Dena Murphy aged 88 lives a healthy lifestyle pictured at NEPHRA allotment in her Mew Moston community
*New public health plan for Greater Manchester set to help every individual and community to lead happier and healthier lives.
*Plan based on feedback from people who live and work here on what can help them to take control of their health.
*Targets all stages of life, puts strong focus on prevention and how better health and wellbeing helps with work prospects and economy.
Not only are children from smoking households three to four times as likely to start the habit, but over a £1bn* could also be spent elsewhere in the Greater Manchester economy, instead of on tobacco, if the region reduced its smoking figures to a target of 13% over the next five years.
That’s just some two of the major findings in a new public health blue-print for Greater Manchester – the first of this scale of ambition in England – which brings together best practice, to improve health and reduce health inequalities across the area.
The hundred-page plus plan is made up of a series of small to major interventions or recommendations, which collectively will have a major impact on the health of the 2.8 million people who live here. It also identifies which strategies could be carried out across Greater Manchester to complement the individual work of its ten boroughs who have also fed into the plan.
Called the Greater Manchester Population Health Plan, it looks at all aspects of life stages – and has also been informed by the views of people who live and work here during a major exercise to ask people what mattered to them most about their health and wellbeing.
It also identifies some of the biggest issues in the region including:
• Almost a fifth of adults smoke in Greater Manchester
• More than a third of our children have dental decay;
• A fifth of adults binge drink;
• Just under a quarter of adults do very little or no exercise;
• And around two thirds of adults are overweight or obese;
• Last year (2016) one in three children in Greater Manchester did not achieve a good level of development by the end of reception;
• One of out of 25 people in Greater Manchester live in the ten per cent most disadvantaged areas in the country.
Jon Rouse, Chief officer of the Greater Manchester Health and Social Care Partnership – the body overseeing the devolution of the region’s £6n health and social care budget – said: “This plan is unique because it states the case for Greater Manchester – and sums up the public health needs for the region. It will complement the individual work in the ten areas of Greater Manchester – and highlights where issues can be tackled more effectively by working together from a Greater Manchester stance.
“It’s also the product of thousands of conversations last year with the people who live and work in this area about how they could take charge of their own health.”
Jane Pilkington, Deputy Director of Population Health for the Greater Manchester Health and Social Care Partnership, said:
“Devolution has enabled us to formulate a plan that reorientates the system towards prevention and a focus on population health and wellbeing.
“We know that poor health and disadvantages are inextricably linked and that disadvantage starts before birth and accumulates through life. This is why we have structured our approach to start well, live well and age well.”
Key points in the three-stage approach include:
1) Start Well:
Smoking in pregnancy – What we know: This is single biggest and preventable risk factor for both the baby and mother’s health.
• A recent North West review that focused on child deaths under one year of age identified that smoking is the biggest preventable risk factor for infant death.
• Greater Manchester currently has around 450,000 smokers – 19.93% of the population. The national average is 13%.
• Parental smoking also quadruples the chance of children becoming smokers.
• The number of under 20s who smoke is two to three times higher than overall rates – and this translates to higher smoking rates in young mothers.
• The GM approach – Identifying Mums-to-be who are smoking will be a key part of the booking in, initial ante-natal visit so that they can be offered help to give up smoking..
• Training will be given to key workforce groups to ensure pregnant women and their families are given the most appropriate advice and support
• If we reduce the region’s overall smoking rate over the next five years to the national average (13%) there could be around £1.2 which could be spent in other areas of the region’s economy.
Child dental health – What we know: The biggest reason for children having general anaesthetic surgery in Greater Manchester is to take out decayed teeth. It’s also a key reason for children attending A&E due to dental pain.
• 5,000 general anaesthetic operations for children up to the age of 18 are carried out each year in Greater Manchester to take our decayed teeth. Tooth decay is largely preventable – so most could be avoided with better oral health habits.
• Tooth decay is strongly linked to deprivation, with some of the most vulnerable children suffering the worst dental health.
• When oral health is poor, children experience pain, infection, sleepless nights, time off school, which affects their ability to learn and develop.
• Child dental problems also mean time off work for parents.
• The GM approach – We want every child in Greater Manchester to have had a dental appointment by the age of one.
• The oral health improvement programme will boost more children having access to fluoride through teeth brushing schemes in nurseries and pre-schools
• Links will be developed between nursery settings and dental services to help with preventative care for infants up to the age of 12 months
2) Live Well:
Work and health – What we know: There is a strong link between not having or not being able to work and poor health. Being out of work can lead to poor physical and mental health, across all age groups, with major impacts for the individual concerned, their partner and family.
Getting back to work improves people’s health, as long as it is good quality work.
There is strong evidence that unemployment is generally harmful to health, linked to:
Higher death rates;
Poorer general health and long-term illness;
Increased smoking and drinking;
Prolonged unemployment increases psychological problems from 16% to 34%.
The GM approach: A programme to ensure that there is an effective prevention and early intervention system in place to support as many adults with health conditions as possible to return to, and remain in, good quality work. Key to this vision will be health, employment and other services working together to give help and support before people fall into long-term unemployment.
Cancer – What we know: By 2020 it is estimated that more than one in two people will be affected by cancer at some point in their lives. Every 30 minutes someone in Greater Manchester is told they have cancer.
The GM approach: A key commitment for Greater Manchester is to reduce early deaths from cancer by 1,300 fewer deaths by 2021.
In summer last year (2016) a new Greater Manchester Cancer Board was established to oversee all cancer activity in the area, and it will develop a five-year plan based on prevention and early detection. Plus we will recruit 20,000 ‘cancer champions’ (see attached story) to promote and support their local communities.
