Agenda item

A summary version of the presentation circulated as part of the agenda pack (pages 25-59) was tabled at the meeting. Dr Jeanelle de Gruchy, Director of Public Health gave the first part of the presentation on the Annual Public Health report. Hard copies of the Annual Public Health report were distributed to the Board. The second part of the presentation was delivered by Marion Morris, Head of Health Improvement, and focused on the delivery of Priority 2 of the Health and Wellbeing Strategy – Increasing Healthy Life Expectancy.  Following the presentation the Board discussed its findings.

 

The Director of Public Health introduced: Joan Curtis, Secretary Haringey Friends of Parks Forum; Wendy Thorogood - Smarter Travel Officer; Andrea Keeble - Commissioning Manager for Sports and Physical Activity; Dr Katrin Edelman, Clinical Service Director, Barnet Enfield Haringey Mental Health Trust.

 

The 2015 Annual Public Health report focused on encouraging Haringey residents to live longer, healthier lives. The Board noted that in spite of an overall improvement in life expectancy over recent years, not all had benefitted, and inequalities in life expectancy remained. There was a 7 year gap in average life expectancy between the most affluent and most deprived areas of the borough, and women were expected to live 4 years longer than men.

 

The Board also noted that, in terms of healthy life expectancy for Haringey, women were on average living the last 25 years of their lives in poor health, and men the last 16 years of their lives in poor health. The main reason people were living in poor health was because they had one or more long term health conditions. Long term health conditions were usually preventable and were often caused by a small number of lifestyle factors. These factors included; an unhealthy diet, low levels of physical activity, smoking and excessive alcohol intake. These factors were also the most important risk factors for people dying early. The impact of these factors on the provision of health and social care was significant. 

 

In response to ensuring that residents lived long, healthy lives, the Board noted that the focus was on three key areas: Making it easier for people to make the healthy choice; working with communities and giving support to those who need it most.

 

The Director of Public Health drew the Board’s attention to the recommendations at the back page of the Annual Public Health Report. Some of the key recommendations were noted as:

• Build on and expand the ‘Health in all Policies’ approach.
• Ensure that plans for the regeneration of Tottenham address factors related to healthy life expectancy such as employment, poor quality housing and ease of walking of cycling.
• Taking a multi-agency approach to prevention including tighter tobacco control.
• Ensuring prevention was everyone’s business from primary care through to hospital care.

 

The Chair queried why West Green ward had significantly higher levels of life expectancy than some of its neighbouring wards in Tottenham. In response, officers advised that the numbers were estimates and that the numbers in individual wards could fluctuate, given the relatively small numbers of people dying in any particular ward. Officers advised that the most striking aspect of the graph contained in the Annual Public Health report was the clear disparity between east and west in terms of life expectancy.

 

Cathy Herman, Lay Member Haringey CCG, asked whether there was an inequality factor involved in women leading longer parts of their lives in poor health across different parts of the borough. Officers responded that whilst there was no ward level data available, the risk factors involved in contributing to healthy life expectancy would be more prevalent in certain areas or wards and therefore there would be an inequality in healthy life expectancy, for example, from the west to the east of the borough.

 

Ms. Grant asked to what extent these figures were broken down by say, ethnicity.  In response, the Director of Public Health commented that there was a lot more data available and a lot more analysis was undertaken on the Joint Strategic Needs Assessment.

 

The Board noted that there were three ambitions within the Health and Wellbeing Strategy that supported Priority 2.

 

• Ambition 4 - Every resident enjoys long lasting good health. The target for Ambition 4 was a 25% reduction in early deaths from stroke by 2016-2018 from 92 to 68 deaths.
• Ambition 3 – Haringey is a healthy place to live. The target for Ambition 3 was to increase the number of people who walk and cycle to the top quartile of London Authorities by 2018.
• Ambition 2 – More adults will be physically active. The target was a reduction in inactive adults to 25% by 2018.

 

The Head of Health Improvement clarified that being physically active amongst adults was measured by 30 minutes or more of physical activity a day and 60 minutes a day or more for children. The Head of Health Improvement also clarified that the data was self reported survey data. In response to a query around accounting for differing levels of activity amongst different age ranges of adults and how that was reflected in inactivity levels among adults, the Director of Public Health commented that the data was age standardised in terms of the sampling. The target given was an average figure for all adults; however the data was available broken down across age bands.

 

The Head of Health improvement identified that the second part of the presentation would focus on two of the risk factors for early death and unhealthy life expectancy; smoking and physical inactivity, in particular walking.

