Climbing ladders: From treatment to prevention (2025)

Dan did not find his childhood easy, but as it was all he knew, he didn't realise that others weren't faced with the same challenges.

Growing up, his family didn't have much money, and drinking was the main hobby of the men he was around at home.

When his dad Mick accepted support to reduce his alcohol use and stop smoking tobacco, Dan was also offered support from Positive Futures, his local young people's drug and alcohol service, and quit smoking completely - inspired by his dad.

The team at Positive Futures helped Dan express himself with creative activities and to feel safe in sharing his worries about his family. Although Mick was never physically dependent on alcohol, and he never hurt him or his mam after drinking, what Dan witnessed growing up still had an impact on him - it was always hard to see how his dad went from being the life of the party to being at home most days.

Dan was never keen on school, but stayed on until he was 18, as he saw how important money was and wanted to have a well-paid job to make things easier on mam.

He worked hard and as a result was accepted onto an apprenticeship with a large local employer.

He was proud to earn his own money, all while gaining experience and qualifications to progress his career.

Things outside of work were looking up for Dan, too. He met Maya shortly after starting his apprenticeship, and Maya moved into the family home. Although the relationship ended soon after Maya became pregnant, Dan was still keen to be a good dad, but he felt like he lacked the skills and confidence to know how to do it. Support from the North East Young Lads and Dads enabled Dan to have the tools to play an active and meaningful role within Isla's life, and he's keen to keep progressing in his career to support his family as best he can.

The snakes and ladders in Dan's story

Snakes

Adverse Childhood Experience (ACE's) are traumatic events a person experiences in childhood that are strongly linked to poorer health outcomes throughout a person's life. Exposure to harmful alcohol use may lead to lifelong impact, including an increased risk of developing harmful patterns of alcohol use later in life.

Environment - Children and Young People are affected in many ways by parental problematic alcohol use, yet it is an issue that for many remains hidden. Children find strategies to cope with the environment they find themselves in, but this is not the same as developing resilience. Early identification, trusting relationships with professionals, peer support, and a whole family approach have been highlighted as being valued by children. (Silent Voices - assets.childrenscommissioner.gov.uk)

Ladders

Access to services - Dan had access to some key services as a child and young adult which have provided him with the ladders to overcome some of the potential snakes in his life. Early identification of need, and the provision of appropriate 'upstream' services often prevent the need for more intensive support further downstream.

Education and Training- Supporting employment- The services Dan had access to enabled him to make the most of his education Dan stayed at school until he was 18 and then was lucky enough to be accepted onto an apprenticeship with a large local employer. Through this he gained experience and qualifications whilst earning a wage. At the end of his apprenticeship, Dan was kept on by the organisation and is in a really good position to progress his career.  This is important to him as he wants to be able to provide for Isla, even though he and Maya are no longer in a relationship.

Upping prevention 

The Tobacco and Vapes Bill is part of the 10 Year Health Plan for England. From January 2027 it will become illegal to sell tobacco to anyone born after 1 January 2009, creating a smokefree generation, and giving our future generations a life free from cancer causing addiction. (fresh-balance.co.uk)

A life course approach

Using the life course approach ³¹ provides a lens through which to view the range of preventive actions that can be taken at different stages of life, which can create cumulative benefits.

Broadly we can split the life course into three areas where we can intervene:

• Starting well:covers preconception, infancy, early years through to adolescence.
• Living well: covers working age and adults from 16-64 years.
• Ageing well: adults aged 65 and over

If we cross reference the primary, secondary, and tertiary prevention with the life course approach, it allows us to visualise some of the activities and interventions that can help in prevention efforts, though the examples below are a small selection only:

• Starting well:
  • Primary prevention: maternity care, health visiting, childhood vaccinations, school readiness, oral health, school nursing programmes
  • Secondary prevention: Developmental screening, oral health checks.
  • Tertiary prevention: Support for children with complex needs.
• Living well:
  • Primary prevention: Workplace wellbeing, active travel, mental health promotion, community cohesion and resilience
  • Secondary prevention: NHS Health Checks, mental health early intervention, smoking cessation interventions
  • Tertiary prevention: drug and alcohol services, long-term condition management, rehabilitation.
• Ageing well:
  • Primary prevention: mobility and physical activity, falls prevention, social connectivity.
  • Secondary prevention: Dementia screening, dementia friendly communities, frailty assessments.
  • Tertiary prevention: Integrated care for chronic illness.

