PHA - improving cardiovascular services

?The Public Health Agency has identified ways of delivering cardiovascular services that will help to tackle health inequalities. These are described in a new "health impact assessment" report, launched on 1 June at the Maureen Sheehan Centre, Belfast.The PHA, in partnership with a wide variety of community, voluntary and statutory bodies, leads the work to improve cardiovascular health and wellbeing, through better prevention and treatment services, delivered through a 'cardiovascular service framework'. The result of a wide consultation, this new report will help to improve the way those services are delivered by focusing on the needs of disadvantaged people.Explaining the importance of this work, Dr Adrian Mairs, Consultant in Public Health Medicine, PHA, said: "The Public Health Agency was set up to tackle health inequalities and promote better health and wellbeing across Northern Ireland. Despite many improvements in prevention and treatment, cardiovascular diseases remain the main cause of death in Northern Ireland. We know that these diseases, including heart disease, stroke, circulation problems, diabetes and renal disease have a greater and more severe impact on people living in poverty. "This work will help us to reduce the health inequalities that exist in our society by improving the way cardiovascular services are developed and delivered, eg ensuring stop smoking services meet local needs, identifying and treating high blood pressure, and helping people to take their medicines properly."The health impact assessment has been developed from other work, including a literature review, cardiovascular health and wellbeing profile, and full technical report. All of these resources are available on the PHA website, under 'Directorates', 'Service Development and Screening'. The work will also be used to help the development of service frameworks covering other disease areas. Putting a health inequalities focus on Northern Ireland cardiovascular service framework - Summary report: www.publichealth.hscni.net/publications/putting-health-inequalities-focu... health and wellbeing profile for Northern Ireland: www.publichealth.hscni.net/publications/cardiovascular-health-and-wellbe... health and wellbeing in Northern Ireland - Literature review: www.publichealth.hscni.net/publications/cardiovascular-health-and-wellbe... focus (newsletter): www.publichealth.hscni.net/publications/hia-focus

Neurological conditions: involvement to improve service delivery

A major, ongoing Public Health Agency led consultation exercise has identified 12 recommendations to improve the lives of the 48,000 people, and their carers, who experience neurological conditions across Northern Ireland. These recommendations will form the basis of an action plan to improve service delivery and support for those experiencing a range of conditions, such as epilepsy, Huntington's Disease, Parkinson's Disease, progressive supranuclear palsy (PSP) and multiple sclerosis (MS).The recommendations cover four areas:accurate information and diagnosis;control and choice, particularly self-management and person-centred services;day-to-day living and independence, including finance, employment, social life and ability to get out and about;emotional and psychological impact on individuals and families, eg the support available to deal with stress, fear, frustration, isolation, loss and vulnerability associated with living with a neurological condition.The report was launched at a regional workshop, held in Cookstown (today) and co-ordinated through the Neurological Conditions Network, which was established to develop this work.Speaking before the workshop, Health Minister Edwin Poots said: "Neurological conditions give rise to complex needs, which require support from a wide range of professionals. They also change lives, both for those directly affected and for their families and carers, and it is so important not to lose sight of this if we are to successfully address the challenges in tackling neurological conditions."Last week, I visited the home of Beth McCune, who suffers from motor neurone disease. I was invited to see for myself the daily challenges faced by Beth and her husband and carer, Arthur, and to hear of their experiences. While I was struck by their courage and patience, this visit underlined again for me the severe life-changing impact of the disease."At present, there are some 48,000 people in Northern Ireland living with neurological conditions. It was in recognition of the needs of men and women like Beth that my department requested the establishment of the Neurological Conditions Network and provided the necessary funding to support it."Michelle Tennyson, PHA Assistant Director and Chair of the Neurological Conditions Network, said: "This detailed engagement exercise was undertaken to get the views and quality of life experiences of those affected by these conditions. We tried to ensure everyone who wanted to contribute could, by providing support through helplines, the internet and face-to-face events. I am honoured that so many people have trusted us with their experiences to help us make a difference and was privileged to be invited into the home of Beth and Arthur McCune for the same reason."The recommendations cover a range of conditions and their implementation will need cooperation and action from professionals, service users, voluntary organizations and others, across many sectors and agencies. The network is looking forward to delivering on these challenging new ways of working to improve the lives of all those affected by neurological conditions."The workshop attracted service users and carers along with delegates from across Northern Ireland's community, voluntary and statutory sectors.If you have a neurological condition, or care for someone who does, and want to share your experiences, please go to: www.publichealth.hscni.net/ncnsurveyYou can also contact Julie Mawhinney, Tel: 028 9032 1313.