 

Some of the key points in regards to smoking raised in the presentation were:

 

• Smoking prevalence had declined in the general population. However, it was now more concentrated in poorer communities and those with mental health conditions. Smoking accounted for half of the difference in life expectancy between the richest and poorest.
• People were more likely to become an addicted smoker if they started to smoke as a child and it was also harder to quit.
• People with serious mental health problems died up to 17.5 years prematurely – mostly attributable to smoking

• On average, smokers needed care 9 years earlier than non smokers and were 2-4 times more likely to have a stroke
• Over 40% of UK tobacco is estimated to be consumed by people with mental health conditions
• Costs to NHS of treating smoking related diseases in people with mental health conditions estimated as £720m in 2013
• Unequal rates of smoking were a big driver of health inequalities.
• In terms of current action on tobacco, there were a number of population level interventions such as targeting underage sales and smoke free policies in the work place and in cars.
• There were also interventions through communities such as peer-to-peer support / health champions and targeting specific communities such as shisha use within the Turkish community.
• Intervention through services was also used, both on a targeted basis such as mental health or pregnant women, and from April 2016 support will be provided by an integrated wellness service linked to wider determinates of health such as debt management.

 

In terms of  what the Board could do to help deliver a reduction in smoking as part of Priority 2, the following outcomes were highlighted:

 

• Ensuring smoke free work places in hospitals and Mental Health Trusts and all work places.
• Supporting work with secondary care – Acute, Maternity and Mental Health sites to ensure NICE guidance on smoking was implemented
• Signing and support of the Declaration on Tobacco Control & NHS Statement of Support.
• Championing the Making Every Contact Count (training across frontline staff working in Haringey).

 

Sarah Price, Chief Officer – Haringey CCG, highlighted that the CCG had the ability to allocate an element of the contract value to incentivise quality improvement and that smoking was one of the issues that the CCG had incentivised NHS trusts to undertake. The Board noted that this was an opportunity to refine how those schemes were set up in the run up to the new financial year to ensure the best value from that investment.

 

Paul Leslie, Interim CEO – HAVCO, asked for the clarification on whether certain communities pushed back on schemes that were targeted to them and if so, how this was addressed. Officers responded that there was some push back, for instance a misconception that shisha was not tobacco and therefore was not as harmful, and that the solution was through education of the harm involved. The Head of Health Improvement commented that the Council had been effective around enforcement of shisha bars but a more joined-up approach across Council partners was required.

 

The Chair enquired about consideration of the inter-relationship between tobacco and cannabis and how much work had been done to understand the prevalence, particularly amongst young people, around cannabis use. Officers responded that there were a number of particular health concerns related to cannabis usage and that understanding the prevalence may require clearer questions around smoking tobacco as appose to cannabis. This would also likely impact the types of interventions required to tackle it.

 

Dr Edelman, advised the Board on the difficulty of bringing in smoke free policies and also how to work with particular groups so that they didn’t feel personally targeted.  The Board noted that the BEH Mental Health Trust attempted to go smoke free at the same time as acute hospitals, however significant difficulties were encountered, particularly with detained patients in wards wanting cigarette breaks and not wanting to use nicotine replacement products. Dr Edelman advised that it was felt that this contributed towards an increase in violent incidents as well as uncertainty as to whether this constituted a breach of their human rights. The ban lasted for a few months and the Board was advised that the inside of premises were now smoke free and that patient were permitted to smoke outside.

 

Dr Edelman commented that the numbers of BEH MET patients smoking was very high, as was evidence of poor physical health. Forensic services were due to go smoke free from 1^st January, which was an NHS England initiative. This provided an opportunity to monitor its implementation as something of a pilot for other services. Dr Edelman advised that they had recently been making use of the mobile stop smoking service and that this had some limited success in engaging patients on a one-to-one basis, as well as raising the profile of stopping smoking campaigns.

 

Sir Paul Ennals commented that, given the strong evidence around people who smoke at a young age smoke for longer and find it harder to quit, there were strong implications around even deferring the age at which people start smoking. Sir Paul also commented that there were some very good materials produced by different agencies around the different information approaches required to bring about behaviour change in children rather than adults. The Head of Health Improvement commented that a number of targeted engagement activities had taken place with young people around smoking such as development of the ‘Young and Healthy’ app. 

 

Some of the key points in regards to walking raised in the presentation were:

 

• Need to shift the common perception of exercise being about gyms.
• Walking decreases the risk of obesity by 4.8% for each additional KM walked per day and can be easily incorporated into everyday activities.
• GLA indicators of a healthy street have been developed which were helpful in assessing how walking friendly Haringey’s streets were.
• In Haringey, 26% of people in lower socio-economic groups are inactive compared to 21% of those in higher-socio-economic groups.
• In terms of current action on walking, there were a number of population level interventions such as outdoor green space, 20 MPH speed limits and the LIP targets for reduced car use.

