Living well? living longer?

Living well? living longer?

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  www.fph.org.uk Living well? livinglonger? John Middleton, President, UK Faculty of Public Health Open Forum Events: Population health: Prevention is better than cure. Manchester Conference Centre, April 30th 2019
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  Who we areand what we do • The United Kingdom Faculty of Public Health is a faculty of the three Royal Colleges of Physicians of London, Edinburgh and Glasgow (Physicians and Surgeons) • FPH is a membership organisation for nearly 4,000 public health professionals across the UK and around the world • We also have a growing number of student, associate and international members in more than 80 different countries To improve and protect the public’s health: through standards, advocacy, training and knowledge www.fph.org.uk
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  Living well? Livinglonger? Population health: some definitions The Public’s Health Prevention is better than cure The NHS plan The Prevention Green Paper 201/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Living well? Livinglonger? Population health: some definitions 301/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Population Health An approachaimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and wellbeing of people within and across a defined local, regional or national population, while reducing health inequalities. It includes action to reduce the occurrence of ill health, action to deliver appropriate health and care services and action on the wider determinants of health. It requires working with communities and partner agencies. Kings Fund 401/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Our definition ofpopulation health is an unpacking of Acheson’s (1998) definition of the purpose of public health, ‘the science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society’. Kings Fund 501/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Population health management oneof many tools for using data to guide the planning and delivery of care to achieve maximum impact on population health. It often includes segmentation and stratification techniques to identify groups of patients (and sometimes wider population groups) at risk of ill health and to focus on interventions which can prevent that ill health or equip them to manage it. Integrated care systems (ICSs) here and abroad often use population health management in this sense when deciding how best to allocate resources to different groups of patients (Noble et al 2014). 601/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  ‘Don’t just fightfor the profession of public health fight for the public’s health’ Alwyn Smith, President of the UK Faculty of Public Health, 1981-1987 Public health professionals are not here to make decisions easier, it is to make things better
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  Living well? Livinglonger? The Public’s Health 801/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  1001/05/2019 Living well? livinglonger? John Middleton, Open Forum events 30/0419
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  1101/05/2019 Living well? livinglonger? John Middleton, Open Forum events 30/0419
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  1201/05/2019 Living well? livinglonger? John Middleton, Open Forum events 30/0419
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  1301/05/2019 Living well? livinglonger? John Middleton, Open Forum events 30/0419
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  • https://rightsinfo. org/schools-are- the-unofficial- emergency- service-for-the- victims-of- britains-poverty- head-teachers- warn/ 1401/05/2019 Living well?living longer? John Middleton, Open Forum events 30/0419
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  Crucial importance ofearly years, the first 1001 days and adverse childhood experiences An evidence based approach – Good systematic reviews re early years interventions, parenting training, youth mentoring; good modelling of alcohol pricing, control of access and enforcement. A life course approach- new concerns about adverse childhood experiences (ACES) impacts on violent behaviours, poor communication and poor mental health in later life A public mental health approach- linked to ACEs, the neurobiological hardwiring of young brains in the first 1001 days; Reinforcing positive mental attributes: self-confidence, self-esteem, self-expression and positive communication A public health approach to violence prevention Early Death Social, Emotional and Learning Problems Adopt Health Harming Behaviours and Crime Disrupted Nervous, Hormonal and Immune Development ACEs Adverse Childhood Experiences Non Communicable Disease, Disability, Social Problems, Low Productivity LifeCourse Death Birth Adverse Childhood Experiences (ACEs): impacts across the life course. adapted from Felitti et al, 1998
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  01/05/2019 16
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  The epidemiology ofviolence Evidence-based violence prevention: a life course approach Asset based community development Primary, secondary &tertiary prevention role of the public health community as primary preventers of violent conflict, through healthy public policies and tackling major social inequalities in health; and as early reactors, mitigaters and responders to violence. New public mental health approaches A role for public health in conflict resolution with aid agencies, political scientists, theologians and international lawyers A role for public health educational bodies A leadership and partnership role for public health www.fph.org.uk/uploads/Violence%20report.pdf Areas of action for the public health community in preventing violence