The PHA message is clear for World COPD Day - smoking is bad for your lungs

In 2011, 31,574 people were registered as having Chronic Obstructive Pulmonary Disease (COPD) in Northern Ireland. The most common cause of COPD is smoking and to mark this year's World COPD day, which takes place on Wednesday 16 November, the Public Health Agency is encouraging all smokers to make a decision to stop smoking today and reduce their risk of developing the disease.COPD refers to a group of diseases which includes emphysema, chronic bronchitis, and in some cases asthma. With COPD, the airways in the lungs become damaged, causing them to become narrower, therefore restricting airflow and thus making it harder to breathe. The most common symptoms of COPD are breathlessness, wheezing, abnormal sputum (a mix of saliva and mucus in the airway), and a chronic cough often mistaken for a 'smokers' cough'. Symptoms can range from mild to severe, depending upon how advanced the disease is. In advanced cases, daily activities, such as walking up a short flight of stairs, can become very difficult.There is no cure for COPD. Stopping smoking is the single most effective wayto reduce your risk of developing COPD and avoid any further damage to the lungs. Gerry Bleakney, Head of Health and Social Wellbeing Improvement, PHA, said: "Smoking causes the lining of the airways to become inflamed and damaged and is the biggest cause of COPD. The risk of developing COPD increases the more an individual smokes and the longer they smoke. "The good news is that making changes to your lifestyle can reduce your risk of developing COPD. Stopping smoking reduces the risk of developing COPD and also slows down its progression. There is support available to help you quit and I would encourage everyone thinking about stopping smoking to log on to our Want 2 Stop website www.want2stop.info and order a 'Quit Kit' free of charge. Alternatively contact the Smokers' Helpline on 0808 812 8008 for help on planning to stop smoking or to find out where your nearest Stop Smoking Service is. "The Health Minister Edwin Poots said: "The impact of living with COPD can place a considerable strain on the lives of those suffering from the condition and their families. I understand that most smokers want to quit but it is not always easy to succeed and that several attempts are frequently necessary. I would therefore urge all smokers on world COPD day, to make that commitment to stop smoking. Professional help and support are readily available. There are almost 650 smoking cessation services provided all over Northern Ireland, mostly in community pharmacies, but also in GP surgeries, hospitals, community halls and schools."

Obesity - an acknowledged public health challenge

As we face a difficult economic climate, in which inequalities may worsen, the PHA faces many challenges in its efforts to improve the health of the population. One such challenge is the issue of obesity. Recently, in the Draft Programme for Government and, again today, in anticipation of the publication of the Consultation on the Review of Health and Social Care Services in Northern Ireland, the specific issue of obesity has been highlighted in the media.The PHA is committed to playing a lead role in tackling this major health issue and has been systematically examining the evidence of best practice and effectiveness to ensure that investment and working in partnership will bring clear benefits. A welcome consequence of any success would be a reduction in the impact of the physical, and emotional costs of obesity related ill-health to individuals - and the financial costs to an overstretched healthcare system.A multi-facetted approach to tackling obesity is required for Northern Ireland. This will mean working across government departments, looking at relevant legislation, taxation, food standards and labelling, as well as supporting a raft of programmes within education, workplace, and at the local community level."The prevalence of overweight and obesity has risen dramatically in recent years in Northern Ireland and is now the norm to be overweight, rather than the exception. The Northern Ireland Health and Social Wellbeing Survey (2010-11) indicated that 36% of adults are overweight and a further 23% are obese; this means that approximately 3 in 5 adults in Northern Ireland carry excess weight. A similar proportion of males and females were obese (23%) however males were more likely to be overweight (44%) than females (30%).Data from the Northern Ireland Health and Wellbeing Survey (2010-11) reported that 27% of children aged 2-15 years are obese or overweight. The findings presented here are based on the guidelines put forward by the International Obesity Task Force. Using this approach, 8% of children were assessed as obese, with similar results for boys (8%) and girls (9%). Obesity has serious implications for health and wellbeing and is associated with an increased risk of heart disease and stroke, type 2 diabetes, some cancers, respiratory problems and joint pain.Evidence indicates that being obese can reduce life expectancy by up to 9 years; and it can impact on emotional and psychological well-being and self-esteem, especially among young people.Obesity also impacts on wider society through economic costs, loss of productivity and increased demands on our health and social care system. It is estimated that obesity in Northern Ireland is resulting in 260,000 working days lost each year with a cost to the local economy of £500 million.The good news is that the intentional loss of significant weight (approx 10kg) in overweight and obese adults has been shown to confer significant health benefits, decreased morbidity and may also reduce obesity-related mortality.Key programmes and interventions are undertaken by the PHA in order to prevent and reduce overweight and obesity. The programmes/interventions are supported by significant ongoing work at local level. Examples include:the promotion of breastfeeding; local programmes to increase awareness of good nutrition and develop cooking skills, for example 'Cook It!'; promotion of more active lifestyles, for example, Walking for Health' and 'Teenage Kicks'; development of community allotment schemes; programmes for primary school children, for example Skip2bfit and Eat, Taste and Grow; and sports and other recreation, for example 'Active Belfast'. The PHA's multi media campaign 'It all adds up!' to encourage children to become more active and understand the importance of keeping fit, in a fun and exciting way, ran until October 2011. It encouraged parents and carers to go to the website www.getalifegetactive.com and download the PHA logbook It all adds up! to plan activities as a family. The logbook helped children and parents plan and keep track of their participation in physical activity at school, home and in the community. PHA is currently developing a public information campaign and other supportive work to increase public awareness of obesity as well as to provide advice and support for those who want to make real changes. The campaign development is well underway and is anticipated for launch in late Spring 2012. Like many common health problems, people living in disadvantaged circumstances suffer most and the PHA is committed to tackling this aspect of health inequality. The good news is that even a modest weight loss, of 1-1 Â_ stones, can help to reduce the risk of many of the health problems resulting from being overweight or obese. Information on losing weight through healthier eating and being more active can be found on the PHA websites - www.enjoyhealthyeating.info and www.getalifegetactive.com . These websites provide help and advice for anyone who wants to improve their eating habits and fitness levels, by making small, sustainable, healthy changes to their lifestyle. The PHA leaflet, Small changes, big benefits is also available to download from the PHA website, 'Publications' section.

