Health Challenges for Hertfordshire: 2014 Health Profile Indicators

Health challenges for Hertfordshire

Hertfordshire Public Health Service

Health challenges for Hertfordshire: 2014 Health Profile Indicators

September 2014

Page 1 of 66 Health challenges for Hertfordshire

Introduction ...... 3 The Tartan Rug of Health Indicators...... 5 Health Profile Indicators ...... 8 1. Deprivation ...... 8 2. Children Under 16 in Poverty ...... 11 3. Statutory Homelessness ...... 13 4. GCSEs Achieved (5A*-C inc Eng & Maths) ...... 15 5. Violent Crime...... 17 6. Long Term Unemployment...... 19 7. Smoking in Pregnancy ...... 21 8. Starting Breast Feeding ...... 22 9. Obese children (Year 6) ...... 23 10. Alcohol-specific hospital stays (under 18)...... 25 11. Teenage Pregnancy (under 18) ...... 27 12. Smoking Prevalence ...... 29 13. Percentage of Physically Active Adults...... 31 14. Obese Adults...... 32 15. Excess Weight Adults ...... 33 16. Incidence of Malignant Melanoma ...... 34 17. Hospital stays for self-harm...... 36 18. Hospital Stays for Alcohol Related Harm...... 38 19. Drug Misuse ...... 40 20. Recorded Diabetes...... 42 21. Incidence of Tuberculosis ...... 44 22. Acute Sexually Transmitted Infections...... 46 23. Hip Fracture in People aged 65 and Over ...... 48 24. Excess Winter Deaths...... 49 25. Life Expectancy – Males ...... 51 26. Life Expectancy – Female...... 52 27. Infant deaths...... 54 28. Smoking Related Deaths ...... 56 29. Early Deaths: Suicide Rate ...... 58 30. Under 75 mortality rate: Cardiovascular diseases (Including Heart Disease & Stroke) ...... 59 31. Under 75 mortality rate: Cancer ...... 61 32. Killed and seriously injured on roads ...... 63 Appendix 1: Notes to the Tartan Rug of Health Indicators...... 65

Page 2 of 66 Health challenges for Hertfordshire

Introduction

This document seeks to provide a snapshot of the key health and wellbeing challenges for Hertfordshire, by looking at each of the District and Borough Council areas within Hertfordshire.

The document describes some of the key areas of public health challenges in Hertfordshire. It uses visual representations to illustrate the 32 “Health Profile Indicators” published annually by Public Health England. The indicators follow a life course perspective which is a principle adopted by the Hertfordshire Public Health Strategy. Wherever possible for each indicator trend information is given for each Hertfordshire District and Borough Council area and for the most recent information, whether the indicator is significantly better, similar or worse that the Hertfordshire average. The 32 indicators are:

 Deprivation  Children under 16 in Poverty  Statutory Homelessness  GCSE achievement (5A*-C inc Maths & Eng)  Violent Crime (violent offences)  Long Term Unemployment  Smoking Status at Time of Delivery  Breastfeeding Initiation  Obese Children (Year 6)  Alcohol specific hospital stays for under 18s  Under 18 conception  Smoking Prevalence in Adults  Percentage of Physically Active Adults  Obese Adults  Excess Weight in Adults

Page 3 of 66 Health challenges for Hertfordshire

 Incidence of Malignant Melanoma  Hospital Stays for Self Harm  Hospital Stays for Alcohol Related Harm  Drug Misuse  Recorded Diabetes  Incidence of Tuberculosis  Acute Sexually Transmitted Infections  Hip Fractures in 65s and over  Excess Winter Deaths  Life Expectancy – Male  Life Expectancy – Female  Infant Mortality  Smoking Related Deaths  Suicide Rate  Under 75 Mortality Rate: Cardiovascular  Under 75 Mortality Rate: Cancer  Killed and Seriously Injured on Roads

A brief overview of the health and wellbeing challenges in each of Hertfordshire’s District//Borough Council area is provided below (“The Tartan Rug”.)

This is followed by information about the key local health and wellbeing challenges – where local indicators are significantly worst than the average for Hertfordshire. Red indicates significantly worse than Hertfordshire, green significantly better than Hertfordshire and yellow no significant difference to Hertfordshire.

Page 4 of 66 Health Challenges for Hertfordshire 2014 The Tartan Rug of Health Indicators

The 2014 Health Profiles data published by Public Health England has been used for this snapshot. These profiles have been published since 2006 and provide information for a number of indicators for each Local Authority area of England. Notes to the Tartan Rug are in Appendix 1.

The data produced by Public Health England provides a comparison to the average for England. However as Hertfordshire is either better than or at least as good as all of these indicators, to provide more locally relevant information, the data for each District/Borough Council area has been compared with Hertfordshire as a whole. The results are summarised in the “Tartan Rug” table below. As well as information for the County Council area and the 10 District/Borough Council areas, the average for England is also included as well as information for the best performing area in England. The years to which this data relates is also provided.

The Tartan Rug uses the following colour coding key:

Significantly better than Hertfordshire average Green Not significantly different from Hertfordshire average Amber Significantly worse than Hertfordshire average Red No significance can be calculated White

By doing this the overall picture becomes clearer about how each of our areas is faring.

Page 5 of 66 Health Challenges for Hertfordshire 2014

NHS East & North Hertfordshire CCG NHS Herts Valleys CCG e d l g t s e e e e s a e i r r r r e i i e i r f s e n t e r g h h h e m d r n b

v a e r Year(s) to i t s s a s v h u u a t r o s H d d d n d a m r o R f b

r r r o l t which data a n e s o b n d o o t o c e a v a A E f f f x r y l

n N t t t a e

Health Profile 2014 Indicators e

t relates o r r e r r g t W a w r l D l S e e e h n H S g (for definitions see Indicator Notes B e T H H H E n

Domain Measure W below) E 1 Deprivation % 2.4 0.0 1.3 2.3 1.5 0.0 1.6 0.0 1.9 0.0 1.0 0.0 20.4 2010 s e i

t 2 Children in poverty % 19.3 9.1 12.7 20.9 15.9 14.6 14.0 8.8 11.8 14.9 13.7 6.9 20.6 2011 i n

u 3 Statutory homelessness per 1,000 6.2 0.6 1.2 1.3 2.1 2.8 2.9 1.8 2.4 4.4 2.4 0.0 2.4 2012/13 m

m 4 GCSE achieved (5A*-C inc. Eng & o

c Maths) % 60.3 71.4 68.0 50.1 66.5 57.2 63.9 73.9 76.9 73.7 66.3 81.9 60.8 2012/13

u 5 Violent crime (violence offences) per 1,000 8.0 5.5 6.6 13.4 7.5 6.0 5.9 5.1 4.2 11.7 7.1 4.1 10.6 2012/13 O 6 Long term unemployment per 1,000 8.0 4.2 5.3 10.7 5.2 4.5 5.2 3.3 3.9 6.6 5.4 2.3 9.9 2013

s 7 Smoking status at time of delivery % Unavailable at district level 9.0 2.3 12.7 2012/13 ' d e n l (Hertfordshire figures appear in the district level profiles)

a 8 Breastfeeding initiation % 78.0 94.7 73.9 2012/13 p

h o s ' t l e

n 9 Obese children (Year 6) % 18.3 11.7 15.5 17.1 16.0 12.5 15.4 10.9 16.7 18.5 14.7 12.7 18.9 2012/13 a p e

e r g h d 10 Alcohol-specific hospital stays 2010/11- l n i u h (under 18) per 100,000 14.1 14.8 11.9 32.6 26.1 17.3 36.3 13.8 25.0 25.6 20.6 15.2 44.9 2012/13 o C y 11 Under 18 conceptions per 1,000 20.8 12.2 20.5 31.0 18.3 13.0 15.7 14.6 11.6 23.6 17.4 14.2 27.7 2012

d 12 Smoking prevalence % 19.3 15.2 17.0 22.3 20.4 17.4 20.8 16.2 15.5 14.3 17.7 12.1 19.5 2012

