Presentation to Bedfordshire and Hertfordshire Environment and Health Group on the new Public Health Agenda and JSNA - March 2012

1. Public Health
From Chadwick To Cameron
Pete Hill & Sarah James

2. Public Health From Chadwick To Cameron
• Back in Time to 1842….
• What is Public Health?
• JSNA – What’s One of Those Then?
• Data – Lies Damned Lies & Statistics?
• Health – The Makeover
• Public Health Outcomes Framework
• Need v Demand
• Conclusions

3. Back in
Time
to1842

5. Origins of Public Health
“That the various forms of epidemic, endemic, and other disease caused, or aggravated,
or propagated chiefly amongst the labouring classes by atmospheric impurities produced
by decomposing animal and vegetable substances, by damp and filth, and close and
overcrowded dwellings prevail amongst the population in every part of the kingdom,
whether dwelling in separate houses, in rural villages, in small towns, in the larger towns
— as they have been found to prevail in the lowest districts of the metropolis.”
“That such disease, wherever its attacks are frequent, is always found in connexion with
the physical circumstances above specified, and that where those circumstances are
removed by drainage, proper cleansing, better ventilation, and other means of
diminishing atmospheric impurity, the frequency and intensity of such disease is abated;
and where the removal of the noxious agencies appears to be complete, such disease
almost entirely disappears.”
Edwin Chadwick Report...from the Poor Law Commissioners on an Inquiry into the Sanitary
Conditions of the Labouring Population of Great Britain [online source]. London, 1842, pp. 369-
372.]

6. “That the younger population, bred up under noxious physical agencies, is inferior in
physical organization and general health to a population preserved from the
presence of such agencies.”
“That the population so exposed is less susceptible of moral influences, and the
effects of education are more transient than with a healthy population.”
“That these adverse circumstances tend to produce an adult population short-lived,
improvident, reckless, and intemperate, and with habitual avidity for sensual
gratifications.”

8. Step Up John Snow
The Broad Street Pump – 1854
Golden Square cholera
epidemic
500 deaths
First mapping to indicate
extent and local of
outbreak - mapped
incidence and checked
facts

9. Health and its determinants
“Health is as a positive concept
that emphasises social and
personal resources, as well as
physical capabilities. It involves
the capacity of individuals to
function and to cope with their
social and physical
environment, as well as with
specific illnesses and with life
in general” (WHO, 1984; Baggott,
1994).

11. JSNA What’s One of Those Then?
Our health, our care, our say white paper:
• identified the need for directors of:
• public health
• adult social services
• children’s services
to undertake regular strategic needs assessments of
the health and wellbeing status of their populations
• Need for joint planning and understanding

12. JSNA What’s One of Those Then?
“JSNA is a process that will identify the
current and future health and wellbeing
needs of a local population… leading to
agreed commissioning priorities that will
improve outcomes and reduce health
inequalities.”
Department of Health (2007)
Guidance on Joint Strategic Needs Assessment

13. JSNA What’s One of Those Then?
Describes a process that identifies current
and future health and wellbeing needs in
light of existing services, and informs future
service planning taking into account
evidence of effectiveness.
• Identifies the “big picture” in terms of the
health and wellbeing needs and
inequalities of a local population.
• Assists commissioning services and
interventions that will achieve better health
and wellbeing outcomes and reduce
inequalities
The Local Government and Public Involvement in Health Act 2007 Section 116 specifies that local authorities
and Primary Care Trusts (PCTs) produce a Joint Strategic Needs Assessment (JSNA) of the health and
wellbeing of the local community

14. “The Department of Health expects local
authorities to commission on an ‘any willing
provider’ basis and they will work to ensure that
voluntary, community and social enterprise
organisations are supported to play a full part in
providing services.”
Healthy Lives Healthy People December 2010

17. JSNA Data Inventory
• People receiving housing benefit
• Number and proportion of households in fuel poverty
• Noise and vibration levels monitored by environmental health
• Information on food poisoning outbreaks – type, location and
number of people affected
• Level of flooding risk
• Proposed developments in the area that might affect population
health and wellbeing
• Houses in multiple occupation
• Housing condition (private sector)
• Overcrowding
• Number of unfit dwellings
• Number of Gypsy and Traveler sites and estimated populations
• Performance and other indicators on local social housing providers
• Perceptions of antisocial behavior

18. Other Contributing Data
• Environmental Quality
• Air Quality
• Contaminated Land
• Private Water Supplies
• IPPC Permits
• Smoking
• Health & Safety at Work
• Accident data
• Young Persons at Work
• Cold and Hot Weather Risk Assessment
• Public Health
• Accumulations
• Filthy & Verminous Premises
• Nuisance Complaints

