Health & Healthcare in London Key Facts September 2006

Overview of London’s Health The geography of London London’s population and diversity Health determinants Key lifestyle issues Health inequalities Key health issues Health care use Health care resources

LONDON’S GEOGRAPHY London Boroughs and Acute Trusts There are 33 Main Acute Trusts in London There are 31 Primary Care Trusts coterminous with all 32 London Boroughs

LONDON’S POPULATION AND DIVERSITY Key Facts 7.5 million resident population in Greater London Highly ethnically diverse with 40% from an ethnic minority group (including White Irish and Other White minority groups) More than 90 different ethnic groups and 300 different languages spoken Largest religious groups are Christian, Muslim, Hindu, Jewish, Sikh and Buddhist Home to many refugees and asylum seekers Highly mobile (20-40% turnover on GP lists every year) 1 million daily commuters 13.1 million tourists every year

LONDON’S POPULATION AND DIVERSITY Population Age Structure London is relatively young with years olds accounting for 36.5% of the population compared to England average of 28%. The proportion of people of retirement age is the lowest of all regions (12 %) as wealthier people tend to move out of the Capital at retirement age. Black and minority ethnic populations are relatively younger but are fast growing and ageing. There are large variations in the demographic structure of different ethnic groups. Source: ONS population estimates 2005

LONDON’S POPULATION AND DIVERSITY Population Growth London’s population increased by 550,000 (8%) between 1994 and 2004 London’s population is expected to increase by 600,000 (8%) by 2016, and by 900,000 (12%) by Only the age group is projected to decrease in numbers by 2026 The age group will increase by more than 500,000 (36%) by 2026 Source: GLA population projections

LONDON’S POPULATION AND DIVERSITY Number of people in each minority ethnic group, London 2001 Almost 3 million Londoners are from an ethnic minority group (40% of the population). 45% of the England & Wales population from an ethnic minority group live in London. The largest minority ethnic group is White Other followed by Indian, Black African and Black Caribbean. The Black African group has more than doubled in the last ten years, and the number of Bangladeshis has increased by nearly three quarters since Source: Census 2001

LONDON’S POPULATION AND DIVERSITY

HEALTH DETERMINANTS Health Determinants in London compared to England average This slide shows how London is doing in terms of the main socio- economic influences on health GCSE achievement is close to the England average More older people are supported to live at home, but 1/3 pensioners live in poverty. Violent crime is high. Air quality is poor. Over 40% of London’s children are living in poverty, much greater than average. Deprivation, including long term unemployment, is higher than average.

HEALTH DETERMINANTS Inequalities in Health Determinants in London Within London there are wide inequalities in living conditions, and other socio-economic factors that have an influence on health. These inequalities exist between people living in different parts of London, between different ethnic groups, age groups and other groups. Over half of London boroughs are in the top 30% most deprived boroughs in England, and 24% of boroughs are in the top 10% most deprived, with nearly all boroughs having pockets of deprivation. Newham, Tower Hamlets and Hackney have some of the highest unemployment rates in the country, whereas other boroughs have rates well below average. The Bangladeshi population has the highest unemployment rate, and the White British the lowest. Educational (GCSE) attainment is highest in Chinese children and lowest in Black Caribbean children. People from a minority ethnic group are more likely to live in an unfit home than the White population.

HEALTH DETERMINANTS

KEY LIFESTYLE ISSUES Lifestyle influences on health in London compared to England average This slide shows how London is doing in terms of the lifestyle factors that influence health compared to nationally –Fewer people binge drink. –More people eat healthy food. –There are fewer obese adults, but London has higher rates of childhood obesity than the rest of England. –Smoking levels are average.

KEY LIFESTYLE ISSUES Obesity – key facts for London In London every year, obesity accounts for 4,000 deaths (7% of all deaths) : –300 deaths and 2,700 hospital admissions for cancers –450 deaths and 1,300 hospital admissions for stroke or raised blood pressure –600 deaths and 2,500 hospital admissions for angina or heart attack –250 deaths and 2,400 hospital admissions for diabetes –1,300 hospital admissions for osteoarthritis or gout Adult obesity is related to social class, and is higher among more deprived populations, particularly for women. London has higher rates of childhood obesity than the rest of England.