' n e l s a t y l

t 13 Physically active adults % 63.5 69.0 63.4 52.7 57.6 49.2 58.6 62.6 53.3 53.9 58.8 68.5 55.6 2013 h u s t l d e

a f 14 Obese adults % 28.3 18.7 19.1 25.6 21.2 25.2 20.2 15.5 24.0 20.9 21.5 11.2 23.0 2012 i A l e h 15 Excess weight in adults % 70.2 65.4 60.0 62.7 52.7 64.4 61.2 59.6 63.9 57.8 61.8 45.9 63.8 2012 16 Incidence of malignant melanoma per 100,000 12.0 14.6 17.5 15.0 17.6 11.4 8.5 14.1 12.9 12.5 13.8 3.6 14.8 2009-2011 h t l 17 Hospital stays for self-harm per 100,000 104 76 128 146 110 134 113 90 133 120 113 50 188 2012/13 a e

h 18 Hospital stays for alcohol related

o harm per 100,000 542 421 477 462 435 463 512 409 543 540 472 365 637 2012/13 o p

19 Drug misuse per 1,000 4.3 5.3 4.8 8.3 5.9 4.1 4.6 4.1 2.5 8.7 5.2 2.5 8.6 2010/11 d

n 20 Recorded diabetes % 6.0 4.7 5.5 5.5 5.1 4.8 5.2 4.1 5.1 5.3 5.1 3.7 6.0 2012/13 a

s 21 Incidence of TB per 100,000 4.3 2.9 5.5 10.7 11.8 6.9 13.0 7.1 6.9 17.7 8.3 0.0 15.1 2010-2012 a

e 22 Acute sexually transmitted s

i District level data not published locally due to data quality issues

D infections per 100,000 713 264 804 2012 23 Hip fractures in 65s and over per 100,000 446 524 524 586 485 645 688 501 616 605 560 403 568 2012/13

Page 6 of 66 Health Challenges for Hertfordshire 2014

NHS East & North Hertfordshire CCG NHS Herts Valleys CCG e e r e r i d i l g t h h s e e s a s e i r r s e e i r f s e d n t e r d g h e r m d r n b r v a e r i a s v o u u a o f r o H d n d a f t m o R f b

t Year(s) to r r o l t n e s r b n d t o c e e a v a A f e x r y l

t which data a e e t H h o e r r g H t W a

t w r l

D l S e h n t H h a S relates g B t e s T H E e r n a d o W

E E f N o

s Aug2009- u

a 24 Excess winter deaths ratio 19.0 20.2 14.9 17.0 18.5 13.6 21.5 12.9 13.5 28.9 17.5 6.4 16.5 Jul2012 c

d 25 Life expectancy at birth (male) years 80.7 81.0 79.9 79.6 80.1 80.3 80.7 81.7 80.3 79.2 80.4 82.1 79.2 2010-2012 n a 26 Life expectancy at birth (female) years 84.4 84.1 82.8 82.6 83.6 84.5 83.5 85.3 84.5 82.3 83.8 85.9 83.0 2010-2012 y c

n 27 Infant mortality per 1,000 3.2 1.6 2.4 5.4 4.1 2.6 3.6 1.7 3.4 2.7 2.9 1.1 4.1 2010-2012 a t

c per e

p 28 Smoking related deaths 100,000 267 246 262 315 273 264 259 222 246 271 259 186 292 2010-2012 x e

per e f i 29 Suicide rate 100,000 - 6.4 - - 8.1 7.3 - - - - 6.0 4.8 8.5 2010-2012 L 30 Under 75 mortality rate: per cardiovascular 100,000 75.1 60.5 73.7 81.7 69.4 76.1 77.6 62.0 65.1 77.0 71.0 55.7 81.1 2010-2012 per 31 Under 75 mortality rate: cancer 100,000 137.4 125.0 133.6 151.8 144.3 126.2 134.1 116.1 125.6 137.8 131.6 114.0 146.5 2010-2012 32 Killed and seriously injured on per roads 100,000 29.5 33.3 37.6 30.9 31.6 32.1 49.8 42.5 33.4 26.1 35.0 16.9 40.5 2010-2012

Compiled by Public Health Evidence and Intelligence, Hertfordshire County Council, August 2014 Source: Public Health England. © Crown Copyright 2014 More information available at: www.healthprofiles.info

Page 7 of 66 Health Challenges for Hertfordshire 2014

Health Profile Indicators 1. Deprivation The Index of Multiple Deprivation (IMD) is an overall measure of multiple deprivation experienced by people living in a specific area. The IMD is based on: income; employment; health deprivation and disability; education skills and training; barriers to housing and services; crime and the living environment.

Figure 1 shows that between 2007 and 2010, the number of people living in England’s most deprived quintile in Hertfordshire increased from 0.8% to 1%. Out of the ten districts in Hertfordshire, Broxbourne was the only district to have a significant increase of residents living in the most deprived quintile. This was from 1.9% to 2.4% and in 2010 it was significantly more than the Hertfordshire average. Stevenage, Three Rivers, Hertsmere, Welwyn Hatfield and North Hertfordshire all had a significantly higher proportion of residents living in England’s most deprived quintile than Hertfordshire. Dacorum, East Hertfordshire, St Albans and Watford had nobody living in the most deprived quintile in England.

Figure 2 shows the distribution of people living in each national deprivation quintile. There are 25.2% people in Stevenage and 24.2% in Watford living in the two most deprived quintiles (most and more deprived) in England. While in East Hertfordshire there are only 4% of people living below the middle quintile.

East Hertfordshire had the most people living in the least deprived quintile (69.8%) and St Alban’s had the second most number of residents living in the least deprived quintile (67.8%).

Page 8 of 66 Health Challenges for Hertfordshire 2014

Percent of people living in the 20% most deprived areas of England

3.0

2.5 2207 1872 1617 2.0 1632 1566 1631 e 1599 g

a 1620 1614 t 1644 n

e 1.5 1655 c r e P 1.0

0.5

0.0 7 0 7 0 7 0 7 0 7 0 7 0 7 0 7 0 7 0 7 0 7 0 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

Hertfordshire Broxbourne Stevenage Three Rivers Hertsmere Welwyn North Herts Dacorum East Herts St Albans Watford Hatfield

Source: Department for Communities and Local Governement (DCLG)

Figure 1. The numbers and percentages of people living in the most deprived 20% areas of England. The numbers on the chart represent the approximate number of people living in poverty. Red indicates significantly worse than Hertfordshire average. Blue is previous years

Page 9 of 66 Health Challenges for Hertfordshire 2014

IMD 2010 make up in Hertfordshire and the districts e l i t n i 80 u q

n 70 o i t

a 60 v i r p

e 50 d

c 40 a e

n 30 i

e l

p 20 o e p

10 f o

e 0 g e e e e e e e e e e e d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d a g g g g g g g g g g g e e e e e e e e e e e t e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e v v v v v v v v v v v a a a a a a a a a a a v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v v i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i r r r r r r r r r r r n r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r r e e e e e e e e e e e e p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p p v v v v v v v v v v v e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e c A A A A A A A A A A A d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d d r

t t t t t t t t t t t t t t t t t t t t t t s s s s s s s s s s s e e e e e e e e e e e e s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s s r r r r r r r r r r r a a a a a a a a a a a o o o o o o o o o o o e e e e e e e e e e e o o o o o o o o o o o P e e e e e e e e e e e L L L L L L L L L L L M M M M M M M M M M M L L L L L L L L L L L M M M M M M M M M M M

Hertfordshire Stevenage Broxbourne Watford Welwyn Hertsmere North Herts Dacorum Three Rivers St Albans East Herts Hatfield

Source: Department for Communities and Local Governement (DCLG)

Figure 2. The percentage of people who live in each national deprivation quintile

Page 10 of 66 Health Challenges for Hertfordshire 2014

2. Children Under 16 in Poverty Child poverty is defined as children living in families in receipt of Child Tax Credit (CTC) whose reported income is 60% or less of the median income.

