Developing The Public Health Observatory For Datblygu Arsyllfa Iechyd y Cyhoedd i Gymru Wales and its Local Health Boards

Demography Profile Wales, covering an area of 20,779 km2 with a population of approximately 2.98 million2, has seven diverse local health boards (LHB). LHB boundaries describe areas whose geographical size ranges from under 500 km2, Cardiff & Vale University LHB, to over 6,000 km2, Betsi Cadwaladr University LHB. LHB resident populations range from 132,000 in Powys Teaching LHB to 678,500 in Betsi Cadwaladr University LHB. The more urban and post industrial Key Statistics UK Wales southern and eastern areas of Aneurin Bevan, Cardiff & Area size [1] 244,168 km2 20,779 km2 Vale University, Cwm Taf and Total population [2] 60,975,000 2,980,000 Abertawe Bro Morgannwg Life expectancy at birth – males [3] 77.2 years 76.8 years University LHBs make up 60% Life expectancy at birth – females [3] 81.5 years 81.2 years of the population of Wales but Persons per km2 [1, 2] 251.0 143.4 just 17% of the area of Wales. % population from ethnic 7.9% 2.1% In contrast, Powys Teaching, minority background (2001) [4] Betsi Cadwaladr University Total number of births [5, 6] 776,272 34,572 and Hywel Dda Local Health Number of deaths [7] 574,687 32,148 Boards are dominated by more rural areas. Fig 1: Population pyramid Wales and UK Wales’ age and sex profile is similar Data source: Office for National Statistics, mid year estimates 2007 to that of the UK as a whole (Fig. 1), but there are fewer people Wales males Wales females among the working ages of 25 to UK

49 years and more amongst those 85+ aged 55 and over. The 2001 Census 80-84 reported that 2.1 percent of the 75-79 70-74 population came from a black or 65-69 ethnic minority background4, the 60-64 55-59 effect of migration since this time 50-54 is more difficult to quantify. 45-49 40-44 35-39 The general fertility rate, the 30-34 number of births per 1,000 25-29 20-24 women of child bearing age, is 15-19 lower in Wales than the UK (Fig. 10-14 2)5. However, rates are broadly 05-09 00-04 similar across LHBs within Wales. 10 8 6 4 2 0 2 4 6 8 10 Proportion (%) of population Demography Profile

The general fertility rate had been Fig 2: General Fertility Rate, LHBs, Wales and UK (2007) falling until 2001/2002 across Wales Data source: Office for National Statistics (Annual District Births Extract, and the United Kingdom; however, mid year estimates, GRO , Northern ) it has been slowly rising since.

70 The under 75 age standardised 65 mortality rate shows substantial variation across Wales (Fig. 3). 60 The rate in Cwm Taf LHB area is 55 25% higher than the all-Wales rate, whereas Powys teaching LHB area 50 has a rate 23% below the Wales rate. 45 These differences from the Wales 40 rate are statistically significant.

UK The under 75 age-standardised Dda Dda GFR per 1,000 women aged 15-44 aged women 1,000 per GFR scale) (truncated Betsi Wales Bevan Hywel Powys

& Vale & mortality rate has fallen in all Cardiff Aneurin Cwm Taf Cwm LHB areas in Wales; overall it has Cadwaladr Morgannwg

Abertawe Bro Abertawe declined by 18% between 1998 and

Error bars represent 95% confidence intervals. These reflect how random variation might influence the rate shown. 2007. This fall is likely to reflect This variation is greater in smaller populations, giving rise to wider intervals (for further details see website). not only the activities of health services, but also improvements in Fig 3: Under 75 mortality rate, LHBs, Wales and UK (2007) living standards in the latter part Data source: Office for National Statistics (Annual District Births Extract, of the 20th century. mid year estimates, GRO Scotland, ) The greatest causes of death in 500 people aged under 75 in Wales 450 are cancer, circulatory disease 400 and respiratory disease, together 350 accounting for 40%, 27% and 9% 300 of approximately 11,000 deaths in 250 20076. 200 150 Geographically based deprivation 100 measures can be used to show 50 inequalities in health and suggest EASR* per 100,000 population EASR*100,000 per 0 areas likely to most need measures UK Dda Dda

Betsi to improve health and manage ill- Wales Bevan Hywel Powys & Vale & Cardiff Aneurin

Cwm Taf Cwm health. The Welsh Index of Multiple Cadwaladr Morgannwg Deprivation 2008, is produced at a Abertawe Bro Abertawe small area level called Lower Super *EASR: European age standardised rate. Age standardisation allows comparison of rates across populations or time Output Area (LSOA), and is derived periods even when the age structures in these populations/time periods are different. from a broad range of factors8.

1. Office for National Statistics, 2007 geography. 6. Office for National Statistics, Annual District Births Extract. 2. Office for National Statistics, 2007 mid year estimates 7. Office for National Statistics, Key Population and Vital In Wales the majority of the (rounded to the nearest 100). Statistics, Series VS no 30 2007 Data. deprived areas are found in the 3. Office for National Statistics, 2005-07 deaths registration 8. Welsh Assembly Government (WIMD domains: income and mid-year population estimates data. employment, health, education, access to service, South Wales valleys, some parts 4. Office for National Statistics, 2001 Census. housing, physical environment, community safety) of the North Wales coast and 5. Office for National Statistics, GRO Scotland, GRO Northern Ireland. parts of Cardiff and Swansea (Fig. 4). However, within less deprived © 2009 Wales Centre for Health and the National Public Acknowledgement to the Wales Centre for Health and the areas there are often pockets of Health Service for Wales. National Public Health Service for Wales to be stated. Material contained in this profile may be reproduced Typographical copyright lies with the Wales Centre for hidden deprivation. without prior permission provided it is done so accurately Health and the National Public Health Service for Wales. and is not used in a misleading context. Wales and its Local Health Boards

Current projections see a rise in Fig 4: Overall Welsh Index of Multiple Deprivation 2008 the older population (75 years Fifths of deprivation, Lower Super Output Areas. and over) of Welsh residents Data source: Welsh Assembly Government from 252,000 (9% of the total population) in 2006 to 452,000 (14% of the total population) in 2031 (Fig. 5). The relative increase Most deprived (379) Next most deprived (379) is higher in some, more rural areas, Median (380) such as Powys and lower in more Next least deprived (379) Least deprived (379) urban areas, particularly Cardiff. Local Health Board Boundary These estimates are based on assumptions about births, deaths and migration. The increase in the number of older people is likely to cause a rise in chronic conditions such as circulatory and respiratory diseases and cancers. Meeting the needs of these individuals will be a key challenge for the local health boards. In the current economic climate, the relative (and absolute) increase in economically dependent and, in some cases, care-dependent populations will pose particular challenges to communities.

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More detail on the demography for Fig 5: Population projections, Wales Wales and its Local Health Boards to Data source: Derived from LA Population Projections (2006-based) accompany this profile is available Welsh Assembly Government at www.wch.wales.nhs.uk. This 0-14 15-24 25-59 includes information at small area 60-74 75+ level, local variations in mortality and further resources to support LHB work. 80 This profile presents information for use by the newly formed Local 60 Health Boards of Wales. It has been produced as the first of a series of information products made 40 available by the newly created Public Health Observatory for Wales, a collaboration between 20 the Wales Centre for Health and

the National Public Health Service ] www.stormvc.co.uk[ STØRM 0 for Wales. LHB requirements will Design & Production: Production: & Design Percentage change from 2006 from change Percentage direct future profile development.

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