Chief Medical Officer for Wales Annual Report 2012-13 Healthier, Happier, Fairer Source: Visit Wales Acknowledgements I would like to thank colleagues from the Welsh Government for contributing to the development and editing of this report. Special thanks to Helen Jones, Hayley Jones and Benjamin Lewis for managing the production of the report, and also to Chris Brereton, David Hands, Suzanne Moore Osley, Dr Heather Payne, Dr Andrew Riley, Dr Chris Riley, Neil Riley, Cath Roberts, Chris Tudor-Smith and Alun Williams. I would also like to acknowledge the contribution made by colleagues in Public Health Wales in providing material and assisting with reviewing the report. WG18489 © Crown Copyright 2013 ISBN 978 1 4734 0301 7 Chief Medical Officer for Wales Annual Report 2012-13 Letter to the First Minister Dear First Minister, I am delighted to publish this, my first Annual Report as Chief Medical Officer for Wales. My role as a doctor at the heart of the Welsh Government gives me an opportunity to assess the health and wellbeing of the people of Wales and see where we might do better. While Wales has developed excellent initiatives and strong systems, this is a difficult time. The economic downturn is making life hard for many people, and that may take a toll on their health. There are no quick fixes for that and its shadow may be long. Against that backdrop, this report will not be restricted to an account of events in the last year. Instead it will set out an Source: Welsh Government assessment of where Wales stands with regard to health and wellbeing and what may lie ahead. In this report I portray health not as something separate but as the foundation for a full and enjoyable life. What makes people healthy is much the same as what makes them happy – having a satisfying role in life with prospects, feeling mentally and physically fit, and living in a decent community and a society where people of all ages and backgrounds have a fair chance in life. Every country is facing similar problems and we need to share ideas and problems with others and learn together. My own experience suggests that there are ideas elsewhere we can pick up and apply in Wales. Throughout this report I will discuss what could improve or harm health now and in the future. I will also stress the importance of encouraging the whole of government and society to work together to improve people’s lives, and how we can better engage the public and those who provide services in joining together in a way that can work in everyone’s interest. This report is focused on evidence and opportunities. After a summary of the current position, chapters assess how we could better protect and promote health and wellbeing for all and support the NHS. The final chapter examines the links between health and the economy, a complex area but one potentially containing untapped benefits. Each chapter includes recommendations, which I will return to in future Annual Reports. I conclude with some suggestions on how we can push faster for real improvements in the health and wellbeing of all of us. Yours sincerely, Dr Ruth Hussey OBE, Chief Medical Officer, Wales Chief Medical Officer for Wales Annual Report 2012-13 List of Figures Figure 1: Percentages of Welsh adults 8 Figure 11: Completed immunisations 23 reporting specific health problems, 2012 (all antigens) by 12 months and 24 months in the UK by country, 2011-12 Figure 2: Relationship between chronic 9 conditions and risk factors Figure 12: Quarterly numbers of MRSA 25 bacteraemias from hospital patients in Figure 3: Health behaviour indicators, 2012 10 Wales, April 2008-March 2013 Figure 4: Healthy life expectancy 11 Figure 13: Quarterly numbers of MSSA 26 as a proportion of life expectancy at birth, bacteraemias from hospital patients in 2000-02 to 2008-10 Wales, April 2008-March 2013 Figure 5: Happiness in the UK, levels of 12 Figure 14: Total antibiotic use (expressed 27 medium or high happiness, 2011-12 as dispensed items/1000 prescribing units/ quarter) in the community across Wales, 2005-12 Figure 6: Gap in years of life expectancy 13 between the most and least deprived Figure 15: Adults’ alcohol consumption 37 quintiles of deprivation in Wales above the daily guidelines, 2008-12 Figure 7: Contribution to life expectancy 14 Figure 16: Physical activity among 39 gap (in months) in men under 75 by adults, 2003-12 underlying cause of death, comparing most and least deprived quintiles of Wales, Figure 17: Fruit and vegetable 39 2001-03 and 2008-10 consumption by adults, 2008-12 Figure 8: The Health Map 15 Figure 18: A whole of society approach 42 to promote healthier, happier and fairer lives Figure 9: Notifications of measles in 21 Wales by week Figure 19: The change in the health system 50 in Wales over the past 40 years Figure 10: Summary of uptake rates