The proportion of children living in poverty in Hertfordshire has remained constant between 2007 and 2011 and is significantly lower than England. However there is a wide variation between the districts. In 2011 Stevenage had the highest percentage of children living in poverty at 20.3% compared to 13.7% in Hertfordshire. In contrast, St Albans had 8.8% of children living in poverty. Stevenage, Broxbourne, Welwyn Hatfield, Watford and Dacorum are all significantly worse than Hertfordshire while North Hertfordshire, Three Rivers, East Hertfordshire and St Albans are significantly better.

Between 2007 and 2011, Watford and St Albans have seen a decrease in childhood poverty. Both Dacorum and East Hertfordshire had an initial increase but are now falling again.

Page 11 of 66 Health Challenges for Hertfordshire 2014

Percentage of children in poverty

3560 20 3665

3145 2685 29980 4045 2790 e 15

g 3095

a 2040 t n

e 10 2390 2570 c r e P 5

0 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Broxbourne Welwyn Watford Dacorum Hertsmere North Herts Three Rivers East Herts St Albans Hatfield

Source: HMRC Child Poverty Statistics and HMRC Child Benefit Statistics

Figure 3. Children living in families in receipt of Child Tax Credit (CTC) whose reported income is 60% or less of the median income. The numbers above the graph bars are the numbers of children affected in 2011. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 12 of 66 Health Challenges for Hertfordshire 2014

3. Statutory Homelessness Statutory homeless is an estimate of households who are involuntarily homeless.

Statutory homeless rates in Hertfordshire are less than the England rate; however there is a wide variance between the districts across the county with Watford, Broxbourne and Hertsmere having significantly higher rates of homelessness than England in 2012/13. For Hertfordshire the rate of homelessness is increasing and between 2009/10 and 2012/13, homelessness rates have doubled in the Watford district. In Broxbourne the rate has nearly doubled between 2011/12 and 2012/13. Though not significantly worse than Hertfordshire, Dacorum has seen rates of homelessness multiply by six between 2008/09 to 2012/13. Unfortunately historic data is missing for Broxbourne due to methods of recording data. In the districts of Welwyn Hatfield, North Hertfordshire and East Hertfordshire rates of homelessness are falling and in St Albans, Stevenage, North Hertfordshire and East Hertfordshire homelessness rates are significantly less than Hertfordshire.

This data only includes statutory homelessness and excludes people who are intentionally homeless or those who are not in priority need categories.

Page 13 of 66 Health Challenges for Hertfordshire 2014

Statutory Homelessness

7 230

s 6 d l o h

e 5

s 154 u o

h 4

0 119 0 168 , 3 1

1110 87 r 103 e 107 p 2 e t 46 65 a

R 1 35

0 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 ------8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Broxbourne Watford Hertsmere Dacorum Three Rivers Welwyn St Albans Stevenage North Herts East Herts Hatfield Source: Department for Communities and Local Governement (DCLG)

Figure 4. Statutory homeless households, crude rate per 1000 estimated households, all ages, all persons. The numbers above the graph bars are the number of households affected in 2012/13. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years. Note that data is missing for Broxbourne in 2008/09 and 2009/10 due to methods of recording data.

Page 14 of 66 Health Challenges for Hertfordshire 2014

4. GCSEs Achieved (5A*-C inc Eng & Maths) GCSE attainment for five A*-C grades including maths and English in Hertfordshire is above the average for England. However for both the districts of Stevenage and Dacorum GCSE results are significantly below the English average. The GCSE attainment for the districts of Stevenage, Dacorum and Broxbourne are all significantly below the 66.3% achievement of Hertfordshire. GCSE attainment was significantly better than Hertfordshire in 2012/13 for the districts of East Hertfordshire, St Albans, Three Rivers and Watford. Welwyn Hatfield has seen the greatest improvements in results between 2011/12 and 2012/13.

This data only contains data from maintained schools and excludes pupils educated in private schools.

Page 15 of 66 Health Challenges for Hertfordshire 2014

GCSEs achieved (5 A*-C inc. Maths & English)

80 763 4 558 1508 e 1375 g a

t 770 70 8592 579 S 825 y

e 699 k

t 60 924 a

e g

a 591 t

n 50 e c r e

P 40

30 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Dacorum Broxbourne Hertsmere Welwyn North Herts East Herts Watford St Albans Three Rivers Hatfield

Source: Department for Education

Figure 5. Pupils achieving 5 or more GCSEs at grades A*-C (including English and Maths) or equivalent, percentage of pupils at end of Key Stage 4 in schools maintained by the Local Authority, at the end of the academic year. The numbers above the bars are the number of pupils achieving these grades. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 16 of 66 Health Challenges for Hertfordshire 2014

5. Violent Crime Violent crime in this indicator is defined specifically as violence against the person. Figure 6 shows that violent crime in Hertfordshire has fallen significantly between 2007/08 to 2012/13 and this follows the England trend. Hertfordshire also has a significantly lower rate of violent crime than England. There is a wide variation across Hertfordshire with the districts of Stevenage, Watford and Broxbourne having significantly worse violent crime rates than the average in Hertfordshire in 2012/13. In 2012/13 there were 1126 violent crimes in Stevenage and rates of crime in this district were significantly higher than the rate for England. However Stevenage has had the largest fall in violent crime out of all the districts, around a third between 2008/09 and 2012/13. Watford also had a violent crime rate significantly higher than England (13.6 per 1,000) but this has fallen by about 25% since 2008/09. At the other end of the scale, Dacorum, Hertsmere, East Hertfordshire, St Albans and Three Rivers are significantly better than the average for Hertfordshire.

This data only includes violence offences against the person which have been reported to the police and is susceptible to changes in police crime reporting procedures.

Page 17 of 66 Health Challenges for Hertfordshire 2014

Violent Crime* 25

0 15 1126 0 0 ,

1 1062

r e p

e 10 t

a 753 829 R 7935 841 875 591 766 721 5 371

0 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 9 0 1 2 3 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 0 1 1 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Watford Broxbourne Welwyn North Herts Dacorum Hertsmere East Herts St Albans Three Rivers Hatfield

*Violence against the person Source: Office for National Statistics (ONS)

Figure 6. Recorded violence against the person offences, crude rate per 1,000 population, all ages. The numbers above the graph bars were the approximate number of people affected in 2012/13. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 18 of 66 Health Challenges for Hertfordshire 2014

6. Long Term Unemployment Long term unemployment is defined as claiming jobseekers allowance for 12 months or more.

Figure 7 shows that the number of people, aged 16 to 64, in long term unemployment has risen significantly in all Hertfordshire districts over the last four years.

The variation in long term unemployment in Hertfordshire is wide with Stevenage having more than twice as many people (593) claiming job seekers allowance for over 12 months compared to St Albans (292).

