Public Health England held their annual conference over two days (16-17th September) and Fiona Reynolds attended. You may have followed some of her (@Fibigibi13) and our (@Peoplesuni) tweets over the course of the event. We're still adding Fiona's notes to the Blog. Tonight's focuses on "Determinants of Inequalities", featuring the need to improve the way we gather evidence and a presentation on "Due North" the PHE report examining the North/South divide in England.While this session was focused on the UK perspective, there are some common themes important wherever Public Health teams are working. Links to the presentations and to the reports mentioned are at the bottom of this page.Dr Ruth Hussey (Chief Medical Officer, Medical Director NHS Wales) was the first to speak.Dr Hussey has worked as Regional Director of Public Health and Senior Medical Director at NHS North West (England). She led the Department of Health in the North West region. The CMO:
  • leads public health policy and programmes, working across all Welsh Government policy departments and with a wide range of external partners, with the aim of improving health and reducing health inequalities,
  • leads the clinical contribution in Wales to improving the quality of healthcare and patient outcomes,
  • leads the medical profession in Wales, having key roles in medical regulation, education and training, standards and performance,
  • maintains appropriate UK and international links, working with other UK Chief Medical Officers, government departments and organisations.
She focused on the need to "use all of the tool in the toolbox". Her opening lines highlighted that while health inequalities appear to be deep-rooted and entrenched, we must continue to take action. She also reminded us that huge progress has been made - a key aspect being the recognition of the link between poverty and health.Various approaches are taken to address these: disease prevention, lifestyle changes, equitable access, socio-economic, community cohesion, assets and coproduction. Each approach has its weaknesses - we can focus on a disease and then find another one emerges - which I took to mean that we must not be downhearted if we resolve one issue, only for another to take it's place. This is the nature of life and public health action!Our tools include legislation, policy, funding, workforce, advocacy, information and evidence and of course, services. Dr Hussey reminded us: "The NHS needs to focus on the social context of health and it has a tremendous role in employment. It contributes to local economy."She concluded on coproduction: we need info we can all use. "We've all got knowledge, it's just different knowledge". It's about using all the tools in the toolkitProfessor Sir Michael Marmot was the next to speak.Professor Sir Michael Marmot is currently Director of the Institute of Health Equity and MRC Research Professor in Epidemiology at University College London (UCL).He has led a research group on health inequalities for the past 30 years. He has been invited by the Regional Director of WHO Euro to conduct a European review of health inequalities. At the request of the British Government, he previously conducted a review of health inequalities, which published its report 'Fair Society, Healthy Lives' in February 2010. He was Chair of the Commission on Social Determinants of Health set up by the World Health Organization in 2005.His speech focused on local action on health inequalities. What would success look like? If countries took up the recommendations of his team's work, and if these countries implemented it.He highlighted that in the UK in 2013 - 52% of children reached a good standard of development, meaning 48% had not. By the age of 3, children living in poverty were 8 month behind peers in language.Action on social determinants creates other benefits. Action to increase young people's access to education, employment and training reduces youth offending and crime.Marmot also discussed the need to widen our definition of evidence. Our current research tools can show an association but not always a definite cause. Case studies tend not be reported or published but it's not always possible or ethical to carry out a Randomised Control Trial.The next speaker was Professor Margaret Whitehead. She holds the W.H. Duncan Chair of Public Health at Liverpool University, and is also the Head of the World Health Organisation (WHO) Collaborating Centre for Policy Research on the Social Determinants of Health. Margaret has worked extensively on social inequalities in health and in health care, in particular the question of what can be done to reduce them.She described the work that Public Health England commissioned her team to undertake - examining the differences between in health between the North and South of England. The report "Due North" is examining what must be done to improve health in the North - and the lessons of this can be applied to the whole country. The report is examining the link between economic growth, public service reform and health.There has been a North-South health divide in England for a long time now, with the gap continuing to widen over the past four decades. The causes of health inequality are broadly similar across the country and on average, poor health increases with increasing socio-economic disadvantage. But the severity of these causes is greater in the North. There are concerns that austerity measures are making the situation even worse, impacting more heavily on the North and disadvantaged areas. It is against this background that the independent Inquiry on Health Equity for the North was set up.The report, Due North, details evidence on trends in health inequalities and flowing from this provides  a set of recommendations – based on the root causes of health inequalities – for policies that can address social inequalities in health within the North and between the rest of England. It has sought to bring a fresh perspective to the issue of health inequalities, seeking to build upon the assets of the North to target inequalities, whilst also outlining what central government needs to do, both to support action at the regional level and re-orientate national policies to reduce inequalities.The abstracts and two of the presentations are available here: summary of Due North is available here: full report of Due North is available here:

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