----------------------------- Contents Acknowledgements ......................................................................................................... 2 Introduction ..................................................................................................................... 3 Localities ......................................................................................................................... 4 Health profiling in localities ....................................................................................... 5 Geographical Localities – Mapping: ........................................................................ 16 An Assessment of the Health of a Population: Analysis of the Data: Northmavine, Shetland ................................................................................................................. 44 Communities of Interest ................................................................................................ 48 Keep Well................................................................................................................... 54 Work and Worklessness ............................................................................................ 55 Suicide and Sudden Death ........................................................................................ 58 Older People and their Medicines .............................................................................. 61 Building Community Capacity ....................................................................................... 65 References .................................................................................................................... 75 Acknowledgements As usual, I am indebted to the contributions and help given by colleagues both within the Department of Public Health, across NHS Shetland, and in partner organisations including Shetland Islands Council, other Community Planning Board partners and other organisations working for the improvement of health in Shetland. In particular my thanks go to: Kim Govier, Wendy Hatrick, Andy Hayes, David Kerr, Dr Susan Laidlaw , Chris Nicolson, Elizabeth Robinson, Karen Smith, members of the Health Improvement Team, colleagues from Primary Care and Benedict Gray for the photo of Fair Isle. Dr Sarah Taylor Director of Public Health All maps throughout this document are reproduced by permission of Ordnance Survey on behalf of HMSO. © Crown copyright and database right 2013. All rights reserved. Ordnance Survey Licence number 0100051628 2 Introduction This year‟s Annual Report takes the theme of „localities‟. We look at some of the information we have on health from geographical localities around Shetland, and from communities within Shetland. We look at the nature of communities, and how the communities we live in say something about ourselves and who we are, along with the other things that make up our lives and our health and wellbeing: social, environmental and personal characteristics: who we work with and what we work at, our friends and family, our ethnicity, gender and sexuality, and our environment. We think about what this means for understanding and improving public health in Shetland. Fae Flugga… …ta Fair Isle 3 Localities Why have we chosen a theme of localities and communities for this Public Health Annual Report? For a number of reasons. We provide information to help us better understand our health and how to improve it – looking at data in geographical areas and mapping data is a useful way of presenting information and showing what it means. Services are often managed in local areas, and looking at information about services in this way can help us to better plan and manage our resources. We live, work and play in communities - some of these communities are geographical i.e. localities - "I bide in Scalloway", and some of them are „communities of interest‟ – “I work for the NHS”, “I am part of a knitting group”, “I fundraise for Mind Your Head”. Sometimes the relationship between geographical and interest groups is simple: I live in Weisdale and play football for the Westside; and sometimes it‟s more complicated: I live in Fair Isle and go to school in Lerwick. Where we live says something about ourselves but of course that‟s only one part of who we are. The other things that make up who we are and how well we are include social, environmental and personal characteristics: how we use our time (work and leisure), our friends and family, our ethnicity, gender and sexuality, and our environment. In the end we are all defined as people, not places. But in Shetland, where our sense of place is so strong, understanding the role of locality (place) and community in our wellbeing is an important part of understanding the public health. 4 Health profiling in localities Understanding the health and the health needs of communities is a core area of public health work. If we are going to try and improve health then we need to know what our starting point is – and what are the particular health issues that need to be tackled. We need to know what the health needs of the local community are, and how we can match that with service provision. We may also want to compare different communities or populations, and look at the differences in health over time. Health profiling is not just about the number of people with particular diseases, or the number of people admitted to hospital. It needs to take into account all aspects of health within the community, including the risk factors for poorer health and the consequences of living with poor health. We often speak about health profiling in a geographical sense, and think about specific localities. But we can also profile the health of „communities of interest‟. For example a particular ethnic group, an age group, or a workplace community; prisoners; travellers; people in care settings; people with particular illnesses or disabilities. There are a number of sources of information that we can use to undertake a health profile, but there can be problems with information: it may not be readily available; may be out of date; not specific to the community you are looking at or not accurate. There is therefore a skill in being able to assess the range of information available that we might use to describe the health of a particular community (geographical or „community of interest‟) and choose what to use to paint an accurate picture of the health experiences of that community. A lot of the information we can use is not directly related to health; this is because we want to look at all the things that affect health, or may affect health in the future, not just the actual illnesses that people might have at the present time. As well as knowing about the things that might cause ill health, we also want to know what there is in the community that can improve health, or protect against illness. So, if we know that within a community many people commute by car to work in sedentary jobs then we may be concerned by their levels of physical activity and possible problems with obesity and heart disease. But if we see in the same community that there is a local leisure centre, good footpaths for walking, allotments and thriving 5 local dance clubs then we know that there is scope to improve physical activity and health. Some of the main risk factors for poor health outcomes are poverty, deprivation and social exclusion. So understanding factors like unemployment, education, income and crime within a community can also help identify if there are likely to be health issues now or in the future. What might we include in health profiling? The list on the following pages focuses mainly on the information that might be available for a defined geographical area. A lot of information can now be collected by postcode, which for many places is a good way of defining geographical area (although not always so good in Shetland where the geographical boundaries for postcode areas can be relatively large). Other information may come from a service that covers just the area in question, e.g. a school or a GP practice. There can be a high degree of overlap between area based services, but this tends to be less of a problem in the more rural and remote communities. Some information is regularly and routinely collected, such as numbers of births and deaths, and is generally up to date and accurate. Other data may be collected infrequently, such as the population census. Information that is routinely collected can still often be out of date because it takes time to collect, verify, analyse and publish data. Sometimes, we cannot find what we want to know from routinely collected data, and have to undertake research, such as a survey, to collect the information. Because of the problems in collecting data, it is important to look at information from different sources which together can paint a more accurate picture than relying on a small number of pieces of information. In the list on the next page we have included a number of examples to illustrate the sort of information that is and could be collected (in boxes). These examples have mostly come from the Community Profiles for different parts of Shetland.i The Community Profiles focus on a whole range of factors within a community, not just 6 health, and they use a wide range of sources to collect information. The sort of information they include is very relevant to health profiling as described above. Please note: As described above it can be difficult to get up to