Health and well-being in Derbyshire “Healthy and fit, from the Peak to the Pit” Dr. Bruce Laurence Acting Director of Public Health Prepared by John Jenkins.
Health and Wellbeing • Health OE hale = whole • Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity • How to interpret this practically…and recognise the prevalence of chronic disease • Add years to life and life to years? • Increase the healthy life expectancy and disability free years experienced by the people of Derbyshire.
Some parameters • Longevity • Enabling people to live to the full and have a good chance in life. Early years, education, healthy habits. • Managing sickness and preventive healthcare • Fairness and reducing inequalities • Attention to the vulnerable • Independence in old age and a good death • Wider determinants. New opportunities • Realistic but imaginative sphere of interest • Life course
To increase the healthy life expectancy and disability free years experienced by the people of Derbyshire START WELL DEVELOP WELL LIVE AND WORK WELL AGE WELL To optimise Children attain People are enabled to live People are enabled to age in children’s health at potential and make healthy independent productive optimal health with dignity the start to life and successful transition to lives of their choosing and independently in settings before school adulthood of their choice Healthy School Stable Employment Control and Vaccination pregnancy readiness domestic direct uptake attainment harmony influence Employment/ breast Dignified end over purposeful Risk health /infant of life resources Healthy Mental activity of Early behaviours feeding experience School wellbeing disabled presentation reduced experience people and Optimal Avoidable Mental Secure diagnosis of health 2.5 re- Children in Educational health Workforce income/ disease years admissions care attainment &disabled sickness entitlement people living absence Vaccination Preventing Access to independent Avoidable Children Safe and uptake avoidable support contact with NEET 16-18 warm living admissions Health Effective criminal environment Avoidable Effective literacy management justice Children in Admissions Recovery reablement of disease system poverty Perceptions and /rehabilitation Risk of safety rehabilitation system Experience Experience Avoidable behaviours Emergency of quality of care admissions modified response Experience Fuel poverty maternity Carers services for chronic plans of care services support illness Utilisation of services green space Keeping Keeping safe Protection Keeping safe Experience safe from from from risk and Social from of care avoidable avoidable hazards to network/ avoidable Violent crime services harm harm health connected harm
Life expectancy is increasing but inequalities remain. Life expectancy at birth for males and females within Derbyshire and gap between highest and lowest areas, 2001-03-2007-09 Female: Local Authorities Male: Local Authorities Female: Derbyshire Male: Derbyshire 90.0 85.0 Life Expectancy (Years) 80.0 75.0 70.0 65.0 60.0 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 Other data from 2005-2009 shows a 7.6 year gap in L.E. between the most and least deprived areas in Derbyshire from males and a 5.4 year gap for females.
Premature mortality varies by place of residence SII; SMRs (under 75), LSOAs in Derbyshire County 250 SMRs (under 75, reference = 100) 200 150 100 50 0 0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 Relative Rank from low to high IMD 2007 score
Disability free years vary by gender & district Proportion by National Quintile Q1 – Best Q2 Q3 Q4 Q5 - Worst
START WELL To optimise children’s health at the start to life and before school
Early life care is on par with England but levels of early development vary In context Derbyshire Similar to England (7.5%) • Of the 8,092 births in 2009 overall, but High Peak 7.4% had a low birth weight (5.1%) was significantly (<2.5kg) lower than Derbyshire Significantly lower than • From 2007-2009 there were England (7.6 per 100 births) 139 perinatal deaths (5.6 varied from 3.7 – 7.4 per per 1,000 live and still 1,000 births by district births) Significantly better than • 61.3% of children aged five England, but 12% achieve a good level of achievement gap exists development at Foundation between districts Stage (age 5)