Gateshead's Health and Wellbeing strategy

In Gateshead, the overarching approach to reducing inequalities and using prevention at a population level is our evidence-based joint local Health and Wellbeing Strategy. It is crucial because it sets out our shared ambition to close the health gap in Gateshead, it is a key enabling partnership strategy, using our collective resources, to drive forward improving health outcomes for everyone.

To achieve our vision, we know the importance of working together, across Gateshead, with communities, breaking down boundaries between organisations and services. The strategy serves as an overarching framework for Health and Wellbeing Board partners, providing a shared vision and strategic direction that helps align the efforts of organisations across the borough.

Our Strategy has been developed and agreed by our strategic partners. It is delivered with the different organisations in the Gateshead Health and Wellbeing Board through all our combined existing strategies, policies, and plans, with our health and wellbeing vision and principles embedded in everything we do. The Strategy recognises that our health and wellbeing are shaped by the world around us. Building a healthy society is like constructing a strong and sturdy building. We need the right building blocks in place. Building blocks like good jobs, safe homes and neighbourhoods, good quality and easy-to-access services, supportive friends, and families and more.

It is useful to cross-reference Marmot's Policy Objectives with relevant Building Blocks to help visualise where action should focus:

1. Give every child the best start in life

• Building blocks: Income, education, housing
• Actions: Expand early years programmes, tackle child poverty, parenting support, school readiness.

2.Enable all children, young people and adults to maximise capabilities 

• Building blocks: Education, social connections
• Actions: Improve educational attainment and digital inclusion, skills development, youth engagement

3. Create fair employment and good work for all  

• Building blocks: Work, transport
• Actions: Target insecure work and unemployment in deprived wards, local employment initiatives, workplace health

4. Ensure a healthy standard of living for all  

• Building blocks: Income, food, housing
• Actions: Reduce food insecurity and fuel poverty, tackling poverty, housing quality, food security

5. Create and develop healthy and sustainable places and communities 

• Building blocks: Housing, environment, transport
• Actions: Invest in active travel infrastructure and green spaces; improve housing quality

6. Strengthen the role and impact of ill-health prevention  

• Building blocks: Education, social connections
• Actions: Improve educational attainment and digital inclusion, skills development, youth engagement

7. Tackle racism, discrimination, and their outcomes   

• Building blocks: Social connections, education
• Actions: Embed equity audits and cultural competence in services, inclusive services

8. Pursue environmental sustainability and health equity  

• Building blocks: Environment
• Actions: Embed climate resilience in health planning, energy efficiency, sustainable food systems

Health and wellbeing in all policies

Taking a Health and Wellbeing in All Policies' (HiAP) means making the most of every opportunity to improve health and reduce inequalities by considering how decisions in any area affect people's health and wellbeing. It is most effective when different organisations, services and sectors work together. It is a well-established established approach, formally supported by the World Health Organisation.

A HiAP approach enables councils and other local organisations to take preventative action by recognising that many of the most important building blocks of health - such as housing, transport, planning, education, green space, licensing, and economic development - sit outside the traditional health sector. By systematically considering the health and wellbeing implications of decisions made across system and place-based partners, we can seek to maximise health and wellbeing, reduce avoidable illness, and narrow health inequalities at the earliest stage.

Embedding HiAP within Gateshead Council is strengthening prevention at organisational level. We want to make sure that every strategic decision - from urban planning to social care commissioning - actively contributes to a healthier population and reduces future demand on services.