1. Living in Tower Hamlets
Findings and Conclusions from Tower Hamlets JSNA
Presentation to HWB Strategy Subgroup
Dr Somen Banerjee, DPH
3rd April, 2012

2. What is Health?
‘Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’ WHO Constitution, 1946

3. What makes for a healthy life?
Throughout life
Having an income that is enough for healthy living
Living in quality housing
Living in an environment that supports health
Having strong social networks
Living in a place with a sense of community
Staying fit, eating healthily, sensible drinking
Living in a place with high quality public services
Being born
The health of your mother
High quality maternity services
Growing up
Good parenting
High quality preschool provision
High quality education
Being an adult
A sense of control of one’s life
Secure and decent employment
Growing old
Staying fit and eating healthily
Maintaining strong family and social relations
Services that are integrated and built around your needs

4. What will improve health?
Giving every child the best possible start in life
Enabling all to make the most of their capabilities and have control over their lives
Creating fair employment and good work for all
Ensuring a healthy standard of living for all
Creating and developing healthy and sustainable places and communities
Strengthen the role and impact of ill-health prevention

5. What will make this happen?
Getting vision and strategy clear
High level strategic engagement across the partnership
Making partnership work at all levels
Doing things systematically and at the right scale
Getting the workforce right
Identifying the missing thousands
Meaningful and systematic community engagement
Being ambitious about achievement overall and for those in greatest need
Being driven by high quality information

6. Simplifying the approach..
Tower Hamlets
People
Place
Life in Tower Hamlets
Being born
Growing up – early years
Growing up – childhood and adolescence
Being an adult
Growing old

7. People in Tower Hamlets
Headlines
Determinants
Evidence of effective intervention
Strategy
Conclusions
Life expectancy remains lower than rest of country but continues to improve:
Male life expectancy 75.3 years compared to 77 years nationally
Female life expectancy 80.4 years compared to 81.1 years nationally
Life expectancy gap between least and most deprived deprivation is 11.2 years in males and 6.5 in females
Amonst highest emergency admission and lowest elective rates in London
Growing population (expected to increase by in 5 years from 242,000 in 2010)
Young population (37% aged cf 27% E)
High population churn (24% around, into or out of borough/ year)
51% non white (34% Bangadeshi)
33% families live on income less than £20,000 (22% E)
12% working age unemployed (9% L)
3.7% provide 20 hr or more unpaid care (50% provide 50 hrs +)
Marmot review
Give every child the best possible start in life
Enable all to maximise capabilities and have control over their lives
Create fair employment and good work for all
Ensure health standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen role and impact of ill-health protection
Community Plan and all that sits under it
‘Reducing the inequalities and poverty that we see all around us, strengthening cohesion and making sure our communities live well together’
Tower Hamlets Community Plan, One Tower Hamlets Vision
Encouraging that life expectancy continues to increase but inequality persists
The major vehicle for improving health and wellbeing in the long term is the community plan through its impact on wider determinants – imperative to continually evaluate its impact on health and wellbeing and threats to delivery
Current economic climate and welfare reform will impact on physical and mental health

8. Tower Hamlets as a place
Headlines
Determinants
Evidence base for effective intervention
Strategy
Conclusions
Ward life expectancy varies by 8 years in males and 6 years in females
The clearest difference is between the two most affluent wards and the variation is less marked between the other 15 wards
3rd highest rate of people killed or seriously injured on the roads in London
16 of 17 wards in 20% most deprived wards (12 in lowest 5%)
54% living in social housing compared to 37% in London
Higher levels of overcrowding
Substantial housing growth
1.1 hectares green space per 100 people compared to 2.4 nationally
42 fast food outlets per secondary school(2nd highest in London)
46% residents perceive high levels ASB (27% L)
Create and develop healthy and sustainable places and communities
Improve active travel
Improve availability of green spaces
Improve food environment
Integrate planning, transport, housing, environmental and health systems to address social determinants of health in locality
Support community regeneration in increase participation and reduce isolation
Community Plan and all that sits under it
Particularly:
Localisation agenda
Local Development Framework
Housing strategy
GP networks
CHS localisation
The Local Development Framework is a major vehicle for shaping Tower Hamlets into a place that builds health and wellbeing into everyday life - it is critical that health and wellbeing impacts are factored into signficant developments in the borough
There is a significant opportunity to drive more integrated and innovative working at the locality level between the NHS and LA as both move towards more locality and sublocality planning arrangements