More work is needed to help new families In context Derbyshire Significantly worse than • 16.3% of mothers smoke England (14.0%) during pregnancy Significantly worse than • After birth only 41% of England (45.2%), possibly a babies were totally or worsening trend partially breast fed at 6- 8 weeks The rate of children • 680 children entered into a entering a second or child protection plan in subsequent plan were 2009/10, 16.3% for the higher than England (13.6%) second or subsequent time
DEVELOP WELL Children attain potential and make successful transition to adulthood
Education varies Percentage of pupils achieving 5 or more GCSEs grades A*-C including English and Maths within Derbyshire 2009 100 90 80 70 Proportion of pupils (%) 60 Range & IQR 50 Derbyshire Median 40 30 20 10 0 Derbyshire High Peak South North East Erewash Amber Chesterfield Bolsover Dales Derbyshire Derbyshire Valley The range of achievement was 13.8-91.1% between best and worst wards* * with 5 or more pupils
Children are less deprived, but more are NEET and higher criminalisation Derbyshire Context • 16% of under 16s live in Significantly lower than income deprived England (21.8%), but varies households - nearly 23,000 widely in the county - from children 3.4% to 44.1% • 7.5% of 16-19 years olds not Worse than England (6.1) in employment, education and the East Midlands (5.6) or training (NEETs) in 2010 • 1,181 children admitted to Worse than England (1,472 the criminal justice system per 100,000) and the East for the first time in 2008/9 Midlands (1,320 per (1,530 per 100,000 100,000) population)
High risk behavior in young people varies around the county Derbyshire Context • 18% of children aged 10, 12 & 14 Higher than that reported for reported they had been drunk in England (15%) the last four weeks Significantly lower than England The rate of teenage pregnancies • (38.2 per 1000), but inequalities in 2007-2009 was 34.2 per 1000 exist between districts (range females aged 15-17 24.2 - 52.1 per 1000) Inequalities remain. The gap In 2008/9 there were 2,002 • between highest and lowest ward emergency admissions to hospital was 27.2 per 1000 population for under 18s due to injury or self harm (13.3 per 1000 population) Variation in the rate from 0 to 8.3 • There were 218 alcohol specific per 1000 depending on ward of admissions for under 18s (1.4 per residence 1000 population)
LIVE AND WORK WELL People are enabled to live healthy independent productive lives of their choosing
Unemployment is decreasing but inequalities remain Derbyshire Context • In May 2011 the claimant • Unemployment is lower count stood at 15,638 or than England (3.7% of 3.2% of the working working age population) population • 2.8% decrease in claimants • This is higher in males since May 2010 (4.3%) than females (2.1%) • Claimant numbers vary by and much higher in young district of residence (1.7% - adults aged 16-24 (6.5%) 4.1%) • 14.6% of claimants had • Long term unemployment been claiming long term varies form 11.6 – 17.1%
Unemployment claiments as a proprotion of males and females of working age within Derbyshire, May 2011 Females Males Females: Derbyshire Males: Derbyshire 6 5 Proportion of working age popuation claiming 4 3 2 1 0 Chesterfield Erewash Bolsover Amber Valley North East High Peak South Derbyshire Dales Derbyshire Derbyshire
Wider society Derbyshire Context • 2.8% of people with Below the East Midlands learning disabilities were in (6.0%) and the England employment in 2009/10 average (6.4%) • 6.6% of the working age The rate is similar to the population claim East Midlands (6.2%) and Employment and Support England (6.6%) Allowance or Incapacity Benefits Significantly lower than • 25 people per 1000 of England as a whole (27.6 working age claimed per 1000) incapacity benefit for mental illness in 2008 Huge variation around the • There were 9,600 violent county depending on ward crimes reported in 2009/10 of residence (1.2 - 83.1 (12.6 per 1000 population) crimes per 1000 population)
Getting and staying healthy Derbyshire Context • 12.0 % of over 16s are Similar to England overall, physically active but significant variation between districts (9.0- 14.4%) As above, with significant • 20.5% of adults in variation between districts Derbyshire are smokers (15.8 - 27.9%) This was lower than the • The of rate of acute STI* East Midlands (704.3 per diagnosis in 2010 was 547.3 100,000), but varied by per 100,000 population District (365.0 – 650.3 per 100,000 *excludes HIV
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