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  Globally, mortality rateshave decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. Countries have saved more lives over the past decade, especially among children under age 5, but persistent health problems, such as obesity, conflict, and mental illness, comprise a “triad of troubles,” and prevent people from living long, healthy lives. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5–24 years. By contrast, numbers of adult deaths increased in each 5- year age bracket above the age of 25 years. Global burden of disease study, 2017
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  These 10 CorporationsControl Almost Everything We Eat
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  http://www.bmj.com/content/358/bmj.j4443?sso= MiddletonJ The public'shealth and the public health system 180530
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  http://www.bmj.com/conten t/357/bmj.j2676 Inequalities in healthcost £65bn (€74bn; $83bn) in lost productivity and taxes and increased benefits payments plus £5.5bn for direct NHS treatment in 2010.5
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  Living well? Livinglonger? Prevention is better than cure 2301/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Prevention is betterthan cure, November 2018 Vision to protect and promote the health of the nation. Healthy ageing grand challenge as part of industrial strategy, to ensure that people can enjoy at least five extra healthy independent years of life by 2035 while narrowing the gap between richest and poorest 1) Why prevention matters 2) Vision for preventing problems from arising in the first place 3) Prevention for people living with a health or social care need ‘Health a precious asset’ Which we must ‘Protect and nourish’ 2401/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Prevention is betterthan cure, November 2018 Good physical and mental health central to our happiness A healthy nation is vital for a strong economy Ill health costs the economy £100 billion a year Better health reduces pressures on NHS, social care, and other public services, including crime, justice and welfare 2501/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  • https://jech. bmj.com/co ntent/71/8/8 27 2601/05/2019 Living well?living longer? John Middleton, Open Forum events 30/0419
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  2701/05/2019 Living well? livinglonger? John Middleton, Open Forum events 30/0419
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  Some features thatweren’t individual focused Health and social care reorientation towards prevention Key leadership role for DsPH Anchor economic role of NHS Predictive prevention (population health management) Action from national and local government - eg Regulation and taxation Soft Drinks Levy Health in all policies and cross government Best start in life Healthier food and drinking choices Physical activity Active travel Loneliness and isolation Air pollution Workplace health 2801/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Living well? Livinglonger? The NHS plan 2901/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  NHS Long termplan, January 2019 1)NHS will move to a new service model in which patients get more options, better support, and properly joined-up care at the right time in the optimal care setting. 2) New, funded, action the NHS will take to strengthen its contribution to prevention and health inequalities. 3)NHS’s priorities for care quality and outcomes improvement for the decade ahead. 4) Current workforce pressures will be tackled, and staff supported. 5) Wide-ranging and funded programme to upgrade technology and digitally enabled care across the NHS. 6) 3.4% five year NHS funding settlement will help put the NHS back onto a sustainable financial path 3001/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Some features National prioritiesbased on Global burden of disease Expectation on prevention, and reducing inequalities: inequalities as in vulnerable groups and protected characteristics Case study of Pathway Homelessness services in primary care Hospital tobacco and smoking cessation efforts RCP ‘Hiding in plain sight’ tobacco control recommendations Strong centrally driven prevention programmes in Diabetes, Cancer, Social prescribing ‘Personalised care’- dream of prevention linking genomics and behaviours Lot of expectation on technology, digital, artificial intelligence, genomics Strong references to staff needs and workforce development Lots of aspiration, and why not? 3101/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Diagram taken fromNHS Prevention Board paper on 22nd January 2018 Draft Population Health diagram v0.1 Population Health Population Healthcare PHM Population Health System-level approach, for optimising outcomes and their distribution, reducing inequity and addressing wider determinants of health (including environmental) across a population Population Healthcare Maximising population health outcomes via healthcare; considering health of the wider population (not just those who present for treatment) through activity such as cross-sector optimal value pathways of care, healthy workplace and sustainability initiatives, action to address inequalities in a health problem of local importance, Population Health Management A delivery approach for how healthcare systems may better organise pathways of care. Includes stratification and modelling to identify defined local ‘at risk’ population to support delivery of prevention and chronic disease management.