• There were also interventions through communities such as Smarter Travel programmes and a Sports and a Physical Activity Framework.
• Intervention through services included targeted walk programmes such as Walk for Life.

 

Joan Curtis updated the Board on a programme of organised walks that was being developed by the Friends of the Parks organisation, in conjunction with the Parks Service and Public Health. Refurbishment work was undertaken in Lordship Rec including works to uncover the Moselle river, this became a catalyst to utilising Haringey’s extensive network of parks and historical locations to promote physical activity through organised walks. Ms. Curtis advised that a book, Walk in Haringey, was being produced which contained a number of different walks and this would be supplemented by asking each of the Friends groups to organise a walk in their local area for a Haringey Walk Weekend on 1 & 2 October 2016. The Haringey Walk Weekend would form part of a wider Year of Walking Campaign and would link to other projects such as walk to work week. The campaign would be accompanied by a communications campaign and a dedicated web page on the Council’s web site.

 

In terms of  what the Board could do to help deliver increased physical activity through walking as part of Priority 2, the following proposals were suggested:

 

• Support for the proposal for a Year of Walking Campaign and walk weekend in October 2016.
• Championing the GLA’s ‘Ten Indicators of a Health Street’ programme.
• Championing walk to work week and walking generally in the work place.

 

Mr Leslie commended the proposed Year of Walking campaign and walk to work weekend and requested elaboration of how the campaign would engage with residents in the east of the borough who may be less engaged generally, as well as communities who may not ordinarily engage in community based activities. Officers advised that one example was the Moselle river walk which connected the east and the west of the borough. Officers also advised the Friends Groups were made up of a variety of people from different backgrounds. Mr Leslie requested that HAVCO’s website be utilised to advertise the campaign. Ms. Curtis advised that an updated version of the Moselle walk was being reprinted to include Tottenham Marshes and that this would be available online in due course. Electronic versions of maps were also being developed.

 

Ms Grant also commended the proposed campaign and requested that consideration be given to expanding these proposals to include encouraging walking in areas of surrounding countryside, particularly for people who tended not to leave their particular area, and advocated the benefits that this would have in tackling some of the biggest health inequalities.

 

Cllr Morton, Cabinet Member for Health and Wellbeing paid tribute to the work that the Friends groups and others had done in the borough. Cllr Morton suggested that some of the new resources that Councillors had been given could be utilised to help scale up a walking programme. Cllr Morton reflected that the numbers involved around the gap in healthy life expectancy gap were a fairly longstanding concern and queried how much of the activities proposed here were new. The Director of Public Health responded that nationally the boundaries were constantly being pushed on smoking, such as the smoke free work place. The challenge locally was to ensure that these policies were enforced and to examine how best to enforce these policies. In terms of walking, policies on this scale were a new undertaking and the challenge for the Board was to bring together the existing pockets and to encourage a concerted effort and focus on the issue across partners.

 

The Deputy Chief Executive asked whether GP’s surgeries could do more to recommend people to local walking groups and also emphasised the number of walking resources that existed, such as TFL’s map that shows the distance between Tube stations. The Deputy Chief Executive questioned if there was an opportunity to collectively find a small amount of resource to bring all of those walking related elements together. The Board also noted that the Smarter Travel team produced a map that covered all of the walking routes in Haringey, copies of which were being reprinted.

 

Ms. Herman emphasised the need for community development and queried how the Board could encourage a culture which facilitated people to help each other. In this respect, the Board noted, GP’s probably had a significant role as they were in contact with quite isolated people.

 

Ms Grant advocated the use of social prescribing to connect General Practice with the rest of the community, to ensure that everyone who worked in General Practice was aware of what else was available in the community. Ms Grant suggested the Board should organise holding a symposium on social prescribing, determining what it would mean in the borough and how the different ambitions and outcomes would be advanced by adopting such a model.

 

The chair thanked those present for their contributions.

 

RESOLVED:

 

I). That the Local Government Declaration on Tobacco Control & the NHS Statement of Support for Tobacco Control, be endorsed.

 

II). That the roll out of Making Every Contract Count Training be encouraged.

 

 III). That support be given to the proposal for a dedicated & coordinated walking programme & walk weekend.

 

IV). That the Board champion the GLA’s ‘Ten Indicators of Healthy Street’ programme.

 

V). That the Board champion ‘walk to work week’ and walking generally in the workplace