West Suffolk Clinical Commissioning Group Equality and diversity information – January 2013
This document outlines some of the key demographic information about west Suffolk’s communities, where this information is available. Information and data is collated from: Equality and diversity data summary for West Suffolk CCG (Public Health), October 2012, West Suffolk CCG Equality and Diversity Strategy 2012-15 and NHS Suffolk Diversity toolkit to support commissioning, December 2011.
Age This refers to a person belonging to a particular age. This protected characteristic can apply to anyone, although younger people and older people are proven to be most at risk of discrimination.
Age discrimination can be direct when a person is treated less favourably because of their age, or indirect where care is offered in such a way that a particular age group is more heavily disadvantaged than people in other age groups. West Suffolk Clinical Commissioning Group Distribution of registered patients by age As at quarter 4 financial year 2011/12 Persons
20000
18000
16000
14000
12000
10000
8000
Number Number of patients 6000
4000 2000
0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ Persons 12806 12668 12770 13088 12299 13184 14214 14752 17583 18307 16018 14677 16315 15485 11214 8891 6612 6213 Age (years) Source: Open Exeter
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West Suffolk Clinical Commissioning Group Distribution of registered patients by age and rural/urban classification As at September 2011 Persons
100%
90%
80%
70%
60%
50%
40% 30%
20% 10%
0% 0-19 20-64 65+ All ages Rural 26.3% 26.7% 31.0% 27.5% Urban 73.6% 73.2% 69.0% 72.5% Age (years) Source: NHS Suffolk, Diversity toolkit to support commissioning (December 2011)
As of March 2012, 237,096 people were registered with a GP in west Suffolk. 51,332 (21.7%) of the population was aged 0 to 19 years and 48,415 (20.4%) was aged over 65 years.
Red Lodge, Newmarket, Culford and Haverhill particularly, had high proportions of people aged 19 years and under. Lakenheath, Red Lodge and Bury St Edmunds had the highest proportions of people aged 65 years and over.
Disability A person has a disability if he or she has a physical or mental impairment which has a substantial and long-term adverse effect on that person’s ability to carry out normal day-to-day activities.
Disability can arise from many health problems including hearing and visual impairment, physical disabilities, both congenital and acquired, and learning difficulties. People’s needs vary greatly and many people will experience several
Page 2 of 20 disabilities or be caring for another family member or friend with health problems (NHS Suffolk & Arana Ltd, 2009).
Physical disability The Department of Health defines physical disability as a physical impairment, which has a substantial and long-term effect on individuals’ ability to carry out day-to-day activities. People with physical disability may experience difficulties with access to care, and communication as well as poorer levels of self reported health and an increased risk of depression.
Projecting Adult Needs and Service Information (PANSI) have produced prevalence estimates for moderate (e.g. unable to manage stairs, and need aids or assistance to walk) and serious (e.g. unable to walk and dependent on a carer for mobility ) physical disability in England based on the Health Survey for England 2001.
The estimates show a clear relationship between physical disability and age, with the prevalence of moderate physical disability increasing by a factor of 4 between the ages of 18 and 64 and serious disability increasing by a factor of 7 (see graph below).
Prevalence of moderate and serious physical disability by age in England (Source: Health Survey for England 2001)
16 14 12 10
8
6
% prevalence % 4 2 0 18-24 25-34 35-44 45-54 55-64 % moderate 4.1 4.2 5.6 9.7 14.9
0.8 0.4 1.7 2.7 5.8 % serious % moderate % serious
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West Suffolk Clinical Commissioning Group Distribution of estimated numbers of registered patients with physical disability by disability severity and age As at September 2011 Persons aged 18-64 years
5000 4697
4500
4000
3500 3292 3000
2500
2000 1840 1828
1500 1146 Estimatednumber of patients 916 1000 709 559 500 138 109 0 18-24 25-34 35-44 45-54 55-64 18-24 25-34 35-44 45-54 55-64 Moderate Severe Severity and age (years)
In September 2011 it was estimated that in west Suffolk there were 11,685 people with a moderate physical disability, and 3551 people with a severe physical disability.
