Joint Strategic Needs Assessment 2012 Summary Southend On

Joint Strategic Needs Assessment 2012 Summary

Southend on Sea The Area

Southend is 16.1 square miles in size and is the largest conurbation in the East of England. Located on the north side of the Thames estuary approximately 40 miles east of central London, it is bordered to the north by Rochford and to the west by Castle Point.

The borough has 7 miles of award-winning beaches and coastal nature reserves; has over 80 parks and green spaces and 14 conservation areas and is home to the longest leisure pier in the world. Southend is served by an international destination airport, two railway lines linking to London, with 10 railway stations and many local bus routes.

Figure 1 Map of Southend Showing Population Density by Electoral Ward

2. Population Estimates

There are currently two main sources of population estimates widely used across Southend. First is the mid-year population estimate from the Office for National Statistics which are based on the 2001 Census figures. The second is the GP registered population.

In Southend there is a marked difference between the ONS 2010 population estimate of 165,300 and the GP registered population estimate of 182,930 (as at April 2011). This disparity is important to recognise as it will have implications in relation to allocated resources versus actual numbers of service users.

Table 1 GP Registered population compared to ONS population

Total Percentage Percentage Percentage Population aged 0-14 aged 15-64 65 and over

Southend on sea GP Registered 182,930 17% 65% 17% population Southend on sea ONS 2010 mid-year 165,300 18% 64% 18% population

3. Population Structure

The age and sex distribution within our population has an impact on the level of need for service provision. People will access different services at different stages of their life and it is important to analyse current and future population trends to plan for service need.

Figure 2 Age/Sex profile for Southend based on ONS 2010 Mid-Year Estimates compared to Projections for 2020

By 2020, the population in Southend is expected to rise by a further 7.3% to 177,300 and by 2030 will have risen 15.3% to 190,600. Southend has an ageing population that will have an impact on the levels and type of service provision in future years.

Over the last ten years ethnic diversity in Southend has been increasing at a faster rate than regional levels. The 2001 census suggested a less ethnically diverse population than we have today.

Table 2 Estimated distribution of resident population by ethnic group*, mid- 2009 (percentage of total population)

% Chinese % Asian % Black or other or Asian or black ethnic % White % Mixed British British group ENGLAND AND WALES 87.9 1.8 5.9 2.8 1.6

EAST OF ENGLAND 90.0 1.7 4.4 2.1 1.7

Southend-on-Sea UA 90.0 1.8 3.7 2.4 2.2 Source: ONS * truncated classification

7. Disadvantage

One of the common measures of disadvantage is the Index of Multiple Deprivation (IMD). IMD 2010 is a measure of deprivation and is comprised of seven domains denoting social or material deprivation which are combined into one index. The domains are income; employment; health and disability; education; housing; living environment and crime. The higher the IMD score the more deprived an area is said to be.

Strong evidence indicates that deprivation and social exclusion can impact on a number of aspects of life including employment, crime, education and skills, health, housing and the environment.

Figure 3 shows that there are significant differences in the relative deprivation across Southend.

Figure 3 Southend IMD 2010 LSOA rank by national group

Children in Poverty

When we refer to „poverty‟ we are considering relative poverty i.e. as compared to the standard of living of a society at a specific point in time, rather than absolute poverty, which is where only the minimum resources for physical survival are available.

Figure 4 Proportion of Children Living in Poverty in Southend on Sea

Source: HMRC

It is difficult to measure poverty however, the main indicator taken to represent the percentage of children living in poverty is provided by HM Revenue and Customs. It quantifies the number of children living in families in receipt of Child Tax Credit whose reported income is less than 60 per cent of the median income or in receipt of Income Support or (Income-Based) Job seekers allowance, divided by the total number of children in the area (determined by Child Benefit data). There is considerable variation across the Borough, with fewer than 5% in West Shoebury contrasting to almost 40% in Kursaal ward.

8. Life Expectancy

In Southend there are significant inequalities in life expectancy between residents in the most deprived wards and those in the least deprived wards. Currently those residents living in the most deprived areas can expect to live on average 8 years less than those in the least deprived areas. Improving overall life expectancy is a key component to tackling health inequalities. The indicator in the local health profile measures life expectancy at birth. This means a male born in Southend-on-Sea now has an average life expectancy of 77.5 years. This is statistically worse than England where the average life expectancy is 78.3 years for men. Women fare much better in Southend-on-Sea with an average life expectancy of 83.3 years which is the same as the average for England. This is not to accept that a life expectancy of 83.3 years is satisfactory for women in Southend-on-Sea.

There is of course wide variance within Southend-on-Sea in terms of life expectancy within the borough. For example, males born in Eastwood Park ward have the highest average life expectancy in Southend-on-Sea at 81.4 years (range 82.6 to 78.3 years). Males born in Kursaal ward have the lowest average life expectancy at birth at 72.4 years (range 74.8 to 70.1 years). There is difference of 8.6 years within the borough. For females, women born in Milton ward have the lowest life expectancy at 78 years (range 80.2 to 75.8 years). Women born in Thorpe ward have the highest life expectancy at 87.3 (range 89.4 to 85.2 years) a difference of 9 years. Figures 5 and 6 provide an overview of life expectancy for males and females by ward.

