Plotting a healthier future for all in Gwent

The plainest measure is the fact that since 1948, average life expectancy in the UK has risen by 13 years.

But what has not happened in those years is the eradication of health inequalities - and again, the plainest measure of this lies in a closer look at life expectancy.

Across the UK, there is a 10-year gap in life expectancy between people living in the richest and poorest areas.

And this inequality is mirrored locally. In Gwent, there is nine-year gap in life expectancy for men in the most affluent and the most deprived areas.

The gaps are even wider regarding what is known as healthy life expectancy - the length of time one can expect to live in good health.

In Gwent, the starkest differences are to be found between Monmouthshire and its neighbour Blaenau Gwent. Healthy life expectancy for men in Monmouthshire is 69.8 years. In Blaenau Gwent, it is 59.6 years.

For women in these areas, the difference is even greater. Healthy life expectancy for women in Monmouthshire is 70.7 years. In Blaenau Gwent, it is just 59.3 years.

The factors that drive health inequalities are several and varied, economic and social policy, and addressing them requires action beyond the sphere of the NHS, as well as within the NHS itself.

But there is much being done, and to be done, within the health sector to reduce these inequalities.

The annual report of Aneurin Bevan University Health Board's director of public health, Dr Sarah Aitken - A Healthier Future for Gwent - acknowledges the scale of the task, while positing a way forward.

And she is clear that we as individuals must assume some responsibility for our own health and - for instance as parents - the health of others, as well as Government and health agencies playing a part.

Cancer, its risk factors, and the things we can do to reduce those risks, looms large in the report.

It stresses too that as the risk factors for cancer are common to heart and circulatory (cardiovascular) disease, addressing them will have a double benefit.

Smoking, obesity and alcohol are identified as the three broad threats to good health, and to reducing health inequalities.

Smoking rates - according to the National Survey for Wales - vary in Gwent, from 22 per cent of adults in Blaenau Gwent, to 14 per cent in Monmouthshire. The rate in Torfaen is 20 per cent, and in Newport and Caerphilly it is 18 per cent.

Rates of overweight and obesity are significantly worse than the Wales average in Caerphilly and Blaenau Gwent.

Healthy eating, based on the measure of five portions of fruit and vegetables a day, is significantly worse than the Wales average in Caerphilly, Blaenau Gwent and Torfaen.

More than a third of people in Newport, Caerphilly and Blaenau Gwent say they are active for less than 30 minutes a week.

And Monmouthshire is significantly worse than the Wales average for people drinking alcohol beyond the guideline amount.

In Gwent, the number of community pharmacies that can now offer a full range of smoking cessation support has been increased, while Wales-wide, Stop Smoking Wales and Help Me Quit phone and website support has been boosted.

The health board is also training doctors, nurses and other healthcare professionals to 'make every contact count' - enabling them to refer smokers to cessation support.

Two-thirds of smokers start before they are 18, and in the fight to reduce this, Dr Aitken sees it as crucial to change attitudes and 'denormalise' smoking in communities.

"We must focus on breaking the generational cycle," said Dr Aitken.

"Giving up in their 40s is hard for people, but we want them to focus on their children and grandchildren.

"We need to create a smoke-free environment for children."

The JustB Smoke Free programme for schools - including training Year 12 and 13 pupils to be smoke-free ambassadors, who can discuss the risks of smoking and the benefits of not smoking with fellow pupils - is available in Gwent, but Dr Aitken's report acknowledges that more must be done to encourage all schools to take part.

She also highlights the Public Health (Wales) Act 2017 - which makes smoking in hospital grounds, council playgrounds and school grounds illegal - as a key piece of legislation, but said it is important that councils and schools enforce it.

The report states that around 1,400 people a year in Gwent get a cancer that was potentially preventable.

After smoking, the second biggest preventable cause of cancer is overweight and obesity.

Again, the focus is on breaking a generational chain. Eighty per cent of obese children and young people remain so into adulthood, so it is, says the report, "vital to tackle the issue in childhood".

Promoting physical activity in workplaces, in schools, and communities is seen as an effective intervention, and initiatives such as the Daily Mile are popular in Gwent.

The Daily Mile encourages children to be physically active, running or walking, outdoors for 15 minutes a day, and as well as improving fitness and wellbeing has benefits for learning and behaviour. More than 70 primary schools in Gwent have introduced it, and Dr Aitken is encouraging its roll-out to all of them.

On alcohol, her report cites the Public Health (Minimum Price for Alcohol) Wales Act as having the potential"to be the most effective intervention for reducing the health impacts of harmful alcohol consumption". She stresses that it is vital however, to enforce it at a local level.

"Every extra unit (above the recommended guidelines) you have increases your risk of cancer. I think that is something not enough people know," said Dr Aitken.

"The focus is on creating an environment that supports people to drink less."

The report also highlights the routine sharing of A&E and police data in strengthening the case to refuse or restrict licences to sell alcohol.

Another focus is screening programmes and early diagnosis of cancer. The health board area performs well in bowel, breast and cervical screening, against Wales-wide uptake, but there are uptake differences between areas of Gwent.

And for bowel cancer, early (stage one) diagnosis ranges from 14 per cent in Caerphilly to just 6.9 per cent in Blaenau Gwent.

It is hoped a new, simpler bowel screening test will improve uptake in Wales, while there is an acknowledgement that more engagement with the public is required - nationally through Screening Engagement teams and locally through GP practices - to boost uptake rates.

"Early diagnosis of cancer greatly improves the chance of successful treatment," said Dr Aitken.

Overall, she believes there must be a "collective commitment" involving bodies like the NHS, and individuals, to help achieve an equality of health outcomes.

"The message of the report is that if we all do one thing, together we can create a healthier future for Gwent, and realise the ambition of the NHS when it was born," said Dr Aitken.

She added that if the health board is to be true to that ambition, "we must renew our commitment to making it a reality".