Transcript Slide 1

Health & Wellbeing in Oldham
Alan Higgins
Director of Public Health
Oldham
Health & Wellbeing in Oldham
• How does Oldham rate for Health &
Wellbeing?
• Why is it worse than other places?
• What can we do to make it better?
Factors that Impact on
Health & Wellbeing
• Fixed – Gender, age, ethnicity, genetics
• Social & Economic – Poverty, employment,
education, income, social exclusion
• Environment – Housing, water & air quality,
transport, crime.
• Lifestyle – Smoking, physical inactivity, diet,
alcohol.
• Access to clinical services – Availability of
services, accessibility, effectiveness of
interventions.
Life Expectancy
Male Life Expectancy at Birth in Oldham
20% MOST DEPRIVED
Gap in Life Expectancy (years)
Most deprived
REST OF OLDHAM
76.1
Least Deprived
85.1
England
80.2
9.6
74.0
75.5
10.1
71.8
70.1
70.4
Males
1999-2003
2005-2009
Source: Primary Care Mortality Database (Open Exeter) and PHBF and ONS mid year population
estimates
REST OF OLDHAM
80.4
Source: Primary Care Mortality Database (Open Exeter) and PHBF and ONS mid year population
estimates
Life Expectancy
Female Life Expectancy at Birth in Oldham
20% MOST DEPRIVED
Females
England
79.3
77.4
 Life Expectancy has been steadily increasing across
Oldham over the last 10 years, but the gap between
Oldham and England does not appear to be narrowing.
 Oldham experiences the 13th worst life expectancy in
England
76.5
 Oldham has a diverse range of communities from the
very affluent to the very deprived and this will therefore
always produce wide inequalities in health outcomes.
1999-2003
2005-2009
Source: Primary Care Mortality Database (Open Exeter) and PHBF and ONS mid year population
estimates
Please note: Denominators for life expectancy used 2001 and 2007 respectively mid year
population estimates for wards.
Life expectancy (Oldham)
CVD
Prevalence
Disease Management
Smoking Prevalence (%) 2006/08
Controlled Cholesterol (%) 2009/10
82.7%
28.0%
23.6%
22.2%
82.1%
81.8%
Oldham
North West
England
% adults, modelled estimate using Health Survey for England 20062008
Obesity Prevalence (%) 2006/08
Oldham
North West
 The Health Checks will help
identify missing CVD patients
Controlled Blood Pressure (%) 2009/10
90.0%
23.8%
Oldham
Local health profiles 2010
North West
Oldham
QOF: CHD 2009/10
 CVD contributes 31% to
life expectancy gap
 Programme Budgeting Spend
for CVD in 2009/10 was
£33.7 million
89.0%
England
Around 700 people die
across Oldham
each year from CVD
related conditions
England
89.8%
23.4%

 Oldham has a higher rate of
deaths in people under 75
than the national average
QOF: CHD 2009/10
24.2%
Outcomes
North West
England
Cancer
Screening
Incidence
% Breast Screening Coverage by Age Group for 3 year
Period Ending May 2010
Under 75 All Cancer Type Incidence DSR 2006-08
398.71
Outcomes
74.1
Cancer Mortality Rates in People under 75 years
(2006/08)
73.3
127.08
137.09
113.96
399.6
DSR per 100,000
40.7
390.41
50-52
53-64
England
65-70
North West
Oldham
Age group
% Cervical Screening Coverage by Age Group for 3 year Period
Ending September 2010
England
North West
Oldham
% screened 3 years
90
80
70
Proportion of Cancer Patients Dying at Home
(2009)
% screened 5 years
79.3
75.4
69.3
60
 Cancer contributes 28% to the life
expectancy gap
46.9
50
40
45%
 Around 560 people die in Oldham
each year from Cancer
30
20
31%
10
0
24%
25-49
 Programme budgeting spend
for
Cancer in 2009/10 was £27.26
million
50-64
Uptake of Bowel Cancer Screening Programme
53
52
Hospice
Hospital
Information sources:
NCIS cancer registry
LASCA: breast screening coverage
Primary care mortality database (Open Exeter)
51
percentage
Home
50
49
48
Oldham
North West
England
 Early diagnosis is key to
survival rates
47
46
45
44
 NHS screening programmes
save lives, it is therefore
important to increase
screening
uptake
COPD
Disease Management
Prevalence
Smoking Prevalence (%) 2006/08
28.0%
23.6%
Percentage of Patients with a record of FeV1 in
the last 15 months (2009/10)
Outcomes
 Around 336 people die from
COPD in Oldham a year
90.8
22.2%
 COPD is strongly related to
smoking
88.5
86.9
Oldham
North West
England
Oldham
Actual vs Predicted Prevalence of COPD in Oldham
