Healthy life styles: prevention better than cure - initiatives in Enfield

Watts, Jacqueline H.; Watts, Tony and Jordan, Lesley (2011). Healthy life styles: prevention better than cure - initiatives in Enfield. In: EU Twin Town Over 50s Project, 28-29 Sep 2011, Strasbourg University, Strasbourg, France.


For older people, preventing ill-health means healthier, and thus more independent and potentially more fulfilling lives, with as short a period of ill-health as possible at the end. The case for authorities spending more on prevention initiatives is reinforced by a number of studies carried out in the UK under the Programme for Older People’s Projects (POPP) banner. These Department of Work and Pensions funded pilot programmes have demonstrated that for every £1 spent on the prevention projects there has been an average of around £1.20 saving in emergency bed days; hospital overnight stays reduced by 47%; accident and emergency attendances reduced by 29%; clinic or outpatient appointments reduced by 11%; and physiotherapy/occupational therapy appointments reduced by 8%. The estimated efficiency gains in the health service appear to have been made without any adverse impact on the use of social care resources. There is some evidence that integrated, co-located health and social care teams achieve improved outcomes for older people. Notwithstanding these findings there is little evidence of widespread adoption of preventative agendas by local authorities.

However as part of the commitment to improving health, local authorities across England have been charged with undertaking a Joint Strategic Needs Assessment (JSNA) for their communities’ health. Enfield’s approach has been to collate statistical data of people’s health in the Borough and to identify practices and strategies which will improve health and lead to a reduction on the demands for the health and social care services . This paper is substantially based on the JSNA report as it pertains to older people. The priorities it identifies include: poverty, health inequalities, obesity, long term conditions, mental health, healthy lifestyles, feeling safe, and access to health and well-being information. Some of the JSNA findings and statistical data are detailed in the Appendix.

Life expectancy and health in Enfield
The most important factors influencing the health of a population are the ‘wider determinants of health’ such as poverty, income and housing. These in turn have powerful impacts on peoples’ lifestyles. For example, it is well established that social deprivation is strongly associated with higher smoking rates, poorer diets, lower levels of physical activity and higher rates of substance misuse. Whilst life expectancy in Enfield is increasing there is a significant and widening life expectancy gap between deprived and more affluent wards within the borough (currently 8.8 years for males and 10 years for females). Long term conditions, which predominantly affect older people, account for 69% of the total health and social care spend in England.

Healthy Lifestyles
There is overwhelming evidence that changing people’s health-related behaviour can have a major impact on some of the largest causes of mortality and morbidity. There are clear links between physical activity and health: a lack of physical activity is linked to cardiovascular disease (CVD); coronary heart disease; some cancers; obesity; diabetes; depression; and musculoskeletal health. The Chief Medical Officer for the UK recommends a minimum of 30 minutes physical activity of at least moderate intensity 5 days a week. In Enfield less than half the population takes part in physical activity on even a weekly basis.
Targeted prevention activities in Enfield
A number of key services and initiatives are available within Enfield on health outcomes and health inequalities. Some of these are outlined below:
Health Trainers: This is a Department of Health lead initiative. Health Trainers work with clients on a one-to-one basis to assess their health and lifestyle risks in order to motivate the clients to change their lifestyles. The programme has been running since 2006.
Health Service Life Check: This NHS Mid-life Life Check is an online health assessment for people aged 45-60 analysing issues around smoking, healthy eating, alcohol use, physical activity and emotional well-being.
Seasonal influenza vaccination programme: The objective of the flu immunisation programme is to protect those aged 65 or over who are most at risk of serious illness or death should they develop ‘flu'. Uptake of the influenza vaccine in the over 65 age group improved from 71.7% in 2007/8 to 72.9% in 2008/9.
Cancer Screening: Nationally coordinated cancer screening programmes including older people exist for breast, bowel and cervical cancers.
Falls: In 2007/8, 850 Enfield residents aged 50 and over were admitted to hospital due to an accidental fall. This is approximately 1 in every 100 residents aged 50 and over. Enfield’s rate of admissions due to a fall has generally been lower than London or national averages. A notable initiative by the Over 50s Forum was the development and publishing of a falls risk assessment booklet.
Since its inception in 1989, the Enfield Over 50s Forum has worked in partnership with the local authority, health service, other older peoples’ groups, clubs and leisure centres to get older people involved and to focus on maintaining their fitness with the tenet: prevention is better than cure. Besides the health and social care authority initiatives outlined above, the Forum plays a significant role in promoting healthy lifestyles by organising and taking part in fitness days and falls awareness, healthy eating and lifestyles events. The Forum was also instrumental in persuading Enfield’s leisure centres to run weekly fitness days for older people at three of its centres where they can spend the day undertaking a whole range of activities and have lunch there. These days are very popular and well supported by older people across the Borough. The Forum newsletter keeps its 3000 plus members informed of the health prevention initiatives within the Borough, and the Forum’s extensive social and meetings programmes help older people maintain their fitness, involvement and active participation in the local community.

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