The health inequalities challenge for Wales www cymru

The health inequalities challenge for Wales www. cymru. gov. uk Dr Tony Jewell Chief Medical Officer for Wales Public Health Conference 1 Stadium Swalec 21 st September 2011

Tobacco kills I will cover. . . Mortality from lung cancer, 1991 - 2008 Source: World Health Organization • • Chief Medical Officer for Wales www. cymru. gov. uk Annual Report 2010 Challenges Inequalities Fairer Health Outcomes for All

Chief Medical Officer’s Tobacco kills. Officer Chief Medical for Mortality from lung cancer, 1991 - 2008 Annual Report Source: World Health Organization Wales Annual Report 2010 www. cymru. gov. uk

Chief Medical Tobacco kills Officer’s Life expectancy at birth Mortality from lungatcancer, 1991 - -2008 Male life expectancy birth, 1992 Annual Report Source: World Health Organization Source: WHO, Statistical Directorate, Welsh Government www. cymru. gov. uk

Chief Medical Officer’s Tobacco Infant and kills neonatal mortality Mortality from lung cancer, 1991 - 2008 1949 -2009 Annual Report Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Chief Medical Officer’s Tobacco Deaths by kills gender Mortality from lung cancer, 1991 - 2008 Deaths by gender, 1971 -2009 Annual Report Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Health in Wales Leading causes of death in Wales, 1971 -2009 Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Deaths from liver disease and Chief Medical Officer’s Tobacco kills Mortality from lung cancer, 1991 - 2008 cirrhosis Annual Report Source: World Health Organization Source: e. Healthshow, NWIS www. cymru. gov. uk

Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www. cymru. gov. uk Challenges

Tobacco kills Getting healthier. . . but? Mortality from lung cancer, - 2008 Female life expectancy at birth 1991 by deprivation quintile Source: World Health Organization Source: Statistical Directorate. Welsh Government www. cymru. gov. uk

Teenage conceptions Teenage Conceptions 15 -17 years, 2007 -2009 Source: Office for National Statistics www. cymru. gov. uk

Chief Medical Tobacco kills Officer’s Teenage conceptions Mortality from lung trends cancer, 1991 - 2008 Teenage conceptions Annual Report Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Tobacco kills Non evidence-based Mortality from lung cancer, 1991 - 2008 Source: World Health Organization behaviours www. cymru. gov. uk ©Maciej Dakowicz

The rise of chronic Tobacco kills conditions Prevalence of non-communicable diseases (2009 -2010) Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Source: NHS Wales Quality Outcome Framework www. cymru. gov. uk

kills ATobacco healthy retirement? from lung cancer, 1991 - 2008 (1999 -2003) Life. Mortality expectancy and income deprivation Source: World Organization Source: Office for. Health National Statistics www. cymru. gov. uk

Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www. cymru. gov. uk Inequalities

Spatial inequalities Tobacco kills Growing gaps Proportion adult obese by BMI, 2009 -2010 Mortality of from lungpopulation cancer, 1991 - 2008 Source: Public Health Wales Observatory Source: Welsh Health Source: World Health. Survey Organization www. cymru. gov. uk

Growing gaps Tobacco kills Growing gaps Comparison of life expectancy, healthy life expectancy and Mortality from cancer, 1991 - 20082001 -2005 and 2005 -2009 disability-free lifelung expectancy in Observatory Wales Source: Public Health Wales Source: World. Health. Wales Organization Source: Public Observatory Males www. cymru. gov. uk SII = Slope Index of Inequality, a measure reflecting socioeconomic dimension to inequalities in health. , For more information see A Leyland (2007) Measuring socio-economic inequalities in health, Scotpho (Glasgow)

Male life expectancy Tobacco kills Male life expectancy at birth 1991 by deprivation quintile, 2007 -9 Mortality from lung cancer, - 2008 Source: Statistical Directorate, Welsh Government Source: World Health Organization www. cymru. gov. uk

Tobacco kills Female life expectancy Mortality from lung cancer, 1991 2008 Female life expectancy at birth by-deprivation quintile, 2007 -9 Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Tobacco killsrate Infant mortality Mortality from lung cancer, Deaths within the first years 1991 of life- 2008 Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Tobacco Male deathskills from heart disease Mortality(under from lung cancer, 1991 from - 2008 Premature 65) male deaths circulatory disease, 2009 Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Tobacco Reversal in kills pattern Mortality from lungabove cancer, 1991 - 2008 Adults daily drinking guidelines Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Tobacco kills Smoking Mortality from lung cancer, 1991 - 2008 Adults who are smokers Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Tobacco killsdie from smoking Twice as many Mortality from lung cancer, 1991 - 2008 across gradient Source: World Health Organization as many die from ng across gradient www. cymru. gov. uk

Tobacco kills More than description Mortality from lung cancer, 1991 - 2008 Source: World Health Organization Epidemiologists are good at describing these gradients, and governments are good at ‘being www. cymru. gov. uk concerned’ about them, because of their consequences for public health. However, each of the inequalities tends to be treated piecemeal, as if they were unrelated to all of the others, and they are generally conceptualised as the consequence of ignorance or error. Nettle, D. (2009). Social class through the evolutionary lens. The Psychologist 22: 934 -7

Tobacco kills Heard itlungbefore? Mortality from cancer, 1991 - 2008 Source: World Health Organization www. cymru. gov. uk

Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www. cymru. gov. uk Fairer Health Outcomes for All