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The Marmot Review highlighted the need to address health inequalities, in an innovative and coordinated way, to reduce the life expectancy gap between rich and poor. He suggests that there should be proportionate interventions and support for people across the socio-economic spectrum, rather than a direct focus of all resources into deprived areas. This approach will support health improvement across the entire population, as well as enabling specific targeted interventions to be undertaken for people with the greatest health needs.

The actions required tackle the major killer diseases such as heart disease, cancer and stroke are wide ranging. The Southend-on-Sea health inequalities strategy sets out a range of initiatives focussed on improving the determinants of health and preventing people dying prematurely.

8. Infant Mortality

Infant mortality measures the probability of dying in the time between birth and exactly one year of age. The infant mortality rate has historically been considered a good indicator of the health of the population. As rates have declined, the proportion of cases that can be influenced by better maternal health or health care interventions also decreases. Southend-on-Sea a lower rate of infant mortality than the England average.

Figure 7 Infant Mortality (all maternal ages, 2008-10)

8. Low Birthweight

Low birth weight is defined as a weight under 2500 grams. Many factors are associated with low birth weight including multiple pregnancy, maternal country of birth, poor maternal nutrition, lower socio-economic status and maternal smoking and drinking. Low birth weight is also associated with premature delivery.

The rates of low birth weight in Southend on Sea are similar to those both regionally and nationally.

Table 3 Low birthweight births 2009 < 1500 grams < 2500 grams Denominator Numerator Numerator Number of Number of Percent 95% CI Number of Percent 95% CI all stated live live and PercentLL PercentUL live and PercentLL PercentUL

and still births still births still births ENGLAND 669560 9445 1.4 1.4 1.4 50108 7.5 7.4 7.5 EAST OF ENGLAND 71264 986 1.4 1.3 1.5 5075 7.1 6.9 7.3 Southend-on-Sea UA 2329 21 0.9 0.6 1.4 161 6.9 6.0 8.0 Essex CC 16299 213 1.3 1.1 1.5 1091 6.7 6.3 7.1 Source:NCHOD

8. Breastfeeding

There is clear evidence that breastfeeding has positive health benefits for the mother and the baby in both the short term and the long term. It has an essential role to play reducing health inequalities. It also supports the development of good attachment, assisting in the formation of a close and affectionate bond between mother and child.

Children who are not breastfed are at increased risk of a number of poor health outcomes. Breastfeeding protects babies from infections including gastroenteritis and urinary tract infection and from childhood diseases, including juvenile-onset insulin-dependent diabetes mellitus and respiratory disease. Breastfeeding can also positively influence maternal health and can protect women against certain forms of cancer, including breast cancer and epithelial ovarian cancer.

Breastfeeding initiation and breastfeeding prevalence at 6-8 weeks are the current indicators collected nationally by the NHS. Locally breastfeeding prevalence is also recorded at 10 days when care is transferred from community midwives to health visitors

Figure 9 shows where the highest and lowest rates of breastfeeding at 10 days are found in relation to Lower Level Super Output Areas (LSOA). There is higher prevalence at 10 days through central Southend, Westcliff and Leigh, with lower prevalence in Southchurch, Thorpe Bay and parts of West Leigh and Eastwood.

Figure 8 Prevalence of breastfeeding at 10 days (2010/11)

Continued breastfeeding over a longer period provides maximum benefits, however over time there is a reduction in the number of babies still being breastfed by the age of 6-8 weeks. The lowest rate is in Southchurch ward. Figure 9 shows where the highest and lowest rates of breastfeeding at 6-8 weeks are found in relation to LSOAs.

Figure 9 Prevalence of breastfeeding at 6-8 weeks (2010/11)

8. Obesity

Obesity has been declared an epidemic in the UK. There are almost two thirds of adults and a third of children either overweight or obese. Without decisive action it had been predicted that this will rise to 9 out of 10 adults and two thirds of children by 2050.

This matters because of the severe impact being overweight or obese can have on an individual‟s health. Both are associated with an increased risk of disease including diabetes, cancer and heart disease and can reduce life expectancy by up to 11 years.

The basic problem is an imbalance between „energy in‟ and „energy out‟. Therefore the answer seems quite simple- eat healthily and do more exercise. However, much of the food we eat has a high fat, sugar and salt content and it is exceedingly hard for people to maintain a healthy weight. In addition we now live in a society where we value labour saving devices and cars have replaced more active forms of transport.

The National Child Measurement Programme (NCMP) is an important element of the work programme on childhood obesity, and is coordinated jointly by the Department of Health (DH) and the Department for Education (DfE). The NCMP was established in 2006.