Mental health People with mental health disorders and disabilities have a higher risk of poor physical health and premature mortality than the general population (Phelan et al , 2001). Reasons for this include the impact on physical health of deprivation and poverty, but also associated lifestyle behaviours with poor nutrition, obesity, higher levels of smoking, heavy alcohol use and lack of exercise contributing to higher rates of morbidity and life expectancy among people with mental health problems (Friedli and Dardis, 2002).
The prevalence of different types of mental health disorders experienced by the population can be seen below (PANSI 2011). There are large variations in prevalence between disorders and gender (see graph below).
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Prevalence of adult Psychiatric Morbidity in England Source: Adult psychiatric morbidity in England 2007. 20
18 16 14
12
10 8 6 4
2 0 Borderline Antisocial Tw o or more Common mental Psychotic personality personality psychiatric disorder disorder disorder disorder disorders % males 12.5 0.3 0.6 0.3 6.9 % females 19.7 0.6 0.1 0.5 7.5
West Suffolk Clinical Commissioning Group Estimated distribution of adult registered patients with mental disorders by type of disorder As at September 2011 Persons
25000
20000
15000
10000
5000 Estimatednumber of adult patients
0 Common mental Borderline personality Anti-social personality Psychotic disorders Psychiatric comorbidity disorders disorder disorder
Number of patients 23002 643 501 571 10289
Mental disorder Source: NHS Suffolk, Diversity toolkit to support commissioning (December 2011)
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In west Suffolk it is estimated that there are approximately 35,006 people with some form of adult psychiatric morbidity (this includes common mental disorders, borderline personality disorders, antisocial personality disorders, psychotic disorders and psychiatric co-morbidity).
Learning disability The term learning disability (LD) is used to describe a significant, lifelong experience that has three components:
• significantly reduced ability to understand new or complex information, to learn new skills (significantly impaired intelligence), and • reduced ability to cope independently (impaired social/adaptive functioning), and • onset before the age of 18 years, with a lasting effect on development (National Institute for Health and Clinical Excellence, 2009)
People with LD have higher rates of mental health problems, respiratory and heart disease, higher levels of obesity and may have additional physical disability (Royal College of Nursing, 2011) and therefore shorter life expectancy and higher risk of premature death.
Evidence suggests that nationally the number of people with severe LD may increase by around 1% per annum for the next 15 years as a result of:
• increased life expectancy, especially among people with Down’s syndrome • growing numbers of children and young people with complex and multiple disabilities who survive into adulthood • a sharp rise in the reported numbers of school-aged children with autistic spectrum disorders, some of whom will have learning disabilities • greater prevalence among some populations of South Asian origin. (Emerson and Hatton, 2004)
By applying prevalence estimates from research to numbers of registered patients in West Suffolk CCG it is estimated that as at September 2011 there were 4660 persons aged 15 years and over with all types of learning disabilities and 976 persons aged 15 years and over with moderate or severe learning disabilities in West Suffolk CCG.
Dementia The term ‘dementia’ is used to describe a collection of symptoms, including a decline in memory, reasoning and communication skills, and a gradual loss of skills needed to carry out daily activities. These symptoms are caused by
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structural and chemical changes in the brain as a result of physical diseases such as Alzheimer’s disease. Dementia can affect people of any age, but is most common in older people. Dementia is a progressive condition and has a disproportionate impact on capacity for independent living (LSE; KCL & Alzheimer’s Society 2007).
West Suffolk Clinical Commissioning Group Estimated numbers of patients with dementia (excluding early-onset dementia) As at September 2011 Persons aged 60 years and over
900
800
700
600
500
400
300
Estimated number of patients 200
100
0 60-69 70-74 75-79 80-84 85-89 90-94 95+ Number of patients 411 321 518 803 815 489 150 Age (years)
Source: NHS Suffolk, Diversity toolkit to support commissioning (December 2011)
Dementia beginning before the age of 65 is known as early onset dementia and although rare does affect people in their 30s.