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  Table 2 aPreventable causes of hospital admission, Sandwell and Western Birmingham Clinical commissioning group, 2012-13
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  Layering population healthintelligence BLMK GP Cluster Spine Charts produced by PHE LKIS East
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  Population health care
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  With thanks toCerner UK HealtheIntent platform
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  Bedfordshire Population healthmatrix Adapted from Dr Steve Laitner (@SteveLaitner) and the NAPC
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  BMJ 2019;364:l218 doi: 10.1136/bmj.l218 3901/05/2019 Living well?living longer? John Middleton, Open Forum events 30/0419
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  Living well? Livinglonger? The Prevention Green paper? 4001/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Challenges in delivery Workforcebiggest issue Needs genuine partnership with local government and communities Unease over ‘para 2.4 role’ for NHS in sexual health and community nursing– seen as a ‘land grab’ Need for more public health skills Need for specialist public health in all levels of NHs management and planning Regional DsPH seconded from PHE a good start Properly funded community involvement and community services Integrated care systems vs Health and wellbeing boards? Good data needed and a national information governance framework that allows data linkage and sharing National plan for reducing health inequalities needed as with the national plan in the 2000s 4101/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Post plan, weneed to see: More investment in public health, local government and social care through the CSR? FPH proposal for a Prevention Transformation Fund spent through local government Health in all policies approach - housing, food and agriculture, transport welfare rights and personal taxation policies A chance for a “National Service for Health” 4201/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  FPH strategy 2019-2025 Improveand protect health through sustainable development principles. Pursue the Sustainable Development Goals for human health, ecosystems, climate and planetary health upon which we rely. Steer, local, national and global health systems towards greater reliance on prevention and early intervention. Promote health as a fundamental economic benefit that enables communities to thrive. Apply an asset-based approach to improve and protect health, recognise our communities as a resource for health and maximise public engagement. 4301/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  FPH Strategy 2019-2025 Healthin all policies. Reduce inequalities in health by reducing inequalities in economic opportunity, educational attainment and environmental conditions. Harness the Right to Health in our campaigning and through the rule of law. Policies and services to improve the health of future generations. Champion equality of opportunity and the rights of all minorities. 4401/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  ‘Protecting resources from onegeneration to the next’ The Welsh Wellbeing of Future Generations Act, 2015
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  Public health andthe EU post Brexit A country fit to live in… where  Britain can power itself ? and  House itself ? and  Employ itself ? http://www.campaigncc.org/sites/data/files/D ocs/one_million_climate_jobs_2014.pdf
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  MiddletonJ The public'shealth and the public health system 180530
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  Thankyou John Middleton [email protected] 4801/05/2019 Living well?living longer? John Middleton, Open Forum events 30/0419
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  www.fph.org.uk 01/05/2019 49
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  Appendix Population Health andPopulation health management 5001/05/2019 Living well? living longer? John Middleton, Open Forum events 30/0419
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  Layering population healthintelligence BLMK GP Cluster Spine Charts produced by PHE LKIS East
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  Table 2 aPreventable causes of hospital admission, Sandwell and Western Birmingham Clinical commissioning group, 2012-13
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  Population health management– A pillar of Primary Care Home Developed by the National Association of Primary Care, the model brings together a range of health and social care professionals to provide enhanced personalised and preventive care for their local community. Key features of the model • A twin focus on personalisation of care and improvements in population health outcomes • An integrated workforce with a strong focus on partnership working, spanning primary, secondary and social care • Aligned clinical and financial drivers • Defined, registered populations of 30,000 to 50,000 Adapted from Dr Steve Laitner (@SteveLaitner) and the NAPC
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  Typical population segmentation
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  With thanks toCerner UK HealtheIntent platform
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  West Suffolk isimplementing PHM as a global digital exemplar • West Suffolk NHS FT one of first 12 GDE sites • Started 2016, £10m central funding, concludes March 2019 – Digital hospital: hardware, software, infrastructure – Health information exchange across the system – Service user access: patient portal, video consultation, apps – Population health management platform… – Blueprinting and sharing learning PHE and NHS E July 2018
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  & everyone willhave access to the analytics platform Business intelligence, quality improvement Health needs assessment and outcomes/evaluation Research Population health intelligence to drive system transformation priorities: • Atrial fibrillation • Risk stratification for integrated neighbourhood teams • End of life • A mental health topic TBC PHE and NHS E July 2018
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  Mapping health behavioursand conditions Adapted from Dr Steve Laitner (@SteveLaitner) and the NAPC
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  Populating the matrix Adaptedfrom Dr Steve Laitner (@SteveLaitner) and the NAPC