Every year, as part of the NCMP, children in Reception and Year 6 are weighed and measured during the school year. The data is collected to inform local planning and delivery of services for children; and to gather population- level surveillance data to allow analysis of trends in growth patterns and obesity. The 2010/11 NCMP dataset provides the fifth year of detailed child height and weight measurements collected across these two age groups.

The NCMP uses the British 1990 Growth Reference (UK1990) population monitoring cut-offs to classify children into weight status groups. The population monitoring cut-offs are:

- Underweight <=2nd percentile - Healthy weight >2nd percentile <85th percentile - Overweight >=85th percentile <95th percentile - Obese >=95th percentile

Children are defined as obese if their body mass index (BMI) is above the 95th centile of the reference curve for their age and sex according to the UK BMI centile classification, and overweight if their body mass index (BMI) is above the 85th centile of the reference curve for their age and sex according to the UK BMI centile classification.

These differ from those used for the clinical definitions of overweight and obesity in children which have cut-offs of the 2nd, 91st and 98th percentiles.

Table 4 Participation in National Childhood Measurement Programme 2010/11 Number of children Participation rate measured Organisation Reception Year 6 Reception Year 6

England 541,255 495,353 93.4% 91.8%

PCT 3,496 3,355 95.4% 91.0%

Southend 1,792 1,641 95.9% 90.8%

All Southend on Sea primary schools participated in the 2010/11 NCMP programme. Participation increased in both year groups, however as in previous years participation was higher in Reception (95.9%) than in Year 6 (90.8%).

The Southend on Sea overall participation rate has increased from 80% in 2006/7 to 93.4 % in 2010/11.

Analysis of NCMP data has shown that a lower participation rate tends to lead to an underestimation of prevalence of obesity for Year 6. However, participation rate was shown to have little or no effect on prevalence for Reception children. It is important to consider these participation rates when analysing the weight prevalence.

Figure 10 National Child Measurement Programme

Southend Reception NCMP 2010-11 Results Southend Year 6 NCMP 2010-11 Results

The charts in Figure 10 show how the levels of overweight and obese are of a significantly higher proportion for children measured at year 6.

8. Health Protection

Community-wide childhood immunisation is an effective means of reducing the burden of morbidity and mortality resulting from many infectious diseases. Apart from its protective effect, immunisation also produces an indirect effect known as “herd immunity”. Herd immunity occurs when a high number of people directly protected by immunisation against a certain disease protect those that have not been immunised. To ensure herd immunity it is important that 95% of the eligible population are immunised against each disease.

Table 5 Percentage of children immunised by their 1st birthday 2009/10 Area No. of children Diphtheria, Meningitis C (%) Pneumococcal aged 1 Tetanus, Disease (%) Polio, Pertussis, Hib (%) S East Essex 3900 95.2 94.8 94.8 East of 71600 94.8 94.2 94.4 England England 664800 93.6 92.7 92.9

Table 6 Percentage of children immunised by their 2nd birthday 2009/10 Area No. of Diphtheria, Measles, Haemophilus Pneumococcal children Tetanus, Mumps Influenzae Disease aged 1 Polio, and type b / (%) Pertussis, (MMR) Meningitis C Hib (%) (%) (%) S East 3800 96.6 88.6 95.4 91.1 Essex East of 71300 95.8 87.3 92.7 88.7 England England 662200 95.3 88.2 90 87.6

In South East Essex, for most antigens, we are achieving the WHO recommended coverage of 95%, and higher coverage than England and East of England. Further work is required to increase the uptake of MMR vaccine.

In 2009/10 the immunisation uptake for the primary vaccinations (i.e. diphtheria, tetanus, polio, pertussis and Hib) for children reaching their first birthday, second birthday and fifth birthday was higher in South East Essex than for East of England or England, and achieved the 95% target required for herd immunity. However, by their second birthday only 91.1% of children in South East Essex had received their Pneumococcal disease (PCV) booster. Table 7 Percentage of children immunised by their 5th birthday 2009/10 Area No. of Diphtheria Hib Diphtheria, MMR MMR children Tetanus, Polio Primary Tetanus First First and aged 5 Primary (%) (%) Polio, Pertussis dose second Booster (%) dose (%) (%) S E 3800 95.0 94.7 86.4 89.4 83.8 Essex East of 67200 94.8 94.3 86.1 89.0 83.4 England England 608100 94 93.1 84.8 91 82.7

More worryingly, only 83.8% of children in South East Essex had completed their full course (two doses) of MMR vaccine. This uptake, although higher than England and East of England, is considerably lower than the 95% required for herd immunity. This low level of immunisation leaves our population vulnerable to community outbreaks of measles, mumps and rubella.

During the late 1990s, following a now discredited study published in The Lancet, there was a lot of adverse publicity and public concern about MMR vaccine. Media reports questioned the safety of the vaccine causing some parents to delay their child's MMR immunisation or not to have it at all. A significant amount of work has been undertaken locally to ensure more children are fully vaccinated. This includes a catch up campaign aimed at children up to 11 years that have missed vaccinations in the past. Rates are increasing slowly.

