Agenda item

Public Health Southwark : Dr Ann Marie Connolly , Director of Public Health

Public Health and Kings Health Partners (KHP):  Professor Moxham,  Director of Clinical Strategy

7.1  The chair welcomed Dr Ann Marie Connolly, Director of Public Health and Professor Moxham, Director of Clinical Strategy, to present on Public Health. The Director of Public Health went through the presentation circulated with the agenda.

7.2  She referred to the health system triangle that considers the determinants of good health. The bottom layer refers to good education, social structure, jobs, and income. She noted that behaviours likely to lead to poor health outcomes tend to come in clusters and are related to deprivation. 

7.3  The Director of Public Health referred to the statistics that show that women and men’s life expectancy in Southwark is improving, but there is a large variation depending on social and physical deprivation. 

7.4  She noted that Chronic Obstructive Pulmonary Disease (COPD) is higher than the national average, as are cardiovascular disease, particularly CHD & strokes, and lung cancer. Mental Health is also a major cause of morbidity. There is an emphasis on long-term conditions – improving the quality of care and quality of life.

7.5  The presentation outlined some of the risks factors: smoking, poor diet, obesity, lack of exercise and alcohol consumption. She outlined the four emerging Southwark Health and Wellbeing priorities as: prevention or reduction of alcohol-related misuse; coping skills, resilience and mental wellbeing; early intervention and families and, lastly, healthy weight and exercise.

7.6  The Director of Public Health referred to research by the New Economics Foundation that identifies ways to keep healthy: connection through relationships; being active; keep learning; taking notice and giving of oneself.

7.7  At the end of the presentation the Director of Public Health concluded by saying that improving health is about acting on the wider determinants of healthand the prevention of risk factors. There is also an emphasis on early detection of conditions through cancer screening, NHS Health Checks and improved management of common chronic health conditions.

7.8  The chair thanked the Director of Public Health and invited Professor Moxham, Director of Clinical Strategy, to present and he also referred to his presentation, circulated with the agenda.  He emphasised Kings Health Partners collaborative approach to Public Health. Alcohol is top priority of their Public Health strategy. This is a priority as hazardous and harmful drinking is a chronic condition with huge numbers presenting  at St Thomas Hospital.

7.9  There is a strong emphasis on smoking cessation, and a focus on staff quitting. Staff who do not smoke are better carers and strong proponents of public health. The strategy focuses on those who are likely to smoke a lot, such as porters. He explained that KHP are looking at smoking as a chronic disease.

7.10  The strategy in aiming to diagnose people with HIV promptly and hospital are trying to do routine testing. 

7.11  There is an emphasis on identifying patients with mental health issues who are users of other services. The Psychological Medicine CAG is focusing on improving mental health of patients with chronic diseases. They are identifying depression in clinics (e.g. Diabetes, Rheumatology) and delivering treatment.

7.12  The Director concluded by emphasising ‘Value-Based Health Care’ because it can improve quality, efficiency and sustainability of care across our health and social care economy. He explained that “Value” is defined as outcomes that matter to patients, divided by the costs of achieving those outcomes, over the full cycle of care.

7.13  The chair thanked both presenters and invited the sub committee to ask questions. A member commented that the evidence had highlighted smoking as a key determinant of health, but it was not in Southwark’s four emerging priorities. He asked why that was. The Director of Clinical Strategy said that he agreed with the emerging priorities as all critical, however he explained that as a respiratory specialist he sees smoking as a key health issue to tackle,. He went on to  commented that smoking  is now being conceptualised as an inherited disease and its adverse health impacts are considerable, for example its negative effective on maternal and pre natal well being. The Director of Public Health explained that in the process of deciding the four emerging priorities there had been advocates of a number of issues and a choice had to be made. She explained that one of the criteria was that the issues would be something that the Health and Wellbeing Board could best address collectively.

7.14  A member asked about the increase in tuberculosis and the Director of Public Health agreed to send a short update report. A member raised concerns about smoking and teenagers and referred to a report she had read that teenage smoking is on the increase. She raised her concerns about the selling of single cigarettes and the importance of educating teenagers. The Director of Clinical Strategy commented that one of the most at risk groups was African Caribbean males at 37%.

7.15  A member refereed to the book ‘Nudge’ and asked if this could be a useful approach to tackling unhealthy behaviours. The Director of Clinical Strategy commented that vouchers for fruit and vegetables and gym membership are not enough to tackle these types of systemic problems. It noted that it took legislation to ban smoking from public places to effect a significant reduction in smoking. He advocated a similar approach to obesity, for  example banning vending machines selling junk food from public places. He said that we need, as a democracy, to get to this place and that can take years of campaigning. He went on to say that we are now an early on in the journey to tackle obesity and commented that if you invite chocolate bar manufactories to discuss the matter they will only offer to manufacture smaller bars.

7.16  The Director of Public Health concurred and noted that those on a better income and with high levels of skills are much more able to maintain a proper diet. She noted that nourishment of children is particularly crucial . The Marmot report evidenced that the foundation for children’s health is laid down by the age of two. She added that there is some scope for Nudge to do the inverse of what big industry to persuade us to eat cheap poor quality food.

7.17  A member asked about the possibility of using Nudge to make fine grained changes to behaviour and went on to ask if he thought there needed to be more national coordinated action on diet. The Director of Clinical Strategy agreed that there did need to be national action , as well as citywide action, and referred to the role of the New York mayor in banning alcohol consumption in public places. The Director of Public Health questioned the national political will to take such action but said there are still opportunities at a local government level. For example, licensing trading outlets, school and public spaces, working with fast food outlets to improve the food they provide. She said that fine-grained actions with diverse communities are also effective as is giving information to parents.

7.18  A member commented that planning is an important power and mentioned the saturation of fast food outlets in places such as Walworth and noted that supermarkets often promote food that is detrimental to people’s health. He agreed that the planning process could be used to constrain commercial outlets food promotion practices  that are so detrimental to wellbeing.  Lastly he commented that there is an opportunity for the council to radically expand the opportunities for people to grow there own food.

7.19  Facilities for outdoor play was raised by a member and the directors both agreed that this was important and that children need more exercise; both in free play and in supervised activities. Physical activity that is integrated into daily life, such as walking is also important.

7.20  A member asked about breast and cervical early screening for cancer and similarly education about prostrate cancer in men, and asked if this was important. The directors agree that early detection was a key part of their respective strategies.

7.21  A member of the public asked about the delivery of alcohol and drug treatment service at Marina House and the chair requested that the Director of Clinical Strategy provide an update.

7.1  A member commented that making links between planning, education and housing and the Health and Well Being board would be important. The chair noted that Public Health is proposed as a review subject for this administrative year, and will therefore be discussed at more length during the work planning process.

 RESOLVED

The committee requested that:

• Professor Moxham provided an update on Marina House and the delivery of services; particularly any that continue to treat alcohol and drug addiction from this. 
• Dr Ann Marie Connolly provide any available evidence on the increase in tuberculosis