Stevenage, Broxbourne and Watford also have a significantly higher long term unemployment problem compared to Hertfordshire. Dacorum, East Hertfordshire, Three Rivers and St Albans have a (statistically) less significant prevalence of long term unemployment.

This data only includes those who are claiming Jobseekers Allowance at a Jobcentre Plus office and therefore will not include unemployed people who are not eligible for the Jobseekers Allowance.

Page 19 of 66 Health Challenges for Hertfordshire 2014

Long Term Unemployment 12 593 4 6 -

6 10 1

d 476 e

g 8 a

n 401 o i t 3912 430 a 6 331 381 l

u 425 p 372 215 o

p 4 292

e h t

f 2 o

0 0 0

, 0 1

0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 r 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 e 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 p

e t

a England Hertfordshire Stevenage Broxbourne Watford North Herts Hertsmere Welwyn Dacorum East Herts Three Rivers St Albans

R Hatfield

Source: Office for National Statistics (ONS) Figure 7. Claimant count: number of people claiming Jobseekers Allowance for over 12 months, aged 16 to 64 year olds. The numbers above the graph bars are the approximate number of people affected in 2013. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 20 of 66 Health Challenges for Hertfordshire 2014

7. Smoking in Pregnancy Figure 8 shows that the number of women smoking at the time of delivery has fallen in Hertfordshire between 2007/08 to 2012/13. Although the general trend for England also shows a decline, Hertfordshire has reduced smoking in pregnancy rates faster than England in general. In 2012/13, Hertfordshire had significantly lower rates of smoking during pregnancy than England.

Data is not currently available for individual districts or for 2008/09 in Hertfordshire.

Smoking During Pregnancy

12 e g a t n

e 8 c r e P

4 1 9 0 8 1 6 7 6 8 1 0 5 4 2 4 2 1 1 1 1 0 8 9 0 1 2 3 8 9 0 1 2 3 0 0 1 1 1 1 0 0 1 1 1 1 / / / / / / / / / / / / 7 8 9 0 1 2 7 8 9 0 1 2 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire

Source: Health and Social Care Information Centre (HSCIC)

Figure 8. Women giving birth whose smoking at time of delivery status is recorded. The numbers on the graph bars are the estimated number of women smoking at time of delivery per year. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years. Data is not currently available for individual districts or for 2008/09 in Hertfordshire.

Page 21 of 66 Health Challenges for Hertfordshire 2014

8. Starting Breast Feeding In 2012/13, Hertfordshire had 78% of mothers initiating breast feeding which was a significantly higher percentage than England. Additionally the percentage of mothers initiating breast feeding has gradually increased since 2007/08.

Data for initiating breast feeding is not currently available at district level. District level data is only available for prevalence at 6 – 8 weeks https://www.gov.uk/government/collections/breastfeeding-quarterly-statistics-england

Breast feeding initiation

75 e g a t

n 70 e 0 2 1 5 9 5 c r 3 3 7 8 2 0 e 1 7 6 9 0 2 P 0 0 0 0 1 1 1 1 1 1 1 1 65 8 9 0 1 2 3 8 9 0 1 2 3 0 0 1 1 1 1 0 0 1 1 1 1 / / / / / / / / / / / / 7 8 9 0 1 2 7 8 9 0 1 2 0 0 0 1 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Figure 9. Women giving birth where breast feeding initiation status is recorded. The numbers above the graph bars are the actual number of women initiating breast feeding per year. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.Source: Department of Health (DH)

Page 22 of 66 Health Challenges for Hertfordshire 2014

9. Obese children (Year 6)

Figure 10 shows that obesity in children aged between ten and eleven has fallen in all districts in Hertfordshire except for Watford and North Hertfordshire between 2009/10 to 2012/13. This is going against the trend for England which is gradually increasing.

The districts of Watford and Broxbourne have significantly higher rates of childhood obesity than the average for Hertfordshire while the districts of East Hertfordshire and St Albans have the lowest rates of childhood obesity.

However even in the district with the least childhood obesity, one child in ten is still obese.

Data does not include pupils from private schools and some academies. Additionally some children with physical disabilities are also excluded.

Page 23 of 66 Health Challenges for Hertfordshire 2014

Obese Children (Year 6) 25

20 147 145 129 117 156 180 126 1471 e 15 g 155 a 162 t 154 n e

c 10 r e P 5

England Hertfordshire Watford Broxbourne Stevenage Three Rivers Welwyn North Herts Hertsmere Dacorum East Herts St Albans Hatfield

Source: National Child Measurement Programme (NCMP), Health and Social Care Information Centre (HSCIC)

Figure 10. Prevalence of obesity in children in Year 6 (age 10-11 years). The numbers above the graph bars are the actual number of children recorded as obese in 2012/13. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 24 of 66 Health Challenges for Hertfordshire 2014

10. Alcohol-specific hospital stays (under 18) In the three year period of 2010/11 to 2012/13, Hertfordshire as a whole had significantly less under 18s with alcohol-specific hospital stays compared to England. Across the whole of Hertfordshire there were 157 cases over the three years. Looking at the individual districts, Hertsmere had the highest rates of alcohol specific stays (25 in the three year period or approximately 8 per year) though this was not significantly higher than Hertfordshire. North Hertfordshire had the least incidents but again this was not significantly lower than Hertfordshire. Since 2006/07 to 2008/09 alcohol-specific hospital stays in under 18s has fallen across Hertfordshire with Dacorum seeing the biggest reduction.

Page 25 of 66 Health Challenges for Hertfordshire 2014

Alcohol-specific hospital stays (under 18s)

60 0 0 0 , 0

0 40 8

1 6

e 6 5

p 5

e 52 t 6 a 20 5 3 R 5 3

7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 7 8 9 0 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Hertsmere Stevenage Welwyn Watford Three Rivers Dacorum East Herts Broxbourne St Albans North Herts Hatfield

Source: Hospital Episode Statistics (HES) via Health and Social Care Information Centre (HSCIC).

Figure 11. Persons admitted to hospital due to alcohol-specific conditions - under 18s, crude rate per 100,000 population. The numbers above the graph bars are the average number of young people affected per year between 2010/11 and 2012/13. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 26 of 66 Health Challenges for Hertfordshire 2014

11. Teenage Pregnancy (under 18) Figure 12 below shows that in Hertfordshire teenage conception rates for under 18s, resulting in a live birth or abortion, is falling in Hertfordshire which follows the trend for England. However there is still a wide variation between the county districts.

In particular, Stevenage had a significantly higher rate than Hertfordshire in 2012 and was more than double the rate of Three Rivers in 2012. Although Hertsmere, St Albans, Dacorum, East Hertfordshire and Three Rivers had lower rates than Hertfordshire in 2012 they were not significantly lower.

Page 27 of 66 Health Challenges for Hertfordshire 2014

Under 18 conceptions 40 8 1

r e d

n 49 u

n 30 o i t a l 38 u p

o 37 48 p

e 36

l 20

a 368 31 m

e 39 f

36 0 34 20 0 0 1

r 10 e p

e t a R 0 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Watford Broxbourne North Herts Welwyn Hertsmere St Albans Dacorum East Herts Three Rivers Hatfield

Source: Office for National Statistics (ONS)

Figure 12. Under-18 conception rate per 1,000 females. The numbers above the graph bars are the average number of females affected in 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 28 of 66 Health Challenges for Hertfordshire 2014

12. Smoking Prevalence Figure 13 shows that the estimated percentage of adults who smoke in Hertfordshire has fallen between 2010 and 2012. In 2012 the percentage of smokers in Hertfordshire was significantly less than for England. However at district level, Hertsmere and Welwyn Hatfield have seen an increase in smokers over this time period.

