Parker Morris standards 1967-80

Dwellings should be fitted with heating

systems that maintain the kitchen and

circulation space at 13oC and the living

and dining spaces at 18oC when the

external temperature is -1oC

Excess winter deathsall cause mortality – East England

Excess winter death by social group of head of household (%)

0

5

10

15

20

25

30

35

Prof Manager Semi-skilled Unskilled

East

Excess winter death by tenure (%)

0

5

10

15

20

25

30

HA LA Owner Privaterented

East

PRIORITISING DISEASES

Disease A Disease B Total

Deaths in all areas 100 100 200

Deaths in deprived areas

20 40 60

Improvement 50% None

Resulting deaths in all areas 50 100 150 (25%)

Resulting deaths in deprived areas 10 40 50 (16.7%)

PRIORITISING DISEASES

Disease A Disease B Total

Deaths in all areas 100 100 200

Deaths in deprived areas

20 40 60

Improvement None 50%

Resulting deaths in all areas 100 50 150

(25%)

Resulting deaths in deprived areas 20 20 40

(33%)

Early successes

• Clean water supply

• Polio immunisation

Flu immunisation

• Over 65s: ¾

• Under 65 at risk: ½

Individual v Herd immunity

• A cluster randomized trial involving 947 Canadian children and adolescents aged 3-15 years who received flu vaccine and 2326 community members who did not receive in 49 Hutterite colonies

• Reduced influenza by 61% in those not vaccinated

Reducing knife injuries

OffendersExcess Mortality Following Release From Prison

0

5

10

15

20

25

30

35

40

45

up to 1 1 up to 2 2 up to 4 4 up to 8 8 up to 13 13 up to 26 26 up to 52 More than52

Total

Weeks since release from Prison

Mo

rtal

ity

Rat

io

Deaths unlreletdto drugs

Drug relateddeaths

Injectable Naltrexone V Placebo

0

20

40

60

80

100

120

Days free

Physiologically notdependent

Licensing

• Taken up by firm in US (Alkermes)

• FDA approved

• Will it ever be licensed in UK?

• Licensed only if commercially attractive

Banning Smoking In Cars With Children

• Ten minute bill by Alex Cunningham

• 84% of public support a ban

• Fine particulate matter in pubs before ban– Average 285 micrograms per square metre

Moving Car With Windows Fully Or Half Open

Moving Car With Windows Closed

The Effect Of Fines

• Smoking associated with deprivation

• Attendance at speed awareness courses

73%

• Seat belt sessions– Offered instead of a fine

Good aspect of Government policy

Health and Social Care Bill

The steps that may be taken … include –

providing financial incentives to encourage individuals to adopt healthier lifestyles

Financial Incentives

“Obese and overweight adults in England could be

paid to lose weight under plans being considered by

the Government. The new strategy to tackle poor

eating habits and sedentary lifestyles includes the

suggestion that people should receive financial

rewards or shopping vouchers for achieving and

maintaining a healthy weight.”

Times Jan 24 2008

NHS Tayside Quit4U

• Smokers in the poorest areas of Dundee offered £150 worth of groceries by the health service if they are able to give up cigarettes

• Participants in 12-week scheme given £12.50 a week by NHS Tayside if a carbon monoxide breath test proves they have not been smoking

• The money will be credited onto an electronic card which cannot be used for cigarettes or alcohol.

Possibilities of working with businesses

To encourage weight loss

– Send two for one vouchers residents of identified

postcodes to buy clothes when there has been

demonstrable reduction in clothes size

To sustain smoking quits

– Savings account (using money saved by quitting) attracting

differential interest if cotinine validated quit at 12 months

Sex workers

Sexually transmitted infections

– Service offered in massage parlours

Exit strategies

– Workers may want to plan their exit