Public Health in Hertfordshire:
Health Walks as a vital part
Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FRSPH
Director of Public Health, Hertfordshire County Council
24th September 2014
Hertfordshire Health Walks Conference
www.hertsdirect.org
Some issues
• On the whole we do better than England
• Look below that though....
• 11 year gap in life expectancy between richest
and poorest
• Significant avoidable disease, disability and
death
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Premature deaths in Hertfordshire
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Obesity
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Contributors to overall health outcomes and why elected
councillors are important leaders
Health
Behaviours 30%
Socioeconomic
Factors 40%
Clinical Care
20%
Built Environment
10%
Smoking 10%
Education 10%
Environmental
Quality 5%
Diet/Exercise 10%
Employment
10%
Access to care
10%
Quality of care
10%
Built
Environment 5%
Alcohol use 5%
Poor sexual health
5%
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Income 10%
Family/Social
Support 5%
Community
Safety 5%
Source: Robert Wood Johnson Foundation and University
of Wisconsin Population Health Institute. Used in US to
rank counties by health status
While this is from a US context it does have significant
resonance with UK Evidence, though I would want to
increase the contribution of housing to health outcomes
from a UK perspective.
The Opportunity for Herts
• The conditions for everyone to be healthy
• The conditions for the poorest and worst off to
be healthier
• Public services which put this at the core of their
business
• People thriving and prosperous
• Healthy workforce, prosperous County
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Priorities
1.
2.
3.
4.
5.
6.
Longer Healthier Lives
Start Healthy, Stay Healthy
Closing the Gap
Understand what’s needed and do what works
Partnership: Making PH everybody’s business
Protecting our communities from harm
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Healthier Herts: A Public Health Strategy for Hertfordshire
OUR PURPOSE
to work together to improve the health and wellbeing of the people of
Hertfordshire, based on best practice and best evidence
OUR VISION:
A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy
and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
The
Public
Health
Outcomes
Framework
(the national
PHOF will
Help us measure
Our success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUR
RESIDENTS
(our strategic priorities: what we achieve for our County)
Priority 1:
Our
Populatio
n lives
Longer,
Healthier
Lives
Building
Strong
Blocks
Leadership
For the
Public Health Family
Priority 2:
Our
Population
Starts Life
Healthy
and Stays
Healthy
Capable,
Skilled People
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Priority 3: We
narrow the
gap in life
expectancy
and health
between
most and
least healthy
Co-production
with citizens
Priority 4: We
protect our
communities
from harm
(chemical,
biological,
radiological and
environmental)
Effective
Partnerships
HOW WE WILL WORK TOGETHER
(our strategic priorities: how we do it for
our County)
Priority 5:
We
understand
what’s
needed and
we do what
works
Evidence and
Knowledge
Driven
Plan and
Deliver for
Localism
Priority 6: We
make public
health
everybody’s
business and
work together
Whole
System
Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels
Why: We are facing an epidemiological crisis with
avoidable disability creating huge burdens
• Avoidable early deaths
• Chronic disease – poor self management, poor
management of sub-clinical risk, must do better
on prevention and early intervention
• Disability and costs to social care and NHS
• Some sections of our population at very high
risk of avoidable misery and death
• Mental health – intervening too late
• Resilience and Happiness – likewise
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Wins and delivery tools
Five big wins
Policy and Delivery Tools
1. Shift up clinical complexity in
• Pathways and structured
2.
3.
4.
5.
primary care
Step up secondary prevention
of complex cases and
Step up self care and self
management in chronic
disease
Commission secondary
prevention pathway
Commission primary
prevention for key risk groups
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•
•
•
•
care approached
Health and social care
integration
Behavioural sciences
Health Checks and public
health services
Brief interventions
Phasing and Layering
• Phasing across the lifecourse and time
Working age
Good early
Years
outcomes
For lifetime
Mental
health
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Accumulation
Of risk in
Late working
age
Phasing and Layering across lifecourse
•Think through what we can do short term
•Start work on the medium term
•Set the policy framework for the long term
•Build this understanding among partners
•Get started and realise
•County, District, Parish, NHS, Business and
Community Sector working together
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What it means for NHS Services
• Preventive services in every patient pathway
• Levels and competencies from brief intervention
onwards
• Preventive services in clinical services link up to
community services (referral for leisure and
behavioural interventions)
• Commissioning for self-management in chronic
disease
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What it means for you
• The Public Health Army
• Physical Activity side of Walking
• Social and Psychological support side of
walking
• Turning you into health trainers
• Keeping you doing what you do best
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Hertfordshire’s strategic commitment to
physical activity
1.
