Facing up to the Welsh public health challenge

Despite being a nation of only three million people, Wales faces a significant public health challenge.

Levels of unhealthy behaviours here are worse than other UK countries, with around one in five smoking, four in ten drinking above the guidelines and nearly six in ten being classified as overweight or obese.

We have made some strides in improving the health and wellbeing of the Welsh population. We are living longer and survival rates for cancer and stroke are on the rise.  But we also have serious health inequalities with the average life expectancy of a male living in the least deprived area being nine years longer than that of a male living in the most deprived. The figures are similar for females.

Unhealthy lifestyles have a massive impact on the NHS in Wales – smoking costs £386 million every year, physical inactivity costs £51 million and the social and economic cost of alcohol and substance misuse is estimated to be around £2 billion each year.

We are taking public health seriously.  Leading the way in public health legislation, Wales was the first country in the UK to ban smoking in public places and the Well-being of Future Generations (Wales) Act 2015 is the first legislation in the world to place duties on public bodies to deliver the United Nations’ Sustainable Development Goals. The National Assembly for Wales is currently scrutinising the Public Health (Wales) Bill which includes a duty on public bodies to assess how their decisions will affect people’s physical and mental health and banning smoking in schools, hospitals and public playgrounds.

While it is clear that more needs to be done, it’s extremely difficult to shift resources from treatment to prevention services when the NHS in Wales, like rest of the UK, is struggling to meet demand that already exists.

But also, the health and wellbeing of the population is not just an NHS issue.  It depends on access to good quality housing, social care, education, employment and community services.

Therefore all public bodies need an increased focus on crucial preventative policies, such as improving access to early intervention mental health services and greater promotion of healthy eating and physical activity in schools and workplaces.

So what needs to happen?

Public services in Wales need to be remodelled to focus on preventing ill health and promoting well-being. The small size of Wales creates an opportunity for public sector leaders to agree what needs to be done and to deliver the change required.

We need to see more services such as the supported Housing and Intensive Rehabilitation and Integration Service in Cardiff and Vale University Health Board which consists of shared houses which provide on-going support to people with enduring mental health needs in partnership with local housing associations. The NHS will continue to work with colleagues in local government, the voluntary sector and housing to focus on preventative measures such as this.

We must engage the public in the public health challenge – people must supported to understand the benefits of self-care and to be able to feel like they can and want to take responsibility for their own health and well-being.  Using motivational behaviour approaches we need to encourage the Welsh population to make healthier life choices.  

Cultural change within organisations is also required which is why the Welsh NHS Confederation supports the introduction of Health Impact Assessment contained in the Public Health (Wales) Bill.

These cultural shifts are critical to our chances of success.  Without them, even with all collective will in the world, we will be restricted in our achievements.

On a practical level the NHS is committed to the preventative agenda and to working with partners to deliver it, but immediate cost and demand pressures are stopping them from investing more. Sharing with Government the financial and performance risks of moving to a preventative system would help to overcome barriers so that more could be achieved.

We believe that all public services should be supported to invest in preventative measures which are proven to save money in the long-term. For example, Public Health Wales’ recent ‘Making a Difference’ report found anti-bullying interventions in schools can return £15 for every £1 spent.

Transition funding is also crucial as it will help to meet the double running costs associated with moving from one way of working to another. 

Finally, the public, NHS staff, partners and politicians must also be prepared to support different ways of delivering services, while taking more responsibility for how they use them.

We know that during a period of austerity, these actions aren’t easy but we ignore them at our peril.