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The Public Health Implications of Brexit in Wales: a Health Impact

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The Public Health Implications of Brexit in Wales: a Health Impact The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach Technical Report: Part 2 The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach Authors Liz Greeni, Nerys Edmondsi, Laura Morgan i, Rachel Andrewii, Malcolm Ward ii, Sumina Azam ii, and Mark A. Bellis ii. This Health Impact Assessment is in three parts: 1. The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach. Executive Summary 2. The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach. Main Findings 3. The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach. Technical Report a. Technical Report: Part 1 b. Technical Report: Part 2 (this document) This Health Impact Assessment (HIA) has been undertaken at a time of ongoing uncertainty and a rapidly evolving Brexit agenda. The HIA will continue to be reviewed and monitored post publication to reflect changing context, evidence and events, and where possible updated. Suggested citation: Green L, Edmonds N, Morgan L, Andrew R, Ward M, Azam S and Bellis MA. (2019). The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach. Technical Report Part 2. Cardiff, Public Health Wales NHS Trust. ISBN 978-1-78986-039-9 © 2019 Public Health Wales NHS Trust. Material contained in this document may be reproduced under the terms of the Open Government Licence (OGL) www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated. Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach Acknowledgments The authors would like to thank all the individuals and organisations who have generously contributed their time and expertise to support this Health Impact Assessment (HIA). HIA Working Group • Rachel Andrew ii • Nerys Edmonds i • Liz Green i • Amy Hookwayiv • Ed Huckle ii, Public Health England • Laura Morgan i • Malcolm Ward ii • Angharad Wooldridge i HIA Strategic Advisory Group • Rachel Andrew ii • Sumina Azam ii • Nick Batey, Welsh Government • Huw Brunt iii • Jo Charles, Betsi Cadwaldr University Health Board Public Health Team, Public Health Wales • Nerys Edmonds i • Eva Elliott, Cardiff University • Liz Green i • Katie Hirono, President of the Society of Practitioners of Health Impact Assessment (SOPHIA) / Edinburgh University • Chrishan Kamalan, Welsh Government • Laura Morgan i • Alice Teague, Food Standards Agency • Malcolm Ward ii The authors would also like to thank the following for their input: Adam Jones ii, Sara Wood ii, Sarah James ii, Sian Kingiv, Louisa Petchey ii, Richard Lewis ii, Sian Priceiv, Stephen Monaghanv, Alisha Daviesii, Mariana Dyakovaii, Lee Parry Williamsi and Hayley Jenney. i Wales Health Impact Assessment Support Unit, Public Health Wales ii Policy, Research and International Development Directorate, Public Health Wales iii Public Health Services Directorate, Public Health Wales iv Health and Well-being Directorate, Public Health Wales v NHS Quality Improvement & Patient Safety Directorate, Public Health Wales 1 The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach Contents Section Page No. 1. Community Health Profile 3 2. Matrix of evidence of impact across the determinants of health 84 3. Matrix of evidence of impact across the population groups 107 2 The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach 1 Community Health Profile This section contains the population health data used to inform the HIA. As part of the HIA of the Public Health Implications of Brexit, a number of groups were identified by members of the advisory group and the participatory workshop, which were deemed to be vulnerable to the impacts of the United Kingdom (UK) leaving the European Union (EU). These included: • Families impacted by uncertain / new immigration regulations • EU citizens living in Wales • People who are living on low income • People who are unemployed / at risk of unemployment • People living in areas with poor economic and health indicators • People living in areas where large employers may move away from • Areas of Wales that have been significant beneficiaries of EU funding • People in need of health and social care services • Young adults • Black and minority ethnic groups • Children and young people • Sex and Gender groups • Farmers / rural communities • Small business owners / employees • Port towns • Coastal towns In this section routine data sources, for example National Survey for Wales and high level evidence, for example Welsh Government reports, were reviewed to provide an overview of the different population groups and to identify any potential impacts to these groups, following departure of the UK from the EU. All data sources and literature used within this report can be found within the References section on page 80. The impact of the UK leaving the EU is an unknown. Any assumptions made in the report have, where possible, been clearly stated to provide transparency around the reasoning behind why certain impacts for specific groups have been highlighted. 3 The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach Contents Key points 8 1 Introduction 11 2 Migration 12 2.1 Vulnerable group: Families impacted by uncertain/new immigration regulations .12 2.1.1 EU citizens living in Wales ...................................................................................................12 2.1.2 Population pyramids ............................................................................................................15 2.1.3 UK citizens living / travelling to the EU ............................................................................17 3 Health and well-being 18 3.1 Vulnerable group: People in need of health and social care services ........................19 3.1.1 National Health Service (NHS) and social care staff .....................................................19 3.1.2 Doctors ...................................................................................................................................20 3.1.3 Nursing and Midwifery ........................................................................................................21 3.1.4 Dentists ..................................................................................................................................22 3.1.5 Social care ..............................................................................................................................23 3.1.6 Satisfaction with access to services .................................................................................23 3.2 Morbidity and mortality .......................................................................................................24 3.2.1 Premature deaths from non-communicable disease ....................................................24 3.2.2 Life expectancy .....................................................................................................................26 3.2.3 Mental health and well-being ............................................................................................27 3.3 Medicines management .......................................................................................................31 3.4 Public Health: Health protection / health security .........................................................31 3.5 Research and development ................................................................................................32 4 Economy and Employment 33 4.1 Vulnerable group: People who are living on low income ..............................................37 4.2 Fuel poverty ............................................................................................................................40 4.3 Food Poverty ..........................................................................................................................42 4.4 Vulnerable group: People living in areas with poor economic and health indicators ...........................................................................................................42 4.5 Vulnerable group: People who are at risk of unemployment ......................................44 4.6 Vulnerable group: People who are unemployed ............................................................48 4.7 Vulnerable group: Small business owners / employees ................................................51 4.8 Vulnerable group: People living in areas where large employers may move ...........52 4.9 Vulnerable group: Communities that have been significant beneficiaries of EU funding .........................................................................................................................55 4 The Public Health Implications of Brexit in Wales: A Health Impact Assessment Approach 5 Communities 58 5.1 Vulnerable group: Black and minority ethnic groups ....................................................59 5.1.1 Hate crime ..............................................................................................................................61 5.1.2 Race hate crime ....................................................................................................................62
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