2009/10
Actual COPD Prevalence 09/10
 It is estimated that over 4000
people are missing off the
COPD register
North West
England
Successful Quiiters by Deprivation Quintile
(2009/10)
Predicted COPD prevalence 2010
28.55%
22.42%
 COPD contributes 5% to the
life expectancy gap
22.18%
5%
15.53%
3.70%
1.9%
1.60%
Oldham
England
 Programme Budgeting spend
for respiratory disease in
2009/10 was 25.9 million
11.33%
Most Deprived
2
Source: QOF data: Information Centre and ERPHO predicted prevalence
modelling
NCHO and Primary Care mortality database
OCHS Stop Smoking Service
3
4
Least Deprived
 Increasing smoking quitters in
wards with the highest
smoking prevalence will have
high impact on COPD
outcomes
Mental Health
% of people that suffered from nervous trouble or depression in the last
12 months
Depression Prevalence 2009/10 (%)
12.5%
11.7%
10.9%
Oldham
North West
England
Prevalence of Registered Mental Illness (2009/10)
Alexandra
Shaw
St James'
Werneth
Hollinwood
Chadderton South
Waterhead
Failsworth West
Medlock Vale
Coldhurst
Oldham
Saddleworth South
St Mary's
Failsworth East
Saddleworth North
Royton South
Chadderton North
Royton North
Crompton
Chadderton Central
Saddleworth West and Lees
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
0.87%
0.63%
20% most deprived
QOF 2009/10
You and Your Community Survey 2010
rest of Oldham
 It is estimated that around 17,000
people are registered with depression
in Oldham
 Programme budgeting spend
on all mental health conditions
in 2009/10 was £5.1 million
 Recent local survey results show a
correlation between mental distress
and financial circumstances
 Programme budgeting spend is
low in comparison to peer
groups and overall need.
 There are approximately 2,400 people
over 65 with dementia in Oldham
 Of the people known to have a
mental health condition only
12% are estimated to have
been referred to psychological
therapies
 By 2020 there will be an estimated
22% increase in people age over 65
 Over the past 12 months the
spend on dementia drugs was
over £546k

Over the past 12 months the
spend on anti-depressants
across Oldham was over £947k
Smoking
Prevalence
Management
Smoking Prevalence (%) 2006/08
Successful Quiiters by Deprivation Quintile
(2009/10)
28.0%
23.6%
Outcomes
28.55%
22.2%
22.42%
22.18%
15.53%
11.33%
Oldham
North West
England
Most Deprived
2
3
4
Least Deprived
 Smoking is the single biggest cause of preventable illness and death in the UK
 Around 410 people die each year from smoking attributable conditions across Oldham
 It is estimated that 49,000 people smoke in Oldham (28%) of the population
 Widening access to stop smoking interventions is essential if we are to increase
quitters across Oldham
smoking
Information sources:
% adults, modelled estimate using Health Survey for England 2006-2008
Oldham’s JSNA 2010
Stop smoking Services Oldham
Obesity
Management
Prevalence
Percentage of Year 6 aged Children Obese
(2008/09)
19.2%
18.8%
In Children
 Targeting parents and children-family
based interventions
18.3%
 Multi-faceted family based behaviour
modification programmes
England
Northwest
Outcomes
 It is estimated that 41,000 adults
in Oldham are obese
 Obesity increases the risk of
diabetes, CHD, hypertension ,
osteoarthritis and some cancers
Oldham
 Support in the use of laboratory based
exercise programmes
In Adults
 People who are obese die on
average 9 years earlier than
those
of normal weight
Obesity Prevalence (%) 2006/08
24.2%
23.8%
 Dietary interventions
 Clinically prescribed low calorie diets
 Excess deaths (2009) among
people with diabetes type II
across Oldham was 156
23.4%
 Increased physical activity programmes
Oldham
North West
England
Source: NCMP childhood obesity database,
Local Health profiles: APHO 2010)
NICE
 Behaviour modification interventions
 Determining the cause of obesity
is the key to tackling it
Physical Activity
Management
Prevalence
Adult participation in 30 minutes moderate intensity
sport
18%
 Increased physical activity
programmes
 Increased active travel through
urban and rural planning
16%
14%
 Develop and maintain public
open spaces that are safe
and accessible and encourage
physical activity.