2.
3.
4.
5.
6.
7.
8.
A priority for the Lifestyle and Legacy Partnership (formerly the Olympic
legacy partnership) bringing 40 agencies together
priority in each district council strategy and there are multiple services
A priority for the University in Sports Science
A large and thriving Sports Partnership
A large network of community sports clubs
A priority in the health and wellbeing, Public Health and Sustainable
Transport Strategies
A priority in the Better Care Fund Plan for health and social care
integration
A priority in each NHS Commissioning strategy
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Whats going on now – a selection 1
•
Significant district council investment in leisure services and offers, every
district offering a form of exercise on referral but this will be further
developed over the next year
•
Every district has a leisure offer encompassing indoor and outdoor leisure
activities
Chief Leisure Officers Association and Sport England are working on a joint
District-County-Sports Partnership project to develop a commissioning
framework for physical activity for Herts
•
•
•
•
Community grants fund for physical activity funded by public health to be
developed by Sports Partnership
Every leisure service employee in Hertfordshire can access free public
health training
£1m per annum public health investment in district councils
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Whats going on now – a selection 2
•
•
2014 is year of cycling, year of walking next….
•
•
•
•
•
Workplace health challenge funded by Public Health
•
32,000 people go on Health Walks a year funded by Public Health and District
Councils, led by Countryside Management Service
•
Cycling development small grant fund for community agencies as part of Year of
Cycling
•
•
Key third sector agencies commissioned like Groundwork and others
Public Health and CCGs and Districts are working with an at scale physical activity
programme
Workplace health work funded by public health
Pool bikes and bike to work scheme in the County Council
District councils working on targeted and universal physical activity and leisure offer
Public Health and NHS about to employ physical activity promotion manager in
primary care to develop physical activity pathways
2,500 bikeability courses in schools
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• Nothing less than a cultural shift to physical
activity as mother nature’s way of keeping us
healthy will resolve the challenges we face
• And nothing less than firm resolve to share the
same strategy and vision, and work to deliver
that, from every partner, will get us there (get
behind the Sports and Physical Activity
Framework consultation])
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Avoidable disability
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Avoidable Disability 2
74 year old sedentary male
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Avoidable Disability 3
70 year old tri-athlete
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Walking...mother nature’s way of keeping us well
• Social benefits
• Psychological and resilience benefits
• Blood pressure and hypertension benefits
• Cardiovascular and respiratory benefits
• Musculoskeletal benefits
• What’s not to love?
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Ok, so if that’s why, then how?
• We cant just turn off the tap
• We can just shift huge quantities of money, the
need is still there
• A culture shift to everybody active has got to
be part of our plan
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So how do we get there?
1.
Produce a clear single framework for physical
activity and sport we all sign up to
2.
Build a system wide approach to deal with it
1. Be clear on roles, responsibilities and
outcomes
3.
A more nuanced understanding of lifecourse
and behavioural change
1.Cogntiive and Planned
2.Habitual and automatic
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From the Annual Report
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Year of Cycling
• We will put cycling on the map in Hertfordshire
as a leisure, health and transport activity
• Complete revision of some work we’ve been
doing including website and apps
• Start of a 3 year plus cultural push on physical
activity
• County Council, Cycle Clubs, Districts, NHS,
Police, working together
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Year of Cycling
• 1 year plus legacy period
• Year of walking follows
• Then year of swimming
• Culture change
• Already having an impact
• £2m investment in District
Councils by Public Health
Chief constable and county council agree
to new policy on cycling events/races
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Year of Walking
• Be ambitious
• You are a public
health army
• You are vital in
cultural change
• We want to work with
you
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Thank you!
Jim.mcmanus@hertfordshire.gov.uk
Public Health page
http://www.hertsdirect.org/your-council/hcc/publichealth/
Free learning resources for public health
www.hertsdirect.org.uk/phelearn
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