UKPHR Consultative Forum
From Strategy to Practice
A perspective from the Institute of Public Health
5 November 2015
Owen Metcalfe, FFPH
Chief Executive, IPH
www.publichealth.ie
“However beautiful the strategy, you should
occasionally look at the results”.
Sir Winston Churchill
“A strategy, even a great one, doesn’t implement
itself”.
Anon
Institute of Public Health in Ireland
• Research – Prevalence of
Long Standing Conditions
• Policy – Obesity,
Smoking, Sexual Health
• Capacity Building – HIA
Training, Open
Conference
• Ageing Research &
Development – Keeping
Active for Better Ageing
www.publichealth.ie
IPH Work Programme
Health Information
Health Well
Established to Promote Cooperation
for Public Health
Why is cooperation necessary?
UK Faculty of Public Health
3 key domains of public health:
• Health improvement
• Improving health services
• Health protection
UK Faculty of Public Health
9 key areas for practice:
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Surveillance and assessment of the populations health and
well being
Assessing the evidence of effectiveness of health and
healthcare interventions, programmes and services
Policy and strategy development and implementation
Strategic leadership and collaborative working for health
Health improvement
Health protection
Health and social service quality
Public health intelligence
Academic public health
IPH
• A focus on health inequalities
• Fairness and justice
Life Expectancy of Men in Northern Ireland
Ranked by Deprivation (2009-11)
Source: Making Life Better
Life Expectancy of Women in Northern Ireland
Ranked by Deprivation (2009-11)
Source: Making Life Better
Life Expectancy and Disability-Free Expectancy (DFLE)
at birth, Persons by neighborhood income level,
England, 1999 - 2003
Inequality Gaps
Inequality gaps between deprived areas and NI
overall were in:
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Alcohol-related deaths – 121% higher
Drug-related deaths – 113% higher
Admissions for self-harm – 94% higher
Teenage births – 80% higher
Suicide – 73% higher
Respiratory death rates – 66% higher
Lung cancer incidence – 65% higher
NI Health & Social Care Inequalities Monitoring Systems 2009
Strategy – Making Life Better
The Gradient Approach
In order to achieve the aims of better health and
wellbeing for everyone and reduced inequalities in
health, the overriding approach must be to take
account of the need for greater intensity of action for
those with greater social, economic and health
disadvantage. This applies right across the social
gradient, as recognised by Marmot, and require action
to improve universal services as well as more targeted
services for those in greater need.
Making Life Better, DHSSPS 2014
Strategy – Healthy Ireland
Goal 2: Reduce Health Inequalities
Health and wellbeing are not evenly distributed across
Irish society. This goal requires not only interventions
to target particular health risks, but also a broad focus
on addressing the wider social determinants of health
– the circumstances in which people are born, grow,
live, work and age – to create economic, social,
cultural and physical environments that foster healthy
living.
Healthy Ireland, DoH 2013
WHO Health 2020
• “Reducing health inequalities and improving
governance for health and health equity”.
European Commission and Health Equity
• “Solidarity in health – reducing health
inequalities in the EU”.
Public Health Policies supporting MLB
& HI
On specific issues:
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Tobacco
Alcohol
Sexual health
Obesity
With references to health inequalities.
Other Countries
Spain
Moving forward equity: a proposal for policies and interventions
to reduce social inequalities in health in Spain 2011
Norway
Norwegian strategy to reduce social inequalities in health 2007
Slovenia
Health inequalities in Slovenia 2011
Finland
Health inequalities in Finland 2009
England
Public Health England – health inequalities division
Developing a Comprehensive Approach
and Action Plan
• Secure political commitment and cooperation
from many sectors
• Assess the extent of the problem, consider
points for intervention along with barriers to
action
• Put in place organisational arrangements and
financial requirements. Allocate responsibility
and resources
• Draw up action plans – what? who? how much?
outcome?
The Equity Action Spectrum: taking a comprehensive approach, WHO 2014
Progress
• Increasing references to health inequalities
• Marmot work leading to increased knowledge
• UK and Irelands collaboration on health
inequalities
• NI health and social care inequalities monitoring
system
• HSE health inequalities action plan
Work To Do
• Dedicated policy
• Accountability mechanisms
• Resources
‒ Personnel
‒ Finance
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Maintain an intersectoral health in all policies
approach
Closing the Gap
Lynch Pins
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Improve daily living conditions
Tackle the inequitable distribution of power, money
and resources
Measure and understand the problem and assess
the impact of action
Train the workforce in the social determinants of
health
Raise public awareness about the social
determinants of health
Closing the Gap in a Generation, WHO 2008