KEY LIFESTYLE ISSUES Smoking in London Smoking is a major cause of cancer, respiratory disease, circulatory and ischemic heart disease. In London, smoking causes: –more than 10,000 deaths each year (1 death/hour) –200 deaths per week among people aged 35 and over in London are attributable to smoking –46,000 hospital admissions and more than 400,000 bed days a year Smoking costs the NHS in London >£105 million a year. Least affluent populations are most likely to smoke. Highest smoking prevalence is amongst Bangladeshi, Turkish and Irish men. Over a million Londoners are affected by smoking in the workplace There are marked social inequalities in smoking rates between the most affluent (who smoke least) and the least affluent who are most likely to smoke.

KEY LIFESTYLE ISSUES Percentage of all deaths attributable to smoking in London by PCT,

KEY LIFESTYLE ISSUES Alcohol in London On average Londoners drink less often and fewer drink above sensible levels compared to the England average. People on high incomes and the unemployed are most likely to drink above sensible levels and to binge drink. People from many ethnic minority groups are more likely to be non-drinkers. More Londoners are dependent alcohol users compared to England. The death rate due to alcohol in London is higher then nationally. Alcohol misuse impacts on health care at all levels. Alcohol consumption contributes significantly to the volume of injuries in London.

HEALTH INEQUALITIES Life expectancy and causes of death This slide shows how London is doing in terms of the major killers It is estimated that compared to nationally –More people die prematurely from heart disease and stroke. –More people are injured or die on the roads per kilometre travelled. –Infant mortality, premature deaths from cancer and smoking, and life expectancy are all average in London. –However, these figures mask wide inequalities between London’s Primary Care Trusts.

HEALTH INEQUALITIES The life expectancy PSA target The PSA target for life expectancy aims to see faster health improvement compared to the average in the “fifth of areas with the worst health and deprivation indicators” – The Spearhead PCTs/LAs. The Spearhead LAs are indicated on this map.

HEALTH INEQUALITIES Life expectancy in London, MaleFemale England London London Spearhead group For males in , life expectancy in England was This is very similar to the average for London, but 2.5% higher than in the London Spearhead Group. For females, life expectancy in England was 80.9, 1.3% higher than in the London Spearhead Group. These gaps have to be reduced by 10% for the life expectancy target to be achieved. London as a whole is on track to reach this target, but not all spearhead areas are on track. Source: ONS

HEALTH INEQUALITIES

HEALTH INEQUALITIES Infant mortality rates (deaths < 1 year), The infant mortality PSA target aims for a reduction in the gap in mortality rate among those with fathers in the “routine and manual” groups and the population as a whole. This target is difficult to measure at local levels due to the small number of deaths involved. Within London as a whole the infant mortality rate is falling. There is more than a two fold differential in the infant mortality rates for different London boroughs. This differential can be measured as a proxy for the PSA target.

SPECIFIC HEALTH ISSUES IN LONDON Key Facts London has highest number of new diagnoses of sexually transmitted infections (STI) out of all regions. London has the second highest teenage pregnancy rate out of all regions. London accounts for 57% of HIV infections in the UK. London has significantly higher demand for mental health services than England, and specifically for people with severe Mental Health problems. London has the highest tuberculosis (TB) rate out of all regions and the number of cases per 100,000 population rose from 32 per 100,000 population in 1999 to 48 per 100,000 in Many diseases such as tuberculosis, diabetes, HIV, renal disease and coronary heart disease are more common in specific ethnic groups who are more commonly resident in London. The prevalence of problem drug use is estimated to be higher in London than average for England.

SPECIFIC HEALTH ISSUES - SEXUAL HEALTH Number of newly diagnosed STI’s reported from genitourinary (GU) clinics in London Chlamydia diagnoses have more than doubled since 1995 and are highest in the young. Syphilis diagnoses have sharply increased in London since The presence of STIs can facilitate HIV transmission. 68% of people in London obtain an appointment with GU clinics within 48 hours, compared with the target of 100% by Source: HPA

SPECIFIC HEALTH ISSUES - SEXUAL HEALTH HIV - a growing burden in London London accounts for 57% of infections in the UK. In 2003 – 3190 new infections diagnosed in London. In 2003 – estimated 27% of HIV infections may be undiagnosed (8,600 Londoners). Nearly all new heterosexual HIV infections have been among Black Africans – three quarters acquired in Africa. Men who have sex with men are the largest group to have acquired infection in this country. Sharpest increase is in heterosexual transmission. 2.9% of injecting drug users contacting specialist services in London have HIV infection (higher than elsewhere).

