthy life expectancy 63.5 18.9 Disability-free life 58.7 14.6 expectancy 59.1 14.8 Females 80.4 6.5 Life expectancy 81.4 7.1 Healthy life 64.7 17.4 expectancy 65.3 17.8 Disability-free life 60.8 12.3 expectancy 61.2 12.5 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
Healthcare Spending Appleby‟s 2009 King‟s Fund reports projections of future healthcare spending in UK (next 50 years). If current trends continue 17% GDP on health by 2060. Slide based on work by Prof Rhiannon Tudor- Edwards, Bangor University
Public Perception 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 on spending on health would be overtaken by other priorities 2 •Could lead to a „flat line‟ of health spending. Slide based on work by Prof Rhiannon Tudor- Edwards, Bangor University
Winning the debate • Science • System • Public support • Scale and • Political support • 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 of 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, Physical Inactivity and Poor Diet • Obesity costs the U.K. NHS £5.1 billion per 3 year (cost year 2007/08). In Wales the cost is £73m (Welsh Government) 4 • Physical Inactivity costs the U.K. NHS £0.9 billion per year (cost year 2007/08). 3 • Ill Health Related to Poor Diet costs the U.K. NHS £5.8 billion per year (cost year 2007/08). 3 Slide by Prof Rhiannon Tudor-Edwards, Bangor University
Smoking and Smoking During Pregnancy • Smoking costs the U.K. NHS £3.3 billion per year (cost year 2007/08). In Wales smoking 3 cost the NHS £386m in 2007. 5 • Smoking during pregnancy costs the U.K. NHS £8- 6 £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 3 risk of pre-eclampsia. Slide by Prof Rhiannon Tudor-Edwards, Bangor University
Alcohol Misuse • Alcohol Misuse costs the U.K. NHS £3.3 billion per year (cost year 2007/08). In Wales the cost of 3 excessive alcohol consumption is between £69.9m and £73.3m 4 • 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). 8 Slide by Prof Rhiannon Tudor-Edwards, Bangor University
Youth Unemployment, Crime and Educational Underachievement • 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. 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) • Examples only • Figures dependent Topic ROI (approx)+ on sectors consider Smoking in 9 to 1 pregnancy • Full report from Suicide 2-4 to 1 Bangor University in prevention November Adult obesity 3 to 1 Workplace health 2 to 1 • Based on US promotion research Conduct 84 to 1 disorders children • NICE also has on- Young people Saving going work drinking 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
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