Measles is a highly infectious and potentially dangerous illness which spreads very easily. According to figures by the Health Protection Agency there were 334 confirmed cases of measles in England in the first three months of 2011, compared with 374 in the whole year of 2010. This is a dramatic increase, and most cases were in under-25s who had not been immunised. Other European countries, particularly France, have also seen increases in 2011 and advice has been issued to general practice and to schools to encourage parents to have their children immunised.

Table 8 MMR Immunisations 2006-2010 School aged children Completed MMR immunisation course by 2nd birthday (%) Names 2006-2007 2007-2008 2008-2009 2009-2010 Southend on Sea 83.2 82.4 83.9 - England 85.3 84.6 84.9 88.2 East of England 85.6 84.2 83.9 87.4

MMR immunisation rates are continuing to improve year on year in Southend.

8. Educational attainment

Educational attainment is influenced by both the quality of education children receive and their family socio-economic circumstances. Educational qualifications are a determinant of an individual‟s labour market position, which in turn influences income, housing and other material resources. These are related to health and health inequalities. Young people who do not get 5 A* -C grade GCSEs (or equivalent) by age 16 tend not to have good opportunities to achieve success later.

Figure 11 Southend on Sea GCSEs achieved at 5 A* - C Including English and Maths

8. Skills

In Southend only 23.4% of residents have a level 4 or above qualification. This compares to 31.3% in Great Britain. In addition, 13.2% of the working age population in Southend have no qualifications, compared to 11.3% nationally.

Figure 12 Qualifications (Jan 2010- December 2010)

Source: NOMIS Official Labour Market Statistics

In order to improve the local economy, it is essential to develop more local high-value jobs and the skills to match. The challenge is to encourage both residents and employers to invest more time and money in skills.

8. Employment

All the evidence suggests that social class inequalities present in early life – and persist throughout life and post retirement. Nationally there is a difference in life expectancy at birth for both men and women between those in standard occupational classification groups 1-3 (Managerial, professional and technical) compared to groups 6-9 (semi-skilled, routine and elementary).

Figure 13 shows the profile of occupation in Southend compared with the region and Great Britain. 41% of the working age population in Southend are in managerial and professional posts, compared to 43.3% nationally. Southend has a higher proportion of administrative and manual workers (44.8%) by comparison to Great Britain (39.1%). Figure 13 Employment by occupation (Oct 2010-Sep 2011)

Source: NOMIS Official Labour Market Statistics

Long term unemployment is a measure of the number of people aged 16 to 64 who are without a job but available for work. People classified under this category, are claimants of the job seekers allowance benefit who have been claiming for 12 months or more. The data is presented as a crude rate per 1000 population.

It is an important indicator because there is a direct relationship between being unemployed and suffering poor physical and mental health. Of particular concern is the increased risk that those who are long term unemployed, are more likely to be engaged in risky lifestyle behaviours such as alcohol misuse and smoking.

Evidence suggests that mortality (death) rates are higher in people who are registered as unemployed than for those in work. In 2009/10 the long term unemployment rate for persons aged 16-64 living in Southend-on-Sea was 7.7 persons per 1000 population. This was significantly worse than the average number of claimants of job seekers allowance in England during 2009/10 (6.2 per 1000 population).

Tackling long term unemployment is a significant challenge. It is however, an essential and key element to tackling health inequalities and improving the health of the local population.

8. Mental Wellbeing

Mental health can be influenced and determined by a range of factors. The World Health Organisation (WHO) has captured the complex interplay between mental illness and mental wellbeing in their definition of mental health:

‘a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.

It is clear that mental well being is much more than an absence of mental illness. Mental well being influences how we think and feel about ourselves and others as well as how we interpret events. It affects our capacity to live our lives and is central to all health and well-being because how we think and feel has a strong impact on physical health.

Currently we have few effective measures of mental well being and we are therefore forced to focus our measures on mental ill health. The charts below present estimates of the percentage of the working age population that is experiencing depression.

Figure 14 Depressive Episodes: Rate per 1,000 Population

People with a history of mental illness are some of the most socially excluded in society. Mental illness is associated with high levels of social exclusion and downward (or lack of opportunities for upward) social mobility. In addition, people with mental health problems are more likely to experience difficulties in finding employment and unemployment itself can lead to mental health problems.

The ultimate poor outcome from mental ill-health is suicide. Southend on Sea is not significantly different to either England or its comparator authorities in levels of mortality from suicide. The latest data suggests that there have been higher levels of female suicides; however the very small numbers of suicides can skew data for an area just by an increase of 1 or 2 deaths in any given period and must therefore be treated with caution.

