Prevention is the ‘golden thread’ that runs through the Better Lives Lincolnshire strategy and underpins its focus on improving health and wellbeing and tackling inequalities. A person’s physical and mental health and wellbeing are influenced throughout life by a diverse range of social, economic and environmental factors, collectively known as “the wider determinants of health”. Across the Lincolnshire health and care system there is widespread commitment to ensuring prevention is at the heart of our work, and acknowledgement that all organisations regardless of size or sector have their part to play in supporting our population.

Addressing the wider determinants of health will help improve overall health by helping to improve the conditions into which people are born, live and work. Addressing these determinants throughout the life course allows us to consider the critical stages, transitions, and settings where large differences can be made in promoting or restoring health and wellbeing. This life course approach underpins how we plan to deliver the priorities set out in the Joint Health and Wellbeing Strategy (JHWS).

We recognise that there are a wide range of protective and risk factors that interplay in health and wellbeing over the life course. By altering policies, environments, and societal norms, inequalities that affect health during the life course can be reduced – an approach shown to benefit the whole population, both now, and in the future.

This means, taking action: to protect and promote health promptly, especially during important transition periods, and appropriately across the life course. By creating healthy environments and improving conditions of daily life together as a society, we will see a reduction in health inequalities throughout the life course. Our delivery of this enabler will focus around four themes:

Theme 1: Preconception, infancy, and early years (0 to 5 years)

Theme 2: Childhood and adolescence (5 to 19 years)

Theme 3: Working age (16 to 64 years)

Theme 4: Ageing well.

What happens during pregnancy, and the first few years of life influences physical, cognitive, and emotional development in childhood and may influence health and wellbeing outcomes in later life. In addition to the critical events that shape an individual’s health trajectory, the number and sequence of exposures to risk and periods of increased susceptibility, some of which occur before birth or are genetically inherited, are also crucial. The preconception stage presents an opportunity for professionals to encourage women and men to adopt healthier behaviours in preparation for a successful pregnancy and positive health outcomes for both them and their child.

We will therefore focus on interventions such as:

• Being aware of screening before or during pregnancy.
• Being up to date with all vaccinations before and during pregnancy.
• Taking folic acid supplements.
• Eating a healthy diet and being physically active.
• Giving up smoking, and reducing or stopping alcohol consumption.
• Expanding oral health promotion activities.

The earliest years of life set the tone for the whole of the lifespan. There is strong evidence that intervening in the first 1,001 days of a child’s life can make a difference over their whole lifetime. During this period, the brain displays a remarkable capacity to absorb information and adapt to its surroundings. Positive early experiences are therefore vital to ensure children are ready to learn, ready for school and have good life chances. It is shaped by several factors such as sensitive attuned parenting, effects of socio-economic status and the impact of high-quality early education and care. Improving children and young peoples’ mental wellbeing has a positive effect on their cognitive development, learning, physical health, and their mental health, social and economic prospects in adulthood. It is known that poor social and emotional wellbeing in young children can lead to behaviour and developmental problems and, later in childhood severe depression, anxiety, self-harm and other poor mental health outcomes.

The areas we will focus interventions on include:

• Increase the uptake of infant and early childhood vaccinations.
• Improve speech, language and communication skills in the under 5s.
• Prioritise early intervention with additional investment in children’s centres and family hubs.

Children and young people face many new challenges and experiences as they grow and develop. Growing up includes experimenting and trying new things, but adolescence can be a very difficult time for some. We know that approximately one in seven young people experience at least one mental disorder, while emotional disorders – such as anxiety and depression – are commonplace. If left unaddressed, these problems often persist into adulthood. Adolescence, defined as the transitional phase between childhood and adulthood, is a time when young people begin developing habits that will carry over into adulthood. Healthy behaviours initiated in childhood, such as physical activity and healthy nutrition, should be maintained during adolescence.

Considering this, we will focus our interventions on:

• Tackling vulnerabilities and adverse childhood events (ACEs) and safeguarding children
• Improving educational attainment.
• Increase the uptake of primary and secondary school-age vaccination.
• Increase motivation, confidence, and physical competence in relation to physical activity.
• Supporting young people’s mental health and emotional wellbeing.
• Tackling tobacco, alcohol and drug use.
• Reducing the number of teenage pregnancies and improving outcomes for young parents and their children.

Emphasis on healthy behaviours does not end after a good start in life – it is equally important to make good choices and behaviours at later stages of the life, too. Adulthood is an important time for building assets, reducing risks and for intervening early. Adult life is a time of significant opportunity to build resilience for older age, to reinforce the improvement in skills and individual empowerment provided by a good start, but also to achieve greater health equity among the existing adult population. In particular, it is essential to reduce stress at work, reduce long term unemployment through active labour market programmes, and address the causes of social isolation. Professionals can ensure that they “make every contact count” (MECC)*, using everyday interactions to support people in making positive changes to their physical and mental health and wellbeing, as well as promoting services such as the NHS Health Check.

The NHS Health Check offers the opportunity to assess the top seven risk factors that drive premature death and disability in England for the 15 million people in midlife. Risk factors include: pulse rhythm, blood pressure and cholesterol levels. Patients are supported to understand their risk of cardiovascular disease (CVD) and make positive behavioural changes that can prevent and delay the onset of CVD. For example, everyone having an NHS Health Check should benefit from personalised support and, where appropriate, access to services such as stop smoking, weight management, physical activity, alcohol support or diabetes prevention.

Our interventions will focus on:

• Working with employers to develop a healthier, highly skilled workforce.
• Improving wellbeing and mental health.
• Preventing musculoskeletal (MSK) conditions by helping people stay fit, active and healthy.
• Improving uptake of screening 7. 

*Make Every Contact Count (MECC) is an approach to behaviour change that uses the day-to-day interactions that health and social care staff have with people to support them in making positive changes to their physical and mental health and wellbeing.

There has been a steady increase in average life expectancy in recent decades, a positive public health success story. However, increases have slowed considerably since 2011. Longer lives benefit society in many ways; financially, socially and culturally, because older people have skills, knowledge and experience that benefit the wider population. There is an opportunity to better utilise increased longevity as a valuable resource – challenging ageism and the view that retirement is about ‘sitting more and moving less’. The older a person is, the more likely they are to experience chronic disease and disability, of body and brain. As life expectancy rises, we must promote the concept of productive healthy ageing; improved health and wellbeing, increased independence and resilience to adversity, the ability to be financially secure through work and accumulation of resources, engagement in social activities, being socially connected with enhanced friendships and support and enjoying life in good health.

We will focus interventions on areas that include:

• Improving access to gainful employment.
• Protecting health by improving housing and the built environment.
• Increasing awareness and uptake of vaccinations.
• Maintaining functional ability for healthy brain and body.
• Preventing falls, preventing loneliness and social isolation.