Healthier Communities & Older People

Healthier Communities

Introduction

Within the LAA and the Devon Sustainable Community Strategy a broad definition of health has been adopted which includes mental and social health as well as physical health. Two definitions of health provided by the World Health Organisation (WHO) demonstrate these wider dimensions of health. The World Health Organisation's 1948 definition of Health now commonly used is " Health is a complete state of physical, mental and social well being and not merely the absence of disease or infirmity". This definition is broad and indicates that health has many components; it is not just being free of disease or illness.

The 1984 WHO definition of Health identifies the utility of health as a resource for everyday life "The extent to which an individual or a group is able to realise aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept emphasising social and personal resources as well as physical capabilities (WHO, 1984).

The determinants of health stretch beyond provision of and access to health services, or exposure to infectious diseases. They include elements of personal lifestyle such as smoking, exercise and diet, social and environmental factors such as education, housing, and social support, to structural social and economic issues such as poverty, and unemployment and housing.

A detailed breakdown of health determinants has been developed by Lalonde (1974) and Lebonté (1993) and is shown in the table below. From this, it is clear that access to public services (including healthcare) is a necessary but not sufficient objective within the overall aim of improving the well being of communities and individuals within them.

Determinants of Health
Biological factors	Age, sex, genetic factors
Personal family circumstances and lifestyle	Including family structure and functioning, education, occupation, unemployment, income, behaviour, diet, smoking, alcohol, substance misuse, exercise, recreation, transportation.
Social environment factors	Including culture, community participation, cultural participation, spiritual participation, peer pressure, discrimination and social support.
Public service factors	Housing, leisure, employment, social security, public transport, policing, access, primary care, community care, secondary health care, child care, social services.
Public policy	National and local priorities, economic, social environment and health trends.

As part of the development of the Devon Sustainable Community Strategy, eight priority issues have been identified for Devon:

Accidental Injury
Emotional Wellbeing
Health Protection and Emergency Planning
Health Inequalities
Obesity
Smoking
Sexual Health
Sensible Drinking

The issues reflect some of the main factors and challenges in health that can be impacted upon positively through the development of public policy across a wide range of sectors. The majority of the areas reflect the main lifestyle factors that can lead to illness and death. The issue of health inequalities highlights that although the health of people in Devon is generally good there are geographical communities and some groups of people who because of their social, environmental and economic circumstances they experience poorer health. Some of these issues have already been picked up through the Devon LAA, the others will be covered in the new 2008-2011 LAA.

Governance

The Healthier Communities and Older People Block is overseen by the Health and Well-being Partnership.

LAA Outcomes

The 2007-2008 LAA Outcomes are:

Improved levels of physical activity
Improved mental health and emotional wellbeing
More healthy eating
Healthy workforces
Reduction in number of people in Devon who smoke
Sensible drinking
Improve Health and reduce health inequalities
Improve Sexual Health

Making healthy choices underpins all the objectives and actions within the block. The Choosing Health strategy (2004) prioritises a number of the main lifestyle risk factors and sets out a range of interventions to support good health. The key objectives of

participating in physical activity
making healthy eating choices
promoting emotional wellbeing
drinking sensibly
giving up smoking

reflect aspects of daily life that can impact positively on people's health and reduce the risk of illness and premature death. They also offer the opportunity for effective initiatives to be implemented within a range of settings e.g. the workplace and the home supported by a range of partners.

See the Healthier & Older Communities Table of Outcomes.

Block Lead: Ian Tearle
ian.tearle@rdeft.nhs.uk

Older People

Coming soon