Health priorities for Charnwood, 2010 and beyond Dr Mike McHugh Consultant in Public Health NHS Leicestershire County and Rutland 7/9/10

What is health? ‘Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity’ WHO, 1948

Charnwood Demography 164,800 people 86% ‘white British’ 3% ‘white other’ Sizeable populations of South Asian people i.e. Indian and Bangladeshi in Loughborough Charnwood is more affected by socio-economic deprivation than Leicestershire as a whole Loughborough and Shepshed are less affluent and smaller

Levels of Health in Charnwood Health of people in Charnwood generally better than England average Life expectancy significantly higher for both men and women Levels of drug misuse, hospital stays for alcohol related harm, deaths from smoking and road injuries and deaths all appear better than average BUT…

BUT.. …the Tyranny of averages.. and also the issue of health inequalities

Children and Young People Diagnosis of children (aged 15 years and under) with Autistic Spectrum Conditions (ASC) has increased ten-fold in the last 10 years. 286 teenage conceptions: % of Leicestershire pupils in year eight and 10 reported using drugs (national average 16%) 9.3% of reception age children obese 23.8% are overweight or obese 15% of year 6 children are obese, 30% are overweight or obese

Adults Charnwood has highest premature mortality from cardiovascular diseases in LCR: 401 premature deaths ( ) 21,839 people on GP registers with diagnosed Hypertension (15.3% of the adult population) 6,794 people are on GP diabetes registers 1,959 people on GP registers with chronic obstructive pulmonary disease

Adults continued 34,088 adults are obese (highest out of all other districts) Only 27.7% of adults eat 5 portions of fruit or vegetables per day Only 26% of the adult population exercise for 30 minutes or more at least 3 times per week 24,175 binge drinkers, 26,027 hazardous drinkers, 5,953 harmful drinkers 31,564 adults smoke

Smoking biggest preventable cause of premature death and illness biggest driver of inequalities relatively quick impact in CVD What are we doing about it? (Smokefree Future 2010) motivating and assisting every smoker to quit stopping the inflow of young people recruited as smokers protecting families and communities from tobacco- related harm

Older people In ,101 people over 65 had a limiting long term illness 8,162 people over 65 years unable to self care Proportion of elderly increasing Biggest use of resources in urgent care Continuing care Dementia care

Health Inequalities Significant health Inequalities exist within Charnwood e.g. men from least deprived areas can expect to live over 9 years longer than those in most deprived areas

All age all cause mortality

We don’t just have socio-economic inequity BME Asylum seekers Homeless Travellers Offenders Sexual orientation Gender Age Rurality

Health inequities ‘The presence of systematic disparities in health (or its social determinants) between more and less advantaged social groups’ Defining equity in health, J Epidemiol Community Health 2003, 57(4):

What causes health inequity? “If the causes of health inequalities are social, economic, cultural and political, then so should be the solutions.” -Sir Michael Marmot, Chair of the Scientific Group on Health Inequalities 2010

So what can we do to tackle health inequalities in Charnwood?

1.Support families, mothers and children Close the gap in infant mortality between advantaged and disadvantaged communities Improve maternal and child health, and child development

2.Engage communities and individuals Strengthen disadvantaged communities Tackle crime and substance misuse Support vulnerable groups BME Older Mentally ill/LD Homeless Offenders Travellers Asylum Seekers Rural

3.Prevent illness and provide effective treatment and care Reduce risk through effective prevention Early detection, intervention and treatment Improve access to effective treatment CVD Cancer Diabetes Mental illness OTIMISE NHS CARE

4. Address underlying (wider) determinants of health Poverty (especially child poverty) Early years, parenting Education, training and skills Employment Social Cohesion Housing Transport

Strategic Goals for NHS LCR Tackling major killers Cardio vascular disease (CVD) mortality Cancer mortality Tackling major risk factors Smoking Alcohol Diabetes control Better quality services Complex elderly Mental health End of life Patient experience One priority outcome in each goal……. Life expectancy and inequalities are overarching

Charnwood Priorities: Summary CYP issues-teenage pregnancy, obesity, drugs, alcohol Adults- Premature mortality-CVD, cancer, obesity Older: increasing population Health Inequalities

Let’s focus on Partnership working to address health inequalities-smoking, substance abuse, alcohol, obesity, teenage pregnancy/sexual health Remember wider determinants of health Engage socially excluded Premature mortality Children, young people, parenting, families Let’s get most out of NHS-work with primary care