Health and care services

Patterns in public health

DOCTOR WITH IPAD

Chief Medical Officer Michael McBride outlines the challenges and changes to health in Northern Ireland.

What are the main responsibilities of the Chief Medical Officer?
As Chief Medical Officer, I have a number of key areas of responsibility within the health and social care sector. I provide professional medical and environmental health advice to ministers and departments and to help inform policy priorities and decisions throughout the Department of Health, Social Services and Public Safety oversee; public health policy, including health promotion, disease prevention and screening programmes, and emergency planning; promote safety and quality policy including standards and guidelines, professional regulation and adverse incident reporting and learning; and I have responsibility for Research and Development Policy through the Health and Social Care R&D Strategy and links to related Executive strategies.

Along with my counterparts in England, Scotland and Wales, we work collaboratively on a number of key public health challenges and priorities from efforts to improve the overall health of the population by providing advice and guidance, to coordinating efforts to protect the population against emerging health threats – be that new and emergent infectious disease or novel psychoactive substances.

Please outline Northern Ireland’s main public health challenges.
Like other developed countries the health of people in Northern Ireland continues to improve. Although people are living longer, too many people still die prematurely or live with conditions they need not have. Obesity, smoking, cancer, diabetes and other chronic illnesses are subjects we still need to address, as well as tackling other issues such as suicide prevention and drug and alcohol abuse. In that respect a number of things need to happen. Improved population health and well-being as in the current Programme for Government needs to continue to feature as a key priority for all Government departments given the benefits to citizens and the economy through increased productivity and constraining the inflationary costs of health care provision.

This will also require a much more comprehensively engaged population than is currently the case. Many of us know we need to eat less, drink less and exercise more, translating that into decision and action is the challenge. We all need to take more responsibility for our own health. Wider government and health and all other sectors need to create the opportunities to enable and support people to make the right choices, the easier choices and the potential harmful choices more difficult to make. We need to be innovative and imaginative in how we engage and work in partnership to achieve this.

How do you assess the level of progress made on public health over the last year?
Health and wellbeing, and peoples’ choices about their health, are affected by a whole range of influences in everyday life, therefore progress in improving health and reducing inequalities in health needs long term sustained and collective action involving all of society.
Over many years, we have worked successfully across government and across sectors to ensure joined up working in order to realise improvements in population health, however, there is always scope for further improvement. 2009 saw the establishment of the Public Health Agency to bring a particular regional focus to health improvement and health protection.

In the last year, we have made significant further progress in promoting better collaboration and co-ordination for health improvement following the publication of the Executive’s new strategic framework for public health, Making Life Better 2013-2023, learning from the success and challenges of implementing the previous framework Investing in Health. This focuses attention on the issues we need to work on collaboratively over the next 10 years across government, regionally and locally, and builds on evidence and work carried out over the last 10 years.

In respect of some specific issues, the latest figures show a 2 percentage points reduction in adult smoking prevalence and a 3 percentage points reduction in smoking amongst children aged 11 to 16. Tobacco control measures such as a ban of point of sale display have been introduced and further control measures such as standardised packaging and stronger penalties for retailers who flout the age of sale laws will be introduced.

Over recent years, we have seen encouraging signs in relation to young people’s drinking. In contrast to the general public perception, the percentage of young people, aged 11-16, who get drunk has fallen from 33 per cent in 2003 to 14 per cent in 2013.

Where would you like to see more improvement?
There continues to be a gap in health between those who are least and most disadvantaged. As I have said for many years perhaps a little simplistically in order to make the point; “where you live in Northern Ireland has always mattered for all the wrong reasons and that it can determine how long you live is wrong.” As I demonstrated in my annual report in 2010, that I can travel on a number 8 bus from Belfast City Hall to the Malone Road and, in that 20 minute journey, see a change in male life expectancy of some nine years is in my view morally indefensible. That members of the travelling community live on average 10 years fewer than the Northern Ireland average is also simply wrong. We are not unique in facing these challenges, we did not invent them but collectively we can and must address them.

Health gets progressively better as the socioeconomic position of people and/or communities improve. I would like to see more inroads made to reducing health inequalities that are preventable by reasonable means, so that everyone has a fair chance to lead a healthy life. This means we need to work more closely across government, and with other sectors, in a coherent way towards shared outcomes.

There is a key interface between public health, health and social care and the role of local government in creating the conditions for individuals, families and communities to be enabled and supported to lead healthy lives. Reform of local government provides an important opportunity for councils to strengthen their already significant contribution to improving the health and wellbeing of communities and tackling health inequalities at the local level.

How can the Health Service make the best use of funding?
Healthcare is complex and challenging and with the added pressures of a growing ageing population, more long term conditions, increasing patient expectations and financial constraints amid rising costs of new drugs and treatment, it is imperative that the service continues to change to meet these demands.

These cost pressures provide a strong economic case for investment in prevention and early intervention. I echo the Minister’s views that if we embrace reform, make transformation our purpose and resolve to realise change for the better, then we can overcome the difficulties we face and deliver a genuinely transformed cost effective world class health and social care service for all the people of Northern Ireland and one that I will continue to be proud to work in and increasingly benefit from.

Michael McBride

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