12%
10%
8%
6%
4%
2%
0%
2005-06
2007-08
Oldham
North West
2008-09
National
 For most people, the easiest and
most acceptable forms of physical
activity are those that can be
incorporated into everyday life
Outcomes
 It is estimated that around 28.3
thousand adults participate in sport
across Oldham
 Currently 63% of men and 76% of
women are not physically active
enough to meet national
guidelines
 Obesity is strongly linked to physical
activity
 Is effective in the treatment of
clinical depression and has
benefits for mental health
 20-30 % reduced risk of
premature death and up to 50%
reduced risk of major chronic
disease
 Levels of walking and cycling
have fallen in the last decade
Source: Sport England's Active People Survey
and The Child Health Profiles for England
2010
 Children are also increasingly
sedentary
Alcohol
Outcomes
Prevalence
Synthetic Estimates of Binge Drinking (2007/08
Emergency Hospital Admission Rates (DSR) for
Alcohol 2006/09
27.2%
650.02
23.3%
19.3%
 Over 38 thousand people are
estimated to drink unsafely
370.28
Oldham
20% most deprived
1,500
North West
Source: NWPHO Alcohol profiles 2010
Oldham
 Oldham has significantly
higher hospital admission
rates for people under 18yrs
than the England average
1,000
500
Oldham
Source: NI39 NWPHO
North West
2009/10
2008/09
2007/08
2002/03
20.1%
2,000
2006/07
22.1%
2,500
2005/06
22.5%
Admission rate for alcohol-related harm
per 100,000 population
2004/05
Percentage of 'increasing risk' drinking (synthetic
estimate) 2005
England
 Digestive disorders are on
the
increase
Rest of Oldham
Source: SUS/CDS through NHS Oldham data warehouse
Source: NWPHO Alcohol profiles 2010
2003/04
North West
DSR per 100,000 population
England
 40 deaths occurred
across Oldham in 2009
that were directly attributable
to alcohol
England
 It is clear from the data that
people from deprived areas
are more likely to be admitted
to hospital for alcohol related
conditions
How does Oldham rate?
• Generally worse
– Life expectancy, mortality statistics, morbidity
statistics
– Health is better than it was but……
– MIND THE GAP
Why is it worse than other places?
• Near determinants
– Lifestyle factors
• Main determinants
–
–
–
–
Poverty
Inequality in income
Education
Environment
What should we do to make it better?
• If it was easy…..
• Good performance on
–
–
–
–
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Smoking cessation
Childhood immunisation
Teenage pregnancy
Chlamydia screening
Smoking in pregnancy
• Success is more likely from combined impact of
complementary programmes.
The Social Prescription
• Give every child the best start in life
• Enable everyone to maximise their capabilities and
control over their lives.
• Create fair employment and good work for all.
• Ensure healthy standard of living for all.
• Develop healthy and sustainable places and
communities.
• Strengthen the role and impact of ill health prevention.