Jude Williams

1
Forecasting the future health of the Nation.

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

Research Methods Festival
3rd July 2008
2
Overview

• Background to Healthcare Commission
• Obesity
• Alcohol abuse
• Pose some questions

3
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 gt 40 Kg/m2
Obese BMI gt 30 Kg/m2
Overweight BMI gt 25-29.9 Kg/m2
Normal BMI gt 18.5-24.9 Kg/m2
Underweight BMI lt 18.5 Kg/m2
Not perfect measure
11
Prevalence in England

• 1980 8 of women Obese
• 6 of men Obese

1998 21 of women Obese
17 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

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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 gt 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)
• gt 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
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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
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• 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
(No Transcript)