19. A Little History

20. NHS Timeline
1950 New 1952
5th July 1948
NHS hits Prescription
NHS Formed
budget charges
problems introduced
1980 Black Report 1962 Enoch
1987 Whitehead finds health Powell’s
report continues inequalities Hospital Plan
Blacks work between social introduces
groups Local Health
Authorities
1990 Community
1992 NHS Trusts 1998 Acheson
Care Act Health
Formed Report on Health
services now
Inequalities
commissioned
from NHS

21. Health – The Makeover

22. Funding
Department of Health
Public NHS
Health BUDGET
Budget £100
£5 billion
billion
Specific Public Health Services
Public Health NHS
Commissioners
England
GP’s
Ring
Fenced
Providers
Grant
Local Health & Wellbeing
Boards
Authorities

23. Public Health Outcomes Framework
Main Aims
Increased healthy life expectancy.
Reduced differences in life expectancy
and healthy life expectancy between
communities
Four Domains of Indicators
1. Improving the wider determinants of health
2. Health improvement
3. Health protection
4. Healthcare public health and preventing premature mortality
Framework will operate from April 2013

24. An example There is an eight year
gap in male life
expectancy between St
Pancras and Somers
Town wards and
Hampstead
3.5
miles!

25. An example
a seven year gap in
In Most Authorities female life expectancy
between Hampstead and
There is at least a 7 Kentish Town.
year gap between the
2 miles!
most and least deprived
Wards!

26. EH Indicators
Air pollution Fuel poverty Diet Excess winter deaths
The percentage of the population affected by
noise
Smoking prevalence – adult (over 18s) Smoking prevalence – 15 year olds
Mortality from communicable diseases
Falls and injuries in the over 65s
Public sector organisations with board Comprehensive, agreed inter-agency
approved sustainable development plans for responding to public health
management plan incidents

27. Housing & Health
• HHSRS
• Decent Homes Standards
• House Condition Survey
• HMO Licensing

28. Healthcare Community
Costs Stability Drugs/ Alcohol
Loneliness Depression
Suicide
Stress
Falls
Sleep Unemployment
Deprivation
Isolation
Access
Problems Dangerous Access to Low Educational
Stairs Burglars Achievement
Lack of Stress
Money X Cold Overcrowding Worry
Trip Damp & Rubbish
Hazards Mould
Pneumonia/ Heart Colds
Attacks
Asthma Anti Social
Work Behaviour
Absence
Bullying Graffiti
Death Truancy
Crime & Environmental
Environmental
Disorder Costs Clean Up Costs
targets CO2

29. EHP’s Need To Be…..
“Give me a smart idiot over a stupid genius any day.” –Samuel Goldwyn

30. “A business that makes nothing but money is a poor business.” - Henry Ford

31. Cost Analysis
Expected Number of Estimated Total Expected
Hazard Incidences Causing Costs to Mitigate Annual Saving to
Harm within the Stock NHS
Damp &
70 £775,250 £28,113
Mould
Excess
417 £2,082,081 £7,101,366
Cold
Falling on
Level
626 £241,072 £1,660,965
Surfaces
etc
Falling on
4589 £1,551,082 £11,295,269
Stairs etc
Crowding
0 £0 £0
& Space
Entry by
417 £436,182 £182,238
Intruders
Totals £5,085,667 £20,267,951

32. Where Does Your Service Fit In
The Health Jigsaw?

33. Need v Demand
Know your population
• How many people at risk?
• What is the structure of the
population at risk?: Are You in a Position to
• Age Say No?
• Sex
• Ethnicity
• What is the deprivation status
of those at risk?

34. In Conclusion - JSNA
•Identifies the most important needs within
a population for the wider determinants of
health
E.g. housing quality is more of a priority
than stroke
•Measures need (not demand!)
.
•Measures, understands and articulates the
needs of individuals, groups and
populations relating to the wider
determinants of health and wellbeing.
• Sets priorities for partners to work together
to address
And God said, 'Let there be light' and there was light, but the Electricity Board said He would have
to wait until Thursday to be connected. – Spike Milligan

35. “The price of a good sanitary environment and the control of pestilence is
eternal vigilance on the part of the medical officer of health. The promotion of
health in a community -in the home, at work, and at play - demands his
constant attention, in co-operation with the sociologist; and education in health
needs for its fulfilment a completely new approach, with teacher, psychologist,
and health officer in joint harness.”
“In fact, when the prospects of a true health service, relieved of the burden of
the medical care of the sick, are properly examined, one is amazed and
enchanted by the gleaming horizon”.
Nye Bevan’s Speech:16 September 1948,
to the Society of Medical Officers of Health

36. Public Health
From Chadwick To Cameron
Pete Hill Sarah James
Corporate Special Projects Officer Chartered Environmental Health
Welwyn Hatfield Borough Council Practitioner
01707-357404 Watford Borough Council
P.Hill@Welhat.gov.uk 01923 278582
Sarah.James@Watford.gov.uk