Figure 15 Mortality from suicide (ICD10 X60-X84), All Persons, All Ages (2008-10)

Figure 16 Mortality from suicide (ICD10 Figure 17 Mortality from suicide (ICD10 X60- X60-X84), Males, All Ages (2008-10) X84), Females, All Ages (2008-10)

8. Smoking

There is ample evidence of the relationship between smoking and health. Smoking is the most important cause of preventable ill health and premature mortality in the UK. It is a key risk factor for many diseases, such as lung cancer, chronic obstructive pulmonary disease (COPD) and heart disease.

The data used to establish smoking prevalence in the 2011 local health profiles was obtained through the Integrated Household Survey (IHS). The IHS is a representative sample of the general, non-institutional population living in England. The survey was conducted by the Office for National Statistics in the period April 2009 to March 2010. A sample of 200,000 people were asked a series of questions about their health including smoking status. Whilst the survey could be open to bias (people may be unwittingly or deliberately providing false information) it is currently the primary means of estimating smoking prevalence within the population. Based on IHS data the smoking prevalence in Southend-on-Sea amongst adults aged 18+ was 24.6%, which was significantly worse than England (21.2%).

This is a new indicator introduced into the local health profiles in 2011. There is currently no data on the prevalence of smoking at electoral ward level. There is however, data available from the predecessor of the IHS, the General Household Survey (GHS) for England. Figure 6 provides ward level smoking prevalence data taken from the GHS.

Figure 18 Adults aged 18+ Smoking Prevalence in Southend-on-Sea 2006 to 2008

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There has been a concerted (and on-going) effort to tackle smoking in Southend-on-Sea, without which it is believed the local prevalence would be much higher. The NHS South East Essex Stop Smoking Service is one the best performing stop smoking services in England. It has met and exceeded the national and local stretch targets set to help local people; (particularly those from routine and manual groups) stop smoking.

Additional tobacco control measures including enforcement action, to ensure only those legally entitled to purchase tobacco products have access to them, are being combined with educational and social marketing interventions. It is hoped these measures will help reduce uptake and assist those people who want to stop.

Smoking attributable mortality

Smoking attributable mortality is the rate of deaths in persons aged 35+ per 100,000 population that can be said to be attributable to smoking. In 2007-9, the smoking attributable mortality rate in Southend-on-Sea was not significantly worse than the England average with a rate of 222.1 per 100,000 population compared to 216.0 for England. Figure 19 provides an overview of smoking attributable mortality for Southend-on-Sea electoral wards. Figure 19 Southend-on-Sea smoking attributable mortality by electoral ward persons aged 35+ direct standardised rate per 100,000 population (95% confidence intervals) 2007 to 2009

Source: Association of Public Health Observatories 2011

Kursaal, Shoeburyness and Victoria wards have the highest direct standardised rates of smoking attributable mortality in Southend-on-Sea at

371.0, 340.7 and 305.8 per 100,000 populations respectively. West Leigh had the lowest rate at 133.5 per 100,000.

Stopping adults smoking will have a major impact on reducing smoking related morbidity and premature deaths from smoking attributable diseases.

Smoking in Pregnancy

Smoking in pregnancy is defined as the number of women recorded as smoking at time of delivery per 100 maternities where smoking status is recorded. In the period 2009/10 the Southend-on-Sea proportion of women who were recorded as smoking at the time of delivery was 15.0%. This was slightly higher than the England rate (14.0%) but a 1.1% reduction on the previous value recorded in 2008/09. There was also a reduction in the crude number of women smoking whilst pregnant. This was down from 358 reported in the 2010 health profile, to 341 in 2011.

The health risk to pregnant mothers who smoke and their unborn child are significant. The risks mothers include (not exclusively) spontaneous abortion, ectopic pregnancy and pre-eclampsia. The national cost of treating these conditions is estimated to be in the range of £8 to £64 million per year (dependant the costing methodology employed). There is also a very negative impact on infants (0-12 months) of women who smoke during pregnancy. These include premature delivery, low birth weight, sudden infant death syndrome, perinatal mortality, asthma, otitis media, and upper and lower respiratory tract infections. Treating and managing the health impact on infants is estimated to be in the region of £12- £23.5 million per year.

Serious efforts are being taken to address the impact of smoking in pregnancy on the health of unborn children and mothers in Southend-on-Sea. A central initiative is the implementation of specific guidance produced by the National Institute for Health and Clinical Excellence (NICE). This action should result in a downward shift in the rate of smoking in pregnancy within Southend-on-Sea in the coming years.

8. Alcohol In recent years the UK has experienced a rising trend the amount of alcohol being consumed within the population. The increase in alcohol consumption, maybe fuelling the rise in the number of people admitted to hospital for a health condition wholly or partially attributable to alcohol.

The South Essex Alcohol Needs Assessment conducted in 2010, established that 71% of high risk drinking within South East Essex occurred within 5 wards of (Kursaal; Victoria; Shoeburyness; West Shoebury and Southchurch). Despite the high levels of deprivation in Milton ward, it did not feature in the top 5. Table 9 provides a breakdown of the percentage of the adult population estimated to be high risk drinkers by ward.

