ON THE ROAD TO BETTER HEALTH Contents The A to Z for Primary Care Groups Introduction Part One Comparative Overview of Primary Care Groups The 1999 Annual Report of Coronary Heart Disease the Director of Public Health Asthma Accidents Medicine Infections Lung Cancer and Smoking Diet Teenage pregnancy Low Birthweight Screening for Breast and Cervical Cancer Socio-economic and Health Inequality: the Walsall Composite Index of Deprivation Part Two Within the Primary Care Groups North Primary Care Group South Primary Care Group East Primary Care Group West Primary Care Group 1 Foreword Acknowledgements The development of Primary Care Groups provides I would like to thank my colleagues who were a new structure and opportunity to address the instrumental in the production of this report: public health. The main focus of this report is thus on Primary Care Groups. Editorial Team Dr John Linnane The report examines the variation in health and its Consultant, Public Health Department. determinants across the Primary Care Groups Rebecca Suri seeking to link the effects of poverty, inequalities Epidemiologist, Public Health Department and lifestyle with morbidity and mortality. Editorial Consultant This report has a number of aims which include: Steve Griffiths, Public Management Associates ■ To give the Primary Care Groups a sense of the Administrative Support communities which they serve. Helena James, Public Health Department ■ To present the type of information and analysis Contributors which is possible on a Primary Care Group and Dr Shalini Pooransingh, Specialist Registrar ward basis. Dr Mamoona Tahir, Specialist Registrar Nigel Barnes, Pharmaceutical Advisor ■ To provide a broad picture of health and its Allison Heseltine, Public Health Nurse determinants across the borough. Dr Sunanda Ray, Locum Consultant ■ To help set the agenda and priorities for action. Production Team John Schaechter, Public Management Associates Normally my reports end in a series or list of Tim Ferguson and colleagues, Walsall recommendations but in this report I intend to Metropolitan Borough Council make only one recommendation: Design “It is my hope and aspiration that the Primary Brian Homer, Homer Creative Communications Care Groups use the information and analysis contained in this report as the basis for positive Print action to address the health of Walsall people.” Russell Press, Nottingham Published by Walsall Health Authority Dr Sam Ramaiah Director of Public Health Medicine Walsall Health Authority All maps are based upon Ordnance Survey mapping and reproduced with the permission of the Controller of Her Majesty’s Stationery Office. © Crown copyright. Unauthorised reproduction infringes Crown copyright and may lead to prosecution or civil proceedings. Walsall MBC. Licence Number LA076414. November 1999. 2 INTRODUCTION This report aims to set out some of the key health Population issues faced by Walsall’s new Primary Care Groups. As the Government’s 1997 report, ‘Our We begin with basic population figures for the Healthier Nation’, maintains, many of the major four PCGs. At present, accurate population figures health problems faced by the population cannot are a difficult issue, particularly since it is eight be addressed without understanding and acting on years since the last Census of Population. The the context from which they arise. At a local level, next is due in 2001, though many of its results that means identifying the relationship between will not be available until 2003. In the meantime, the population, the conditions in which they live, what we have is the Office for National Statistics’ their health, illnesses and mortality, and the use Mid-Year Estimates, which are confined to they make of the National Health Service. There borough figures; and the totals of Walsall are some complex relationships involving age, residents based on patients registered with GP ethnicity, health behaviour, inequality and social practices. These too are imperfect, because there exclusion. However, some of the key factors and are Walsall residents registered with GPs outside relationships at work in Walsall can be expressed Walsall; others not registered with a GP at all; powerfully and graphically. That is what this and there are what is known as ‘ghosts’: numbers report aims to do, hopefully in a way that will be of patients who have moved away or died and of use both to those involved in making the PCGs who have not yet been removed from Practice work, and many others who are concerned with lists. The GP Practice list Walsall ‘population’ health and the many social, economic and given below is about 17,000 below the estimated cultural factors that influence it. population of the borough. (Table 1) However, what is useful about these