The science of creating
wellness
Prof Carol Tannahill, Director,
Glasgow Centre for Population Health
Scotland & other Western
European countries
18
51
18 -18
55 53
18 -18
59 57
18 -18
63 61
18 -18
67 65
18 -18
71 69
18 -18
75 73
18 -18
79 77
18 -18
83 81
18 -18
87 85
18 -18
91 89
18 -18
95 93
18 -18
99 97
19 -19
03 01
19 -19
07 05
19 -19
11 09
19 -19
15 13
19 -19
19 17
19 -19
23 21
19 -19
27 25
19 -19
31 29
19 -19
35 33
19 -19
39 37
19 -19
43 41
19 -19
47 45
19 -19
51 49
19 -19
55 53
19 -19
59 57
19 -19
63 61
19 -19
67 65
19 -19
71 69
19 -19
75 73
19 -19
79 77
19 -19
83 81
19 -19
87 85
19 -19
91 89
19 -19
95 93
19 -19
99 97
20 -20
03 01
-2
00
5
Not always
the ‘Sick Man of Europe’
Male life expectancy: Scotland & other Western European Countries, 1851-2005
Source: Human Mortality Database
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
Comparison to WE Mean
(Males)
Proportionate Contribution by Cause - Males
Coronary heart disease mortality
Men aged 15-74 years
Denmark
Finland
Norway
Sweden
Scotland
Age-standardised mortality per 100,000
600
500
400
300
200
100
1950
1960
1970
1980
1990
Healthy Life Expectancy
Life Expectancy vs Healthy Life Expectancy* at Birth, Males , 1999-2000
Source: ISD Scotland
80
70
19.2
Life Expectancy at birth
60
21.8
25.8
24.9
22.5
19.6
46.8
46.8
48.3
50.5
20.2
17.8
20.8
19.2
52.6
53.2
53.6
53.8
19.7
17.6
56.5
58.5
50
40
30
53.8
46.7
20
10
Years of life with a LLI
w
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R
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So
HLE at birth
re
na
Ay
rs
h
h
ut
West of Scotland Council Area
* defined as absence of Limiting Longterm Illness (LLI)
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ire
So
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or
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G
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C
ity
nd
0
Percentage of adults aged 16 and over
with a long-standing illness, disability or health problem
by SIMD quintile, 2007/08 (Scottish Household Survey)
Percentage of adults aged 16 and over
with a long-standing illness, disability or health problem
by SIMD quintile, 2007/08 (Scottish Household Survey)
2001
Census
figures.
Scotland:
20%;
NHSGGC
range from
16% - 30%
A whistlestop tour
around some concepts
1. Prevention
•
•
•
•
Reduce the incidence of health problems
(primary prevention)
Reduce the progression of health problems
(secondary prevention)
Reduce the impacts of disease (tertiary
prevention)
Reduce unnecessary health interventions
(quarternary prevention)
BUT…
A whistlestop tour
around some concepts
1. Prevention
•
•
•
•
Reduce the incidence of health problems
(primary prevention) health problems only?
Reduce the progression of health problems
(secondary prevention)
Reduce the impacts of disease (tertiary
prevention)
Reduce unnecessary health interventions
(quarternary prevention)
A whistlestop tour
around some concepts
1. Prevention
•
•
•
•
Reduce the incidence of health problems
(primary prevention) health problems only?
Reduce the progression of health problems
(secondary prevention) covers almost all of
health care activity
Reduce the impacts of disease (tertiary
prevention)
Reduce unnecessary health interventions
(quarternary prevention)
A whistlestop tour
around some concepts
1. Prevention
•
•
•
•
Reduce the incidence of health problems (primary
prevention) health problems only?
Reduce the progression of health problems
(secondary prevention) covers almost all of health
care activity
Reduce the impacts of disease (tertiary prevention)
covers almost all of social care activity
Reduce unnecessary health interventions
(quarternary prevention)
A whistlestop tour
around some concepts
An alternative
1. Prevention of the onset or first manifestation of
a disease process, or some other first
occurrence, through risk reduction
2. Prevention of the progression of a disease
process or other unwanted state, through early
detection when this favourably affects outcome
3. Prevention of avoidable complications of a
health problem or other unwanted state
4. Prevention of the recurrence of an illness or
other unwanted phenomenon.
A whistlestop tour
around some concepts
Preventative spend
•
•
•
Spending now that is expected to reduce
public spending demands in the future by
reducing avoidable health and social
problems
Must increase healthy lifespan/compress
morbidity
Wanless: requirement for ‘fully engaged’
scenario
A whistlestop tour
around some concepts
Wellness
Aaron Antonovsky
Sir Harry Burns
Sense of coherence....