Stevenage has more smokers than the Hertfordshire average but it is not a significantly greater percentage. Watford has the lowest percentage of smokers in the county but again it is not significantly less.

The data is collected from the Integrated Household Survey (HIS) and consideration must be given to the quality of the data as it relies on self reporting data from a limited sample of people.

Page 29 of 66 Health Challenges for Hertfordshire 2014

Smoking Prevalence 30

20 e g a t

n 15 e c r e P 10

0 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Hertsmere Welwyn Broxbourne Dacorum North Herts St Albans Three Rivers East Herts Watford Hatfield

Source: Integrated Household Survey analysed by Department of Health and published by Publlic Health England.

Figure 13. Percentage of adults 18 and over who smoke. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 30 of 66 Health Challenges for Hertfordshire 2014

13. Percentage of Physically Active Adults In 2013 the estimated percentage of adults in Hertfordshire who exercised for more than two and a half hours per week was 58.8% which was slightly more than in 2012. Across the districts Dacorum had the lowest percentage (49.2%) of adults exercising for two hours and 30 minutes per week. Both Dacorum and Stevenage (52.7%) were significantly worse for physical activity than Hertfordshire. East Hertfordshire had the greatest percentage (69.0%) of physically active adults which was significantly higher than Hertfordshire.

Percentage of adults (16+) participating in more than 150 minutes of physical activity per week 80

60 s t l u d

a 50

f o

g 40 a t n

e 30 c r e P 20

0 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 2 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Dacorum Stevenage Three Rivers Watford Welwyn Hertsmere St Albans North Herts Broxbourne East Herts Hatfield

Source: Active People Survey, Sport for England

Figure 14. Percentage of people participating in more than 150 minutes of physical activity per week. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 31 of 66 Health Challenges for Hertfordshire 2014

14. Obese Adults Adult obesity is defined as having a BMI of 30 or more. In 2012 the percentage of adults in Hertfordshire who were obese was estimated to be 21.5%. Across the districts Broxbourne had the highest percentage (28.3%) of obese adults and this was significantly more than Hertfordshire. St Albans had significantly less obese adults in which there were 15.5% obese adults.

Obese Adults in 2012 30

25 s t l u d a 20 e s e b o

f 15 o

e g a t

n 10 e c r e P 5

Source: Active People Survey,Sport for England

Figure 15. Percentage of obese adults in 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better.

Page 32 of 66 Health Challenges for Hertfordshire 2014

15. Excess Weight Adults Figure 16 below shows the estimated percentage of adults with a BMI of 25 in 2012 in Hertfordshire and the districts. In Hertfordshire 61.8% of adults were carrying excess weight in 2012 but this was significantly less than England. The district of Broxbourne had a significantly greater percentage (70.2%) of adults who were considered overweight than Hertfordshire. Welwyn Hatfield had the least overweight adults at 52.7% and was significantly lower than Hertfordshire.

Excess weight in adults in 2012 80

70 s t l 60 u d a

s 50 e b o

f 40 o

e g a

t 30 n e c r

e 20 P

Source: Active People Survey, Sport for England

Figure 16. Percentage of adults carrying excess weight in 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better.

Page 33 of 66 Health Challenges for Hertfordshire 2014

16. Incidence of Malignant Melanoma Incidence of malignant melanoma in the under 75s has gradually risen in Hertfordshire since 2004-06 following the trend for England. The rate in Hertfordshire has increased significantly between 2004-06 and 2009-11. However there was a decline in 2009-11. The district of Hertsmere has a significantly lower rate than Hertfordshire and Welwyn Hatfield has the highest rate though not significantly higher.

The total number of people in Hertfordshire with an incidence of malignant melanoma in 2009-11 was 458 which is an average of 153 per year.

Page 34 of 66 Health Challenges for Hertfordshire 2014

Incidence of Malignant Melanoma

20 0

0 18 23 0 , 0 0

1 12 21

r 15 153 20 e 11 p 10 12 e 17 t a R

d 10 9 e s i d r a d

n 5 a t S

y l t c e

r 0 i 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 6 7 8 0 1 D 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 ------4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 4 5 6 8 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Welwyn North Herts Stevenage East Herts St Albans Three Rivers Watford Broxbourne Dacorum Hertsmere Hatfield

Source: Public Health England (PHE) Regional Cancer Registries and Office for National Statistics (ONS)

Figure 17. Registrations for malignant melanoma of the skin (ICD-10 C43), directly age-standardised rate, persons, under 75, (3-year average of annual rates), per 100,000 European Standard population. The numbers above the graph bars are the average number of people affected per year between 2009 and 2011. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 35 of 66 Health Challenges for Hertfordshire 2014

17. Hospital stays for self-harm Figure 18 shows that the number of hospital stays from the result of intentional self-harm increased in Hertfordshire between 2009/10 and 2012/13 though it was still significantly lower than England in 2012/13. In 2012/13 there were almost 1300 admissions in Hertfordshire due to intentional self-harm.

Stevenage had a significantly higher rate than Hertfordshire and East Hertfordshire and St Albans had significantly lower rates of hospital admissions resulting from self-harm than Hertfordshire.

The districts of Dacorum, Three Rivers and St Albans have all seen a steady increase in hospital admissions due to self-harm between 2009/10 and 2012/13.

It is important to be aware that the identification and coding of self-harm can be subject to recording bias.

Page 36 of 66 Health Challenges for Hertfordshire 2014

Hospital stays for self harm 250 0 0 0 , 0 0

1 200

r e p

e t

a 126

R 150

198 115

d 163

s 117 i 1297 114

d 137

r 99 a

d 100 125 n a

t 103 S

y l t c

e 50 r i D

0 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Dacorum Three Rivers North Herts Watford Hertsmere Welwyn Broxbourne St Albans East Herts Hatfield

Source: Health and Social Care Information Centre - Hospital Episode Statistics (HES) and Office for National Statistics (ONS), Compiled by PHE (2014)

Figure 18. Emergency hospital admissions for intentional self-harm, directly age-sex standardised rate, all ages. The numbers above the graph bars are the number of people affected in 2012/13. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 37 of 66 Health Challenges for Hertfordshire 2014

18. Hospital Stays for Alcohol Related Harm The number of hospital admissions for all primary diagnosis alcohol-attributed conditions or externally alcohol- related causes has risen in Hertfordshire between 2009/10 and 2012/13. In 2012/13 there were nearly 5000 admissions Hertfordshire. However Hertfordshire still had significantly hospital stays for alcohol related harm than England.

Among the districts in 2012/13, Three Rivers, Broxbourne and Watford had significantly higher rates of alcohol related harm admissions than the Hertfordshire average. East Hertfordshire and St Albans had significantly lower rates of alcohol related harm admissions than Hertfordshire. There have been steady rises in admissions in the districts of Three Rivers, Watford, North Hertfordshire, Dacorum, Welwyn Hatfield and St Albans

Note: This indicator has changed from the Health Profiles 2013. The 2014 Health Profiles uses only primary diagnoses and external causes of alcohol-attributed conditions whereas the Health Profiles 2013 used both primary and secondary diagnoses.