Table 9 Percentage of adult population engaged in high risk drinking

Southend-on-Sea Percentage High-Risk Ward Drinkers % Kursaal 20% Victoria 16% Shoeburyness 14% West Shoebury 11% Southchurch 10% St. Luke„s 4% Blenheim Park 3% Belfairs 2% Prittlewell 2% Leigh 1% Milton <1%

Source: South East Essex and South West Essex Alcohol Needs Assessment 2010

A recent study commissioned by the North West Public health observatory estimated 459,8421 people were admitted to hospital as a consequence of their alcohol consumption in 2005. For males and females, the most common reasons for hospital admission were hypertensive diseases (n=133,307), mental and behavioural disorders due to use of alcohol (n=94,382) and cardiac arrhythmias (n=76,540).

Within Southend-on-Sea, the local health profile found 4079 people were admitted to hospital during 2009/10 for an alcohol attributable condition. This was a significant increase (431 persons) on the 3648 admitted in the 2008/09 period.

The national rate for people admitted to hospital for an alcohol attributable condition in 2009/10 was 1734 per 100,000 population. In Southend-on-Sea the rate of hospital admission was 1967 per 100,000 population. The Southend-on-Sea rate of hospital admission for alcohol related harm in 2008/09 was 1750 per 100,000 population.

Table 10 provides a breakdown of the number of alcohol attributable admissions for Southend-on-Sea residents by age range during 2010/11. Admissions are broken down into 3 categories. Admissions for conditions: wholly attributable to alcohol consumption (e.g. alcoholic liver disease) partially acutely attributable to alcohol consumption (e.g. falls) partially chronically attributable to alcohol consumption (e.g. hypertensive diseases)

Table 10 Alcohol attributable hospital admissions by attribution and age range 2010/11 (n=4178)

Alcohol attributable hospital Total number of hospital Percentage of hospital admissions by age range admissions by category admissions by attributable condition Age *Total Overall Partially Partially Wholly Partially Partially Wholly Range number of proportion of Acute Chronic Acute Chronic admissions total admissions 16-24 121 2.9% 107 11 3 88.4% 9.1% 2.5% 25-34 117 2.8% 73 35 9 62.4% 29.9% 7.7% 35-44 210 5.0% 113 85 12 53.8% 40.5% 5.7% 45-54 421 10.1% 122 260 39 29.0% 61.8% 9.3% 55-64 566 13.5% 88 451 27 15.5% 79.7% 4.8% 65-74 771 18.5% 103 658 10 13.4% 85.3% 1.3% 75+ 1874 44.9% 751 1120 3 40.1% 59.8% 0.2% Source: NHS SEE Health Informatics 2011 *This is the total number of admissions by count. i.e. a person could have been admitted more than once in the period in question. Each admission will add to the total.

The greatest number of admissions (1874) occurred in persons aged 75+. This is unsurprising given this age range will be more susceptible to chronic diseases through long term alcohol consumption. This is reflected in the fact that over 59.8% of the 1874 admissions in the 75+ age range were partially related to chronic alcohol consumption. The remaining 40% of admissions were partially associated with acute consumption. Only 0.2% of admissions were found to wholly attributable to alcohol consumption in persons aged 75+.

For persons aged 16 to 24, the greatest proportion of admissions were related to acute alcohol consumption. This may reflect the more hazardous and risky lifestyle behaviours that younger people may engage in. (see Table 10 for rates)

Gender appears to play a significant role in alcohol attributable hospital admissions. Figures 20 and 21 provide an overview of admissions for male and females by age range. A greater proportion of admissions in males aged between 45 to 64 appear to be wholly associated with alcohol than females of the same age range. In males and females aged 75+, females appear to have fewer admissions related to chronic alcohol use than males. For acute alcohol attributable admissions however this is reversed. 9.7% more females (43.5%) were admitted for conditions acutely attributable to alcohol than males. It could be surmised that this may be due to an increased number of older females being admitted as result of an injurious fall, or similar adverse event.

Figure 20 Admitted to hospital with Figure 21 Admitted to hospital with alcohol attributable conditions: Males, all alcohol attributable conditions: Females, all ages, DSR per 100000 population ages, DSR per 100000 population

The ultimate adverse event associated with alcohol consumption is premature death. An estimate of the increase in life expectancy at birth that would be expected if all alcohol-attributable deaths among males/females aged under 75 years were prevented has been undertaken. Southend-on-Sea males lose 12 months of their life as a result of excessive alcohol consumption. This is second only to Great Yarmouth in the East of England where males can expect to lose 14 months of life. It is however 4.5 months more than the regional average of 7.5 months for males. The borough is ranked 286 worst of the 325 local authorities in England for male alcohol related premature mortality.

Southend-on-Sea women lose 5.1 months of life due to alcohol, the regional average being 3.4 months. The borough is ranked 262 worst of the 325 local authorities in England for female alcohol related premature mortality.

