1. Dr Stephen Monaghan Why Cardiff? A Tale of Two Cities
Public Health Director, Cardiff LHB
Consultant in Public Health Medicine, NPHS
Why Cardiff? A Tale of Two Cities

2. A Tale of Two Cities Whilst Cardiff is a thriving, affluent city,
It is really a tale of (at least) two cities
in terms of health outcomes and deprivation indices,
the reality is that there are still over 50,000 people living in the top decile of of disadvantage according to the Welsh Index of Multiple Deprivation.
More people in the top decile of deprivation than than
in RCT or
in Merthyr Tydfil and Blaenau Gwent combined
10 year life expectancy difference between the Lisvane and Butetown 2 LSOAs
“southern arc” – south of the railway line – “wrong side of the tracks”

3. Demography and population sub-groups

4. Current Population
2006 Population Estimates give Cardiff a population of:
317,523 as derived from the ONS or
352,954 as derived from NHSAR

5. Cardiff Population Age Structure in 2006 [317,500 persons - ONS data]

6. Population Trends
The average annual increase in Cardiff’s population was 2,400 persons ( )
natural population growth
net migration
Migration accounted for 43.7% of the total estimated population change.

7. Ethnic Minority Populations
25,735 persons (2001 Census)
Cardiff has the highest population proportion of ethnic minority in Wales
Half of the ethnic minority population in Wales live in Cardiff
Often live in the poorest inner city areas
Many rank amongst the most impoverished of the city’s inhabitants

8. Ethnic Minority Populations

9. Asylum Seeker Population

10. Student Population 25,000 students (and rising) in Cardiff
Population is concentrated in specific areas:
Cathays, Plasnewydd, Penylan (Central Locality)
Gabalfa (North Locality)

11. Determinants of Health

12. Welsh Index of Multiple Deprivation by LSOAs (2001)

13. Lifestyle
<29% of Wales’ residents reported meeting the physical activity guidelines (30 mins moderate exercise 5 days / week)
Cardiff had a lower proportion of adults who met the guidelines than the Welsh average
64.1% of Welsh adults are overweight or obese. The proportion in Cardiff is slightly lower than this Welsh average
Welsh Health Survey 2003/5)

14. Lifestyle
27.1% of Welsh adults reported being smokers with the proportion in Cardiff just above this Welsh average
Almost 40% of Cardiff (and Wales’) adults report their average weekly alcohol consumption is above recommended limits
Cardiff residents report higher rates of binge drinking than the Welsh average
Welsh Health Survey 2003/5)

15. Lifestyle Sexually transmitted infection rates continue to increase
Cardiff has the highest prevalence of HIV in Wales

16. Health Outcomes

17. EASMRs for All Cause Mortality by MSOA (2002-2004)

18. EASMRs for all circulatory diseases (persons, all ages) by MSOA (2000-2004)

19. EASMRs for respiratory disease (persons, all ages) by MSOA (2000-2004)

20. Female Morbidity from All Malignancies (excl NMSC) WASR Per 100,000 Population

21. Female Mortality from All Malignancies (excl NMSC) WASR per 100,000 Population

22. Key Points
A Tale of Two Cities

23. A Tale of Two Cities Whilst Cardiff is a thriving, affluent city,
It is really a tale of (at least) two cities
in terms of health outcomes and deprivation indices,
the reality is that there are still over 50,000 people living in the top decile of disadvantage according to the Welsh Index of Multiple Deprivation.
More people in the top decile of deprivation than
in RCT or
in Merthyr Tydfil and Blaenau Gwent combined
10 year life expectancy difference between the Lisvane and Butetown 2 LSOAs
“southern arc” – south of the railway line – “wrong side of the tracks”

24. Most modern health problems and diseases are:
All major diseases except cancer – a genetic disease
Problems of maladaptation between human biology and the modern environment 24

25. If we truly want to tackle our modern health problems:
we have to consider changing the environment
Economic, social, physical
not just treating human biology consequences
not just educating/informing people re: choices

