UK Public Health Association

Public Mental Health
RCN Conference – February 17th 2012
Angela Mawle
Former Chief Executive, UKPHA

What was the UK Public Health Association ?
UKPHA - a unifying and powerful voice for the public's health and well being in the UK, focusing on the need to eliminate inequalities in health, promote sustainable development and combat anti-health forces.

UKPHA Special Interest Groups
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Health & Housing
Alcohol & Violence
Food
Child Public Health
Health & Sustainable Environments
Pharmacy & Public Health
Public Mental Health

BIG QUESTION?

From “No Society”
To : “Big Society”/”Fair Society”??

Health Inequalities
“We have concluded that early childhood is the period of life at which intervention could most hopefully weaken the continuing association between health and class.”
The Black Report 1980

Health Inequalities
Sir Donald Acheson’s
Definition of Public Health (1988)
“The science and art of preventing disease, prolonging life and promoting health through the organised efforts of society.”

Health Inequalities
Independent Inquiry into Inequalities in Health
Sir Donald Acheson 1998
• The Acheson Report concluded that the
"weight of scientific evidence supports a socio-economic explanation of health inequalities." • 'Poverty, low wages and occupational stress, unemployment, poor housing, environmental pollution, poor education, limited access to transport and shops, crime and disorder, and a lack of recreational facilities all have had an impact on people's health' Acheson 1998

Fair Society Healthy Lives
„The Strategic Review of Health Inequalities in England
– post 2010‟
Sir Michael Marmot – February 2010
“Rise up with me against the organisation of misery”
Pablo Neruda

MARMOT FINDINGS
•The physical and social characteristics of communities, and the degree to which they enable and promote healthy behaviours, all make a contribution to social inequalities in health. •Communities are important for physical and mental health and well-being.
•There is a clear social gradient in „healthy‟ community characteristics.
•Mental health is very closely related to many forms of inequality.
•The social gradient is particularly pronounced for severe mental illness.

MARMOT FINDINGS
“Rise up with me against the organisation of misery”
Pablo Neruda

In the case of psychotic disorders the prevalence among the lowest quintile of household income is nine times higher than in the highest.
•While the particularly high rate of psychotic disorder in the lowest quintile may, to some extent, result from downward social drift, this is unlikely to account for the social gradient.

MARMOT RECOMMENDATIONS

Ease of access to a range of integrated social and health care services focused on recovery, psychological therapy and outreach is critical.
•Out of hours support is important in supporting recovery and enabling people receiving secondary care services to continue in employment or re-enter the labour market.
•Work contributes to maintaining and recovering self confidence and self esteem and reduces social exclusion by extending social networks and support.

Prevention rather than cure??

No health Without Mental
Health??

Mental Health & Smoking

• Smoking prevalence is significantly higher among people with mental health problems than among the general population
• Daily cigarette consumption is considerably higher among smokers with mental health problems who may also inhale more deeply from their cigarettes.
Smoking & mental health: a review of the literature; Dr Ann
Mcneil Symposium Report 9th November 2001

Mental Health & Smoking

Numerous studies have found association between various indices of psychological stress and smoking uptake:
– adverse childhood experiences (Anda et al., 1999)
– parental divorce (Patton et al., 1998a),
– negative life events