Clearly the burden that of alcohol plays in both health terms and societal impact is marked. Southend-on-Sea has statistically higher alcohol related hospital admissions for males and females than should be expected in England. It ranks 303 of 325 local authorities for alcohol related sexual assaults and is statistically worse than England for alcohol related reported crimes and violent crime.

8. Abuse and safeguarding

The experience of domestic and sexual violence has significant impacts on the health, mental health and wellbeing of women, and domestic abuse is a preventable cause of death.

Data on domestic abuse in Southend can be drawn from: incidents reported to Essex Police; referrals to local specialist services; presentations to the

Council‟s Housing Services; and the selective enquiry taking place in the Emergency Department at Southend Hospital.

All data in relation to domestic abuse, national and local, should be understood within the context that there is significant under-reporting.

Table 11 Domestic Abuse incidents reported to Essex Police

Data 2009/10 2010/11 2011/12 Essex Police – recorded incidents 3,784 3,649 3,881 Essex Police – recorded crimes 957 959 1,105 Referrals to Multi-Agency Risk Assessment 181 205 347 Conference (total high risk cases) Approaches to SBC Housing Services, unavailable 154 202 citing domestic abuse as reason for move Positive disclosures following selective unavailable unavailable 23 enquiry at A&E, Southend Hospital

It should also be noted that the majority of domestic abuse is unlikely to come to the attention of Police. For example the emotional and psychological abuse experienced by victims on a day-to-day basis, such as restrictions on their movement, money, access to friends and family, as well as the pressures of living in a fearful environment, will not be reported to the Police, and cannot easily be translated into data.

8. Growing Older

The overall number of older people in our population is expected to grow sharply in the coming years, with particularly large increases in the numbers of people aged over 85. The number of people in the oldest age groups matters. Whilst, at present, just over 60% of the older population is in the 65- 74 age groups, there are significant numbers of older people in the age groups over 80 years, at which the greatest impact of morbidity on health and social care services is likely

Figure 22 The population structure of people aged over 65 in Southend-on-Sea in 2007 and projected structure in 2020

Source: Eastern region public health observatory (2)

The living circumstances of older people affect both opportunities for social interaction and the need for additional support from formal and informal services.

A significant proportion of those aged 75 and over live alone, 75% of which are women. Evidence suggests that older people who live alone are more likely to report fair or poor health, social isolation, difficulties in the basic activities of daily living, lower mood and lower levels of physical activity, which has implications for the potential level of support that may be required from external agencies.

Figure 23 Proportion of population aged over 65, unable to manage at least one self-care activity on their own

Falls are common in older people and have serious consequences in people aged 65 and over, including physical injury such as fractures of the hip, lost confidence, increased social isolation and reduced independence. Fear of falling (or fear of falling again amongst those who have fallen before), can severely limit an older person’s daily activities and thereby have a dramatically detrimental effect on their quality of life and their physical and mental wellbeing. Each year 35% of over 65‟s experience one or more falls. This rises to 45% of over 80‟s living in the community experiencing at least one fall each year. Over 60% of those living in nursing homes will fall repeatedly. Figure 24 Percentage of people over 65 years in Southend on Sea predicted to have a fall in 2025

% of Older People Predicted to Have a Fall (2025)

50.00%

45.00% 43.59%

40.00%

35.00% 32.70%

g 30.00%

a t

n 23.76% e 23.38%

c 25.00% r

e 20.61% P 20.00%

15.00%

10.00%

5.00%

0.00% Aged 65-69 Aged 70-74 Aged 75-79 Aged 80-84 Aged 85 and over

Age Band

(Table produced on 10/05/12 12:16 from www.poppi.org.uk version 6.0)

Dementia

The human cost and impact of dementia on sufferers, carers and their families is severe. Dementia is a terminal condition. Sufferers live on average between 7 and 12 years with the condition before death. It therefore has a major impact on the number of disease free life years that people experience before death.

Figure 25 Projected number of cases dementia (%)

Source: NEPHO

8. Excess Winter Deaths

Excess mortality related to temperature extremes is an important public health issue. It has been well documented that there is risk of increased mortality in older people due to a fall in temperature and problems with heating homes and keeping warm. Excess winter deaths is expressed by an indicator based on the ratio of extra deaths that occur in the winter months (December-March) compared to the average number of deaths in 4 months in non-winter months (August- November and April-July).

Figure 26 shows excess winter deaths by local authority. This is not significantly different in Southend-on-Sea, Castle Point and Rochford compared with East of England and England.

Figure 26 Excess winter deaths 2006-2008 by local authority (with confidence intervals

35.0000

30.0000

25.0000

ue l

a 20.0000 V

t ca

i 15.0000

d n I 10.0000

5.0000

0.0000 England East of England Southend-on- Castle Point CD Rochford CD Sea UA

Source: ERPHO

Since the summer heat wave of 2003, the risks associated with excess heat are now also being considered and addressed. A national heat wave alert system operates and heat wave advice is distributed locally to ensure health and social care services take appropriate action for vulnerable groups of older people.

