In my recent annual report I draw attention to real successes: a decline in teenage pregnancies, reduced smoking and drinking in young people and decreasing numbers of deaths from circulatory diseases. We are all living longer healthier lives.
However, if we travel on the train line into Cardiff, we see significant differences. In Dinas Powys, male life expectancy is 81.8 years. Three stops along in Grangetown, it is 71.5 years. Health is improving overall, but we are leaving some people behind. Inequalities in health are caused by inequalities in society; where people are born, grow up, work and live, the opportunities open to them. Creating a healthy Wales requires action across government at all levels, with families and individuals as well as the NHS.
The Welsh Government is addressing this through the Programme for Government, Together for Health and the strategic action plan Fairer Outcomes for All which focuses on building health into all policies, and all policies into health.
The foundations of good health are laid during pregnancy and the early years. Maternal smoking, drinking and poor nutrition in pregnancy are all associated with poor health over the course of a lifetime.
There is also a well established link between poverty and poor health in children and young people, which is why Local Health Boards working in partnership with local authorities and others are required to make demonstrable progress locally on achieving child poverty targets on infant mortality, low birth weight and teenage pregnancies. The Flying Start programme is a key Welsh Government initiative, focusing on the early pre-school years. Targeted areas receive more support from health visitors and a childcare entitlement as part of a package to support parenting.
The Welsh Government is working to promote a wide range of health resources which help us to maintain our health and wellbeing. From the Communities First Programme, aiming to improve living conditions and prospects in Wales’ most disadvantaged communities, to supporting peer educators to promote breastfeeding or good mental health, to ensuring everyone has access to green space. Health assets which include local community leaders, can buffer against life’s stresses, and they include the capacity, skills and potential in a community, rather than focusing on dependency.
Health literacy, how well we understand information to make decisions or follow instructions, is also important. Low levels of health literacy are most prominent amongst disadvantaged groups, but can affect everyone.
Studies suggest that people with ‘inadequate or marginal health literacy skills have a 50% higher mortality rate than those with adequate skills’, which research in the US has linked to medication errors, unnecessary hospitalisation, longer stays, more use of emergency departments – all of which place extra demands on healthcare providers. The Welsh Government is working to target health literacy improvements through basic education reforms as well as through the Expert Patient Programme, which educates people with chronic conditions so they can self manage their condition.
Drinking too much alcohol, smoking, an unhealthy diet and physical inactivity are the four main risk factors contributing to premature death. At present, 26% of the population take action on one of these things, and only 6% of the population takes action to be healthy on all four counts. A recent study in the Lancet medical journal indicated a lack of exercise is now causing as many deaths as smoking worldwide. If we can encourage more people to take action on more of these risk factors, it will have a major impact on the health of the population.
The proposed Active Travel Bill will promote more short journeys on foot or by bike so we can all live more active lives. The proposed Housing Bill addresses family homelessness, creating affordable homes and improving home energy efficiency. All of these things will help people to be safe, healthy and warm, and benefit physical and mental health.
Children breathing in other people’s cigarette smoke resulted in 300,000 GP visits and 9,500 hospital admissions last year in the UK. The Welsh Government’s Fresh Start campaign is asking people not to smoke in cars with children, and is considering its powers around introducing a ban. Children have no choice in whether they are exposed to the dangerous toxins in tobacco and the Welsh Government has signed up to the UN convention on the rights of the child, which states that governments must do all they can to ensure children grow up healthy. Homes with children must also in the future become smoke free.
The Welsh Government is considering a public health bill, which would ensure that improving health and wellbeing becomes, like sustainability, a central operating principle and sets out duties across government and civil society. I want to see a healthier Wales, with a world-class reputation for public health and am pleased with the progress we have made over the last six years. My successor as CMO, Dr Ruth Hussey, was born in Wales and spent her early years here. She has worked at a senior level in public health in England, and brings extensive experience to the role, and I wish her well in her work towards a healthier fairer Wales.