Health and Wellbeing Boards
Health and Wellbeing Boards will own the joint strategic needs assessment (JSNA) and will be responsible for commissioning public health services. Clinical commissioners need to work closely with their local Health and Wellbeing Board on public health issues and so that the clinical commissioning group's strategy ultimately supports delivery of the JSNA and improvement in population health.
A JSNA template has been developed to provide guidance to aid the development of Joint Strategic Needs Assessments and is available in the useful resources section.
Clinical commissioners who focus on improving eye health and preventing sight loss will find a natural ally in the Health and Wellbeing Boards. By encouraging the Health and Wellbeing Boards to make eye care and prevention of sight loss an early priority for public health, clinical commissioning groups will increase the impact of their eye care commissioning strategy.
Health and wellbeing strategies that address the following all also impact on eye health and support prevention of sight loss. The following are examples of links between public health and sight loss:
Smoking: The link between smoking and age-related macular degeneration (AMD), the UK's leading cause of sight loss, is as strong as the link between smoking and lung cancer. Smoking causes harm to the tissues of the eye. Research has confirmed the harmful effects of smoking on eyesight, particularly in the development of AMD and cataracts.
Smokers not only double their risk of developing AMD, they also tend to develop it earlier than non-smokers do. Treatment options for AMD are limited. It has been shown that stopping smoking can reduce the risk of macular degeneration developing. While cataracts are treatable and therefore do not lead to blindness, they remain a major cause of sight loss in the UK. Furthermore, smoking makes diabetes-related sight problems worse.
Obesity: Recent research suggests that obesity may put someone at greater risk of developing certain eye conditions, which can cause sight loss, including:
- diabetic retinopathy - obesity increases the risk of developing type 2 diabetes. Someone with a body mass index (BMI) of over 35 is up to 80 times more likely to develop the condition than someone with a BMI of less than 22.
- age-related macular degeneration (AMD) - obesity may increase the risk of developing dry AMD. Dry AMD is likely to impede the ability to carry out daily activities such as driving, reading a newspaper or watching television. Obesity also increases the speed of progression of AMD.
- cataracts - overweight people can have double the risk of developing cataracts compared to people who are not overweight. Cataracts usually don't lead to blindness as they are treatable.
Diabetes: Poor diabetic control increases the risk of diabetes- related sign problems. Good blood sugar control and good blood pressure control substantially reduce the risk of sight-threatening diabetic retinopathy. For people with type 2 diabetes who have dyslipidaemia, the ACCORD trial has shown that treatment with fenofibrate reduces the likelihood of needing laser treatment by 40%. Strategies that seek to prevent diabetes and improve the quality of diabetes care will help prevent avoidable diabetes related sight loss.
Further information about the links between these public health issues and sight loss can be found in the Royal College of Ophthalmologists Public Health Resources (see useful resources).