Director of Public Health Annual Report ACKNOWLEDGEMENTS
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2011 Director of Public Health annual report ACKNOWLEDGEMENTS As always the production of the Director of Public Health Annual Report is a team effort. Chapter Authors: Dr Corri Black, Dr Emily Burt, Dr Mike Crilly, Dr Simon Hilton, Dr Helen Howie, Dr Marjorie Johnston, Chris Littlejohn, Dr William Moore, Dr Emmanuel Okpo, Dr Maria Rossi, Mr Ray Watkins, Susan Webb and Dr Diana Webster Health Intelligence: Jillian Evans, and in particular Nicola Beech, Peter MacLean and Fred Nimmo Editorial Support: Jenna Bews, Gill Johnston, Dr Linda Leighton-Beck, Diane Murray and Alison Wood Corporate Communications: Laura Gray and Corporate Graphic Design team, in particular Andrew Mitchell Editor: Dr Dorothy Moir The use by others of information and data contained in this publication is encouraged. Brief extracts may be reproduced provided the source is fully acknowledged. Proposals for reproduction of large extracts should be sent to the address below. Public Health Directorate NHS Grampian Summerfield House 2 Eday Road Aberdeen AB15 6RE Telephone: 01224 558539 Email: [email protected] This document is also available from www.nhsgrampian.org . © NHS Grampian Published October 2012 1 Director of Public Health Annual Report 2011 Foreword .............................................................................................................3 Executive Summary ............................................................................................4 Section 1 HEALTH INTELLIGENCE ...............................................................7 1a) Health Status .........................................................................................7 1b) Health Inequalities ..............................................................................17 Section 2 HEALTH IMPROVEMENT ............................................................25 2a) Health Improvement Policy ................................................................25 2b) Health Improvement Programmes ....................................................29 Section 3 HEALTH PROTECTION ...............................................................36 3a) Joint Health Protection Plan ..............................................................36 3b) Gastrointestinal Infections ................................................................39 3c) Blood Borne Virus Infections ............................................................41 3d) Tuberculosis .......................................................................................45 3e) Immunisation/Vaccination .................................................................48 Section 4 HEALTH CARE .............................................................................51 4a) Screening Programmes .....................................................................51 4b) Coronary Heart Disease .....................................................................58 4c) Cancer .................................................................................................62 4d) Alcohol and Drugs ..............................................................................67 4e) Dental Services ...................................................................................73 References ........................................................................................................75 2 Foreword This report, which covers the public health of Grampian for the year 2011, is my first as Director of Public Health. It provides a snapshot of the health status of the Grampian population and of the many activities underway to protect and improve the health of the public. Overall, the report signals that Grampian compares favourably, on a number of counts, to the Scottish average, including life expectancy. However, there are a number of significant and compelling challenges that must continue to be addressed, including: the growing numbers of elderly people, the inequalities in health among our communities, the rising tide of obesity and the ongoing problems of alcohol and drug misuse. Giving our children in Grampian the best start in life is a key priority, as is the promotion of the physical and mental health of all of our people, and reaching out to the most vulnerable in our society. Going forward, in order to address these many challenges, it will be crucial for all relevant agencies to work very closely together, in common cause. There are already many encouraging examples of effective partnership working with local/national government, the statutory authorities, the third/voluntary sectors, the further/higher education sectors and the business community of Grampian, some of which are described in this report. We must build on these endeavours in order to rise to the occasion. In effect, nurturing and empowering the public health of Grampian is everyone’s business. I look forward to describing further progress in future reports. I am grateful to all colleagues who contributed to the compilation of this report, particularly to Dr Dorothy Moir as editor. They are listed in the Acknowledgements Section. This report has been prepared in two formats - the Full Report (this version) and a Summary Version. Both are available on the NHS Grampian website: www.nhsgrampian.org . Sir Lewis Ritchie Director of Public Health NHS Grampian 3 Executive Summary Overall, health trends in Grampian are improving. We are living longer and enjoying a longer period in good health, comparing favourably to the Scottish average. The population of Grampian, as elsewhere, is getting older with an estimated 77% increase in those over 65 years of age by 2035. As we get older, our chances of experiencing multiple diseases, and requiring care, increase. Older people are high users of health services and, once admitted to hospital, patients in this age group typically stay for longer. In the same time period (by 2035), adults of working age are predicted to increase by 9%. In other words, there will be less people of working age to care for and support older people. As well as ageing, we are ‘growing’ as a population. It is estimated that 30% of adults in Grampian are already obese and this trend does not appear to be slowing. Obesity for women is associated with living in deprived areas, but not for men. Recent data suggest there has been a reduction in the number of children who are overweight or obese, however, 20% of children are overweight or obese in the first year of primary school. This is important, as obesity increases the chances of developing a number of long-term conditions as we age. It has been estimated that among those with type-2 diabetes, at least half could have been avoided by preventing obesity. Grampian’s relative prosperity improves the regional average for a number of health indicators, but it also masks the range of heath and illness in the population. People living in the least affluent communities in Grampian will die sooner, and will spend more of their shorter lives with a disability, than the more affluent communities. The causes of inequalities are complex and interlinking - genetic factors, biological variation, lifestyles - which in turn are influenced by where we live, work and learn. The future health of the population can be improved by making conditions in pregnancy, infancy and childhood as favourable as possible – in policy terms this is known as the Early Years agenda. In Grampian, encouraging progress has been made. Since 2001, there has been a significant reduction in the percentage of women who smoke when they first become known to the maternity services. The greatest improvements were in women from the most deprived areas, which have narrowed the inequalities gap. However, 42% of women from deprived areas, compared to 9% from least deprived areas, smoke – emphasising the need for further efforts. Lifestyle choices in young people are showing promising trends in Grampian when behaviours in 2002 and 2010 are compared. Fewer young people smoke, drink alcohol or take illicit drugs. While smoking prevalence in the adult population has reduced, an estimated 43% of the population consume alcohol above the sensible limits, either on a weekly or daily basis. Using 2007/08 data, the cost of treating obesity related illness in the North of Scotland was estimated at £48.7 million and is predicted to double by 2030, the cost of smoking related disease estimated at £85.7 million and alcohol related disease estimated at 4 £68.9 million. Health improvement work is, therefore, viewed as an essential component of Government and NHS Grampian policy in order to improve and protect health, reduce avoidable ill health, tackle health inequalities and contain rising demands and costs. Health protection work involves surveillance, investigation, control and prevention of communicable disease and environmental hazards. The Grampian Joint Health Protection Plan 2010/12 provides an overview of health protection priorities, provision and preparedness. Grampian has one of the highest rates of gastrointestinal infections in Scotland due to certain factors, such as an extensive rural landscape and a large number of private water supplies. Hepatitis C is the most common blood borne virus (BBV) in Grampian and is curable in the majority of cases. However, it is estimated that approximately 1,500 people exposed to the virus remain undiagnosed. By raising awareness of how to avoid infection, and by normalising BBV testing, more people will be enabled to address these potentially life-shortening conditions