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Jude Williams Head of Public Health Dr. Dan Murphy Head of Research and Evaluation

Jude Williams Head of Public Health Dr. Dan Murphy Head of Research and Evaluation. Forecasting the future health of the Nation. Research Methods Festival. 3 rd July 2008. Overview. Background to Healthcare Commission Obesity Alcohol abuse Pose some questions.

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Jude Williams Head of Public Health Dr. Dan Murphy Head of Research and Evaluation

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  1. Jude Williams Head of Public Health Dr. Dan Murphy Head of Research and Evaluation Forecasting the future health of the Nation. Research Methods Festival 3rd July 2008

  2. Overview • Background to Healthcare Commission • Obesity • Alcohol abuse • Pose some questions

  3. NHS organisations that commission services inc 152 PCTs 170 hospital trusts including 70 foundation trusts Other NHS trusts including 12 ambulance, 59 mental health andcommunity We regulate 2000+ private sector organisations including hospitals and clinics

  4. Our role re public health • In the Act that set up the Healthcare Commission • PH part of healthcare • Standards for Better Health and Targets • External Drivers • Wanless – a health service we can afford • Public health challenges such as obesity • Health inequalities • But generally longevity and health improving

  5. Public health targets • Mental health • GP Body Mass Index (BMI) recording • Suicide prevention • Smoking • Older people • Health inequalities • Sexual health • Long-term conditions

  6. Public health - what we have done Annual health check • Standards • Targets In-depth reviews • Tobacco Control • Obesity (with NAO and Audit Commission) • Unintentional Injury in Children (with the Audit Commission) • Sexual Health • Are we choosing Health ? • Positive feedback

  7. OBESITY

  8. Tackling child obesity – First stepsFebruary 2006

  9. Indicators for PCTs: 2006/7: • GP recording of body mass index (BMI) status 2007/8: • GP BMI recording 16 plus • Childhood obesity data quality (National Childhood Measurement Plan) and data completeness • Compliance with NICE Guidance 43 (PCTs and provider trusts) 2008/09: • Childhood obesity data quality and rate (NCMP) - Data completeness and prevalence measure

  10. Definition Obesity may be defined as “an excess of body fat frequently resulting in a significant impairment of health and longevity” (H.C.) or Body mass index – Weight in kilos divided by height in metres squared Morbidly obese = BMI > 40 Kg/m2 Obese = BMI > 30 Kg/m2 Overweight = BMI > 25-29.9 Kg/m2 Normal = BMI > 18.5-24.9 Kg/m2 Underweight = BMI < 18.5 Kg/m2 Not perfect measure

  11. Prevalencein England 1998 21% of women Obese 17% of men Obese 1980 8% of women Obese 6% of men Obese 1998 32% of women Overweight 46% of men Overweight 1998 58% of adults Overweight / obese 2003 23% of UK adult Obese population • Three fold increase in obesity since 1980

  12. Prevalence Age Overweight + Obesity increase with age Location 18% of men in London were obese 25% of men in Yorkshire and Humber - About 28% of men 16-24 are overweight / obese • About 27% of women 16-24 are overweight / obese • But 76% of men aged 55-64 are overweight / obese • But 68% of women aged 55-64 are overweight / obese

  13. Prevalence(2) Where both parents overweight/obese, their children are six times more likely to be overweight/obese compared with children living with parents of healthy weight. Socio-economic differences • More common for women in manual occupations. Less prevalent for men in lower supervisory and routine occupations. • Quarter of women in unskilled manual occupations have BMI > 30Kg/m2 compared with one in seven in ‘professional’ work. • Both men and women working in unskilled manual occupations are four times more likely to be morbidly obese.

  14. Risks • Diabetes • Hypertension • Cardiovascular diseases • Respiratory problems (asthma) • Muscoskeletal diseases (arthritis) • CHD causes 270,000 heart attacks each year in UK of which 28,000 heart attacks a year are attributable to obesity (BHF) • 6% of all deaths attributable to obesity • Over BMI 25, 10% increase in weight corresponds to approx 30% increase in incidence of heart disease (Framingham heart study) • Obesity causes a 40 year old man or woman to lose 6-8 years of life. • Risk factors greater than smoking or excessive drinking • Severely obese individuals are likely to die on average 11 years earlier than those with a healthy weight