Traveller Focus Week - improving health and wellbeing

Members of the Traveller community and their support organisations joined the Public Health Agency and the Health and Social Care Board at an event in Dungannon to mark Traveller Focus Week (5 - 11 December) by sharing the progress made, and celebrating good practice in meeting the health and wellbeing needs of Travellers.These needs were identified in the 'All Ireland Traveller Health Study' by University College Dublin in June 2010. It estimated that there are 3,905 Travellers living in 1,562 families in Northern Ireland, and the stark findings include that when compared with the life expectancy of the general population, male Travellers lose 15 years of life and females lose 11 years.The report made a number of recommendations, including:prioritising mother and children's health; enhanced preventative work for respiratory and cardiovascular disease, as well as better risk detection and management of the disease; development of primary care interventions which involve Travellers engaging with other Travellers in health improvement;engagement of men and young men in improving health and wellbeing and access to healthcare.Speaking at the event, Mary Black, Assistant Director of Public Health (Health and Social Wellbeing Improvement) PHA, said: "The Public Health Agency works in partnership to promote health and wellbeing and reduce health inequalities."This event with the Travellers Health and Wellbeing Forum was an important opportunity to look at progress against agreed priorities and share good practice across Northen Ireland and the successful work of the Forum. One such example is the recruitment of Travellers into employment as health workers developed by the Belfast Health and Social Care Trust and part-funded by the PHA. Other areas are also considering work placements and all of this developing practice will help inform future partnerships with employers and help break down the real prejudice that can be experienced by Travellers."We also heard about the progress Travellers have made in their own right, and their views about how the Travelling community is fully engaged and participates in the future development of the Forum and programmes that aim to improve health and wellbeing and contribute to a more equal society."Mark Donahue, Equality Officer, An Munia Tober (a Traveller support organisation), added "The event was a great success in terms of highlighting the main health issues for Travellers, which came out of the All Ireland Traveller Health Study. I was heartened to see a great turn out by the Traveller community from all over Northern Ireland and also by the interest and commitment of so many public agencies and other organisations to work together to improve Traveller health."The event, at 'Breakthru' in Dungannon, also brought together representatives from the five health and social care trusts, Cooperation and Working Together (CAWT), Housing and key voluntary sector organisations, all involved in delivering the recommendations from the 'All Ireland Traveller Health Study'.