9. Being born in Tower Hamlets
Headlines
Determinants
Evidence base for effective intervention
Strategy
Conclusions
Infant mortality not significantly different to London (4.4 per 1000 live births < 1 year)
Higher percentage of low birth weight babies to London (9% compare to 7.5%)
High deprivation linked to low birth weight
45% of births to Bangladeshi mothers
3.3% smoke in pregnancy but 16% white mothers
Substance misuse, problem drinking, poor diet , poor mental health general issues
17% reduction teenage pregnancy since 1998 (now average for London)
Average early access to maternity services (improving but only 65%), patient experience issue
Ensure women have adequate income in pregnancy to maintain health and nutrition
Access to strong midwifery workforce ensuring early access and avoiding unnecessary intervention
Address behavioural risk factors eg smoking, diet, substance misuse
Intensive home visiting programmes during and after pregnancy
Community Plan
Children and Young Peoples Plan
Healthy Improvement Strategy for Maternity Services
Antenatal elements:
HWHL
Tobacco Control
Substance Misuse
Child Death Overview Panel
The evidenc e base highlights the importance of the prenatal period for future health
Whilst overall there is encouraging progress eg early access, improvements in patient experience and birth outcomes are relatively good, this could mask particularly poor outcomes in certain population segments
Equality impact assessment is therefore essential in monitoring outcomes

10. Growing up in Tower Hamlets Early years
Headlines
Determinants
Evidence base for effective intervention
Strategy
Conclusions
By the age of 5 only 46% of Tower Hamlets infants have achieved a good level of cognitive development compared to 56% nationally
13.3% are obese - 7th highest in the country
39% have experience of tooth decay compared to 31% nationally - declining
55% children in Tower Hamlets classified as living in poverty
80% mothers initiate breast feeding at birth and 68% are still breast feeding at 6-8 weeks (cf 72% and 45% England)
Immunisation uptake in under 5s is amongst the highest in the country (94% have second dose MMR)
40% of under 16s are estimated to have Vit D deficiency
Early years experience has lifelong effect on health and wellbeing
Supporting families to achieve improvement in early child development
Providing good quality early education and childcare
Good nutrition important for future health: breast feeding, good feeding practices
Benefits of childhood immunisation far outweigh any adverse effects
Community Plan
Children and Young Peoples Plan
Healthy Improvement Strategy for Maternity Services
Immunisation Action Plan
Early years elements:
Healthy Weight, Healthy Lives
Tobacco Control
Substance Misuse
The Marmot review is unequivocal in stating the critical importance and need to prioritise early years.
Despite some encouraging outcomes, there is strong evidence Tower Hamlets infants have outcomes at age 5 that are linked to poorer health and wellbeing outcomes in later life.
Good early education, access to childcare and support to family are evidence based interventions to give Tower Hamlets infants the best start in life

11. Growing up in Tower Hamlets Children and Young People
Headlines
Determinants
Evidence base for effective intervention
Strategy
Conclusions
25.7% year olds are obese (3rd highest in the country) - plateaued
8th highest incidence of sexually transmitted infections in the country
2nd highest rate of injuries (deliberate and unintentional) to children and young people
17% reduction teenage pregnancy since 1998 (now average for London)
1 in 10 children are estimated to have a mental health disorder
55% children in Tower Hamlets classified as living in poverty
52% pupils entitled to free school meals (highest in country)
Improvement at key stages 1, 2 and 4 to above national average
49% pupils (yrs 1-13) participate in at least 3hrs high quality PE/Sport in week (69% nationally)
1 in 5 children under 15 have tried a cigarette 3 in 10 an alcoholic drink by age 15
Extending the role of schools in support families and communities
Developing schools-based workforce to support the health and wellbeing of children
Support and advice for year olds on life skills, training and employment
Whole systems approaches to tackling obesity
Peer led approaches in supporting behaviour change
Health/social care tailored to CYP needs
Community Plan
Children and Young Peoples Plan
CYP elements
HWHL
TH Healthy Borough
Tobacco Control
Substance Misuse
Sexual Health
Educational attainment is a major determinant of health. The improvement in educational outcomes in Tower Hamlets is a fantastic achievement in the context of the levels of child poverty in the Borough
It is good news that the rise in childhood obesity in plateauing but it remains 1 in 4
There have been improvements in the extent to which schools have promoted health within schools but there remains significant scope for further improvement

