www.hertsdirect.org

Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FCIEH, FRSPH

Director of Public Health, Hertfordshire County Council

31st August, Hertfordshire Cycling Forum

Public Health and the Year of Cycling in Hertfordshire

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Overview• We have an opportunity in cycling no other

county has• Lots of clubs, lots of participation• Amazing cycle infrastructure• A need to revise policy on cycling events –

Chief Constable has now agreed this! • Working together• Cycling expertise, public health investment

brings a year of cycling

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Events in 2014

• Womens tour• Mens tour• We intend to look at a full leg in 2016 being held

in Hertfordshire • Cycling events all over the County this year• Nomination for national transport award for

promoting cycling to children and cycle training

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Our ambitions

• More people cycling more often• Cycling as sustainable transport• Cycling as pleasure and keeping healthy• Cycling on referral from health professionals• Cycle safety and learning for kids and adults• Mental health and physical health benefits• A new way of doing the Cycling Forum

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We are facing an epidemiological crisis

• Avoidable early deaths • Chronic disease – poor self management, poor

management of sub-clinical risk, must do better on prevention and early intervention

• Some sections of our population at very high risk of avoidable misery and death

• Mental health – intervening too late• Resilience and Happiness – likewise

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Strategies

• Priority on maintaining a healthy weight

• Priority on Physical activity

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Phased Approach to public health transformation

• Phase 1 – to Sept 2012. Focus on transactional issues, accommodation, co-location, scoping further work

• Phase 2a – to March 2013 – moving into transformational. Wide engagement of team and staff etc

• Phase 2b – to March 2013 – Transformational – the vision and strategy of what Public Health is offering Hertfordshire

• Phase 3 – march 2013 to March 2014 – Embedding the transformation and new way of working

• Phase 4 – 2014 onwards – the hard long term work of making Hertfordshire a public health county.

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Healthier Herts: A Public Health Strategy for Hertfordshire

OUR PURPOSEto work together to improve the health and wellbeing of the people of

Hertfordshire, based on best practice and best evidence

OUR VISION:A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well

against Hertfordshire

Priority 5: We understand what’s needed and we do what works

Priority 6: We make public health everybody’s business and work together

HOW WE WILL WORK TOGETHER(our strategic priorities: how we do it for

our County)

ThePublicHealthOutcomesFramework(the nationalPHOF willHelp us measureOur success)

WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUR RESIDENTS

(our strategic priorities: what we achieve for our County)

Priority 1: Our Population lives Longer, Healthier Lives

Priority 2: Our Population Starts Life Healthy and Stays Healthy

Priority 3: We narrow the gap in life expectancy and health between most and least healthy

Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental)

BuildingBlocks For the Public Health Family

Strong Leadership

Capable, Skilled People

Co-production with citizens

Effective Partnerships

Evidence and Knowledge Driven

Plan and Deliver for Localism

Whole System Approaches

Making better use of behavioural sciences at individual, interpersonal, community and service levels

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Some key challenges

• Inactivity• Disease of Lifestyle• Culture• Cost• Sustainability• Air Quality

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The Opportunity for Herts

• The conditions for everyone to be healthy• The conditions for the poorest and worst off to

be healthier• Public services which put this at the core of their

business• People thriving and prosperous• Healthy workforce, prosperous County

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Cycling as part of a County of Opportunity

• Physical activity becomes second nature• Health benefits from self propelled transport

(walking, cycling)• Sustainability benefits from self propelled

transport• Cycling on referral

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Year of Cycling

• We will put cycling on the map in Hertfordshire as a leisure, health and transport activity

• Complete revision of some work we’ve been doing including website and apps

• Start of a 3 year plus cultural push on physical activity

• County Council, Cycle Clubs, Districts, NHS, Police, working together

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Year of Cycling

• 1 year plus legacy period• Year of walking follows• Then year of swimming• Culture change• Already having an impact• £2m investment in District

Councils by Public Health

Chief constable and county council agreeto new policy on cycling events/races

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The Policy Context (England) does give us scope to address this

• Local Authorities – duty to promote and protect health of population

• NHS CCGs – duty to reduce inequalities in health

• Behaviour change is a tool but we need to use it properly and use the right methods

• A balanced strategy using a range of tools and strategies

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Contributors to overall health outcomes and why elected councillors are important leaders

Smoking 10%

Diet/Exercise 10%

Alcohol use 5%Poor sexual health

5%

Health Behaviours 30%

Education 10%

Employment 10%

Income 10%

Family/Social Support 5%Community Safety 5%

Socioeconomic Factors 40%

Access to care 10%

Quality of care 10%

Clinical Care 20%

Environmental Quality 5%

Built Environment 5%

Built Environment 10%

Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status

While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.

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Investing in the Right Things Our Burden of Disease is not the right way round

PrimaryPrevention

SecondaryPrevention

TertiaryPrevention

in andOut of hospital

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Phasing and Layering across Lifecourse

• Layering levels of action

• Population – smoking ban• Sub-Population – NHS health checks• Individual – motivational interviewing, asserting

clinical management of risk factors, pathways

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Phasing and Layering

• Phasing across the lifecourse and timeWorking age

AccumulationOf risk inLate workingage

Good early Years outcomesFor lifetimeMental health

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Just some actions being taken so far (more will be done)1. New weight management service already

commissioned and reached 1st 1,000 referrals in three months, more will be commissioned

2. Obesity pathway in place for tiers 1 -3 obesity care. Revision late 2014

3. New lifestyle partnership launched with lifestyle offer for Herts residents to be ready by Easter for phased roll out

4. New online lifestyle service launched in February

5. Workplace physical activity challenge funded and running (Herts Sports Partnership)

6. Workplace Health improvement programme running (Business in the Community)

7. 93% of GPs in Herts now doing NHS HealthChecks

1. Obesity Plan approval by Cabinet due March 2014

2. New child weight management service to be commissioned in 2014

3. Broxbourne whole area obesity pilot underway with Borough and County Council, schools and NHS

4. Fast food takeaway restrictions

5. Countryside walks scheme

6. Year of Cycling launching May 2014

7. Funding for District Councils to work on health improvement agreed and each District working out its plans

8. Continue child weight measurement programme

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Thank you!

Jim.mcmanus@hertfordshire.gov.uk

Other free slideshows www.slideshare.net/jamesgmcmanus

Public Health page

http://www.hertsdirect.org/your-council/hcc/publichealth/

Free learning resources for public health

www.hertsdirect.org.uk/phelearn