Public Health challenges in the
South West
Dr Shona Arora
Centre Director, Avon, Gloucestershire
and Wiltshire
Public Health England
Key Issues
– Demographic pressures
– Inequalities
– Financial challenges for Local Authorities & the
NHS
Wider, but fragmented system – how do we
work together?
(Some) Shared priorities
Public Health Outcomes Framework
Where is the SW an overall outlier?
• Healthcare and preventable mortality:
– suicides (5/13 LAs worse than national)
• Health Improvement:
– Smoking in pregnancy (4/13 LAs)
– Excess weight in children (6/13)
– Injuries in young people (4/13)
– Health checks take up (7/13)
SW demographic pressures
65+ 2015
30%
26%
25%
20%
23%
18%
25%
23%
22%
24%
22%
18%
17%
20%
19%
15%
15%
10%
5%
0%
13%
Change in healthcare consumption
Long term health problems
Long Term Health Problems
14%
12%
10%
8%
6%
4%
2%
0%
Cornwall
Plymouth
Torbay
Devon
Bristol
North Som Somerset South Glos
BANES
Gloucs
Swindon
Wilts
Healthy life expectancy
LGA Graph of Doom
• Councils were cut earlier and harder than the
rest of the public sector as the government
began to implement its deficit reduction policy
• •National gap in income versus expenditure of
£16.5b by 2019/20
Inequalities
• Marmot review (2010) ‘Fair Society, Healthy Lives’
• Differences in health outcomes reflect, and are caused by, social
and economic inequalities in society
• Genetics, lifestyle and access to healthcare are not the only factors
that cause health inequalities
• People in poorer areas die earlier but spend more of their shorter
lives with a disability
• Cost to NHS = More than £5bn a year
• Response needs to be across the lifecourse, and proportionate to
need
Life Expectancy and deprivation in the
SW
• Life expectancy continues to rise generally but is below the
national average in certain parts of the SW:
– E.g. Plymouth, Gloucester, Swindon
• Gaps in life expectancy of 8+ years within some areas
• Deprivation varies across the SW, which also has some of the
least deprived areas in England, but is often in small pockets
in more affluent LAs
What contributes to health inequalities?
Wider determinants of health – the
causes of the causes
Influences on population health
King’s Fund summary:
Impact of social relationships on
health
Public Health Challenges
• What is the balance between the full range of actions
we need to take – from prevention to palliation, from
cradle to grave , that will ensure health & wellbeing
into the future, and help to ensure are services are
affordable?
• How do we stop health inequalities from increasing?
• How do we build a lifecourse approach into our
approach to the challenges facing health & social care?
• How do we develop a stronger evidence base? And
disseminate good practice and evidence more quickly?
Link between social and health
inequalities
• How can the NHS take
action?
– Treating patients – Every
Contact Counts, PH in
Clinical Networks
– Community leadership
through H&WBB – action
on wider determinants
– Advocacy for most
disadvantaged
– Preventative Strategies,
e.g. primary care