Cook it! Fun, fast food for less: community nutrition education programme

This training manual was produced to support the Cook it! programme, which was specially developed for use in Northern Ireland. The Cook it! programme is delivered in the community by trained facilitators and can be used with a wide range of groups, including young/single parents, young people leaving residential care, offenders during rehabilitation programmes, older people in sheltered accomodation etc.The manual contains all the information needed to deliver Cook it! programmes in the community, including background information on healthy eating, information about dealing with special dietary requirements, sessions outlines, photocopiable resources and 75 recipes for snacks and meals.This updated version replaces the March 2007 edition.For information on training as a Cook it! facilitator, contact the health promotion service in your local Health and Social Care Trust.

Standard of Healthy Living on the Island of Ireland

Pre-requisites for health are equity, minimum income, nutrition, peace, water, sanitation, housing, education, work, political will and public support (WHO, 1986). It has long been known that social disadvantage harms health (Black, 1980, Ettner, 1996). Many researchers have documented that those in lower socio-economic groups are more at risk of developing major chronic diseases such as cardiovascular diseases (Beaglehole and Yach, 2003, WHO, 2003a), diabetes (Wilder et al., 2005), and some cancers (Brunner et al., 1993, Strong et al., 2005), and are at a higher risk of having multiple risk factors associated with these diseases (Lynch et al., 1997). The living standards that many people enjoy and the behavioural choices they make are heavily determined by their access to resources such as income, wealth, goods and services (O’Flynn and Murphy, 2001). The most prominent explanation between disadvantage and health is that lack of resources restricts access to the fundamental conditions of health such as adequate housing (Macintyre et al., 2003, Macintyre et al., 2005), good nutrition (Nelson et al., 2002) and opportunities to participate in society (McDonough et al., 2005). Each of these issues are very much influenced by material and structural factors inherent to and determined by fiscal, social and health policy (Graham and Kelly, 2004, Milio, 1986).

A good practice guide for community food initiatives

Food and nutrition are key determinants of health. What people eat, and how much they eat, influences how healthy they are, and even how long they live. Food poverty arises when people lack the money or other resources needed to eat a healthy diet. The overarching objective of Healthy Food for All is to end food poverty on the island of Ireland.

REACH - Rethinking Eating and Activity for Children's Health

The aims of the REACH programme were to: - Provide a quality whole-family healthy lifestyle programme that is accessible and equitable to support children aged 4-7 and 8-11years who are above the healthy weight range in maintaining or achieving a healthy weight; - Target areas of poor health and high prevalence of childhood obesity; Contribute towards the prevention and reduction of obesity prevalence in South Gloucestershire; - Be a resource for other health professionals and services in South Gloucestershire. As this was a pilot of a child weight management programme being developed from scratch the objectives of REACH were to: Provide a high quality service which meets the needs of the local health community; - Improve childrens diet and nutritional intake and promote a healthy weight; Encourage exercise and physical activity participation; - Develop a range of skills with participants in order to increase their confidence and self esteem; - Be participant centred but also use a whole family approach to deliver healthy lifestyle messages; - Develop appropriate referral protocols, resources and course plans; - Advertise and promote the programme locally liaising with communications and the Public Health Team in NHS South Gloucestershire, GPs and staff working in the community such as School Health Nurses (SHNs); - Successfully recruit families on to the programme; Enable eligible new participants referred to the service to take part; - Encourage participants to complete the programme; - Deliver a service that helps to address health inequalities; - Monitor participants weight and lifestyle changes as part of a follow up programme; - Provide continuous professional development of service staff; - Ensure individuals and families are signposted and supported to access other services such as after school clubs, local sports clubs and leisure centres; - Provide equitable access to the service and ensure equitable outcomes are achieved by the service; Ensure continuous quality improvement;

Y W8?

The aims of this intervention are to: Coach parents in the skills to change their childrens unhealthy behavioural patterns to healthy ones that promote weight maintenance or modest weight loss Increase parents and childrens knowledge of nutrition and a healthy balanced diet Help parents modify the family environment to develop healthy lifestyle patterns through practical advice and support Give children the opportunity to exercise and increase their confidence to take part in physical activity

Weigh2go: A Peripatetic Level 1 Weight Management Service

The aim of this intervention is to increase the accessibility of appropriate evidence based support to people who are clinically obese to enable them to make lifestyle changes that will lead to weight loss. Objectives1. Identify patients whose lifestyle put them at risk of obesity and poor health outcomes and provide them with advice and support along with signposting to specific services and activities. 2. Identify patients who are overweight or obese and offer them a structured multi-component programme of support for them to loose weight. 3. Through the use of software collect data to monitor outcomes at individual and practice levels.