“.....expresses the extent to which one has
a feeling of confidence that the stimuli
deriving from one's internal and external
environments in the course of living are
structured, predictable and explicable, that
one has the internal resources to meet the
demands posed by these stimuli and,
finally, that these demands are seen as
challenges, worthy of investment and
engagement."
For the creation of health....
....the social and physical environment must be:
• Comprehensible
• Manageable
• Meaningful
• ......or the individual would experience chronic
stress
Summary
• Scotland’s health ranking is a relatively recent
phenomenon, and reflects a slower rate of improvement
than other countries
• The outcomes for (young) working age men and women
are particularly concerning
• For many causes of death, Scotland’s improvement is in
line with other countries
• But ‘social dis-eases’ are increasing
• Inequalities are also increasing
• There is a lot of evidence (and more emerging all the
time) that traditional explanations of socio-economic
deprivation (underpinned by effects of post-industrial
decline) are not sufficient.
How do we respond?
1. Programmatically
on individual issues?
• The most common response
• Evidence-based and often with a clear
method
• Positive outcomes for (a proportion of)
participants
• Tends to increase inequality
• Rarely achieves population-level impact
• Need to respond to each new issue afresh
-70
-60
-50
-40
-30
-20
-10
0
10
20
30
40
50
60
70
-70
-60
-50
-40
-30
-20
-10
0
10
20
30
40
50
60
70
2. Through national policy
on individual issues?
•
•
•
•
•
•
Smoking in public places
Alcohol minimum pricing
Screening and immunisation programmes
Housing quality standards
Social protection
School meal standards
• Less likely to increase inequality
• More likely to achieve population-level impact
• But still need to respond to each new issue afresh
3. On the cross-cutting determinants
operating at individual & community
levels?
• Fundamental influences that perpetuate
poorer health outcomes, regardless of the
issue
– Power distribution
– Knowledge
– Social networks
– Access to (financial and other) resources
• Asset-based working
Creating wellbeing
Generalised
resistance resources
Family
Nurture
Intelligence
Work
Material resource
Identity
Cultural stability
Optimism
Stable set of answers
Sense of coherence
Seeing the world as:
Structured
Predictable
Feeling that it is:
Manageable
Meaningful
Events
Stress
Tension
Resolution
Wanting to engage
Wellbeing
Antonovsky. Health, stress and coping. 1979
Inflammation in plaques
cytokines
Lumen
MMP
Inflammatory
Degraded Cells
SMC
matrix
apoptosis
Cap
Core
Inflammatory cells
MMPs, IL-6,
IL-15, IL-18, CRP
Unstable
Thin
Fibrous Cap
Choice reaction time
1200
p<0.001
milliseconds
1000
800
MD
LD
600
400
200
0
35-44
45-54
Age (years)
55-64
Environmental determinants of
inflammatory status
CRP (median) mg/dl
Depcat
% smokers
Never-smokers
Smokers
1
36.8
0.71
1.42
2
35.9
1.00
2.34
3
39.1
1.11
2.25
4
44.1
1.21
2.44
5
46.6
1.13
2.53
6
49.3
1.25
3.07
7
55.5
1.48
3.29
affluent
deprived
Implementing at scale….
can it be done?
The Early Years Collaborative - Aims
1. To ensure that women experience positive pregnancies which result in the birth of
more healthy babies as evidenced by a reduction of 15% in the rates of
stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and
infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in
2015).
2. To ensure that 85% of all children within each Community Planning
Partnership have reached all of the expected developmental
milestones at the time of the child’s 27-30 month child health review, by
end-2016.
3. To ensure that 90% of all children within each Community Planning Partnership
have reached all of the expected developmental milestones at the
time the child starts primary school, by end-2017.
Lochrin Nursery
Children receiving a bedtime story
120
Parents
survey
Percentage
of children
100
Goal
Median
.
80
60
Books
available
at
collection
time.
Grassmarket
changes
40
introduced
20
.
weekly
average
displayed
for parents
Research
information
handed to
parents
.
0
M
T
W
TH
F
M
T
W
TH F
M
Day of the
w eek
T
W
TH
F
M
T
W
TH
F
90% of children at Grassmarket nursery
school will receive a bedtime story at
least 3 times a week.
Children receiving a bedtime story
100
90
Goal
Percentage
of children
80
70
60
Median
50
Family garden
party
40
A very hot
weekend
30
20
10
0
M
T
W
TH
F
M
T
W
TH F
M
Day of the
w eek
T
W
TH
F
M
T
W
TH
F
Alfie
‘I like my
bedtime story
because it helps
me to dream’
Do one brave thing today….then run like hell!