8. Living Independently

Around one in five adults in the UK has a disability, and more than 1 million of those live alone. The ability for an individual to be able to live independently gives them a greater sense of control over their life and the ability to function as part of a community.

Figure 27 reflects the high numbers of older people and high numbers of care homes in Southend

Figure 27 People aged 65 and over in local authority residential care, independent sector residential care, and nursing care during the year, purchased or provided by the ASSR

Figure 28 People supported to live independently through social services (all ages)

Disability

Learning Disability

A “learning disability” is defined by the Department of Health (DH) as including the presence of: Significantly impaired intellectual functioning and reduced ability to understand new or complex information, to learn new skills Meeting the diagnostic criteria of ICD10/ DSM4 with an intellectual functioning being markedly below average, with an IQ of 69 or less social functioning which significantly reduces ability to cope independently, and that difficulty functioning presents in 2 or more of the following areas: o Communicating o Care for self o Living at home o Relating to others o Directing self o Using community resources o Academic functioning o Working in employment o Health and safety which started before age 18 and with a lasting effect on development.

Southend has a rate of 4 adults with a learning disability per 1,000 of the population aged 18+ (based on 2005/6 figures) which is equivalent to the national rate.

Figure 29 shows that Southend on Sea compares well to both England and its comparator group for the percentage of people with learning disability in employment.

Figure 29 Adults with learning disabilities in employment

Physical Disability

There is extensive evidence to suggest that disabled people are at significantly higher risk of exclusion in a number of areas:

Disabled people have significantly reduced employment opportunities and are more likely to experience income poverty and material hardship than their non-disabled peers Disabled people are less likely than their peers to vote or otherwise participate in the political and civic life of their communities As children and as adults disabled people are more likely to have restricted social networks, have looser ties to their local community, to experience bullying and to be victims of crime

Availability of services is crucial to enable people with disabilities to live independently.

Figure 30 Number of clients with a physical Figure 31 Clients with physical disability disability by age receiving services in community

Carers Over 3,000 people in Southend provide over 50 hours of care every week with 37% of that delivered by carers aged 65 and over. In 2006 a sample survey was carried out with older people living in Southend. A total of 7% of respondents were providing care for someone and of these 70% felt that their caring role had an impact on their daily life.

Numerous studies have identified the health inequalities experienced by carers. Compared to non-carers, being an unpaid carer is associated with increased rates of psychological distress, including symptoms of anxiety and depression, reduced social functioning, increased susceptibility to physical illness and some carers being at risk of injury associated with their caring activities. The lack of employment opportunities due to their caring responsibilities means that many carers are likely to live on low income, also contributing to health inequalities,

Several groups of carers face increased health risk, especially those looking after a partner and women providing long hours of care to a disabled child or parent in the same household.

There is supporting evidence that carers face social exclusion in Southend. The 2009 Carers Survey (The Information Centre for Health & Social Care, 2009) revealed that a significant number of carers in Southend feel socially isolated/excluded, 58% of the total number of carers who responded to the survey felt that they are socially isolated or have little social contact with people.

Housing

Poor housing can have a significant impact on physical health as well as general well being. There is evidence that overcrowded housing contributes to the transmission of infectious and respiratory diseases and that damp, cold housing is associated with asthma and other chronic respiratory symptoms. In particular damp housing can create an environment in which moulds and mites breed most successfully, both of which can contribute to the development of respiratory illnesses.

Southend is an area of high density housing. The borough is fortunate in that it offers attractive residential areas with good infrastructure and strong communities, however, like most urbanised areas it also has areas with poorer housing which present a greater challenge.

Homelessness

Being homeless can have a hugely detrimental effect on an individual‟s health. Being homeless can erode skills and self-esteem, acting as a major barrier to gaining employment and as a result thrust people into poverty) and the health consequences associated with it.

Rough sleepers: have an average life expectancy of 42 years. are 35 times more likely to kill themselves than the general population are four times more likely to die from unnatural causes such as accidents, assaults, murder, drugs or alcohol poisoning (Griffiths, 2002).

There are specific health issues associated with homeless rough sleepers, including: Poor physical health, such as higher rates of tuberculosis and hepatitis than the general population, poor condition of feet and teeth, respiratory problems, skin diseases, poor sexual health, injuries following violence and infections. Mental health problems, including serious mental illnesses such as schizophrenia, as well as depression and personality disorders. Drug and alcohol dependency

Figure 32 Percentage Homeless by Local Authority Comparator Group

Figure 32 shows that Southend has a rate that is not significantly different from England or its comparator authorities.

8. Mortality

Figure 34 Mortality trends, by age group, per 1000 population – Southend-on- Sea

Figure shows how there is a general downward trend in mortality from the major causes of death for most age groups

Source: ERPHO

This data illustrates that measures implemented locally as a result of National Service Frameworks during recent years are likely to have contributed to the reductions in mortality from the main causes of death.