The graph below shows the prevalence of early onset dementia by age in the UK.
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Rate of early onset dementia per 100,000 population in the UK Source: Dementia UK (2007)
200 180 160 140 120 100 80 60 40 20 0 30-34 35-39 40-44 45-49 50-54 55-59 60-64 Per 100,000 males 8.9 6.3 8.1 31.8 62.7 179.5 198.9 Per 100,000 females 9.5 9.3 19.6 27.3 55.1 97.1 118
Estimated number of people with early onset dementia in west Suffolk, as of September 2011:
West Age group Suffolk 30-34 1 35-39 1 40-44 2 45-49 5 50-54 9 Total 18
It should be noted that 6.1% of all people with dementia among BME groups in the UK are early onset, compared with only 2.2% for the UK population as a whole, reflecting the younger age profile of BME communities.
Visual impairment People with severe visual impairments may experience difficulties with access to care, and communication.
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West Suffolk Clinical Commissioning Group Estimated numbers of patients with visual impairment (18-64 years: severe visual impairment; 65+: moderate and severe visual impairment) As at September 2011 Persons aged 18 years and over
3000
2500
2000
1500
1000
Estimated numberEstimated patients of 500
0 18-24 25-34 35-44 45-54 55-64 65-74 75+ Number of patients 11 18 21 22 20 1447 2672 Age (years)
It is estimated that there may be approximately 4212 people with a serious visual impairment in west Suffolk.
Hearing impairment People with hearing impairments may experience difficulties with access to care, and communication.
The definition of hearing impairment includes: • Moderate deafness: People with moderate deafness have difficulty in following speech without a hearing aid. The quietest sounds they can hear in their better ear average between 35 and 49 decibels. • Severe deafness: People with severe deafness rely a lot on lip reading, even with a hearing aid. British Sign Language (BSL) may be their first or preferred language. The quietest sounds they can hear in their better ear average between 50 and 94 decibels. • Profound deafness: People who are profoundly deaf communicate by lip reading. BSL may be their first or preferred language. The quietest sounds they can hear in their better ear average 95 decibels or more.
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By applying prevalence estimates from research to numbers of registered patients in West Suffolk CCG it is estimated that as at September 2011 there were 27811 persons aged 18 years and over with moderate or severe deafness and 573 persons aged 18 years and over with profound deafness in West Suffolk CCG.
Gender reassignment Gender reassignment is the process of transitioning from one gender to another.
According to the 2010 review of evidence of the equality strands in the East of England:
“Transgender people are highly susceptible to depression and more than one in three adult transgender people (34%) have attempted suicide (DoH 2007). Discrimination and prejudice in every-day lives also places many transgender people at risk of alcohol abuse, self harm, violence, substance abuse and HIV (DH 2007). Transgender people, especially those in need of gender reassignment services, require access to specific health services such as assessment, counselling or psychotherapy, hormonal treatments, and gender reassignment surgeries. Evidence suggests that large numbers of transgender people face a high level of discrimination when accessing these services.”
Data are not collected on numbers of transgender people in England. Prevalence estimates range from 0.1% to 0.6% for all adults (Huntingdonshire County Council 2011). By applying these estimates to the number of registered patients in West Suffolk CCG in 2011/12 (237096 registered patients), it is estimated that there may be 200-1400 transgender persons in West Suffolk CCG.
Pregnancy and maternity Pregnancy is the condition of being pregnant or expecting a baby. Maternity refers to the period after the birth, and is linked to maternity leave in the employment context. In the non-work context, protection against maternity discrimination is for 26 weeks after giving birth, and this includes treating a woman unfavourably because she is breastfeeding.
Between 2003 and 2010 the number of births to residents of West Suffolk CCG increased by 10.0% from 2397 live births and stillbirths to 2637.