12. Being an adult in Tower Hamlets
Headlines
Determinants
Evidence base for effective intervention
Strategy
Conclusions
Amongst the highest premature death rates from the major killers in London
3rd highest CVD
Highest Cancer
5th highest COPD
12,000 adults with diabetes and increasing (17,000 by 2020)
Amongst highest rates of HIV, TB and sexually transmitted infections
5th highest admission rates for mental health reasons in London
Levels of long term illness/disability 34% higher than national average (2001 census)
People and place factors outlined previously
27% smokers compared (21%)
43% drinkers (50%) have hazardous or harmful patterns (21%)
68% do not do recommended levels physical activity (68%)
88% do consume recommended 5 a day (70%)
Highest rate of problem drug users (23/1000 cf 12/1000)
Improving health and social care outcomes
Addressing wider determinants of health
Environmental intervention to make healthy living easier
Structured behavioural change programmes
Screening /early awareness programmes
At risk/ disease registers providing systematic, person centred care
Structured rehabilitation programmes
High quality health and social care services
Community Plan/ Improving HWB strategy
Healthy Lives Strategy:
Tobacco control, Healthy Weight, Health Lives (obesity),
Tower Hamlets Healthy Borough, Substance Misuse, Sexual Health
Health and social care:
Transforming Adult Social Care,
Primary Care Investment Programme Care Closer to Home, Cancer Strategy, Mental Health Whole System review, Carers Strategy
Sustaining peoples income, housing and employment through the economic downturn is a critical health intervention
Remains scope to further embed healthy lifestyles into frontline services and target at risk groups
Successful implementation of new substance misuse strategy
Improving health and wellbeing strategy needs to be refreshed
Care packages
Prevention emphasis
Personalisation
Integration

13. Growing old in Tower Hamlets
Headlines
Determinants
Evidence base for effective intervention
Strategy
Conclusions
56% of year olds report long term limiting illness compared to 48% nationally
80% of over 65s have at least one chronic condition of which 35% have at least 3 comorbid conditions
Underdiagnosis of dementia
2nd highest stroke mortality in London
Falls admissions lower than London average high in some wards
Most people do not die in their place of choice (over 60% in hospital)
People and place factors outlined previously
Higher proportion living alone
80% of TH residents aged 65+ do not meet recommended physical activity levels
Service data
At least 20% have significant hearing loss?
60-75% on DN caseloads have incontinence problems?
Adult protection need?
As for adults (root out age discrimination)
Promotion of healthy lives and social contact to delay onset and reduce impact of mental and physical illness and disability
Integrated services for complex needs
Single assessment
Integrated commissioning
Integrated service provision
Integrated pathways: falls, stroke, continence, dementia, end of life
Community Plan/ Improving Health and Wellbeing Strategy
Older People’s Housing Strategy
Transforming Adult Social Care
Promoting Independence Strategy
Information
Linkage Plus
Reablement
Telecare
Carers Support
Older People’s Delivery Group
Integrated model of care
Community Virtual Ward
Older people in Tower Hamlets are a smaller proportion of the population but the evidence suggests their health is generally worse than elsewhere
There is some distance to go to get to level of integration and the targeting of resources to meet their needs more effectively
It is recommended that this is an area for focussed review across the partnership

14. Top 10 considerations from JSNA (1)
The economic downturn will impact on health and particularly the health of those who already have the worst health outcomes in the borough
Tower Hamlets is not an easy place to be healthy. If it is to become an easier place, health needs to be at the heart of housing and planning strategy
There is a big opportunity to drive more integrated and innovative partnership working at a very local level and to involve local people much more in improving local services
There are 20,000 under 5s in Tower Hamlets and what is happening to them right now will have far reaching impacts on how healthy they will be for the rest of their lives
Education is a major determinant of health. The improvements in educational attainment this year mean that today’s Tower Hamlets school children are likely to have better health in their adult lives

15. Top 10 considerations from JSNA (2)
Young adulthood is when despite an absence of disease, problems accumulate that manifest in later life. The high levels of smoking, problem drinking, drug use, poor diet and sedentary lifestyles mean people get disease earlier and die younger in Tower Hamlets.
Diabetes outcomes in primary care are improving but numbers are increasing. This is particularly an issue in Tower Hamlets because of ethnicity. Diabetes can be prevented and if this trend continues costs to health and social care services will become unsustainable
Death rates and survival from cancer are amongst the worst in the country and this is driven by both high levels of smoking resulting in lung cancer and also late presentation to health services
One in five over 65s in Tower Hamlets have at least four chronic conditions at the same time. This means services need to be integrated around their needs across health and social care services and wider council services . Patient are asking for better integration too.
Older people in Tower Hamlets are more socially isolated, have higher level of poverty, poorer housing quality and this is manifest in poorer health. There is a lot going on across the PCT and council to support older people but should there be an overarching strategy?

16. JSNA Process and Accountability
Health and Wellbeing Board
JSNA Programme Board
JSNA PMO
Senior level partnership group NHS/LA/THInK
Officer group: corporate, adults, childrens, public health

17. JSNA Products Summary Document Topic specific factsheets
Summmary
People
Place
Being born, growing up, adult life and growing old in TH
(setting out local picture, evidence base, strategy, recommendations)
Summary Document
Topic specific factsheets
Data Repositary (quantitative, qualitative, evidence base)
Disaggregation of data by :
Place (locality, LAP, ward)
Socioeconomic determinants
Equality dimensions
Predictive variables (eg social marketing)
Provider (eg primary care, CHS, social care, polysystems, acute trusts)
What is the local picture?
What should we be doing?
What are we doing?
What is the user/community perspective?
What more do we need to know?
What are the priorities?