15.09.15
Study shows people are living longer, but with more public health issues – PHE
The combination of unhealthy diets, physical inactivity and high BMI is the biggest overall contributor to the total number of years lived with ill-health, new research shows.
A new study published by the Lancet, funded by the Department of Health and led by Public Health England (PHE), found that potentially preventable risk factors explain 40% of ill-health in England.
The researchers looked at data from 1990-2013 on mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs).
The two biggest risks within this calculation are unhealthy diets and tobacco, accounting for 10.8% and 10.7% respectively of overall disease burden. For women, tobacco is now the number one risk factor, overtaking diet and high blood pressure.
Furthermore, improvements in life expectancy – which rose by 5.4% between 1990 and 2013 – have not been matched by improvements in levels of ill-health. This means that the English population is living longer but spending more years with poor health, often as a result of comorbidity.
With diabetes, for example, the years of life lost to the disease dropped by 56%, but years living with it increased by over 75%.
Professor Kevin Fenton, director of health & wellbeing at PHE, noted that an “important implication” for health services is that up to 40% of its workload is due to potentially preventable risk factors.
He added: “This reaffirms the importance of people taking positive steps today, like eating well and stopping smoking, to improve their health in the long term.”
The report calls for “systemic action locally and nationally” to reduce risk exposure, enhance prevention, support healthy behaviours and alleviate the effects of socioeconomic deprivation.
It said: “Quantification of the continuing burden of preventable ill health in England more than justifies recent calls for a ‘radical upgrade in prevention and public health’. A huge opportunity exists for preventive public health: if levels of health in the worst performing regions in England matched the best performing ones, England would have one of the lowest burdens of disease of any advance industrialised country.
“The scale of the increasing level of disability suggests the need for new, more integrated models of care spanning health and social services that respond to the specific needs and circumstances of individual patients.”
It added that inequalities in health are greater within regions that between them, therefore largely explained by deprivation rather than geography. This outlook calls for the causes of public health inequalities to be addressed and necessitates “robust, standardised comparative assessments of the cost-effectiveness of different public health policies to aid decision making, akin to those used in England for health technologies”.
For local authorities, who now lead local public health in their regions, the “striking” findings related to inequalities should stress how tackling the effects of deprivation on health should become a priority – both due to the size and nature of its effects, but also as a result of the gap between the most and least deprived areas within a region.
In addition to public health factors leading risks in deprived areas, smoking was also found to be “socially stratified”, with its damage ranking above high BMI in the most deprived regions while the opposite is observed in less deprived locations.
Dr Adam Briggs, co-author and Wellcome Trust research training fellow at the University of Oxford, said how “large inequalities” proved that deprivation is a “key driver” of differences rather than where one lives – concluding that deprivation and its causes needs to be tackled wherever they occur.
Chief knowledge officer at PHE, Professor John Newton, said that the findings showed the “huge opportunity” for preventative public health.
“If levels of health in the worst performing regions in England matched the best performing ones, England would have one of the lowest burdens of disease of any developed country,” he added.
Public health cuts
The government recently ran a consultation on public health budgets and how they should be assigned to each local authority.
As a response to the consultation, which ended on 28 August, several public health professionals spoke out against planned £200m cuts to public health services, with the Association of Director of Public Health (ADPH) expressing “deep concern and disappointment”.
It had previously sent letters to chancellor George Osborne and prime minister David Cameron highlighting the “serious impact” cuts would have on health and social care, “both now and in the future”.
In its official response to the consultation, it said that, despite being aware of financial pressures nationally and locally, pressures on health and social care systems only proved the “imperative” need to invest in public health and prevention at all levels.
In August, NHE also revealed that in-year cuts to public health budgets would mean some contract with the NHS could have to be re-examined. Cuts would force several councils to save on money already allocated to long-term contractual health work in the NHS, many of which require six-month notice of changes.
Many of the services threatened by the cuts are also required by law, including tackling alcohol and drug misuse, smoking and obesity, as well as generally promoting a healthier lifestyle.
More recently, a report by the King's Fund said that the upcoming Spending Review, set for 25 November, will be a "litmus test" of whether the government is committed to investing in public health and prevention.