Tobacco kills Our Healthy Future Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www. cymru. gov. uk

Tobacco kills 10 Mortality Priorities from lung cancer, 1991 - 2008 Source: World Health Organization 1. Reducing inequities in health 2. Improving people’s mental well-being 3. Improving health in the workplace 4. Reducing the level of smoking 5. Increasing physical activity 6. Reducing unhealthy eating 7. Stopping the growing harm from www. cymru. gov. uk alcohol and drugs 8. Reducing the number of teenage pregnancies 9. Reducing the number of accidents and injuries 10. Increasing immunisation rates

Tobacco kills Fairer Health for All Mortality from lung cancer, Outcomes 1991 - 2008 Source: World Health Organization • • Building health into all policies and all policies into www. cymru. gov. uk health Giving every child a healthy start Developing health assets in communities Improving health literacy Making health and social services more equitable Improving health at work Strengthening the evidence base.

Tobacco kills Whole oflunggovernment approach Mortality from cancer, 1991 - 2008 Source: World Health Organization www. cymru. gov. uk

Tobacco kills 10 Mortality Priorities from lung cancer, 1991 - 2008 Source: World Health Organization www. cymru. gov. uk

Tobacco kills The 4 from E’s Mortality lung cancer, 1991 - 2008 Source: World Health Organization

Tobacco kills to action: Turning evidence Mortality from lung cancer, 1991 - 2008 Hypertension interventions Source: World Health Organization www. cymru. gov. uk

Tobacco kills to action: Road Turning evidence Mortality from lung cancer, 1991 - 2008 safety interventions Source: World Health Organization www. cymru. gov. uk

Improving and reducing inequities Tobacco kills Child pedestrian injuries from motor vehicle Mortality lung cancer, 1991 - 2008 accidents byfrom deprivation quintile Source: World Health Organization Source: Statistical Directorate, Welsh Government www. cymru. gov. uk

Variation in primary care Chief Tobacco kills Percentage of. Medical patients with Chronic. Officer’s Obstructive Pulmonary Disease with. Mortality a recordfrom of a lung breath test (Fe. V 1) in the previous 15 cancer, 1991 -recorded 2008 months Annual Report Source: World Health Organization Source: Primary Care Information Set 2010 www. cymru. gov. uk

Tobacco kills Data oratory Mortalityand from lung cancer, 1991 - 2008 Source: World Health Organization Using his forceful oratory skills and sound data, and recognizing the need to deal with the social and political dimensions of. . . [health]. www. cymru. gov. uk Obituary of Jonathan Mann – International expert in AIDS research and management Peter Piot & Daniel Tarantola, Bulletin of the World Health Organization, 1998, 76 (5): iii-v

Tobacco kills Developing health assets in Mortality from lung cancer, 1991 - 2008 communities Source: World Health Organization www. cymru. gov. uk Nye J, Kamarck EC (2002). Governance. com: democracy in the information age. Brookings Institute Press. (Washington)

Tobacco kills Communities First and Flying Mortality from lung cancer, 1991 - 2008 Start Source: World Health Organization www. cymru. gov. uk

Tobacco kills Innovation: Learning Mortality from lung cancer, 1991 - 2008 from others Source: World Health Organization www. cymru. gov. uk

Tobacco kills International approaches to Mortality from lung cancer, 1991 - 2008 reducing inequality Source: World Health Organization for infant mortality 1. Gemany – Law 20 on 8. Veneto (Italy) – High Council prevention www. cymru. gov. uk for immigration 2. Ireland – Building healthy 9. Tuscany (Italy) – Community communities programme Healthy Partnerships 3. Netherlands - a health for all 10. Scotland – Whole system approach to public health 4. Norway – national strategy to approach to health reduce social inequalities in inequalities health 11. Pomurje (Slovenia) – 5. Poland – improving equity of Programme MURA, access to healthcare Investment in health 6. Sweden – public health policy 7. England – inequalities target S Simpson et al (2010) Putting our own house in order: examples of health system action on socially determined health inequalities. WHO (Venice)

Chief Medical Tobacco kills Officer’s Reducing smoking Mortality fromsmoking lung cancer, 1991 - 2008 15/16 year olds weekly Annual Report Source: World Health Organization Source: Health behaviour in school-aged children, 2011 www. cymru. gov. uk

Tobacco killslong term Short, mid and Phased results Mortality from lung cancer, 1991 - 2008 programmes and outcomes Source: World Health Organization Immunisation Contraception A www. cymru. gov. uk Alcohol programmes Cardiovascular B C Education Health at work 2011 2016 2021 2026

Tobacco kills Getting A 1991 to- 2008 B Mortality from lung cancer, Source: World Health Organization www. cymru. gov. uk

Chief Medical Tobacco kills Officer’s Global inequality Mortalitylife from lung cancer, 19912009 - 2008 Estimated expectancy at birth, Annual Report Source: World Health Organization Source: Global Health Observatory, WHO www. cymru. gov. uk

Tobacco kills Mortality from lung cancer, 1991 - 2008 Source: World Health Organization www. cymru. gov. uk Vision without action achieves nothing. Action without vision just passes time. Vision with action can change the world Nelson Mandela

Diolch yn fawr Thank you very much Tony. jewell@wales. gsi. gov. uk http: //wales. gov. uk/topics/health/ocmo/? lang=en http: //wales. gov. uk/topics/health/ocmo/? lang=cy