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Live births and stillbirths to residents of West Suffolk Clinical Commissioning Group 2003-2010
3000
2500
2000
1500
Number of births 1000
500
0 2003 2004 2005 2006 2007 2008 2009 2010 West Suffolk CCG 2397 2468 2421 2381 2547 2637 2555 2637
Race Race refers to people defined by their race, colour, and nationality (including citizenship) ethnic or national origins.
Race and ethnicity can have a variety of impacts on a person's health, from the way they are treated in the health service to a person's susceptibility to conditions or diseases.
There is evidence which shows that certain health conditions including high blood pressure, diabetes and coronary heart disease (CHD) are more common in BME communities living in Britain and therefore these communities are at higher risk of ill health than the rest of the population. (NHS Scotland 2011).
Many BME groups also experience higher rates of poverty, in terms of income, benefits use, worklessness, lacking basic necessities and area deprivation. Much of the variation in self-reported health between and within BME groups can be explained by differences in socio-economic status. However, there is a complex interplay of factors affecting ethnic health, such as the long-term impact of migration, racism and discrimination, poor delivery and take-up of health care,
Page 11 of 20 differences in culture and lifestyles, and biological susceptibility (Parliamentary Office for Science and Technology, 2007).
Estimated population figures suggested that in 2009, there were 26,210 people in west Suffolk of non-white British ethnicity. The largest black and minority group was ‘white other’ (10,270), followed by Chinese or other ethnic group (5,840).
Population estimates at a county and local authority level by ethnic group for 2009 (ONS 2010) estimated that 10.9% (64,800) for the NHS Suffolk population were from a non-white British ethnic group. The largest ethnic group was ‘white other’, at 3.4% of the population (20,300 people). The next largest group was Asian or Asian British at 2.6 % and Chinese or other ethnic group, at 1.9%. The largest minority ethnic group in the Forest Heath, St Edmundsbury, Mid Suffolk and Babergh districts was ‘white other’. This group includes migrants from Europe such as Portugal, Lithuania and Poland, as well as American service personnel based at Lakenheath and Mildenhall.
Gypsies and Travellers experience some of the worst health in all BME groups, (Suffolk Travellers’ Health Needs Assessment 2009). On average, Gypsy and Traveller infants are 2-3 times more likely to die than infants in the general population. Twice as many Gypsies and Travellers report anxiety or depression compared to the general population. Up to 16% are not registered with a GP, and immunisation rates are low. Barriers to healthcare access include low levels of literacy and fear of racism (NHS Suffolk Annual Public Health Report, 2008)
Approximately 10% of Gyspies and Travellers in the Eastern region live in Suffolk (based on proportionate caravan counts), giving a total estimated population of between 3000 – 5000 Gypsies and Travellers in the county (Suffolk Travellers’ Health Needs Assessment 2009).
Data held on the number of calls made to NHS Suffolk’s telephone interpreting service can give an indication of the range and prevalence of particular communities. In 2011/12, Polish (31%), Kurdish (10.2%) and Lithuanian (12.3%) accounted for the greatest number of calls.
Data for Suffolk as a whole (no west Suffolk specific data available):
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Source: Office for National Statistics
Residents of West Suffolk Clinical Commissioning Group Estimated numbers of National Insurance number registrations to adult overseas nationals entering the UK Registration years 2002/03-2011/12 Persons of all ages
2500
2000
1500
1000
Number of registrations 500
0 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
Persons of all ages 879 936 1211 1990 1542 1482 1426 1018 1244 1315 Year of registration
Source: Department for Work and Pensions
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West Suffolk Clinical Commissioning Group Estimated population in black and minority ethnic groups 2009 Persons of all ages
12000
10000
8000
6000
Number persons Number of 4000
2000
0 Chinese or other ethnic White Other Mixed Asian or Asian British Black or Black British group Persons of all ages 10270 3500 3690 2910 5840 Ethnic group
Source: Office for National Statistics
Religion or belief Religion is as you would expect e.g. Hindu, Muslim, Church of England. Belief includes religious and philosophical beliefs including lack of belief (e.g. Atheism). For religion to be included in the definition, generally, a belief should affect your life choices or the way you live.
