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Glo U Cestershire Gloucestershire County Health Profile The Annual Report of the Director of Public Health June 2010 gloucestershire healthy living DRAFT 1 Introduction The 2010 Area health Profile provides information on the main health issues for the county. It includes data at district level, and makes comparisons with the English national average where possible. Many factors impact on health and wellbeing in a population. In addition to health care services, socio-economic factors such as education, housing, employment and income have a significant influence. The 2010 Area Health Profile contains information on socio-economic determinants not covered in the 2009 Area Health Profile - employment, income and living environment. It also contains information about some of the typical health and lifestyle behaviours of children and young people, taken from the Gloucestershire Pupil Online Survey. This gives an important insight into the challenges we need to address in our young people today to ensure they become healthy adults. An update on some of the current partnership and project work is also included, and finally some recommendations for future work are made. This document is divided into the following sections: • Demographics – now and in the future • How Healthy is Gloucestershire – key issues • The burden of disease • What we are doing now • What else we need to do 2 Demographics – now and in the future Gloucestershire is a diverse county with a population of approximately 601,405 residents. It is mainly rural, with two major urban centres of Gloucester and Cheltenham at its heart. Nearly 40% of the county’s population live in Gloucester and Cheltenham. The age structure of the population varies within the county, with the more urban of the six districts tending to have a ‘younger’ profile than the others. Gloucestershire already has a greater proportion of people aged 65 and over than England and Wales. Based on 2005 mid-year estimates, this age group makes up 18.2% of the total population compared with 16.1% nationally. By 2025, the number of older people in Gloucestershire aged over 65 is expected to rise by 44%, compared to an increase of 8.8% for all ages. The number of 0 to 19 year olds is expected to fall by 2.8% based on current projections. The latest estimates suggest that the county’s resident population will increase by about 9% in 2025 to around 654,340 (Figure 1). The latest projections have been updated on the basis of a trend based model with the anticipated effects of the Regional Spatial Strategy removed. This has implications at a local level which are considered within each district profile. 1 DRAFT Figure 1 Gloucestershire Population 2009 vs. 2025 90+ 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 Age Band Age 30-34 25-29 20-24 15-19 10-14 5-9 0-4 30000 20000 10000 0 10000 20000 30000 Population Female 2009 Male 2009 Female 2025 Male 2025 Source: eJSNA Figure 2 illustrates the projected shift in numbers and proportions of children, adults and older people over the next 16 years. Figure 2 Resident Population by age group in Gloucestershire 2009 and 2025 2025 136,262 362,570 155,507 Year 2009 140,251 353,337 107,819 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of total population Gloucestershire 0‐19 Gloucestershire 20‐64 Gloucestershire 65+ 2 DRAFT Ethnicity Gloucestershire has a small black and ethnic minority population (4.9%) compared to England (11.8%) although there is considerable inter-district variation with Gloucester city having the highest black and ethnic population (8.6%). The black and minority ethnic groups represented in Gloucester are shown in Figure 3. Figure 3 Ethnic minority population 2007 6.00% 5.00% 4.00% 3.00% 2.00% 1.00% Percentage of total population 0.00% Asian or Asian Black or Black Chinese or Other Mixed British British Ethnic Group Gloucestershire 1.30% 1.70% 1.00% 0.90% England 1.70% 5.70% 2.80% 1.50% Source: eJSNA The proportion of school age children (aged 5-16 years) from BME backgrounds is higher than for the population as a whole (12.5%). The percentage of children in the county whose first language is not English is low at (3.1%) compared to England (13.2%). 3 DRAFT 2. How healthy is Gloucestershire – key issues Data taken from a survey of the local population in April 2009 indicates that 79.5% of respondents in the county reported overall good health and well being. This data is supported by the information from the Joint Strategic Needs Assessment (JSNA) which shows that the health of people in Gloucestershire is generally good with life expectancy being better than the England average. The three main causes of death and serious illness, like the rest of the country are: • Circulatory diseases ( heart disease and strokes) • Cancers • Respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) Further data taken from the JSNA shows that in most areas Gloucestershire is doing better compared to England as a whole with just a couple of health indicators where Gloucestershire rates are worse than nationally. The areas where the county is either doing better or worse are shown respectively in the green and red boxes below. Better than the England Average • At county level Gloucestershire has a similar or better than average for all health and wellbeing indicators except for those listed below However there is considerable intra county variation which will be examined both here and within the individual area health profiles. Worse than England • Breast Cancer • Malignant Melanoma In addition to the above depression and dementia rates may be higher than nationally, but the figures currently available are estimates. The amber box below contains a number of lifestyle factors that influence the health and well-being of people but for which the data are not robust, making comparisons against national data less valid, or where there is no nationally agreed population target. Whilst it is encouraging that the county is performing well in certain areas, it is important that continued efforts are made to improve performance in all the key lifestyle behaviours that impact on ill-health if further health gains are to be made and inequalities reduced. 4 DRAFT • Physical activity in adults • Physical activity in children • Healthy eating in adults • Healthy eating in children • Obesity in adults • Obesity in children • Smoking and tobacco control • Alcohol misuse 3. Burden of disease 3.1 Introduction The three main causes of illness and death are circulatory diseases, cancers and respiratory diseases. These and other important conditions are examined in this section. Data for this section comes from a variety of sources as outlined below: • Disease Registers in General Practice As part of the Quality and Outcome Framework (QOF) General Practitioners (GPs) keep registers of patients with long term conditions. The number of patients on the register gives us some indication of the prevalence1 of the disease (i.e. the number of people living with the condition). These registers may under-estimate the true burden of disease as the rates are lower than expected prevalence rates calculated from national studies and extrapolated to Gloucestershire. Nevertheless they do provide a proxy of the prevalence of long term conditions such as CHD, stroke, chronic obstructive pulmonary disease (COPD), diabetes and cancer in the community. The rates calculated from these registers are crude rates which mean that they do not take into account the age and gender profile of the district. Inter-district variation could be the result of different age/gender population distributions in each district. • Cancer Registry The National Cancer Registry keeps a register of all new cancers. Each new diagnosis of cancer is notified to them and entered onto a national database. This therefore provides a robust indication of the incidence2 (new cases) of cancer. These data are made available directly from the Cancer Registry and also via other databases such as the Compendium of Clinical and Health Indicators (the source used here). 1 Prevalence is the total number of cases of a disease. 2 Incidence is the number of new cases of a disease. 5 DRAFT • Estimates of incidence and prevalence In some areas disease registers are less well-developed. This is particularly so for mental health problems where there is little local incidence or prevalence information. In such cases the best available data are provided by estimates which are based on age and gender specific rates from studies extrapolated to the local population. Mortality (Death) data Information on deaths is collected from death certificates. This is analysed and made available via the Compendium of Clinical Indicators. Standardisation of data Some data presented throughout this document are Directly Standardised Rates (DSR). This means that the data are gender and age-standardized by using a standard European population profile. Standardised rates are used because death and disease rates are influenced by the age and gender distribution of a population. For example, two populations with the same age-specific mortality rates for coronary heart disease will have different overall rates if the age distributions of their populations are different. Where data are not standardised (such as QOF data), variation between districts may be due to differences in the population’s age- distribution. 3.2 Cardiovascular disease Cardiovascular disease refers to conditions involving the heart or blood vessels and comprises of coronary heart disease and stroke. CHD disease occurs when the blood supply to the heart is reduced to such an extent that it cannot function normally, resulting in either a heart attack or angina.
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