Agenda item

The Select Committee will receive a presentation on this item from the Director of Public Health.

Dr Bruce Laurence addressed the Select Committee, a copy of the presentation can be found on their Minute Book and as an online appendix to these minutes, a summary is set out below.

Prevention is better than cure…but…

·  Humans are risk taking. If we didn’t we’d still be living in caves

·  Balance of risks and benefits. We love convenience.

·  All cultures have their mind expanding drugs… we can’t handle too much reality

·  We are all ostriches

·  We prefer to use technical fixes

·  We prefer to think that the NHS will bail us out

·  We didn’t evolve to sit on sofas but our brains have made it possible

Primary prevention = “prevention”

·  Don’t get it in the first place

·  Environmental, social, behavioural, medical, esp vaccination.

·  Councils > NHS… and everywhere else

Secondary prevention

·  Nip it in the bud

·  Early identification, screening, reduce established risks.

·  NHS  > Councils

Tertiary Prevention

·  Don’t let it get you down.

·  Having a condition isn’t the same as being ill!

·  Treatment, avoiding advanced disease and complications

·  NHS and social care

But what is “it”?

·  What is a disease? Where does it start?

o  Chains of causality and progression – eg. Diabetes (type2)

·  Deprivation, poverty, limited education and range of cultural, commercial, structural and environmental factors

·  Poor diet, lack of exercise

·  Overweight

·  Increasing blood sugar and insulin –  “Pre-diabetes”

·  Type 2 Diabetes and early symptoms

·  Poorly controlled diabetes and start of complications

·  Heart/kidney/foot/eye problems

·  Disability, blindness, death.

Working on the “wider determinants” or creating the conditions for health

·  Environment (air quality, climate change)

·  Work and conditions, benefits etc.

·  Build environment: transport, settlements, houses

·  Water and food supply

·  Social networks, social cohesion, avoidance of conflict,

·  Economy

Supporting people along the road to health

·  Targeted work at different levels

o  Screening and vaccination programmes

o  Early years support eg health visiting, children’s centres

o  Specifics eg smoking cessation, support to diet and exercise, sexual health, drug treatment and harm reduction… also built into NHS

o  Mental health promotion

o  Protection and safeguarding

We need both to create the conditions for good health and encourage and support people to play their part in achieving it. There are no magic bullets.

In practice: (It’s all in the Council’s strategy)

·  Work on the conditions: starts with understanding of health impact, and then maximise benefits and minimising risks

·  Maintain support to individuals according to need

·  Work in partnerships eg. the Active lifestyles group or the DAP

·  Use all opportunities: Preventive NHS, STP, WECA

B&NES has recently successfully bid for funding to begin work on a whole system approach to attempt to tackle obesity.

Councillor Tim Ball said that implementation of the Council’s strategy is key. Referring to the Bath Sports Centre he commented that the new system / design do not work for him.

Councillor Eleanor Jackson stated that she believed the real challenge is austerity. She added that cuts to the Parks Service were creating a lack of exercise space for members of the public to use. She also raised the matter of life expectancy for local males and that it could be ten years less for a man living in Twerton / Radstock against males in more affluent areas of the Council.

Dr Laurence replied that targeted services are available through both GPs and Community Services. He added that education was also a key factor and that he regrets the fact that the Council have a lessening role in that on a day to day basis.

Councillor Lin Patterson asked if provision of warm water swimming / exercise were available at any local facilities as GLL were not providing this service at Bath Sports Centre.

Dr Laurence replied that he remembered previous discussions on the matter and that the benefits of it are known. He said that he could not add anything specific at this time.

Councillor Vic Pritchard asked if any targets had been set in relation to the funding received in relation to work on obesity.

Dr Laurence replied that the people involved on the project from the Council and NHS were going to take a step right back and discuss what areas to focus upon to best use the resource.

The Chair thanked Dr Laurence for his presentation on behalf of the Select Committee.