The science of creating wellness Prof Carol Tannahill, Director, Glasgow Centre for Population Health Scotland & other Western European countries 18 51 18 -18 55 53 18 -18 59 57 18 -18 63 61 18 -18 67 65 18 -18 71 69 18 -18 75 73 18 -18 79 77 18 -18
79 77 19 -19 83 81 19 -19 87 85 19 -19 91 89 19 -19 95 93 19 -19 99 97 20 -20 03 01 -2 00 5 Not always the Sick Man of Europe Male life expectancy: Scotland & other Western European Countries, 1851-2005 Source: Human Mortality Database 90.0
80.0 70.0 60.0 50.0 40.0 30.0 20.0 Comparison to WE Mean (Males) Proportionate Contribution by Cause - Males Coronary heart disease mortality Men aged 15-74 years Denmark Finland
Norway Sweden Scotland Age-standardised mortality per 100,000 600 500 400 300 200 100 1950 1960 1970 1980 1990 Healthy Life Expectancy Life Expectancy vs Healthy Life Expectancy* at Birth, Males , 1999-2000
Source: ISD Scotland 80 Life Expectancy at birth 70 60 19.2 21.8 25.8 24.9 22.5 19.6 46.8 46.8
56.5 58.5 50 40 30 53.8 20 46.7 10 0 n tla o Sc d ow
sg a l G ity C st Ea Ay re hi s r rth No r na a L
re hi s k ba un D t es W re hi s n rto de ly c r ve In
rth No rs Ay re hi nf Re r ire sh ew h ut So West of Scotland Council Area HLE at birth
* defined as absence of Limiting Longterm Illness (LLI) Years of life with a LLI re hi s r Ay h ut So La na re hi s rk ba un
D st Ea re hi s n rt o en R t s Ea ire sh w fre Percentage of adults aged 16 and over with a long-standing illness, disability or health problem by SIMD quintile, 2007/08 (Scottish Household Survey)
Percentage of adults aged 16 and over with a long-standing illness, disability or health problem by SIMD quintile, 2007/08 (Scottish Household Survey) 2001 Census figures. Scotland: 20%; NHSGGC range from 16% - 30% A whistlestop tour around some concepts 1. Prevention Reduce the incidence of health problems (primary prevention) Reduce the progression of health problems
(secondary prevention) Reduce the impacts of disease (tertiary prevention) Reduce unnecessary health interventions (quarternary prevention) BUT A whistlestop tour around some concepts 1. Prevention Reduce the incidence of health problems (primary prevention) health problems only? Reduce the progression of health problems (secondary prevention) Reduce the impacts of disease (tertiary prevention) Reduce unnecessary health interventions (quarternary prevention)
A whistlestop tour around some concepts 1. Prevention Reduce the incidence of health problems (primary prevention) health problems only? Reduce the progression of health problems (secondary prevention) covers almost all of health care activity Reduce the impacts of disease (tertiary prevention) Reduce unnecessary health interventions (quarternary prevention) A whistlestop tour around some concepts 1. Prevention
Reduce the incidence of health problems (primary prevention) health problems only? Reduce the progression of health problems (secondary prevention) covers almost all of health care activity Reduce the impacts of disease (tertiary prevention) covers almost all of social care activity Reduce unnecessary health interventions (quarternary prevention) A whistlestop tour around some concepts An alternative 1. Prevention of the onset or first manifestation of a disease process, or some other first occurrence, through risk reduction 2. Prevention of the progression of a disease process or other unwanted state, through early detection when this favourably affects outcome 3. Prevention of avoidable complications of a health problem or other unwanted state
4. Prevention of the recurrence of an illness or other unwanted phenomenon. A whistlestop tour around some concepts Preventative spend Spending now that is expected to reduce public spending demands in the future by reducing avoidable health and social problems Must increase healthy lifespan/compress morbidity Wanless: requirement for fully engaged scenario A whistlestop tour around some concepts Wellness
Aaron Antonovsky Sir Harry Burns Sense of coherence.... .....expresses the extent to which one has a feeling of confidence that the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable, that one has the internal resources to meet the demands posed by these stimuli and, finally, that these demands are seen as challenges, worthy of investment and engagement." For the creation of health.... ....the social and physical environment must be: Comprehensible Manageable Meaningful ......or the individual would experience chronic stress
Summary Scotlands health ranking is a relatively recent phenomenon, and reflects a slower rate of improvement than other countries The outcomes for (young) working age men and women are particularly concerning For many causes of death, Scotlands improvement is in line with other countries But social dis-eases are increasing Inequalities are also increasing There is a lot of evidence (and more emerging all the time) that traditional explanations of socio-economic deprivation (underpinned by effects of post-industrial decline) are not sufficient. How do we respond? 1. Programmatically on individual issues? The most common response Evidence-based and often with a clear method Positive outcomes for (a proportion of) participants
Tends to increase inequality Rarely achieves population-level impact Need to respond to each new issue afresh -70 -60 -50 -40 -30 -20 -10 0 10 20
30 40 50 60 70 -70 -60 -50 -40 -30 -20 -10
0 10 20 30 40 50 60 70 2. Through national policy on individual issues?
Smoking in public places Alcohol minimum pricing Screening and immunisation programmes Housing quality standards Social protection School meal standards Less likely to increase inequality More likely to achieve population-level impact But still need to respond to each new issue afresh 3. On the cross-cutting determinants operating at individual & community levels? Fundamental influences that perpetuate poorer health outcomes, regardless of the issue Power distribution Knowledge Social networks Access to (financial and other) resources Asset-based working
Creating wellbeing Generalised resistance resources Family Nurture Intelligence Work Material resource Identity Cultural stability Optimism Stable set of answers Sense of coherence Seeing the world as: Structured Predictable Feeling that it is: Manageable Meaningful Events Stress
Tension Resolution Wanting to engage Wellbeing Antonovsky. Health, stress and coping. 1979 Inflammation in plaques cytokines Lumen MMP Inflammatory Degraded Cells SMC matrix apoptosis Cap Core Inflammatory cells MMPs, IL-6, IL-15, IL-18, CRP
Unstable Thin Fibrous Cap Choice reaction time 1200 p<0.001 milliseconds 1000 800 MD LD 600 400 200 0
35-44 45-54 Age (years) 55-64 Environmental determinants of inflammatory status CRP (median) mg/dl Depcat % smokers Never-smokers Smokers 1 36.8 0.71
3.29 affluent deprived Implementing at scale. can it be done? The Early Years Collaborative - Aims 1. To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015). 2. To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the childs 27-30 month child health review, by end-2016. 3. To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017.
Lochrin Nursery Children receiving a bedtime story Percen tag e o f ch ild ren 120 Parents survey 100 Goal Median . 80 60 40 Grassmarket changes 20
introduced Books available at collection time. . weekly average displayed for parents Research information handed to parents . 0 M
T W TH F M T W TH F M Day of the w eek T W
TH F M T W TH F 90% of children at Grassmarket nursery school will receive a bedtime story at least 3 times a week. Children receiving a bedtime story 100 Percen tag e o f ch ild ren 90
Goal 80 70 60 Median 50 Family garden party 40 A very hot weekend 30 20 10 0 M
T W TH F M T W TH F M Day of the w eek T W
TH F M T W TH F Alfie I like my bedtime story because it helps me to dream Do one brave thing today.then run like hell!
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