figures is Part One that they give a sense of the differences between the four PCGs’ populations. The age bands for Part One takes ten of the key themes of health in which each PCG is the highest or the lowest in Walsall. For each one it takes a comparative the borough are colour-coded. Perhaps most overview of the four PCGs, weaving in some of striking is that East PCG has the lowest proportion the wider factors that influence them. While some in every population band up to the age of 44; and comparisons of overall health need are made the highest from 45 to 74. This says a great deal between PCGs, Part One also goes down to ward about the nature of need and demand. level to compare the distribution of need, social North and South PCGs share the highest circumstances and use of services. The proportions among the younger age groups: North constraints of time and space have meant that between the ages of 5 and 14, and South at 0-4 some major issues are not dealt with in this and 15-24, suggesting that as the older age group report, including sexual health, mental health, continues through childbearing years, we may see drugs and alcohol and diabetes. These will be greater increases in the proportions of children in dealt with in future reports. South, then in North. Perhaps surprisingly given Part One finishes with a summary from the this younger age profile, South has the highest Walsall Poverty Profile (WPP) on the distribution proportion aged 85 or over. of poverty, which includes health, social and West has the highest proportion in the 25-44 economic indicators. It sets out some conclusions age group, and the lowest between 65 and 84. about the relationship between these indicators, Comparison of these GP Practice populations and their distribution across Walsall, with some with the 1991 Census population figures reveals new analysis that takes account of the PCGs. some sharp differences between PCGs. (Table 2) There may be a number of reasons for these Part Two variations, including the imperfections in the GP lists described above. They may reflect actual Part Two takes its perspective within each of the population trends to some extent. The figure for four PCGs in turn. It summarises the key points South PCG is likely to reflect the national pattern arising from Part One. It then presents some of of significant undercounting in the 1991 Census the mapping of deprivation from the Poverty among large ethnic minority populations. Profile, again focusing on its distribution within Whatever the explanation, the variation is likely to each PCG. The aim is to provide a brief summary have substantial implications for the resources of the challenges facing each PCG. needed and made available for public services. The only ward population estimates for Walsall since the Census have recently been prepared by Oxford University for the Department of the Environment, Transport and the Regions, and they correspond closely with the 1991 Census figures. 3 Ethnic minorities under 16, compared to only 19% of the white population. This means that by 1999, as that The only comprehensive figures for Walsall’s generation moves into adulthood, there is likely to ethnic minority populations come from the 1991 be a substantial degree of growth in the ethnic Census, and they are likely to be flawed due to minority population. The figures below (Table 3) undercounting. One of the most striking convey something of this trend, giving both the characteristics of the borough’s ethnic minority 1991 Census breakdown, and the 1998 primary populations is their youthful age profile. In 1991, school population. 38% of the ethnic minority population was aged A breakdown of the 1991 populations by each Primary Care Group is given in Part Two of this report. Walsall Population from GP Practice Lists 1999 Table 1 Lowest in age range Highest in age range WALSALL EAST NORTH SOUTH WEST Total 244112 67903 48949 68225 59035 Age 0-4 15675 6.4% 3744 5.5% 3348 6.8% 4686 6.9% 3897 6.6% 5-9 16967 6.9% 4242 6.2% 3742 7.6% 4743 7.0% 4240 7.2% 10-14 16557 6.8% 4064 6.0% 3605 7.4% 4752 7.0% 4136 7.0% 15-24 29678 12.2% 6923 10.2% 5892 12.0% 9545 14.0% 7318 12.4% 25-44 70378 28.8% 19205 28.3% 14252 29.1% 19503 28.6% 17418 29.5% 45-64 56468 23.1% 17681 26.0% 10600 21.7% 14582 21.4% 13605 23.0% 65-74 21637 8.9% 7016 10.3% 4334 8.9% 5623 8.2% 4664 7.9% 75-84 12839 5.3% 3857 5.7% 2555 5.2% 3510 5.1% 2917 4.9% 85+ 3913 1.6% 1171 1.7% 621 1.3% 1281 1.9% 840 1.4% Male 121819 33645 24358 34355 29461 Female 122293 34258 24591 33870 29574 Differences Between 1991 Census Populations and 1999 GP Practice Table 2 Populations, Primary Care Groups EAST NORTH SOUTH WEST Excess of 1991 Census Over GP -22000 -4000 +18000 -7000 Practice Population 1999 Walsall Communities 1991 Census