Page 38 of 66 Health Challenges for Hertfordshire 2014

Hospital Stays for Alcohol Related Harm

700

600 456 478 431 489 585 500 4957 641 355

0 438

0 551

0 534 ,

0 400 0 1

r e p 300 e t a R

e 200 s i d r a

d 100 n a t S

y l

t 0 c 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 0 1 2 3 e 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 r / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / i 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 D 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Three Rivers Broxbourne Watford Hertsmere North Herts Dacorum Stevenage Welwyn East Herts St Albans Hatfield

Source: Hospital Episode Statistics (HES) via Health and Social Care Information Centre (HSCIC)

Figure 19. Number of admissions for alcohol-attributable conditions, directly age and sex standardised rates, all ages, admissions per 100,000 European Standard Population. The numbers above the graph bars are the number of hospital admissions. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 39 of 66 Health Challenges for Hertfordshire 2014

19. Drug Misuse The estimated number of people misusing either opiate drugs or crack cocaine in Hertfordshire has remained relative stable between 2006/07 and 2010/11. Compared to England, Hertfordshire had a significantly lower rate in 2010/11. The district of Watford has seen a significant increase between 2006/07 and 2010/11. In comparison to Hertfordshire, Watford, Stevenage and Welwyn Hatfield all have significantly higher rates of drug misuse. At the other end of the scale, Broxbourne, Dacorum, St Albans and Three Rivers all have significantly lower rates of drug misuse compared to Hertfordshire.

It is important to be aware that this data is a modelled estimate from the number of drug offences in each area and the number of people receiving treatment for drug addiction. It only includes drug misuse for opiates and crack cocaine and excludes other illegal drugs.

Note: There have been no new updates since the 2013 Health Profiles.

Page 40 of 66 Health Challenges for Hertfordshire 2014

Drug misuse

10 527 9 462 8 7 0

0 439 0 , 6 481 1 3753

r 393

e 5 299

p 259 385 366 e t 4 a R 3 141 2 1 0 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 7 9 0 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 0 0 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 6 8 9 0 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Watford Stevenage Welwyn East Herts North Herts Hertsmere Broxbourne Dacorum St Albans Three Rivers Hatfield

Source: Drug Action Team (DAT), Government Office Region (GOR) and England for 2010/11 provided by the National Treatment Agency

Figure 20. Estimated prevalence of opiate and/or crack cocaine use, crude rate per 1,000 population aged 15-64. The numbers above the graph bars are the estimated number of people affected. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 41 of 66 Health Challenges for Hertfordshire 2014

20. Recorded Diabetes The percentage of people over the age of 17 being diagnosed with type 1 or type 2 diabetes has increased significantly in Hertfordshire and all the districts between 2008/09 and 2012/13. In 2012/13 48422 people in Hertfordshire where registered with a GP as having either type 1 or type 2 diabetes. In comparison to England Hertfordshire does have a significantly lower rate of recorded diabetes.

Broxbourne has the highest percentage in Hertfordshire and has almost the same prevalence as England (6%). Broxbourne along with Stevenage, North Hertfordshire and Watford all have levels significantly higher than the Hertfordshire average. Dacorum, East Hertfordshire and St Albans have significantly lower percentages of people diagnosed with diabetes.

This data is a measure of recorded prevalence and many cases of diabetes go undiagnosed. In addition this data does not include people from under reported groups who are not registered with a GP. People from these groups include those from ethnic minority populations, young people, homeless people, migrants and travellers.

Note: Data is from QOF. Type 2 diabetes makes up approximately 90% of all diagnoses.

Page 42 of 66 Health Challenges for Hertfordshire 2014

Recorded diabetes

7 4962 6 3970 6016 4165 48422 5257 5103 2938 5 6073 5178 4760 e 4 g a t n

e 3 c r e

P 2

England Hertfordshire Broxbourne Stevenage North Herts Watford Hertsmere Welwyn Three Rivers Dacorum East Herts St Albans Hatfield

Source: QualityManagement Analysis System (QMAS) via the Health and Social Care Information Centre (HSCIC)

Figure 21. The prevalence of Quality and Outcomes Framework (QOF)-recorded diabetes in the population registered with GP practices aged 17 years and over. The numbers above the graph bars are the number of people recorded to have diabetes in 2012/13. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 43 of 66 Health Challenges for Hertfordshire 2014

21. Incidence of Tuberculosis The rate of new cases of tuberculosis in Hertfordshire has increased slightly between 2006-08 and 2010-12 with approximately 93 incidents per year. No district is significantly worse or better than Hertfordshire but Hertfordshire does have significantly lower rate of new cases than England.

Watford had more incidents than any other district in Hertfordshire in 2010-12 which was approximately 16 incidents per year. East Hertfordshire had the lowest rate in Hertfordshire in 2010-2012 with just 4 incidents per year. Watford, Stevenage, North Hertfordshire and Broxbourne have all seen falls in new cases while Hertsmere, Welwyn Hatfield, St Albans, and Dacorum have seen increases.

A small number of cases may be missing due to missing postcodes from homeless people.

Page 44 of 66 Health Challenges for Hertfordshire 2014

Incidence of tuberculosis

20 16 0 0 0 ,

0 15

0 13 1

r 13

e 9 p

t 10

a 93

R 10 10 7 7 5 4 4

0 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 ------6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Watford Hertsmere Welwyn Stevenage St Albans Dacorum Three Rivers North Herts Broxbourne East Herts Hatfield

Source: Public Health England

Figure 22. 3-year average of TB incidence per 100,000 population. The numbers above the graph bars are the average number of people affected per year between 2010 and 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 45 of 66 Health Challenges for Hertfordshire 2014

22. Acute Sexually Transmitted Infections In 2012 there were 713 acute sexually transmitted infections (STIs) per 100,000 residents in Hertfordshire. This amounted to 7984 cases. In comparison to England, Hertfordshire had significantly lower rates of STIs.

The data for 2012 included Chlamydia (all ages), Gonarroea, Syphilis, Genital Herpes, Genital Wards, PID and epididymitis, Chancriod/lymphogranuloma (LGV), Molluscum contagiosum, Trichomoniasis, Scabies, Pediculus pubis and new HIV diagnoses. As the data for 2010 did not include new HIV diagnoses or Chlamydia in people over 24, it is not possible to compare the 2012 data set to the 2010 data set.

Due to problems with data recording in 2012, rates are not available at district level.

Page 46 of 66 Health Challenges for Hertfordshire 2014

Acute Sexually Transmitted Infections in 2012

1000

0 800 0 0 , 0 0 1

r 600 e p

e t a

R 400 7984 200

Source: Genitourinary Medicine Clinic Activity Dataset (GUMCAD)

Figure 23. Number of diagnoses of acute sexually transmitted infections (STIs) per 100,000 population. The numbers above the graph bars are the approximate number of people affected per year. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better.

Page 47 of 66 Health Challenges for Hertfordshire 2014

23. Hip Fracture in People aged 65 and Over Between 2010/11 and 2012/13 the rate of hip fractures in people aged 65 and over have remained stable in Hertfordshire and are a little lower than for England. In 2012/13 there were 1149 cases in Hertfordshire. Across the districts Hertsmere had the highest rates of hip fractures and Broxbourne had the lowest rates; however neither district were significantly different to Hertfordshire. Rises in hip fractures have been seen in Hertsmere and Dacorum while decreases have been seen in Watford, North Hertfordshire, Welwyn Hatfield and Broxbourne.

Note: The data has been recalculated since the 2013 Health Profiles using the new European Standard Population so the data below is not comparable to the 2013 Health Profiles data. Hip Fractures in 65s and over

0 800 0

0 132 ,

0 700 0 177 1 106 78

r 80

e 600 1149 p 126 136 134 e 97 t

a 500 83 R

e 400 s i

rd 300 a d n

a 200 t S

l 100 t c re i 0 D 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 0 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Hertsmere Dacorum Three Rivers Watford Stevenage East Herts North Herts St Albans Welwyn Broxbourne Hatfield

Source: Hospital Episodes Statistics (HES) via the NHS Information Centre.

