Gloucester Area Health Profile June 2010 gloucester healthy living DRAFT 1. Introduction The 2010 Area Health Profile provides a brief overview of some of the main health issues for Gloucester. It does not include comparative locality data on these issues as this is presented in the Gloucestershire Health Profile. Therefore it is recommended that these profiles should be read together. 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 characteristics of local populations using a social marketing tool, HealthACORN. 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 • How healthy is Gloucester – what are the key issues • Factors influencing health and wellbeing – what and where • What we are doing now • What else we need to do 2. Demographics – now and in the future The geographical area of Gloucester covers 1.5% of the County’s total area and has a population of 114,900 people, which equates to 19.6% of the total County population (Office for National Statistics (ONS) 2008). According to the Office for National Statistics, Gloucester is forecast to have a population increase (2009-2025) of 12.4% in those aged 19 and under (County 2.9%) and a 39.8% population increase in those aged 65 and over (County 48.1%) Gloucester is predominantly an urban area with only 0.3% of people living in rural areas (2001). The Gloucester population is relatively evenly spread across all 5 quintiles. However, it has the highest percentage of residents in the county living in the most deprived quintile (25.1%), [based on national quintiles of the Index of Multiple Deprivation 2007 by Lower Super Output Area]. Figure 1 shows estimates of the current and projected population by age and gender. Population projections are constructed using a set of assumptions. If these assumptions or variables change, the projected populations will alter. For example, population projections presented last year included assumptions based on the Regional Spatial Strategy (RSS). Current projections no longer take into account the RSS assumptions; therefore the population pyramids presented in this report are slightly different from last year. 1 DRAFT Figure 1 Gloucester 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 6000 4000 2000 0 2000 4000 6000 Population Female 2009 Male 2009 Female 2025 Male 2025 Source: eJSNA Figure 2 illustrates the projected shift in the numbers and proportions of children, adults and older people over the next 16 years. Figure 2 Resident Population by age group in Gloucester 2009 and 2025 2025 34,961 84,018 24,537 Year 2009 31,102 72,409 17,549 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of total population Gloucester 0‐19 Gloucester 20‐64 Gloucester 65+ Source: eJSNA 2 DRAFT Ethnicity Gloucester city has the highest black and minority ethnic (BME) population (9,800) which is 8.6% of the population compared to the county average of 4.9%, as shown in Figure 3 below. Figure 3 Ethnic Minority Population 2007 10 8 6 4 Percentage 2 0 Forest of Cheltenham Cotsw old Gloucester Stroud Tew kesbury Dean District 6.1 3.7 2.6 8.6 3.7 3.2 Gloucestershire 4.9 4.9 4.9 4.9 4.9 4.9 The minority ethnic groups represented in Gloucester are shown in Figure 4. Figure 4 Ethnic minority population 2007 3.5 3.0 2.5 2.0 1.5 1.0 0.5 Percentage of total population 0.0 Mixed Asian or Asian British Black or Black British Chinese or Other Ethnic Group Gloucester 2.1 3.3 2.3 0.9 District number 2400 3800 2600 1000 Gloucestershire 1.3 1.7 1.0 0.9 Source: eJSNA A higher percentage of school pupils (years 1-11) come from a BME background (19.6%), compared to the county average of (12.5%). The percentage of pupils with a first language other than English is 7.2% compared to the county rate of 3.1%. 3 DRAFT 3. How healthy is Gloucester – what are the key issues? Data taken from a survey of the local population in April 2009 indicates that 77.6 % of respondents reported having overall good health and wellbeing, which is less than the County rate of 79.5%. This data is supported by the information in the Joint Strategic Needs Assessment (JSNA) which shows that Gloucester is a relatively deprived area and the health of the people in Gloucester is worse in some aspects than the England average. Although there are inequalities in Gloucester, the life expectancy is similar to the England average. In addition, over the last ten years, the rates of early death from cancer, heart disease and stroke have improved. The main causes of death and serious illness in Gloucester, like the rest of the county are: o circulatory diseases (heart disease and stroke) o cancers o respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) Data taken from the JSNA show that compared to the Gloucestershire and England averages, Gloucester has some areas of health and wellbeing where the City is either doing better or worse as shown respectively in the green and red boxes below. Better than the England or County Average • Lower percentage of overweight and obese children in reception • Higher percentage of adults setting a smoking quit date • Higher percentage of adults 18 and over who successfully quit smoking at 4 weeks • Lower ratio of excess winter deaths compared to average non-winter deaths • Lower percentage of people over 75 admitted to hospital after a fall • Lower prevalence1 of coronary heart disease (CHD) • Lower prevalence of people having suffered stroke and/or transient ischaemic attack (TIA) • Lower prevalence of chronic obstructive pulmonary disease (COPD) • Lower incidence2 of breast cancer Worse than the England or County Average • Higher incidence of reported domestic abuse crimes • Lower rate of breastfeeding initiation • Higher percentage of children living in poverty • Higher rates of alcohol related recorded crimes • Higher rates of hospital stays for alcohol related harm • Higher percentage of people 16 and over who smoke • Higher percentage of deaths from smoking • Higher percentage of early deaths from cancer • Higher percentage of early deaths from heart disease and stroke 1 Prevalence is the total number of cases of a disease. 2 Incidence is the number of new cases of a disease. 4 DRAFT • Higher incidence of all cancers • Higher incidence of malignant melanoma • Higher prevalence of people living with Type 2 diabetes • Higher percentage of mothers who smoke at time of booking • Higher teenage pregnancy rate in under 16 and under 18 year olds • Higher percentage of people over 75 admitted with a fractured femur after a fall • Higher prevalence of people under 75 living with mixed anxiety, depression and neurotic disorders • Higher prevalence of people aged 65 and over living with severe depression The amber box below contains a number of lifestyle factors that influence the health and wellbeing of people but for which the data are not robust, making comparisons against national or county figures less valid, or where there is no nationally agreed population target. Whilst it is encouraging that Gloucester is performing well in certain areas, (as described in the county profile) 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. • 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 Further information on all the above issues can be found in the county profile. 4. Factors influencing health and wellbeing – what and where? The county profile provides details of the burden of disease at a district level and in the county as a whole. Where data is available national comparisons are made. It highlights the main causes of illness and death (circulatory diseases, cancers and respiratory diseases) and identifies other health issues of relevance to the Gloucestershire population. If we are to reduce the burden of disease and ill-health it is important that we understand the factors that influence this and how best they can be modified. In February 2010, Professor Michael Marmot published a review on health inequalities, Fair Society, Healthy Lives. The review proposed an evidence-based strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age and which can lead to health inequalities. Together with lifestyle factors such as smoking, physical activity, alcohol intake and diet these can significantly influence the risk of developing disease, disability or dying prematurely. 5 DRAFT These factors tend to be concentrated among the same people and their effects on health are cumulative. The rest of this section explores intra-district variations in some key social determinants and lifestyle factors. We use information from the Index of Multiple Deprivation (IMD) 2007 to assess where inequalities exist.