Health Protection is a term used to describe a range of activities within Public Health which aim to reduce risks to health, this includes environmental hazards, transmission of communicable disease, screening programmes and managing emergencies such as outbreaks. Current priority areas include immunisation and screening uptake; incidence and management of Tuberculosis (TB); air quality; and incidence of serious reportable infectious disease.
Tuberculosis or TB is a bacterial infection which is spread thorough tiny droplets from the coughs or sneezes of an infected person. It is a serious condition, but can be cured with proper treatment. TB mainly affects the lungs. However, it can affect any part of the body, including the glands, bones, and nervous system. Nearly three quarters of all TB cases occur in those born abroad, mainly in high TB burden countries, and the vast majority of these cases (85%) occur among settled migrants who have been in the country for more than two years, rather than in new entrants. There is a strong association between TB and social deprivation, with 70% of cases occurring among residents of areas in the two most deprived quintiles in the country. While the majority of cases are due to reactivation of latent infection acquired some years before, transmission of TB continues to occur, leading to spread of infection and outbreaks. TB incidence and TB treatment outcomes are included in the Public Health Outcomes Framework.
In Derby, the incidence of TB (rate of reported new cases) is comparable to the England average at 13.9 per 100,000 population (2013 data), though this has been increasing since 2011 at a steeper rate. Public Health England (PHE) have published several national TB Strategy Monitoring Indicators at an upper tier Local Authority (UTLA) area level. The very latest 2012-2014 combined data suggests that Derby has a significantly higher rate of TB incidence (three year average) than England, given the continued increase, and that as a Local Authority area we fall in the bottom half of all upper tier authorities in the country for new cases of the disease. We do however, report 100% (2014) of culture confirmed TB cases having had drug susceptibility testing, which is significantly better than the national average. Providing universal access to high quality diagnostic testing is a key action of the Collaborative Tuberculosis Strategy for England 2015-2020 (PHE and NHS England). Further indicators can be found on the Public Health England website.
Poor air quality is a significant public health issue. The burden of particulate air pollution in the UK in 2008 was estimated to be equivalent to nearly 29,000 deaths and an associated loss of 340,000 life-years at the population level (PHE, 2015). Estimates of the number of deaths in UK Local Authorities that can be attributed to long-term exposure to particle air pollution have recently been published. In Derby, the fraction of mortality is 5.7 compared to the England average of 5.3 and the East Midlands regional average of 5.6. This means that in Derby, 5.7% of annual deaths in those aged over 30 years is associated with long-term exposure to anthropogenic (pollution resulting from human activity) particulate air pollution at current levels. The full report can be found on the gov.uk website, while the outcomes indicator in relation to air quality can be found on the Public Health England website.
Notifiable infectious disease
There are 26 high-level notifiable infectious diseases in England and Wales, ranging from Acute encephalitis (inflammation/swelling of the brain) to Whooping cough. The twenty-sixth category is ‘other’, beneath which diseases ranging from Campylobacteriosis and Salmonellosis (foodborne illnesses causing severe diarrhoea) to Influenza (flu), be that bird, swine or other identified strain, can be found. It is critical that any such disease, when suspected, is brought to the attention of the relevant authorities so that the individual(s) can be appropriately treated and the disease, where confirmed, can be contained to prevent the spread of infection to the wider population. The following website offers Public Health England’s provisional 2014 annual report of notified diseases in England and Wales.
Vaccination coverage is the best indicator of the level of protection a population will have against vaccine preventable communicable diseases (PHE, 2015). A communicable disease is one that can spread from one person to another, or from an animal to a person, by way of airborne viruses or bacteria, or through blood or other bodily fluid. Immunisation is one of the most effective healthcare interventions, preventing illness and admissions to hospital. Population vaccination coverage is closely related to levels of disease, and so monitoring coverage helps to identify potential reductions in immunity before levels of disease rise.
In Derby, the population vaccination coverage (2014/15) for Flu in those aged over 65 years is 74.1%, compared with 72.7% of the national 65 years and over population. The target for vaccination coverage in England is 75%. The population vaccination coverage for those considered “at risk” (pregnant, having certain medical conditions, very overweight, living in a long-stay care facility, in receipt of a carer’s allowance, or a front-line health or social care worker) in Derby is 47.5% (2014/15). This is significantly lower than the England average of 50.3% for that group. Population vaccination coverage is closely related to levels of disease, and so monitoring coverage helps to identify potential reductions in immunity before levels of disease rise. Furthermore, lower immunisation uptake is often seen within the most deprived communities. The latest immunisation data can be found on the gov.uk website, while NICE guidance provides evidence related to increasing immunisation uptake.
Screening is a way of identifying apparently healthy people who may have an increased risk of a particular condition. The NHS offers a range of screening tests to different sections of the population. In England there are 11 screening programmes including screening in pregnancy, types of cancer screening, diabetic eye screening, aortic aneurysm screening and newborn screening. Further information about screening programmes can be found on the gov.uk website, while key performance data for screening can be found on the NHS Screening Programme national data reporting website.