Figure 24. Emergency Hospital Admission for fractured neck of femur, directly age-sex standardised rate, 65 years and over. The numbers above the graph bars were the number of people affected in 2012/13. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years. Page 48 of 66 Health Challenges for Hertfordshire 2014

24. Excess Winter Deaths The percentage of excess winter deaths in Hertfordshire remained stable between 2006-09 and 2009-12 and was slightly higher (but not significantly higher) than England in 2009-12. In the period of 2009-12 there were on average, 489 excess deaths per year in Hertfordshire. There were no significant differences to Hertfordshire in any of the districts. Only two districts have seen a fall in excess winter deaths between 2006-09 and 2009-12 and these are North Hertfordshire and Dacorum. Watford has seen the greatest increase though this is not statistically significant. Watford had approximately 58 excess winter deaths per year in 2009-12.

Excess winter deaths are calculated by comparing the deaths in the summer months to the winter months and expressed as a ratio. The ratio will be dependent on the number of elderly people in the area as most excess winter deaths affect older people.

Page 49 of 66 Health Challenges for Hertfordshire 2014

Excess winter deaths

30 58

e 58 g 64 a t 41 52

n 20 489 e 35 c

r 58 e 15 49 32 P 42

5 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 ------6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 6 7 8 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Watford Hertsmere East Herts Broxbourne Welwyn Stevenage North Herts Dacorum Three Rivers St Albans Hatfield

Source: The Annual Public Health Mortality File provided by ONS

Figure 25. The excess number of deaths in winter compared with non-winter months from 1 August 2009 to 31 July 2012 expressed as a percentage. Numbers on the chart represent the approximate number of people affected per year from 1 August 2009 to 31 July 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 50 of 66 Health Challenges for Hertfordshire 2014

25. Life Expectancy – Males Life expectancy at birth for men has been increasing year on year in Hertfordshire since 2006-08 and is significantly higher than England. The districts of Stevenage, Welwyn Hatfield, Hertsmere, East Hertfordshire and St Albans have also seen a year on year increase. However North Hertfordshire, Dacorum, Three Rivers and Broxbourne have seen a fall in life expectancy and Watford has remained the same. Watford (79.2 years) has a significantly lower life expectancy for men than Hertfordshire (80.4 years) and St Albans (81.7 years) has a significantly higher life expectancy for men than Hertfordshire. The gap in life expectancy across the Hertfordshire districts was 2.5 years in 2010-12 which is a decrease from 3.2 years in 2006-08.

Life Expectancy - Males

82 81.7

81.0 81 80.7 80.7 80.4 80.3 80.3 79.9 80.1 80 79.6 79.2 79.2 e

g 79 A

76 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 ------6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Watford Stevenage North Herts Welwyn Dacorum Three Rivers Broxbourne Hertsmere East Herts St Albans Hatfield

Source: Office for National Statistics (ONS) and Public Health England (PHE) Figure 26. Life expectancy at birth, years, all ages, males. Numbers on the graph show the average life expectancy from 2010 to 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years. Page 51 of 66 Health Challenges for Hertfordshire 2014

26. Life Expectancy – Female Life expectancy at birth for women has increased in Hertfordshire between 2006-08 and 2009-11 and remained the same between 2009-11 and 2010-12. For women life expectancy in Hertfordshire is significantly better than the England average.

In Dacorum and St Albans life expectancy has improved year on year and both districts have significantly better life expectancy than Hertfordshire. A dip in life expectancy has been seen in all the other districts since 2009-11 except for Welwyn Hatfield where there has been no change. Watford, Stevenage and North Hertfordshire all have life expectancies which are significantly less than the average for Hertfordshire. The variation in life expectancy for women across Hertfordshire has increased from 2.4 years in 2006/08 to 3.0 years in 2010/12.

Page 52 of 66 Health Challenges for Hertfordshire 2014

Life expectancy - female

86 85.3

85 84.5 84.4 84.5 84.1 83.8 84 83.5 83.6 83.0 82.6 82.8

e 83 82.3 g A 82

79 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 ------6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Watford Stevenage North Herts Hertsmere Welwyn East Herts Broxbourne Three Rivers Dacorum St Albans Hatfield

Source: Office for National Statistics (ONS) and Public Health England (PHE)

Figure 27. Life expectancy at birth, years, all ages, females. Numbers on the graph show the average life expectancy for females from 2010 to 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 53 of 66 Health Challenges for Hertfordshire 2014

27. Infant deaths Figure 28 shows that the rate of infants dying under one year in Hertfordshire. In 2010-12 was 2.9 infants for every 1,000 live births which was significantly lower than the rate for England. On average this was 44 infants per year in Hertfordshire. Since 2006-08 the rate has fallen from 3.5 deaths per 1,000 live births.

Stevenage had the highest rate of infant deaths (5.4 for every 1,000 live births) which was around 7 deaths per year. The lowest rate was in East Hertfordshire with 1.6 deaths per 1,000 live births. The district with the largest rise is Hertsmere which has gone from 2.1 in 2006-08 to 3.6 in 2010-12.

Page 54 of 66 Health Challenges for Hertfordshire 2014

Infant Deaths

6 s 7 h t r i B

5 e v i 6 L 4 0 5

0 4

0 4 ,

1 44

r 3 4 5 e 4 p

e t

a 2 3 3 R

0 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 ------6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Welwyn Hertsmere Three Rivers Broxbourne Watford Dacorum North Herts St Albans East Herts Hatfield

Source: Office for National Statistics (ONS)

Figure 28. Infant deaths, crude rate, persons, aged less than 1 year, per 1,000 live births. The numbers above the graph bars are the average number of infants affected per year between 2010 and 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 55 of 66 Health Challenges for Hertfordshire 2014

28. Smoking Related Deaths Smoking related deaths in people over the age of 35 fell slightly in Hertfordshire between 2007-09 and 2010-12. It was significantly lower than England in 2010-2012. . The rate of deaths was significantly higher in Stevenage and significantly lower in St Albans during 2010-12. All the districts have seen a reduction in rates of smoking related deaths. However there were still approximately 1490 deaths per year in Hertfordshire from smoking in 2010-12.

Note: The data in the Health Profiles 2014 has been recalculated using the new 2013 European Standard Population so it cannot be compared to the data in the Health Profiles 2013.

Page 56 of 66 Health Challenges for Hertfordshire 2014

Smoking Related Deaths

400

350

0 123 0 0 ,

0 300

0 153 99 127 1

1490 194 183 143 r

e 117 159

p 250

e 149 t a R

200 R S D 150

100 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 9 0 1 2 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 0 1 1 1 ------7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 7 8 9 0 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Welwyn Watford Broxbourne Dacorum North Herts Hertsmere Three Rivers East Herts St Albans Hatfield

Source: Office for National Statistics (ONS)

Figure 29. Estimated deaths attributable to smoking per 100,000 population, aged 35+. The numbers above the graph bars are the average number of people affected per year between 2010 and 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 57 of 66 Health Challenges for Hertfordshire 2014

29. Early Deaths: Suicide Rate In 2010-12 there were approximately 66 recorded suicides per year in Hertfordshire which is a rate of 259 per every 100,000 residents. Hertfordshire had a significantly lower suicide rate than England and it has gradually fallen since 2006-08. The rates and numbers for most districts are too low to be shown on a chart so only the rates for England and Hertfordshire are shown below.