Health Inequalities and the Living Wage

Evidence Review 6 - Health inequalities and the living wage Briefing 6 - Health inequalities and the living wage This pair of documents, commissioned by Public Health England, and written by the UCL Institute of Health Equity, address the role of a minimum income in improving health. These papers provide a summary of evidence on the health impacts of living on a low income. They assess the evidence around how the living wage addresses low incomes, health and health inequalities. The living wage is an hourly minimum wage, optional for employers, calculated according to the basic cost of living. Local authorities and other organisations that have implemented the living wage for their staff are presented as case study interventions to show how it is possible, the challenges faced and how they were overcome and any reported income, health and business benefits. The full evidence review and a shorter summary briefing are available to download above. This document is part of a series. An overview document which provides an introduction to this and other documents in the series, and links to the other topic areas, is available on the ‘Local Action on health inequalities’ project page. A video of Michael Marmot introducing the work is also available on our videos page.

Craigavon & Banbridge Community HSS Trust - Primary Care Mental Health Services Triage Pilot Scheme (PDF 266 KB)

Craigavon & Banbridge Community HSS Trust's final report on Primary Care Mental Health Services Triage Pilot Scheme. Part of the Department's redesign of community nursing project.

A Process Analysis of Males and Females who Attended a Community Based Addiction Treatment Service: Towards an Expanded Paradigm

A process analysis was conducted in a community - based treatment programme for alcohol abuse. The aims of the study were: to evaluate assessment instruments and measures; to measure change following treatment; to monitor gender differences; to assess the importance of early and current relationships; and to evaluate the effects of therapists. Subjects (n=145, males 83/females 62) completed a semi-structured interview schedule, Severity of Alcohol Dependency Questionnaire (SADQ), Short Alcohol Dependence Data Questionnaire (SADD); General Health Questionnaire (GHQ 12), and Alcohol Problems Questionnaire (APQ). A further three non-standardised self-rated measures were devised by the author. Included was the opportunity to obtain qualitative data. Follow up data was collected at 3, 9 and 15 months following first assessment. The SADD, APQ and consumption measures using detailed drink diaries proved the most relevant assessment measures. Following treatment, there was significant reduction in clients' dependency levels at 3 months, maintained through 9 and 15 months. Key client-rated changes were progress in reducing consumption and alcohol problems leading to a better quality of life and health. Qualitative data augmented these quantitative results. Psychological and acquired cognitive behavioural skills emerged as the main reasons for positive change and the treatment programme was found to have played a significant role in their acquisition. It appears that addressing marital problems can lead to a reduction in alcohol dependency levels. Gender analysis showed that males and females were similar in demographic characteristics, alcohol history details and dependence levels. It was concluded that the differences found did not necessitate different treatment programmes for women. Early family relationships were more problematic for females. Therapist performance varied and that variance was reflected in their clients' outcomes.This resource was contributed by The National Documentation Centre on Drug Use.

A Study of the Epidemiology of AIDS in Ireland and an Evaluation of an AIDS Education Programme in Second-level Schools

Second-level school students have been identified by the Minister for health as a priority group for education on AIDS. An education programme was accordingly initiated in 1988 in Community Care Area 1 in South county Dublin. This report evaluates this education intervention by means of pre- and post- intervention questionnaires. The questionnaire examined knowledge and attitudes of students relevant to AIDS. The results showed that the level of knowledge of students living in this area was high prior to intervention. The education programme succeeded in improving some aspects of knowledge and also influenced some attitudes of the students. A study of the epidemiology of Aids in Ireland reveals that the epidemic is at a relatively early stage with a consequent rapid doubling time of 9-10 months. In comparison with most developed countries Ireland has a high proportion of AIDS cases occurring among intravenous drug abusers and directly related to this a high number of HIV infected children. Examination of the literature reveals that behaviour change has occurred most noticeably among the homosexual/bisexual risk group. There is some evidence that the comprehensive programmes can achieve change in the behaviour of intravenous drug abusers. There are very few reports linking behaviour change among adolescents and young adults to education programmes. Much of the available literature relates to changes in knowledge and attitudes. International recommendations on the nature of the ideal health education intervention on AIDS are reviewed. The importance of a comprehensive health education programme which incorporates AIDS education and which commences early in youth is noted. The role of the community physician in relation to education programmes and other aspects of monitoring and management of the AIDS epidemic is discussed.This resource was contributed by The National Documentation Centre on Drug Use.