26. WHO Healthy Cities This is what led us to Healthy Cities
A world-wide movement of city-based public health initiatives
“In one sense the Healthy Cities Project was a new initiative, in another it was the Health of Towns Association of Exeter 1844 reborn…the challenge to us is to pick up where Chadwick’s thinking left off 100 years ago” (John Ashton 1992)
Origins of public health in the Victorian era:
Context of new type of industrial town in Northern England (cotton, wool factories) – owners built cheap back-to-back housing with little or no sanitation, with overcrowding, where workers & their families were vulnerable to epidemic infectious disease
Argued that it was possible for the government to improve people’s lives by bringing about reform – response was seen to lie in housing standards & hygiene regulations, paved streets & publicly funded water & sewage systems

27. Phase V themes (2009 – 2013) Caring and supportive environments
Healthy Living
Healthy urban environment and design (Healthy Urban Planning)
Overarching theme
Health and health equity in all local policies

28. Cardiff: WHO Healthy City
Obesity proposed as an initial unifying theme -
incorporating healthy urban planning as a major element (alongside physical activity, food, work place health and weight management)
Political:
Support from CMO, Tony Jewell
Rodney Berman, Leader of Cardiff Council & WLGA spokesperson for health improvement has agreed in principal to taking this approach forward in Cardiff, supported by CC Corporate Directors and Proud Capital Vision Forum; will go to CC Executive Business Group on 8th Nov 07
WLGA has identified funding to advise the 4 cities in Wales in developing this approach – Cardiff, Swansea, Wrexham, Newport
Infrastructure:
Need to identify a focal point & someone to co-ordinate the approach
Needs to be developed through a partnership arrangement (exploring how this might be done through the Proud Capital Vision Forum
Politician responsible for the project
Admin & office support
Dedicated resources
Products & outcomes:
City health profile (needs assessment)
Activities – programme to deliver the goals of Healthy Cities; systematic monitoring & review process
Annual report must be produced using standard ‘annual reporting template’
Networking:
Attend annual business meetings of the WHO European Healthy Cities network (will be held in Zagreb, Croatia in 2008)
Can also join European ‘sub networks’ for different themes, e.g. Healthy Urban Planning
UK currently has informal networking arrangements at the national level
Require an identity, including an address & web site

29. Obesity – initial exemplar / unifier
Partners have agreed to use the issue of obesity as an exemplar and unifier, as a framework for the Cardiff Healthy City Programme.
The causes of obesity and overweight are complex, resulting in the need to implement a range of approaches and complimentary strategies to address individual, social, and environmental determinants.

30. Obesity Trends Health consequences Mortality Financial costs
Issues are well known and will not be covered here

31. Obesity: What is the explanation?
What in particular has changed in recent years to potentially explain the rise?

32. Can a city make you fat?
How can a city change its environment to help prevent its people not to be obese?

33. Foresight Report 2007

34. Foresight Report 2007

35. Causes of obesity
Causes of obesity are complex and the Foresight Report summarises:
Technology
The built environment
Opportunities for physical activity
Food and drink availability
The price of food and drink
Food marketing
Purchasing capacity and impact on eating patterns
Impact of working practices

36. Obesity: An Initial Exemplar and Unifier
leaves people with chronic health problems like diabetes, cancer, osteoarthritis,
as well as increasing mortality from heart disease and strokes.
Our answer can't be to just treat people in the NHS and send them home again,
Rather to design our city, educate people and provide opportunities that stop people developing these problems in the first place.

37. Obesity: An Initial Exemplar and Unifier
Reducing obesity levels is a major challenge and involves far more than consideration of what we eat and whether we go to the gym.
We need to consider:
healthy urban planning,
the food environment,
transport,
housing regeneration
Introducing changes that may not be easy for us, but are critical to our long term health.

38. Work so far / future action
Much work already focuses on tackling obesity in Cardiff
To ensure co-ordination and synergy, a draft Cardiff-wide Healthy Weight Strategy and Action Plan has been developed.
WHO European Healthy Cities Network will
support and strengthen the delivery of this multi-agency strategy,
build on current work,
identify gaps in activity
and address the broader issues.

39. Work so far / future action
The momentum from WHO Healthy City should enable Cardiff to drive forward the public health agenda with regards to
lifestyle choices,
the impact of the built and natural environment on health
and the provision of supportive services.
Although the initial focus will be on obesity, the action will impact right across the determinants of health.
Community involvement and engagement will be key.

40. Next Steps Today is both a celebratory event and a planning workshop
to discuss the way forward and to develop plans for implementing the Healthy Cities Programme
Health is everybody’s business
The workshops will be your opportunity to:
highlight issues,
voice your ideas and the contributions you can make to this important work.