The importance of good health to breaking the poverty cycle

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The importance of good health to breaking the
poverty cycle
Thursday 3rd November 2011
Professor Sir Mansel Aylward CB
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Wales now

• Health of the population continues to improve
• but
• The inverse care law still persists - health
  inequities remain stark and resistant to change

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Overview

• The importance of the early years in laying the
  foundations for good health
• Harnessing Public Health expertise
• Tackling Child Poverty Public Health Wales core
  business
• Bevan Commission
• Together for Health

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Tobacco killsMortality from lung cancer, 1991 -
2008 Source World Health Organization
The importance of early intervention Source
Heckman Curve
www.cymru.gov.uk
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Tobacco killsMortality from lung cancer, 1991 -
2008 Source World Health Organization
Complementary approaches
Child Poverty Strategy
Our Healthy Future

• Reduce the number of families living in workless
  households.
• Improve the skills of parents and young people
  living in low income households so they can
  secure well-paid employment.
• Reduce inequalities that exist in health,
  education and economic outcomes of children and
  families by improving the outcomes of the poorest.

www.cymru.gov.uk

• Improve the length and quality of life.
• Fairer health outcomes for all

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Early Years
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Child Poverty and Health Targets

• To reduce difference in outcomes between the most
  deprived 5th and middle 5th except infant
  mortality (most and least deprived 5th) -
• Teenage Conceptions
• Infant Mortality
• Pedestrian Injuries in Children
• Low Birth Weight
• Dental Caries

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Public Health Expertise

• Epidemiology
• Understanding causal factors
• Evidence Base what should we do
• Targeting and reach
• Partnership working and sharing
• Public health advice and consultancy
• Measuring change

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Example Early Years Pathfinder Project low
birth weight

• Aim To explore how an explicit evidence based
  approach and coordination could add value to the
  public health activity in Wales on early years
  health.

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Outcome indicators
Need to also capture interventions at an
individual level
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Evidence for interventions

• Clear evidence base

• Less clear

• Obesity prevention
• Reducing inequalities

• Folic acid supplementation
• Smoking cessation
• Breastfeeding
• Newborn hearing and bloodspot screening
• Immunisations
• Parenting programmes (e.g. Incredible Years)
• Family Nurse Partnerships

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What interventions are in place and next
steps...

• Variation between Health Boards
• Pathways for obesity, smoking cessation and
  perinatal mental health
• Flying start variation in parenting programmes
  used

• Finalise outcome indicators, aligned with the
  Welsh Government Maternity Strategy.
• Pilot a Reproductive and Early Years Surveillance
  System.
• Review literature focussing on specific questions
  that address effectiveness of interventions and
  models of service provision.
• Model potential impact of risk factors and
  interventions to inform effective targeting of
  action

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Tobacco killsMortality from lung cancer, 1991 -
2008 Source World Health Organization
Teenage conceptions Under 18, Teenage
Conceptions, 2007-2009 Source Office for
National Statistics
www.cymru.gov.uk
Annual Quality Framework 2011-2012 Teenage
conceptions (Under 16s) Source StatsWales
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Reducing the teenage conception rate in Wales

• Background (a) Poor health and social outcomes
  for young mothers and children (b) conceptions
  clustered amongst repeat pregnancies, looked
  after children and care leavers, areas of high
  social deprivation
• Phase one to reduce repeat conceptions
  (currently 20 of pregnancies)
• Phase two to reduce conceptions amongst looked
  after children and care leavers (in some areas up
  to 1/3 conceptions amongst this group) and young
  people with substance misuse problems
• Phase three wider population

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Health and worklessnessCombined rate of workless
benefits (IB, ESA, JSA) within local authorities

• The areas with the poorer health outcomes are
  also the places with the highest rates of
  worklessness
• To improve the health of our population it is
  vital to get people to meaningful work
• Healthy Working Wales 2011-2015

Source Nomisweb
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The Bevan Commission First Ministers
Announcement

• .. a source of independent, expert advice on
  the development of health services here in Wales.
  
• its core purpose will be to provide .
  assurance that the reforms . will succeed ..
• a health service which is publicly owned and
  publicly provided a service which is rooted in
  an ethic of care, rather than competition and a
  service which has, at its core, the pursuit of
  health, as well as the treatment of illness.
• A NHS, in other words, which would be
  recognisable to its founder.
• First Minister 16 July, 2008

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What Bevan wanted in 1948

•  
• Comprehensive treatment, within available
  resources
• Universal access, based on need
• Services delivered free at the point of delivery

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What he might have added the Bevan Commission
additional principles

• A shared responsibility for health between the
  people of Wales and the NHS
• A service that values people
• Getting the best from the resources available
• A need to ensure health is reflected in all
  policies
• Minimising the effects of disadvantage on access
  and outcome
• A high quality service that maximises patient
  safety
• Patient and public accountability
• Achieving continuous performance improvement
  across all dimensions of healthcare

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Going for gold World Class Healthcare

• Services best suited to Wales but comparable with
  the best anywhere1
• Essential Elements include
• Balance and integration
• Measured quality as good as or better than
  comparable systems
• A step change in population health
• A crucial leadership role for government
• Performs well against Bevan Commission
  Principles2

• Bevan Commission Report 2008 2011

2. Bevan Commission. World Class Health Care for
Wales (2010)
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So how is the NHS doing? Outstanding business

• The NHS must do more on
• cutting health inequalities and inequities
• promoting a sea-change in public attitudes
• driving out waste in the health system
• effective partnerships across public health and
  local government
• getting solutions to health problems across all
  policy agendas.

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The AnswerPartnership with the Welsh People

• Government, the NHS and the people of Wales need
  to work together to
• look after themselves with help
• take control of their lives
• use the system well
• redesign services
• get real about what is feasible

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The answerReal Political leadership

• Help and encourage people be responsible citizens
• Dont change the system if it isnt broken
• Look for health benefit in every policy area
• Help educate the public that change is needed
  and
• Champion a culture geared towards quality

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The Commission, the NHS and the future

• Aneurin Bevans principles still stand as strong
  today as they did in the late 1940s
• The Welsh system will be distinctively Welsh
• Tough challenges that require commitment,
  tenacity, leadership and partnership throughout
  healthcare, government and society
• A system willing to match itself against the best

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The Welsh Governments response

• On 1 November 2011 Lesley Griffiths AM, Minister
  for Health and Social Services launched
• Together for Health
• A vision for the next 5 years responding to the
  Bevan Commission report

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Acknowledgments

• Dr Tony Jewell, CMO, Welsh Government
• Tony.jewell_at_wales.gsi.gov.uk
• Dr Shantini Paranjothy
• ParanjothyS_at_cardiff.ac.uk
• Dr Noel Craine
• Noel.craine_at_wales.nhs.uk
• Eryl Powell
• eryl.powell_at_wales.nhs.uk