Public Health Annual Report 2014 Inequalities in Health

Public Health Annual Report 2014 Inequalities in Health

Public Health Annual Report 2014 Inequalities in Health in Worcestershire Report Summary and Conclusions Public Health Annual Report 2014 Why a DPH Report? Public Health Annual Reports remain a statutory requirement Personal assessment and my opportunity as DPH to present the state of the Countys areas health and highlight key issues Aim to stimulate discussion and debate, and influence organisations and individuals to take action Public Health Annual Report 2014 Why health inequalities? Variations that cannot be explained by biological factors such as age, sex or genetic inheritance alone Poor health in certain groups is not inevitable, it is a consequence of people's circumstances and choices. These can be influenced with action by statutory agencies, businesses, communities, families and individuals

Economic case Productivity loss Welfare costs Healthcare costs Social justice case Most deprived lose 17 years of disability free life expectancy compared to most affluent Tackling inequalities benefits all There is a gradient in health The costs fall to all of us Public Health Annual Report 2014 Background Overall health in Worcestershire is good Life expectancy and healthy life expectancy are significantly above average Mortality from common and preventable causes is low These overall figures mask differences between areas and groups The Annual Report in 2008 examined these across Worcestershire The Marmot report into health inequalities has since been published This years report: Examines progress since 2008

Reviews action against the Marmot recommendations Public Health Annual Report 2014 Overall health inequalities in Worcestershire Slope Index of Inequality is the gradient of life expectancy across deprivation groups Life expectancy by IMD decile 2007-2009 2011-2013 90 Changed little in the last 4 years 85 This means life expectancy has 80 increased similarly across whole population 75

70 0% Public Health Annual Report 2014 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Perecentage of Population Overall health inequalities in Worcestershire Under 75 death rate is a more sensitive indicator Bigger reductions in more deprived groups Public Health Annual Report 2014 Under 75 death rate by IMD decile Overall health inequalities in Worcestershire Under 75 mortality across all LSOAs Shows that the biggest reduction in early mortality is in the most

deprived groups 2011-2013 2007-2009 6,000 5,000 4,000 3,000 2,000 1,000 0 Public Health Annual Report 2014 Super Output Area Rank Health hotspots

Methodology takes data at LSOA level Overall Index of Multiple Deprivation for 2010 (IMD 2010) The health component of the IMD 2010 All cause mortality aged under 75 Mortality from causes amenable to healthcare aged under 75 Largely the same as they were in 2008. Main changes in expansion of some and emergence of a few new areas Comberton West Redditch (formerly Abbey, Batchley and Central) Ronkswood and Nunnery (formerly just Nunnery) Westlands now includes Berry Hill Greenhill and Broadwaters includes more of these areas Two rural hotspots North Wyre Forest Deblin's Green & Madresfield Public Health Annual Report 2014 Worcestershire Health Hotspots 2014 Public Health Annual Report 2014

Under 75 Mortality in Hotspot Areas 2007-2009 1,000 900 800 700 600 500 400 300 200 100 0 Public Health Annual Report 2014 2011-2013 1,000 900 800 700 600 500 400 300 200

100 0 Give every child the best start in life Health inequalities and Level of development IMD quintile contributing factors can be identified from birth more likely to have mothers who are younger and who smoke, drink and/ or are overweight Through early development disadvantages widen By school they are much more likely to have poor levels of development Public Health Annual Report 2014 80 74.9 70

69.8 % of children achieving a good level of development Babies from deprived areas are Early Years Foundation Stage 60 50 61.2 51.4 53.4 40 30 20 10 0 1 (Most deprived) 2 3 4

5 (Least deprived) Enable all children, young people and adults to maximise their capabilities and have control over their lives Health inequalities persist during school years Shows as differences in educational achievement Those living in deprived areas are far more likely To have special educational needs To be excluded from school To be subject to child protection plans They are also more likely to Have excess weight Attend A&E Require emergency hospital treatment Have mental health problems requiring CAMHS Public Health Annual Report 2014 Educational achievement by IMD quintile Enable all children, young people and adults to maximise their capabilities and have control over their lives

Inequalities in baseline achievement persist through school Difference in percentage achievement between most deprived and least deprived is around 33% in KS1 maths and 32% in KS4 5 GCSEs Inequalities in high achievement get worse Difference in KS1 Writing achievement is 50% At KS2 level 5 achievement it is 124% In KS5 it is over 300% Educational achievement by IMD quintile 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Foundation Stage Key Stage 1 Maths

(Level 2b) Key Stage 2 English & Maths (Level 4) Key Stage 4 GCSEs 1 2 3 4 5 350% 300% Foundation Stage 250% 200% Key Stage 1 Writing (Level 2b) 150%

Key Stage 2 English & Maths (Level 5) 100% Key Stage 5 50% 0% 1 Public Health Annual Report 2014 2 3 4 5 Create fair employment and good work for all Overall unemployment in Worcestershire is low (2.2%)

Some wards are higher (6.6%) Unemployment rose after 2008 but has been falling recently The proportion long-term unemployed has increased There is a strong association between areas of high unemployment and poor health outcomes Public Health Annual Report 2014 % medium & long term unemployed by time Ensure a healthy standard of living for all There is an association between income and health outcomes Worcester has relatively few low income households However, these are fairly concentrated In the 20% most deprived areas 37% of

children are classed as living in poverty In the 20% least deprived it is just 5% Public Health Annual Report 2014 Death rate under 75 by ward & household income Creating Healthy and Sustainable Communities Worcestershire has a healthy environment Lots of green spaces Low levels of poor air quality There are small pockets where these are not so good These tend to be the areas of higher deprivation The same areas also have Lower levels of satisfaction Lower levels of feelings of belonging Public Health Annual Report 2014 Feeling of belonging to local area by IMD Quintile

Strengthen the role and impact of ill health prevention A small number of conditions cause the Smoking Poor diet Physical inactivity Drinking too much alcohol 40% Worcester Walk-in Centre 35% Smoking prevalence based on all those aged 15 and over who were eligible majority of premature death and ill health These are all linked to health related behaviours Smoking prevalence by GP practice & deprivation Recent improvements nationally in lifestyles have mostly been in more affluent groups Worcestershire follows this pattern: people in

the most deprived areas are more likely to have one or more unhealthy behaviours Public Health Annual Report 2014 30% R = 0.7675 25% 20% 15% 10% 5% 0% 0 5 10 15 20 25 Average Deprivation Score (IMD 2010) 30 35

Conclusion Health inequalities in Worcestershire have reduced But some persist and have complex causes We know that working together we can make a difference The public sector cant solve the problem alone And pouring more and more resources into deprived areas is neither sustainable or desirable We need an asset-based approach, building on what communities have rather than focusing on what they lack This is consistent with the Boards principles of Partnership, Empowerment and Local Action Public Health Annual Report 2014 Reports Recommendations 1. Intensive ongoing support for vulnerable families 2. Intensive focus on early years development in priority areas 3.

Employment opportunities in priority areas 4. Change to a place & asset-based approach to commissioning 5. Strengthen and improve prevention of ill-health Public Health Annual Report 2014

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