There is no recent data on religious diversity. However 2001 Census estimates that 75% of the west Suffolk population were Christian, 16% indicated they had no religion and 1% belonged to another religion. 8% did not state their religion.
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West Suffolk Clinical Commissioning Group Estimated distribution of population enumerated at 2001 Census by religion Persons of all ages (n=204786)
8%
16% Christianity
Other religion
No religion 1% Not stated
75%
Source: Office for National Statistics
Sex In line with national figures, the proportion of males and females in west Suffolk in 2011/12 was estimated to be approximately even. Above the age of 75 years old, there were proportionally more females than males and over the age of 85 years, 65.5% of the west Suffolk population were female.
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West Suffolk Clinical Commissioning Group Percentage distribution of registered patients by age and sex As at quarter 4 financial year 2011/12
100%
90%
80% 70%
60% 50%
40%
30%
20%
10%
0% 0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ All ages Females 48.8% 48.7% 49.4% 50.0% 49.3% 49.4% 51.3% 51.4% 54.0% 65.5% 50.6% 51.2% 51.3% 50.6% 50.0% 50.7% 50.6% 48.7% 48.6% 46.0% 34.5% 49.4% Males Age (years)
Source: Open Exeter
Sexual orientation This is whether a person is sexually attracted towards their own sex, the opposite sex or to both sexes.
Lesbian, gay and bisexual people experience a number of health inequalities which are often unrecognised in health and social care settings (Department of Health, 2007).
• Lesbians are more likely to have smoked and to drink heavily than women in general. At various ages they are less likely to have had a smear test and more likely to have had breast cancer. Levels of self harm and suicide are significantly higher than in the wider population (Stonewall, 2008). • Gay men may have higher rates of drug, tobacco and alcohol use, which may increase their risk of lung and liver cancer. They may be more susceptible to eating disorders and have higher rates of mental health problems (DH 2007). • Evidence shows a two fold excess in suicide attempts in lesbian, gay and bisexual people, the risk for depression and anxiety disorders are at least 1.5 times higher, and alcohol and other substance dependence is also 1.5 times higher (Mental Health: 2009 Annual Public Health Report, NHS Suffolk)
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Estimates for the lesbian, gay and bisexual population in England varies from 0.3 to 7%. By applying these estimates to the number of registered patients in West Suffolk CCG in 2011/12 (237,096 registered patients), it is estimated that there may be 700 -1700 lesbian, gay or bisexual persons in West Suffolk CCG.
Inequalities West Suffolk CCG acknowledges that people who can experience discrimination or disadvantage are not limited to the communities and groups outlined above. People can also experience discrimination as a result of having a combination of protected characteristics. There are many other potentially marginalised or vulnerable groups in west Suffolk, such as: asylum seekers and refugees; homeless people; prisoners and ex-offenders; sex workers; and, those living in rural areas.
West Suffolk CCG is committed to advancing equality of opportunity for all our communities.
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References Parliamentary Office for Science and Technology. (2007) Ethnicity and health, Number 276. http://www.parliament.uk/documents/post/postpn276.pdf (accessed 3rd November 2011)
Kings Fund (2000) Briefing note: age discrimination in health and social care. http://www.kingsfund.org.uk/publications/age.html (accessed 10th November 2011)
Office for National Statistics (2010) – 2008 based sub-national population projections http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Sub- national+Population+Projections (accessed 3rd November 2011)
NHS Suffolk and Arana Ltd (2009) Improving GP access for marginalised communities.
