Setting the Scene: Policy Context

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Setting the Scene Policy Context

• Dr. Emer Shelley
• Population Health
• HSE East

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Policy Context

• A little more background demography
• Context for high risk strategies Trends in
  mortality and morbidity
• Context for population strategies trends in
  health behaviours and risk factors
• Policy formulation and structures for
  implementation

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Policy Context

• A little more background demography
• Context for high risk strategies Trends in
  mortality and morbidity
• Context for population strategies trends in
  health behaviours and risk factors
• Policy formulation and structures for
  implementation

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Ireland, projections, using assumption 1 re
migration and fertility (M1F1)
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Policy Context

• A little more background demography
• Context for high risk strategies Trends in
  mortality and morbidity
• Context for population strategies trends in
  health behaviours and risk factors
• Policy formulation and structures for
  implementation

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Falling CVD mortality, but

• What about trends in morbidity from chronic
  diseases in older age groups?

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Policy Context

• A little more background demography
• Context for high risk strategies Trends in
  mortality and morbidity
• Context for population strategies trends in
  health behaviours and risk factors
• Policy formulation and structures for
  implementation

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SLÁN-07 SURVEY

• Three components
• Interview
• 10, 000 individuals aged 18
• Anthropometric measurements
• 1,000 individuals aged 18-44
• Physical examination
• 1,500 individuals aged 45

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Ireland Take HeartAudit of implementation of
Building Healthier Hearts 1999-2005
Dr Siobhan Jennings Consultant in Public Health
Medicine Lead for Heart Health, HSE
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Health Promotion Key successes

• Public policy Smoking Ban and big increase in
  smoking cessation services, Quitline in place
• Settings based achievements (Schools
  curriculum, workplace, community development)
• Procurement Low salt bread procurement in HSE

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Health Promotion Key gaps

• Obesity emphasis
  especially childhood
• Settings based work Resource HP schools and HP
  hospital programmes
• Smoking Enhance smoking cessation
• Implement alcohol TF reports

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Prevalence ratios for hypertension (that is, a
doctor's diagnosis or three readings 140/90 mm
Hg) by sex, age, and BMI category. Data derived
from cross sectional data from the NHANES III
study (Must et al)
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Gradients have been identified within countries
and between countries

• "We have a new mantra, borrowed from Geoffrey
  Rose The causes of the causes," Marmot said.
  "It's not enough to think about the causes in the
  way that good public health professionals
  normally do."

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Health Behaviours and major
Risk Factors

• Await SLAN results
• Need research into
  population sub-groups and
  on impact of economic and cultural
  factors on health behaviour

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Policy Context

• A little more background demography
• Context for high risk strategies Trends in
  mortality and morbidity
• Context for population strategies trends in
  health behaviours and risk factors
• Policy formulation and structures for
  implementation

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European Guidelines on CVD PreventionFourth
Joint European Societies Task Force on
cardiovascular disease prevention in clinical
practice

• September 2007

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The Health Information
and Quality Authority .

• is responsible for driving quality and safety in
  Ireland's health and social care services through
• Setting Standards in Health and Social Services
• Monitoring Healthcare Quality
• Social Services Inspectorate
• Health Technology Assessment
• Health Information
• Our work spans the entire health and social
  services system, with the exception of Mental
  Health Services.

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Need structures and processes to support
integrated patient care, including secondary
prevention and rehabilitation
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Dáil picketed over Sligo services

• Hundreds of protesters picketed the Dáil today
  over plans to abolish vital cancer services in
  the north-west.
• Last Updated 21/11/2007  1600 Ireland.com

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Portlaoise Cancer Review (Nov 2007) likely to
increase focus on quality, including
implementation of guidelines
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GMS contract does not address risk assessment and
primary prevention
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First Edition August 2006

• Medical requirement for CA, developing role of
  HIQA, and expansion of information systems likely
  to enhance audit, including of prevention.

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Department of Health and Children
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And wed like healthy food from Agriculture and
Food, safe and accessible to all
Could environment provide clean air and water,
and footpaths and cycle paths, and . ?
And could Education and Sports provide more SPHE
and PE and healthy school meals?
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and could the entire Cabinet act to reduce
alcohol intake?
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Oh, and by the way, please may we have 15
billion next year?
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Interdepartmental and
Inter-sectoral Collaboration

• The Government has recently agreed to structures
  to address the wider determinants of health ....
  building on the work of the senior officials
  group on social inclusion

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Conclusions (1)

• Population projections indicate there will be
  large increases in older age groups
• Continuing high levels of morbidity, especially
  in older age groups

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Conclusions (2)

• Improvements in some health behaviours and health
  promotion services
• Await SLAN results
• Need research into
  population sub-groups and
  on impact of economic and cultural
  factors on health behaviour

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Conclusions (3)

• With new legislation, new health service
  structures and recent focus on audit and quality,
  it is likely that there will be increased
  attention to implementation of guidelines and
  protocols
• Ditto re audit and surveillance
• Advocacy needed to raise awareness re prevention
  and the importance of intersectoral action

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NEW EDITIONRose's Strategy of Preventive Medicine

• Geoffrey Rose updated by
• Kay-Tee Khaw and Michael Marmot
• Price 19.95 (paper)ISBN-13 978-0-19-263097-1E
  stimated publication date January 2008
• http//www.oup.com/uk/catalogue/?ci9780192630971
  authors