  15. Risks (2) • 10% of all cancer deaths among non smokers are related to obesity • Risk of coronary artery disease is increased 3.6 times for each unit BMI (eg from BMI 26 to BMI 27) • 85% of hypertension is associated with a BMI greater than 25 • Risk of developing type 2 diabetes is about 20 times greater for people who are very obese (BMI 35+) compared to individuals with BMI between 18 and 25 • Time lag between onset of obesity and related disorders suggests risk in UK is only just being realised and being stored for the future

  16. Causes • Many and vary by country • Deterioration in eating patterns • Larger portions • Fast / take away food with high fat and salt content • Fewer meals prepared at home • Too little fruit and vegetable • Favourite vegetable named by UK adolescent : CHIPS • As a country we were healthier during WW2 with rationing • Less and less physical activity – 2/3rds world children not active enough • Watching TV and computer games • More cars – less walking “we live in an environment that has been dubbed ‘obesogenic’, full of stimuli that encourage us to eat, to take less exercise, and to, above all consume”

  17. Costs • Direct and indirect costs (loss of earning due to sickness and premature mortality) estimate at: £3.3 to 3.7 Billion (Hoc Health Committee 2004) • Direct cost to NHS is at least £ 0.9 billion PA • 80% of this from CHD, hypertension + type 2 diabetes • 18,000 sick days a year lost due to obesity (NAO) • Normal Lamb, MP, surveyed Trusts about specialist equipment eg. Bigger beds, reinforced ambulances, extra-strong hoists, reinforced stretchers costing around £ 10 million PA

  18. International comparisons • 3% of population of Korea and Japan obese (2001) • Around 10% of Denmark, Sweden, Norway, France, Italy, Netherlands and Switzerland obese (but rising) • > 20% of Australian adults obese (1999) • 23% of UK adults obese (2003) same as USA 10 years ago • 24% of adult Mexicans are obese • USA 30% + of adults are obese – highest in OECD (2003) * USA, UK, Australia based on actual measures, rest self-report

  19. Trends • Obesity in children in England has ‘doubled’ in a decade • From 1995 to 2004, obesity among boys aged 11-15 rose from 14% to 24% and girls from 15% to 26%. • About a third of children aged 2 to15 were estimated to be overweight or obese in 2006. • Individuals get heavier as they age, as UK population gets older, and survives longer, there will be an underlying trend toward more overweight • If prevalence continues to rise at the current rate, more than one in four adults will be obese by 2010 • By 2050, levels of obesity will rise to: • 60% in men • 50% in women • 25% in children, with a further • 35% adults, and nearly • 40% of children overweight. (Healthy weight, healthy lives)

  20. ALCOHOL ABUSE

  21. Alcohol • In 2007, alcohol misuse and related harm estimated to have cost English economy £ 1.4 - £ 1.7 Billions pa. • Between 15,000 and 22,000 alcohol related deaths every year in England. Deaths associated with alcohol consumption have risen 1991 - 9.1 deaths per thousands men - 5.0 deaths per thousands women 2006 -18.3 deaths per thousands men (double) - 8.8 deaths per thousands women (80% increase) Deaths associated with alcohol consumption

  22. Each man dying in this group loses 20 years of life compared • with the average • Each woman dying loses 15 years • Total contribution that alcohol makes is to reduced life • expectancy on average : • 9.9 months for men • 4.4 months for women

  23. Estimated 6.3 million people in England in 2005 drinking at hazardous levels (between 20-50 units per week for men, and 15-35 units for women) • Estimated 1.55 million people in England in 2005 drinking at harmful levels (over 50 units for men per week, 35 for women)

  24. Alcohol-related hospital admissions have more than doubled in the last 10 years • 1995/1996 – 93,459 adults over 16 admitted with primary or secondary diagnosis related to alcohol • By 2006/2007 – 207,788 admitted • Increase true for all regions but greater in more deprived areas. • Between 2001 and 2007, alcohol-related deaths increased by 19%. • Rate of admission to hospital in North West for alcohol-specific conditions was over twice as high as East of England.

  25. And in Scotland • The alcohol-related death rates for males and females were around double the rate for the UK as a whole (2002-2004)

  26. Two questions: • What will be the other public health challenges over the next twenty years ? • What would you do about the growing problems of obesity and alcohol abuse ?

  27. Aim Better health and better healthcare for everyone

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