3) Ageing Well
What we know: The risk of malnutrition and dehydration increases in people aged over 65. Malnutrition often develops gradually and can go unnoticed. It is estimated to be part of around 30% of hospital admissions; affect 10-14% of people living in sheltered housing; and be a factor for as many as 35% of people admitted to care homes.
Malnutrition and dehydration significantly affect overall health and wellbeing – including energy levels, healing and recovery, mental alertness, mobility and steadiness, which can all increase the risk of a fall.
The GM approach – Recognising the need to raise individual, family, carer and practitioner awareness of the issues in older people, so that it can be spotted earlier and more easily in day-to-day situations and more people can benefit from information, advice and support to address the problem. In particular, results from the pioneering work in Salford will be used as a guide.
(See our attached case study below – how one 88-year-old great granny is living the good life and has advice for Greater Manchester Health and Social Care Partnership on how older people can eat better).
Lord Peter Smith, Chair of the Greater Manchester Partnership Board, said: “This plan belongs to every single one of us in Greater Manchester – from the input of the people and the neighbourhoods it covers to the health, voluntary and community sector. This cannot be done in isolation and our stance is very much that engaged and involved communities are the key to helping transform health results for the 2.8 million people who live here.”
Smoking: We know that children born into households where both adults smoke are four times more likely to take up smoking themselves. Any parental smoking increases the chance threefold of children becoming smokers.
*This figure – £1.2bn – refers only to how much Greater Manchester smokers would save from not spending money on tobacco. It does not include any wider societal or NHS treatment costs. This figure is based on a forecast reduction of 1.47% smoking prevalence per year to target of 13% by 31 Dec 2021. (Average cost of smoking per year is £5.36 per person based on national average of 11.4 cigarettes being smoked a day and a pack of 20 costing £9.40). The calculation takes into account accumulation of savings made by ex-smokers year on year. Please note this is a calculated estimation – it does not take into account local prevalence variations of target audiences, potential change in price of cigarettes and potential changes to population. Figure from Healthier Futures.
• Greater Manchester Health and Social Care Partnership is the body made up of the 37 NHS organisations and councils in the city region, which is overseeing devolution and taking charge of the £6bn health and social care budget. Governed by the Health and Social Care Partnership Board, which meets in public each month, the Partnership comprises the 37 local authorities and NHS organisations in Greater Manchester, plus representatives from primary care, NHSEngland, the community and voluntary sectors, Healthwatch, Greater Manchester Police and the Greater Manchester Fire and Rescue Service. The Strategic Partnership Board Executive, which represents the full Partnership, reviews work streams and makes recommendations to enable the Strategic Partnership Board to make effective decisions.
CASE STUDY: Green Goddess Great Granny tells health chiefs how a community allotment has sown the seeds for older people to eat better – and tackle loneliness
An 88-year-old gardening dynamo, who feeds 50 pensioners a week with her allotment-grown fruit and vegetables, has passed on her advice about better eating in later life to the top bosses at Greater Manchester Health and Social Care Partnership.
Green-fingered great-grandma Dena Murphy, who is the chair of New Moston residents’ group NEPHRA, produces so much fruit and veg that a weekly three-course meal can be made for 50 lunch-club members.
“I grow enough to fill our freezers and keep us going for a year,” she says.
“This year I’ve grown at least a 100lb of carrots, 30 cabbages, 60lbs of leeks and 140lbs of onions.
“Gardening is something I love and I’ve had a ball doing it. To me, gardening is a basic skill, which lies dormant in a lot of people.
“Plus, it’s a way of making friends – either by tending to the allotment – or by going to the lunch club that uses the produce.”
Dena, who is widowed, says she more than understands the temptation to not cook or eat properly when you may only be doing it for one.
“I call it the ‘tea and toast’s syndrome. It’s all too easy to get into a pattern where you feel tired because it’s so hard to buy food in small quantities. Then that stops you feeling hungry and it’s a vicious circle.
“These days there are so few local shops or butchers. If you go to a supermarket you can’t just buy a single chop – you have to buy a packet of them. Same with a lof of other fruits and vegetables, that come in large pre-packaged quantities.
“So that’s one of the reasons why gardening is so valuable and you can see how much it helps our lunch club and ensures that people are eating a varied diet full of nutrients. That is in turn helps with good health and fighting falls or illnesses,” she says.
“I’d also like to see more breakfast clubs across Greater Manchester. Not only could they make sure that older people eat well and keep hydrated, but they are also a social outlet, and a good start to the day that doesn’t feel intimidating if you are on your own.”
According to retired nurse Dena, who spends around three hours a day gardening, there’s no plant, fruit or veg that can’t be grown – the secret is to nurture seedlings like a child.
“Give them care, attention and empathy like you would a child,” she says. “But don’t take any nonsense – and there won’t be anything you can’t grow.”
From alpine strawberries to French breakfast radishes and pak choi – you name it, Dena has grown it. And the second secret to her success is never to ask for anything.
“I’ve always been very lucky. I never ask for anything, but people have always been very generous to me. If I need something, somehow it just happens and people will turn up and offer things for the allotment,” she says. “I call it ‘grandma’s wish list’.
“I’ve always believed that there is no heart without love. The more you take out of a heart the more it fills up.
“That’s how I’ve lived my life and a garden works on the same basis.”
And for those, who may be under the impression that Dena’s diet is singly wholesome, think again. “You have to try everything in life,” she says. “It’s about keeping all those doors open. This includes trying all sorts of different foods and having everything in moderation.
“I’ve had a life-long passion for chocolate – but a little of bit of what you love can never be bad for you.”