The consultant in public health presented the public health plan for 2017 – 2020, which identified key priorities and future intentions. The presentations today focused on two key areas, problematic alcohol use in the county, and an integrated programme for children and young people focusing on child dental health and obesity. 

Problematic alcohol use

The presentation highlighted that:

·         around 30-40,000 people were thought to be consuming alcohol at harmful levels in the county with the trend being towards drinking at home rather than at licenced venues

·         it was considered that alcohol was a greater public health risk than smoking, possibly attributed to differing perceptions of risk by consumers

·      it was notable that mortality rates were lower despite higher levels of drinking and it was not clear how demographics explained this in comparison with other areas

·      alcohol related hospital admissions were reducing, including those connected with road traffic incidents, despite the nature of roads in the county. This perhaps reflected the trend towards drinking at home rather than drink-driving, and it was though that this was attributed to successful campaigns over the past 20 years, although there was still more to do

·      outcomes from addressing alcohol consumption were currently below the national averages

A number of actions had been identified to address these issues which included reviewing service delivery and performance of the contract with the current provider (Addaction), working with primary care to extend GP brief intervention work and use of a national toolkit.  It was agreed that a briefing note would be provided to board members to show how these action points were making a positive impact.

Over the rainbow - integrated programme for health and wellbeing for children and young people

The health improvement practitioner presented information on this programme, focusing on dental health and obesity in children and young people.

She drew attention to emerging data which suggested that almost 30% of reception age children were obese and that oral health was a serious concern.

The level of dental extractions was noted as a serious concern by board members and discussion took place regarding water fluoridation and potential barriers to introducing this in the county. There were possible alternatives such as fluoride supplements and fluoride varnish treatments which could be explored via national commissioning. It was noted that oral health had been picked up as a safeguarding issue as children were losing significant numbers of teeth, including some 10% under anaesthetic each year.  It was noted that levels of dental decay were worsening in the county, with 41% of 5 year olds with dental decay issues.

In terms of obesity in children and young people, there apeared to have been a dramatic rise in obesity of 50% in the last 2 years and there was a danger that this could become normalised amongst the population, and this needed early intervention before children started school. There was a range of programmes and work to address this including looking at food provided in school and nursery settings and at home, and identifying the barriers to healthy eating.  The data in terms of obesity and also dental health was going to be checked further by public health officers.

The chairman noted the range of good work set out to tackle serious issues but observed that there needed to be more passion, and asked if there was more merit in focusing on fewer remedies but doing these well.

Board members added that campaigns needed to be more assertive to bring about changes in behaviour and encourage people to talk about the issues in order to address them and to encourage self-care as the norm. There was evidence of good practice within schools to encourage active lives, although there were challenges around parents’ perceptions of their children’s weight, and establishing the evidence base for GPs to recommend action. 

A board member commented in conclusion that these issues were a worry, and were highlighted by the joint strategic needs assessment (JSNA) and prioritised by the health and wellbeing board. He added, however, that interventions needed to identify what difference they would make.

RESOLVED

That:

a)    the following recommendations be considered to improve achievement of outcomes or alignment with the health and wellbeing strategy, with particular focus on alcohol related harm and dental health in young people:

·         explore what interventions would be feasible to achieve fluoridation

·         to identify, from the available range, they key initiatives and interventions to focus work to deliver better outcomes

·         to develop an assertive approach to bringing about changes in behaviour to pursue healthier lifestyles; and

b)    that a briefing note be provided to the board showing actions and timeframes for improvements in service delivery by Addaction, with information to show improved performance.