12.45 paul lincoln obesity event
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Transcript of 12.45 paul lincoln obesity event
A common approach to linked avoidable non communicable diseases
Manchester 25 March 2014
Purpose
• Avoidable NCD’s – the huge challenge for the health and social care system and the economy
• Common causes, pathologies and solutions• Ways forward with impact• Implications for the public health system • UK Health Forum raison d’etre• UK Health Forum work and resources
Non communicable diseases
• Grammatical as well as a public health challenge• Nonsense term- “non” , communicable! etc• Unfriendly• Answers on a post card to the UK Health Forum please
Avoidable NCD’s and conditions• CHD and Stroke • Circulatory diseases• Cancers• Respiratory diseases• Liver disease• Type 2 Diabetes• Kidney disease• Obesity• Vascular Dementia
PowerPoint presentations as major risk factor
Population level determinants of risks to health
• Social• Environmental• Economic• Cultural• Commercial and market• Global/EU• Civic• POLITICAL
NCDs – a major global burden• Globally – almost two-thirds of all deaths in 2008
from NCDs (36 million)• WHO European Region - 86% of deaths and 77%
of the disease burden• United Kingdom - the leading cause of death in
2008 (518,400)
UN High Level meeting on NCD’s 2011
• Second ever UN high level meeting on health• Political Declaration- 191 countries• WHO Global action plan 2013• UN Agencies• MDG review links
Macroeconomics• Estimated at $47 trillion over the next two decades. • Approximately 75% of the 2010 global gross domestic
product (GDP). Source: World Economic Forum / Harvard School of Public Health. 2011
• Diseases that “break the bank “• Lancet – 2% reduction per annum, 36 million lives saved,
$9 billion• Austerity• No new global fund
Non Communicable Diseases - The Big Challenge
• Major causes of avoidable mortality, morbidity and disability and inequalities
• Common risk factors and wider determinants • Linked chronic conditions- many manifestations • That’s Life!• Risk factors and protective factors• Decades lag period throughout the life course• Genotype and phenotype interactions
Non Communicable Diseases- The Big Challenge• Industrial epidemics- commercial determinants• Major risks from consumption of tobacco, alcohol and ultra
processed foods• Habitual and addictive behaviours• Social and environmental patterning of behaviour• Dose and duration• Changing intergenerational risks • Avoidable or delayable components of morbidity,
disability and ageing• Solutions predisposed to have considerable ideological bias
Comorbidities: Our current understanding • Comorbidity is expected to;
• grow in prevalence (1.9 to 2.9million 2008-2018)
• grow in cost (currently £8-13billion/year in England)
• Because of;• an ageing population and younger cohorts• increasing health inequalities • Poor management of the physical health of people
with mental illness• Poor management of the mental health of people
with LTCs• Fragmented disease driven not people centred
system, services and guidelines etc
NCD’s are a cause and manifestation of health inequalities in current and future generations
An integrated model of the relationships and levels of intervention
Health improvement & protection
Tertiary prevention
Secondary prevention
Behavioural risk factors
Poor diet Low intake of vegetables, fruit,
nuts, pulses, whole grains & fish High intake of dairy products, red
& processed meat, processed foods, snacks and confectionery
High intake of salt, saturated fat & sugar
Physicalinactivity
Smoking Alcohol
Unhealthy food, Tobacco & Alcohol and their affordability, accessibility, availability, marketing
Agriculture & food production Walking, cycling & public transport
infrastructure
Blood Pressure
Cholesterol
Obesity
Diabetes
Asymptomatic (Sub-clinical disease)
Symptoms & disability
Stroke Some cancers & other NCDs
Dementia & Cognitive
loss
Avoidable death
Intermediate clinical risk
factors
Clinical end-points
(single or co-morbidities)
Social & Environmental determinants (protective &
harmful factors)
Heart disease
Depression & anxiety
Primary
prevention
Physical & built environment Poverty, income, employment status Education & lifelong learning Parenting, social capital & networks Access to health & social services
Humans are
endowed with an
ANCIENT
PHYSIOLOGY
moulded by
famine ...
… especially when we do so little!
.... and ill equipped to
handle our modern food
environment ….
Tackle environmental factors
Agenda for the Long Term• Threats posed by business as usual• Generated most of the externalities• Existing structure bestows a higher premium on
immediate returns on investment• What is owed to future generations?• Revalue the future• Invest in younger generations• Establish a common platform of understanding
Tackle the “Inverse (Public) Health Law”• Poor utilisation of evidence of impact• Avoidance of high impact upstream public health
measures• Poor absolute and relative investments in health
improvement especially primary prevention• Underutilisation of the third sector- civic and civil society• Commercial freedoms of health damaging industries
trump human rights, especially protection of the young and vulnerable
Public health organisations– sectors of operation
Leadership
Everything you wanted to know about the UK Health Forum and more
UKHF strategic focus- avoidable chronic diseases (NCD’s)
• Upstream- international, national and local• High impact• Systemic and sustainable change• Take account of equity, inequalities, social justice
and sustainable development
How we work
Business areas
1. The Forum
2. Interdependent policy focused business areas:• Policy development and research• Modelling and forecasting• Research and information services• Global health
The UKHF’s information niche
web-based resource
Information services
Prevention Information and Evidence eLibrary (P.I.E) UKHF websiteukhealthforum.org.uk
NHS, local authority/gov, VCS, government, international organisations, academia
Prevention of NCDs: risk factors, determinants &
inequalities
Collection and dissemination of quality assessed news
(media), policy reports, case studies etc.
Searchable P.I.E elibrary, subscription briefing service
Obesity Learning Centre – Knowledge and
innovation networkobesitylearningcentre.org.uk
NHS, local authority/gov, VCS, government, international organisations, academia, schools, industry, weight
management orgs.
Obesity, physical activity and nutrition
Collection and dissemination of quality assessed news
(media), policy reports, case studies and tools.
Discussion boards, membership and resources
directory, national networks, content geared to specific
roles (e.g. local gov.), legacy, elearning
Healthy Places – Wellbeing in the local
environmenthealthyplaces.org.uk
Public health, local authorities, city/transport planners, VCS
Access to healthy food, local alcohol control, active
communities, active travel, healthy housing
Regulatory and case law, soft policy (e.g. government
scheme for local fuel poverty)
Case studies, plain language case law, regulatory options,
cross-sector links, PDF maker
Ncdlinks.org Community of Practicencdlinks.org
Global policy, government, health and care practitioners
Physical activity & nutrition (Panacealink), Tobacco
(Globalink), Alcohol (Caribapan for the Caribbean; new Alcohol and Health Link).
Feeds through topic specific news and content from P.I.E
The closed networks function independently, knowledge and
information sharing in discussion boards,
membership directories
Audience
Topics
Content
Functionality
Websites, information & knowledge products
Strategic Partners Portal
The Voluntary Sector Health and Care Strategic Partners Portal website was launched on the 17 October 2013.• Hosted by the UK Health
Forum. • This will be the first site to
show the logos of the Department of Health, Public Health England and NHS England together in one place.
• The site will be used to promote the works of the Strategic Partners to the public and a closed area for Partners to share information.
www.voluntarysectorhealthcare.org.uk
Concluding threads• NCD’s major continuing cause of health inequalities -between
population groups, countries and generations• Individual, social, economic disasters• Consider an integrated approach to NCD’s, their common risk
factors ,determinants and distribution – including co- morbidities
• Address the “Inverse PH Law” – tackle -structural inequalities• A difference will only be achieved by smart investment in
publically supported upstream measures especially on the commercial determinants
The end!