for 23 selected immunisations in resident children Figure 20: Number of attendances and 51 reaching their 1st, 2nd, 5th and 16th attendance rate per 1,000 population at major birthday between 01/01/13 and 31/03/13 A&E departments in Wales by age, 2012-13 and resident on 31/12/12 Figure 21: Physical and mental wellbeing 61 by socio-economic classification of household, 2012 Chief Medical Officer for Wales Annual Report 2012-13 Substance misuse 40 Contents Making real progress – the whole 40 of government and the whole of society Chapter 1: Wales in the past year – 6 Health assets and health literacy 43 healthy, happy, fair? Health and wellbeing across public services 44 How healthy are we? 7 Priorities for prevention across Wales 46 Health status 7 Recommendations 47 Health behaviours 9 Life expectancy 11 How happy are people in Wales? 12 Chapter 4: Creating safe and resilient 49 How fair is health in Wales? 13 21st century healthcare services The changing nature of the Welsh 50 Health, happiness and fairness – 15 health system the wellbeing of Wales The impact of population change 51 Recommendations 17 Economic factors 52 How much to spend on healthcare? 52 Chapter 2: Protecting the nation’s health 19 A relentless focus on quality 52 Infection 20 Clinical staffing and leadership 53 Avian influenza A(H7N9) 20 Fair and flexible healthcare 54 Middle East respiratory syndrome 20 A partnership with the public – co-production 54 coronavirus (MERS-CoV) A health service for the 21st century – 55 Measles 21 balanced and innovative Immunisation 22 Looking forward 56 Sexual health 24 Recommendations 57 HIV awareness raising campaign Healthcare associated infections (HCAI) 24 Clostridium difficile (C. diff) 25 Chapter 5: Acting on the relationship 59 Staphylococcus aureus (S. aureus) 25 between health and wealth The economic challenge 59 bacteraemias Long-term structural poverty 59 Infection prevention and control (IPC) 26 and deprivation Antibiotic resistance 27 Impact of the economic downturn 60 Wales wide population screening for early 28 Impact of benefit reform 60 detection What can be done about the challenges? 60 Major environmental hazards 28 Supporting people to get into and 61 Air Quality 29 stay in work Climate change and extreme weather events 30 Using regeneration to create better health 63 Lessons learned 32 and wellbeing Recommendations 33 The role of the health and social care 63 sector in economic development Chapter 3: Achieving health and 35 Developing the life-science sector 63 happiness through prevention Skills development 64 Act earlier, prevent more 35 Other possibilities 65 Lifestyle factors 36 Harnessing the potential 65 Smoking 36 Recommendations 66 Alcohol misuse 36 Low levels of physical activity and 38 poor eating habits Conclusions 68 Chapter 1 Wales in the past year – healthy, happy, fair? In many ways health in Wales is improving. However, some problems continue and action to support healthy behaviours is essential. Happiness levels vary across Wales and there is a need to understand the causes better. The gap between the health of the most deprived and least deprived communities is not decreasing. There are many positive aspects to report about However, there are challenges. Obesity continues health and wellbeing in Wales. As this year’s report to increase, with an associated rise in diabetes. shows, the Welsh population is living longer than There are more adults being treated for high blood ever and has more years of healthy life than ten pressure and poor mental health remains a problem. years ago. Too few people do enough physical activity. There is still a large gap between the health of the most and least deprived communities1. 2 Source: Visit Wales Chief Medical Officer for Wales Annual Report 2012-13 The purpose of this chapter is to look at the data and intelligence that contribute to understanding the health and wellbeing of the population of Wales. It is divided into three sections, looking firstly at health status, health behaviour, and life expectancy; then at indicators of the relative happiness of the population; and lastly at fairness and the inequalities that continue to affect the lives of people in Wales. These elements together create a picture of health and wellbeing of the more than three million people in Wales. Further data related to each chapter can be accessed from the data compendium on the Welsh Government website: www.wales.gov.uk/cmo Source: Public Health Wales healthcare interventions are available, should be How healthy are we? rare. In 2011, there were 7,470 deaths to Welsh residents caused by conditions considered avoidable, Health status representing about a quarter of all deaths. Avoidable The health status of the population presents a mixed mortality rates for Wales decreased by 26 per cent picture.