Improving Public Health OutcomesKings Fund Conference, March 2013

Gabriella Lake Walker, April 2013

Introduction: Kings Fund report Exploring and understanding multiple

behaviours in young people: DECIPHer and Mentor

Fair Society: Healthy Lives (The Marmot Review)

Session two: Understanding clustering of behaviours

Session three: Putting research into practice Summary and Conclusion

Kings Fund study August 2012 Looked at health Survey for England data Examined how smoking, excessive alcohol

use, poor diet and low physical activity levels co-occur in the population and how this distribution has changed between 2003-2008

2003: 33% of the population had 3 or 4 behaviours

2008: 25% of population

However improvement has been seen mainly amongst higher socioeconomic groups

2003: People with no qualifications were 3x more likely to engage in all four behaviours

2008: People with no qualifications were 5x more likely to engage in all four behaviours

Overall health of population therefore is improving but health inequalities are widening

Silo approach in policy has led to lack of joined up and holistic working, not recognising that most people do not have single risk factors

Almost 70% of population engage in two or more risky behaviours: multiple not single risk factors

People have very different combinations of risk

Who the people are differs systematically

Avon Longitudinal Study of Parents and Children (ALSPAC, also known as Children of the 90s)

Long-term health research project. Biological, behavioural and family data from before

birth through to late adolescence The largest such birth cohort in the world: More

than 14,000 mothers enrolled during pregnancy in 1991 and 1992, and the health and development of their children has been followed ever since

http://www.bristol.ac.uk/alspac/external/interactive/risky.htm

Multiple behaviours particularly common with drug users

Particular behaviours are not necessarily confined to specific socioeconomic groups but numbers/clusters of health harming behaviours are greater as you go down the socioeconomic scale

Inactivity and not wearing a cycle helmet were the two health-harming behaviours most likely to be displayed as a single behaviour (10%)

40% of 15-16 year olds had 3, 4 or 5 health-harming behaviours

Mentor: Charity working to protect young people from alcohol and drugs

Presentation by Clare James: How risky behaviours in young people overlap

Taken from Mentor’s Thinking Prevention series of public health briefing papers.

Jessica Allen www.instituteofhealthequity.org Overview of Marmot Review: Fair Society

Healthy Lives Closing the inequality gap

Health Inequalities result from social inequality

Solely focusing on disadvantaged won’t work - proportionate universalism is a better approach:◦ Asset-based ◦ social factors◦ multiple risk

Whole life course and holistic approach to prevention

Impact of economic downturn and current policy?

A. Give every child the best start in life B. Enable all children, young people and adults

to maximise their capabilities and have control over their lives.

C. Create fair employment and good work for all D. Ensure a healthy standard of living for all E. Create and develop healthy and sustainable

places and communities F. Strengthen the role and impact of ill-health

prevention

www.phr.nihr.ac.uk Research Programme to fund non-NHS

interventions intended to improve behaviour Commissioned and Specified research

Programmes Researcher-led funding Open at different times, last one open all year Visit website for details Something for this group? Unique parterships

are developing

Review of research programmes into multiple behaviours

University of East London: Well London, professor Adrian RentonStudied reaching people with multiple lifestyle risks in different ways – working with different communities to understand health-harming behaviours and why/how they occurWorking on inner-city estates with high deprivationMore people had multiple behaviours than single behavioursNot defined by gender or socioeconomic groupEthnicity/cultural impact? Deprived white community more likely to have multiple behaviours than deprived BME communities

• Experian• Healthy Foundations

• CACI ‘Wellbeing Acorn’

Programmes to target people based on ‘who’ they are rather than behaviours

Focus on local assets: individual and community

Not expensive marketing programmes but for insight

Bolton Hospitals: Making Every Contact CountTrain hospital staff in lifestyle and brief interventionsSpread holistic risk assessment throughout TrustInitial findings:Holistic approach makes people less defensiveStaff changing behaviours following trainingPatients prefer holistic support to targeted services

Leeds Metropolitan University: All Together Better, Jane SouthPeer support community health champion programme:Community volunteers who, with training and support, bring their ability to relate to people and their own life experience to transform health and well-being in their communitiesLarge evidence base of successhttp://www.altogetherbetter.org.uk/home.aspx

Well at the Free: Royal Free Hospital Trust, Lucy Gate and Dr Jason StrelitzFunded by Friends of the Royal Free: initiative to improve health and wellbeing of all acute patientsDedicated clinic with holistic assessments and lifestyle supportIncludes onward referral and intervention in the community (using existing assets)Spread techniques through hospital clinical teamsInclude specific ‘clinics within clinics’, build lifestyle assessment into clinical appointments

Knowsley Public HealthIn-house provider transferring to local authorityDesigned new ‘Public Health System’ with clear and defined pathwaysBreak down silo workingIncludes single point of contact and holistic assessment with onward specialist referral where requiredPartnership working to include wider determinants

Policy needs to focus on addressing multiple risky behaviours, particularly in lower socioeconomic groups, using a holistic approach

Need integrated wellbeing services that include debt/housing/employment/training support

Include Community and peer support Focus and build on assets within

communities

http://www.kingsfund.org.uk/events/improving-public-health-outcomes (presentations tab for full presentations from the day; posters tab to view the posters with full information)

Full report that inspired the conference: http://www.kingsfund.org.uk/publications/clustering-unhealthy-behaviours-over-time