Being Strategic About Population Health

9.12.05

Eg. Choosing Health: Making Healthy Choices Easier

Outline strategic approach to population health.
• What is the prevention strategy for stroke?
• Strategy for multidisciplinary care for stroke? What voluntary groups are there?
• Strategy for reducing burden of stroke on population?
• Strategy for reducing impact of
-hypertension
-back problems
on population?
• Do data/statistics help inform strategy?

Population perspective theme (using seven pointers)
• 2, 4, 5 and 7 relevant to strategy.

Strategy
• Consider one model of health promotion.
• Health promotion: "process of enabling people to increase control over and improve their health. It involves the population as a whole in the context of their everyday lives…" World Health Organisation.

Demonstrate awareness of development of national health strategy in England from 1990s.
• Current strategy: Choosing Health.
• Following on from Our Healthier Nation.
• Following on from The Health Of The Nation.

Key features of The Health Of The Nation Green Paper (1991)
• Emphasise health promotion versus health care.
• Setting clear challenging targets.
• 'Working together' - inter-sectoral collaboration.

White Paper (1992)
• Key areas.
-Coronary heart disease and stroke.
-Cancers (breast, cervical, lunch, skin).
-Mental (illness) health.
-HIV/AIDS and sexual health.
-Accidents.
• Action settings.
-Healthy cities.
-Healthy schools.
-Healthy hospitals.
-Healthy workplaces.
-Healthy homes.
-Healthy prisons.
-Healthy environments.

SET TOO MANY TARGETS!

Other public health white papers…
• 2 related government publications.

The New NHS: Modern, Dependable White Paper (1997)
• Increased collaboration, not competition.
• Decreased management costs.
• Decreased waiting times for 'suspected cancer.'
• Establishing primary care groups (now primary care trusts).
• Plus, Health Improvement Programmes, Health Action Zones, National Institute for Clinical Excellence (NICE), 24-hours nurse-led telephone advice, NHSnet.

The NHS Plan (2000)
• Increased beds, facilities, staff, 'modernisation.'
• Increased patients' influence (views; advocates; surveys and forums; action on cancellations…)
• Decreased waiting times.
• Better services for cancer, ischaemic heart disease, mental health, older people.
• National inequalitites target (primary care; screening; smoking cessation; better diets for children).

Key features of Our Healthier Nation Green Paper (February 1998)
• Key aims:
-Lengthening lives.
-Higher quality of life free from illness.
-Narrowing inequality gap.
• Criteria.
-'Marked inequalities.'
-'Real causes of public concern.'
-'Significant cause of premature death.'
• One target in each of four priority areas:
-Heart disease and stroke.
-Cancers (all).
-Mental health.
-Accidents.
• Three health settings:
-Healthy schools.
-Healthy workplaces.
-Healthy neighbourhoods.
• Strengthen public health function and research.
• Expect all NHS personnel to accept responsibility for public health issues.

White Paper (July 1999)
• As per Green Paper.
• Want to:
-Improve health of everyone.
-Improve health of worst off in particular.

Main features of Choosing Health
• Consultation (early 2004).
-Choosing health.
-Choosing better diet.
-Choosing activity.
• Through by November 2004.
• Overarching priorities.
-Decreased number of smokers.
-Decreased obesity and increased diet/nutrition.
-Increased exercise.
-Decreased alcohol misuse.
-Increased sexual health.
-Increased mental health.
• Plus, underpinning principles.
[-Free healthcare.
-Free at point of delivery.]
-Informed choice.
-Personalisation.
-Working together.
• Action setting still the same.
• Attention focuses on:
-Health in a consumer society.
-Children and young people - starting on the right path.
-Local communities leading for health.
-Health as a way of life.
-A health-promoting NHS.
-Work and health.
-Making it happen - national and local delivery.

Other elements of strategy
• National service frameworks and their standards.
• One for 'older people' (2001).

Epidemiological indicators
• Incidence of outcome in exposed = Relative risk
Incidence of outcome in unexposed
• Incidence = Epidemiological measure of risk. Absolute measure of risk.
• Relative risk = incidence risk ratio.
• RR of 4: 4 times as many new cases occurring per unit population per unit time in those exposed to risk factors versus those not exposed to risk factors ie. more in exposed groups.
• 95% confident that true RR lies between 1.6 times as many and 8.2 times as many in exposed versus unexposed.
• RR only estimate of truth - want to know how precise estimate is.
• Risk from inactivity.
-Incidence rate.
-RR (l¬e/lu).
-Population attributable fraction (percentage disease in population associated with certain risk factor).
• Comparing 'like' with 'like.'
-Standardised mortality ratio versus standardised mortality rate?
• Eg. SMR = 150 - 50% higher mortality than expected - indirect.
• Standardised rate (direct).

How to be strategic?
• Where are we now?
-Describe.
• Where are we trying to get to?
• How are we going to get there?