Suicide Rate 10 9

n 8 o i t a

l 7 u

p 6 o p 5 0 0 0

, 4 0 0

1 3

r e

p 2

S 1 70 71 69 65 66 D 0 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 ------6 7 8 9 0 6 7 8 9 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2

England Hertfordshire

Source: Public Health England

Figure 30. Recorded suicides in Hertfordshire The numbers above the graph bars are the average number of suicides per year in Hertfordshire. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 58 of 66 Health Challenges for Hertfordshire 2014

30. Under 75 mortality rate: Cardiovascular diseases (Including Heart Disease & Stroke) Figure 31 shows that early deaths (before the age of 75) from cardiovascular diseases have significantly fallen in Hertfordshire between the periods of 2006-08 and 2010-12. On average there were 595 deaths per year in 2010- 12 in Hertfordshire. Hertfordshire has a significantly lower rate of deaths from cardiovascular diseases than England.

This fall is seen in all districts however no district is significantly worse or better than Hertfordshire.

Note: The data in the Health Profiles 2014 has been recalculated using the new 2013 European Standard Population so it cannot be compared to the data in the Health Profiles 2013.

Page 59 of 66 Health Challenges for Hertfordshire 2014

Under 75 mortality rate: cardiovascular

120 0 0 0 ,

0 110 0 1

e 100 p

e t 90 a

R 47

d 59 44 85 e 80 55 75 s

i 595

d 53 r

a 70 46

d 65

n 66 a

t 60 S

y l t 50 c e r i

D 40

30 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 ------6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Hertsmere Watford Dacorum Broxbourne North Herts Welwyn Three Rivers St Albans East Herts Hatfield

Source: Public Health England based on ONS source data

Figure 31. Mortality from all circulatory diseases (including heart disease and stroke), directly age-standardised rate, persons under 75, per 100,000, 2013 European Standard population. The numbers above the graph bars are the average number of people affected per year between 2010 and 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 60 of 66 Health Challenges for Hertfordshire 2014

31. Under 75 mortality rate: Cancer Figure 32 shows that early deaths from cancer (before the age of 75) have significantly decreased in Hertfordshire between the periods of 2006-08 and 2010-12. In addition, Hertfordshire has a significantly lower rate of deaths than England. In 2010-12 there were approximately 1116 early deaths from cancer in Hertfordshire

Among the districts, no district is significantly higher or lower than Hertfordshire though Stevenage has the highest rates and St Albans has the lowest rates. All districts have seen a fall in early deaths from cancer between 2006- 08 and 2010-12.

Note: The data in the Health Profiles 2014 has been recalculated using the new 2013 European Standard Population so it cannot be compared to the data in the Health Profiles 2013.

Page 61 of 66 Health Challenges for Hertfordshire 2014

Under 75 mortality rate: Cancer

180 0 0 0 , 0

0 160 1 89

e 113 p

e 80 102 t 105 a 140 1116 137 R 89 d 141 136 e s i 124 d 120 r a d n a t

S 100

y l t c e r i

D 80

60 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 8 9 0 1 2 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 0 0 1 1 1 ------6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 6 7 8 9 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

England Hertfordshire Stevenage Welwyn Watford Broxbourne Hertsmere North Herts Dacorum Three Rivers East Herts St Albans Hatfield

Source: Office for National Statistics (ONS)

Figure 32. Mortality from all cancers, directly age-standardised rate, persons under 75, per 100,000, 2013 European Standard population. The numbers above the graph bars are the average number of people affected per year between 2010 and 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years.

Page 62 of 66 Health Challenges for Hertfordshire 2014

32. Killed and seriously injured on roads Road injuries and deaths on Hertfordshire roads have fallen significantly between 2006-08 and 2010-2012 and Hertfordshire had a significantly lower rate of people killed or seriously injured on the roads than England. All the districts have also seen falls in road injuries and deaths with Welwyn Hatfield seeing the greatest fall by over 40% in this time period.

Hertsmere had significantly higher rates of people injured and killed on the roads than Hertfordshire (50 per year) and also had a higher rate of injuries and deaths per 100,000 compared to England which was 49.8 compared to 40.6 per 100,000 of the population.

Page 63 of 66 Health Challenges for Hertfordshire 2014

Killed and seriouly injured on roads 70

50 50 60

0 40 48 0 392 29 0 , 46 47 0 35 26

0 28 1

30 24 r e p

t 20 a R 10

England Hertfordshire Hertsmere St Albans North Herts Three Rivers East Herts Dacorum Welwyn Stevenage Broxbourne Watford Hatfield

Source: Department for Transport (DfT)

Figure 33. People killed or seriously injured on the roads of the area, crude rate per 100,000 resident population, all ages. The numbers above the graph bars are the average number of people affected per year between 2010 and 2012. Red indicates significantly worse than Hertfordshire average, Yellow indicates not significantly different, Green indicates significantly better. Blue is previous years. Data is based on the location of the injury or death.

Page 64 of 66 Health Challenges for Hertfordshire 2014

Appendix 1: Notes to the Tartan Rug of Health Indicators

The data is as used in national indicators and is most recent data available. Numbers correspond to the indicator number in the Tartan Rug

Indicator Notes

1. % people in this area living in 20% most deprived areas in England, 2010 2. % children (under 16) in families receiving means-tested benefits & low income, 2011 3. Crude rate per 1,000 households, 2012/13 4. % key stage 4, 2012/13 5. Recorded violence against the person crimes, crude rate per 1,000 population, 2012/13 6. Crude rate per 1,000 population aged 16-64, 2013 7. % of women who smoke at time of delivery, 2012/13 8. % of all mothers who breastfeed their babies in the first 48hrs after delivery, 2012/13 9. % school children in Year 6 (age 10-11), 2012/13 10. Persons under 18 admitted to hospital due to alcohol-specific conditions, crude rate per 100,000 population, 2010/11 to 2012/13 (pooled) 11. Under-18 conception rate per 1,000 females aged 15-17 (crude rate) 2012 12. % adults aged 18 and over, 2012 13. % adults achieving at least 150 mins physical activity per week, 2013 (downloaded from PHOF Aug-14) 14. % adults classified as obese, Active People Survey 2012 15. % adults classified as overweight or obese, Active People Survey 2012 16. Directly age standardised rate per 100,000 population, aged under 75, 2009-2011 (1976 European Standard Population) 17. Directly age sex standardised rate per 100,000 population, 2012/13 (2013 European Standard Population) 18. The number of admissions involving an alcohol-related primary diagnosis or an alcohol-related external cause, directly age standardised rate per 100,000 population, 2012/13 (2013 European Standard Population) 19. Estimated users of opiate and/or crack cocaine aged 15-64, crude rate per 1,000 population, 2010/11 20. % people on GP registers with a recorded diagnosis of diabetes 2012/13 21. Crude rate per 100,000 population, 2010-2012 22. Crude rate per 100,000 population, 2012 (chlamydia screening coverage may influence rate) 23. Directly age and sex standardised rate of emergency admissions, per 100,000 population aged 65 and over, 2012/13 (2013 European Standard Population) 24. Ratio of excess winter deaths (observed winter deaths minus expected deaths based on non-winter deaths) to average non-winter deaths 1.08.09-31.07.12

Page 65 of 66 Health Challenges for Hertfordshire 2014

25. Life expectancy at birth, 2010-2012 26. Life expectancy at birth, 2010-2012 27. Rate per 1,000 live births, 2010-2012 28. Directly age standardised rate per 100,000 population aged 35 and over, 2010-2012 (2013 European Standard Population) 29. Directly age standardised mortality rate from suicide and injury of undetermined intent per 100,000 population, 2010-2012 (2013 European Standard Population) 30. Directly age standardised rate per 100,000 population aged under 75, 2010-2012 (2013 European Standard Population) 31. Directly age standardised rate per 100,000 population aged under 75, 2010-2012 (2013 European Standard Population) 32. Rate per 100,000 population, 2010-2012

Page 66 of 66