SPECIFIC HEALTH ISSUES – SEXUAL HEALTH Teenage Pregnancy Source: TPU, DfES, 2006 Teenage Pregnancy (TP) are all conceptions to women aged <18 years of age. In 2004 the London TP rate was 48.1/1000 females aged compared with 41.5/1000 nationally with the highest number of TP occurring in deprived areas. Rates have fallen recently in 19 boroughs but large increases in 6 boroughs.

SPECIFIC HEALTH ISSUES – MENTAL HEALTH Mental Health Estimated 1 million London residents experienced a common mental health problem during The most common cause of death of young men under 35 is suicide and London is not on track to meet the suicide target of a 20% reduction in overall suicide rates by Mental health problems are more prevalent in deprived areas Significantly higher demand for mental health services than England, and specifically for people with severe mental health problems –Higher admission rates –Higher proportion of inpatients with sever mental illness –Higher occupancy rate despite more beds –Higher use of forensic beds –Highest rate of compulsory admissions –Higher crude caseload rates in some community services –Highest spend on mental health services –Large populations at risk of mental health problems e.g. asylum seekers

SPECIFIC HEALTH ISSUES – TUBERCULOSIS (TB) London sector TB rate per 100,000 resident population London tuberculosis (TB) rate per 100,000 population rose from 32/100,000 in 1999 to 48/100,000 in Nationally 70% of newly diagnosed cases in 2004 were among foreign born populations. In London the highest number of new cases occurs among the Asian and Black African populations. Source: HPA London Regional Unit, 2006

SPECIFIC HEALTH ISSUES – ETHNICITY Mortality from diabetes by London Borough Source: Compendium of Clinical Indicators There are wide inequalities in mortality from diabetes, boroughs with large populations from ethnic minority groups such as Tower Hamlets, Hackney and Newham have the highest rates.

HEALTH CARE USE Total QOF points scored for coronary heart disease by PCT in London This map shows points achieved under the Quality and Outcomes Framework for PCTs in London in 2004/05. Lighter shaded areas are performing better than others. Source: QPID

HEALTH CARE USE Age standardised admission rates by PCT, April 2005-September 2005 Source: Hospital episode statistics

Londoners are less satisfied with the NHS; BME patients are particularly dissatisfied NB risks of Patient Choice. HEALTH CARE USE Healthcare Commission Inpatient Survey 2004 Source: Healthcare Commission Patient Survey

HEALTH CARE USE Length of Stay In there were about 800,000 excess bed days, or 2,100 excess beds, in London hospitals compared to the national mean, with a Reference Cost value of £216 million. This represents over 13% of all bed days. Most were in acute teaching or small acute trusts. King’s/Bart’s Whipps Cross Source: Admitted patient care data for London October 2004 – September 2005

HEALTH CARE RESOURCES Wanless underestimates likely growth? While population changes will have some impact on resources and financial stability, this will be largely compensated for by the Resource Allocation Formula, although time lags may cause problems in rapidly growing PCTs. Future pressures on resources will above all be critically dependent on the proportion of GDP allocated to healthcare, and demand for that care.

HEALTH CARE RESOURCES The SHA will need to ensure that PCTs in affluent areas reduce demand for healthcare, and that, in order to meet the health inequalities life expectancy target, NHS resources are directed proactively (as their populations will not demand them) to deprived areas and Spearhead PCTs to find new cases of disease and reduce disease risks.

SUMMARY OF LONDON’S KEY HEALTH CHALLENGES Ethnically diverse population with high mobility and population growth London as a whole has average mortality rates and life expectancy, however it has high rates of premature mortality from heart disease and stroke, and wide inequalities between boroughs/PCTs Key lifestyle issues such as obesity, smoking and alcohol are contributing to poor health in London’s more deprived areas London has high rates of teenage pregnancy and sexually transmitted infections such as HIV The incidence of tuberculosis is rising and is more common among ethnic minority groups London has significantly higher than average demand for mental health services, particularly for people with severe mental illness and is not on track to meet the required suicide reduction target.

SUMMARY OF LONDON’S HEALTH CARE CHALLENGES Primary care services are performing relatively poorly. Length of stay is excessive in many hospitals. Londoners are more dissatisfied with the NHS, especially those from BME groups. 4/5 sectors are overspending, partly because of demanding populations and providers. NE London has low demand and spending- primary care resources should be proactively developed to reduce inequalities.