National Institute for Health and Clinical Excellence (2009) QOF briefing paper 2010/11: learning disability http://www.nice.org.uk/media/F40/35/QOFAdvisoryCommitteeBriefingPaperLearn ingDisability.pdf (accessed 01-11-11)
Royal College of Nursing (2011) Meeting the health needs of people with learning disabilities - RCN guidance for nursing staff www.rcn.org.uk/__data/assets/pdf_file/0004/78691/003024.pdf (accessed 4th November 2011)
Emerson, E. and Hatton, C. (2004) Estimating future need/demand for support for adults with learning disabilities in England. Institute for Health Research, Lancaster University http://www.lancs.ac.uk/shm/dhr/research/learning/download/estimatingfuturenee d.pdf (accessed 2nd November 2011)
Institute of Public Care (2011) Projecting adult needs and service information http://www.pansi.org.uk/ (accessed 19 th October 2011)
Institute of Public Care (2011) Projecting older people population information http://www.poppi.org.uk/ (accessed 20th October 2011)
Phelan, M., Stradins, L., & Morrison, S. (2001). Physical health of people with severe mental illness. British Medical Journal, 322, 443 – 444.
Friedli, L and Dardis, C. (2002) Not all in the mind: mental health service user perspectives in mental health, Journal of Mental Health Promotion, 1, 1, pp. 36- 46
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London School of Economics; Kings College London & Alzheimer’s Society 2007). Dementia UK: the full report. http://alzheimers.org.uk/site/scripts/download_info.php?fileID=2 (accessed 4th November 2011)
NHS Scotland (2011) http://www.healthscotland.com/equalities/race.aspx (accessed 3 rd November 2011)
Office for National Statistics (2011) Population estimates by ethnic group mid- 2009 for primary care organisations (experimental) http://www.ons.gov.uk/ons/rel/peeg/population-estimates-by-ethnic-group-- experimental-/current-estimates/population-estimates-by-ethnic-group-mid-2009- for-primary-care-organisations--experimental-.xls (accessed 4th November 2011)
Department for Work and Pensions (2011) National Insurance number allocations to adult overseas nationals entering the UK http://research.dwp.gov.uk/asd/asd1/niall/index.php?page=nino_allocation (accessed 4th November 2011)
NHS Suffolk (2009). Suffolk Travellers’ health needs assessment 2009.
NHS Suffolk (2008). 2008 NHS Suffolk annual public health report: health inequalities and diversity in Suffolk. http://www.suffolkobservatory.info/JSNASection.aspx?Section=82&AreaBased=F alse (accessed 15th November 2011)
Ahmed, T., Cock, J.C., Irurita, M.I., Hammerton, C. and Pilmer. B. (2010) A review of evidence of the equality strands in the East of England. http://www.edf.org.uk/blog/wp-content/uploads/2010/12/A-review-of-Equalities- Evidence-final-design.pdf ( accessed 3rd November 2011)
NHS Suffolk (2009). Mental health: 2009 annual public health report http://www.suffolkobservatory.info/JSNASection.aspx?Section=82&AreaBased=F alse (accessed 14th November 2011)
NHS Suffolk, Diversity toolkit to support commissioning (December 2011) http://www.suffolk.nhs.uk/LinkClick.aspx?fileticket=gU5BOPQsaUY%3d&tabid=6 99&mid=1317 (accessed 10 January 2013)
Stonewall (2008) Prescription for change: lesbian and bisexual women’s health check 2008. http://www.stonewall.org.uk/documents/prescription_for_change_1.pdf (accessed 15th November 2011)
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Department of Health (2007) Reducing health inequalities for lesbian, gay, bisexual and transgender? people - briefings for health and social care staff. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy AndGuidance/DH_078347 (accessed 14th November 2011)
Huntingdonshire County Council (2011). Equality mapping: potential inequalities faced by people who are lesbian, gay, bisexual and transgender (LGBT) in Huntingdonshire. http://www.huntingdonshire.gov.uk/SiteCollectionDocuments/HDCCMS/Documen ts/Policy%20documents/Equality%20Impact%20Assesment/Lesbian%20Gay%2 0Bisexual%20Transgender%20equality%20mapping%20in%20Huntingdonshire. pdf (accessed 16th November 2011)
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