THE HEALTH OF THE PEOPLE OF HELENSBURGH AND LOMOND Needs assessment report June 2007 0 Acknowledgements This report was written by Elaine Garman. Its preparation was invaluably supported by the following for: Data sourcing and creation of tables and graphs Ann Boyle Chris Carr Ian Douglas David Greenwell Colin Steel Susan Vaughan Stephen Whiston Supporting the community roadshow events Caroline Champion Mavis Gilfillan Anne Helstrip Carol Millar David Ritchie Providing comments and thoughts on the communities’ health needs All members of communities who devoted their own time to coming to the community roadshow events Attendance at the health needs assessment working group David Bruce Chris Carr Caroline Champion Anne Helstrip Sylvia Moran Jim Proctor Stephen Whiston 1 Contents Page No. 1. Introduction to the area 3 2. Demography and socio-economic determinants of health 4 3. Life-style, behaviour and child health 8 4. Morbidity, mortality and life-expectancy 12 5. Activity in secondary care 14 6. Transport and access 15 7. Perceived needs of the population 16 8. Conclusions 17 Appendices 1. 18 2. 19 3. 39 4. 43 5. 51 6. 61 7. 63 2 1. INTRODUCTION TO THE AREA Helensburgh and Lomond is one area of four localities in Argyll and Bute. The locality stretches from Inverarnan in the north, encompasses Ardgarten and Arrochar at the top of Loch Long, goes south and west to Rosneath peninsula and takes in Garelochhead, Helensburgh and Cardross. The eastern boundary is created by Loch Lomond (see Figure 1.1). Both Argyll and Bute Council and the Community Health Partnership use the four administrative areas. The other three are Bute and Cowal; Mid Argyll, Kintyre and Islay; and Oban, Lorn and the Isles. The total population of Argyll and Bute is 90,870 (based on 2005 General Register Office for Scotland (GROS) Mid Year Estimate (MYE)). The Helensburgh and Lomond population is estimated at 26,438. Argyll and Bute itself is one of the largest and most sparsely populated local authority areas in Scotland. Its population is scattered across an area of just under 2,700 square miles, more than a third live in settlements with a population of less than 1,000 compared to a Scottish average of 8% of the population living in such small communities. The population density of Argyll and Bute as a whole is approximately 0.13 persons per hectare. For Helensburgh and Lomond it is around 0.75, which reflects the main population centre of Helensburgh. The population sparseness in the rest of the locality and indeed in the local authority area as a whole makes transport and communications difficult. 3 2. DEMOGRAPHY AND SOCIO-ECONOMIC DETERMINANTS OF HEALTH Demography The GROS MYE for 2005 indicates a population total of 26,438 for Helensburgh and Lomond with a broadly similar age structure as Argyll and Bute and Highland (see Figure 2.1) but a fall of almost 1,500 since 2002. Figure 2.2 shows the change in the age groups in this time. The small differences in the percentages in the age groups are around slightly fewer in the older age groups and more in some of the younger age groups (see Figure 2.3). The presence of large numbers of military personnel in the 15-29 years and 30-44 years make both these larger cohorts than the comparators. Whilst the population in Helensburgh and Lomond and Argyll and Bute as a whole has been declining recent GROS projections indicate population growth. This is due to the assumption of positive migration into Argyll and Bute with concomitant large increases in projected numbers of elderly people by 2014 (47% rise in numbers of 75+ years from 1984 figures – see Table 2.1 and Figures 2.4 and 2.5). The GROS 2004 based projection relied on quite large inward migration. This offsets the negative natural change and therefore generates population growth over the course of the projection. However it may be that these assumptions are too high given lower level migration assumptions that underlie subsequent mid-year estimates for the area in 2005 and 2006 (see Figure 2.6). Argyll and Bute Council has undertaken their own analysis using the 2001 Census as the base year for the model and subsequent years using Small Area Population Estimates (SAPEs) where they were available (2002 to 2005). Whilst they project an overall decrease of the Helensburgh and Lomond population by 15.3% by 2024 they also project an increase of 32%, 30% and 39% for 65+ years, 75+ years and 85+ years respectively by 2020 for Helensburgh and Lomond (see Table 2.2 and Figure 2.7). Using the same year’s GROS projections the increase in Argyll and Bute’s population to 2024 is around 4% (compared with the local authority’s projection of a decrease of - 4.3%). Whichever projection is considered both indicate a likely increase in the older population. Based on the GROS projection in comparison to other local authority areas, Argyll and Bute is likely to have a higher dependency ratio than many other areas (see Figure 2.8). The increased numbers of elderly people not only gives rise to the increasing need for services but also raises the issue of how that care is provided with a smaller, younger population. Feeding into this dependency ratio is the number of live births in the area. Since the 1980s the birth rate has been declining and projections indicate (again based on 2004 GROS projections) a levelling off and indeed a small increase for Argyll and Bute (see Figure 2.9). The number of births in Helensburgh and Lomond in 2002 was 260. Alongside a current projection in population numbers there is also a projected increase in the numbers of households with greater numbers of people living by themselves. The increase in the population between 2004 and 2024 is predicted to be 3,486 whilst the number of households is predicted to increase by 5,320 (see Figure 2.10). This increase is fuelled by a changing pattern of household occupancy with greater numbers living by themselves. Between 2004 and 2024 there is expected to be a 6% increase in the number of 75+ year olds living by themselves with a smaller increase (2%) of lone parent households (see Figures 4 2.11 and 2.12). The affect this has on average household size is around the Scottish average (see Figure 2.13). Socio-economic determinants of health Argyll and Bute is not highly deprived compared to other local authority areas, but there are still significant numbers of people in deprivation. For much of the area the population is heterogeneous in its nature and therefore does not have many areas of concentrated multiple deprivation. Houses with the same postcode can be at opposite ends of the socio-economic spectrum. In many rural areas deprived individuals and households are fairly evenly distributed throughout the patch, with circumstances of deprivation having more to do with an individual’s characteristics than the area in which they live. In Argyll and Bute it is often individuals and households rather than communities who face deprivation and social exclusion. That said some areas within Argyll and Bute are classed through the Scottish Index of Multiple Deprivation (SIMD) as within the 15% most deprived in Scotland and two are within the 5% most deprived. Ten datazones (each datazone made up of 500 – 1,000 people) in the most deprived 15% are found within the local authority boundary, two of which are in Helensburgh and Lomond (see Figures 2.14 and 2.15). One of these is within the most deprived 5%. Given the population numbers, around 4% of the Helensburgh and Lomond population lies in a datazone that is within the 15% most deprived and in Argyll and Bute as a whole the number equates to around 8%. Overall in Helensburgh and Lomond employment deprivation extends to 5% of the population and with regard to income deprivation – 8%. The latter is measured by the number of people in households receiving income based benefits such as Income Support. For the main population base in the locality the local economy relies a lot on the activity produced by the naval base at Rhu and its associated services. However many of the Helensburgh population travel to Glasgow for work. In the more rural parts of the locality labour markets are localised due to high cost of travel and the distances and time of travel required to access other labour markets. There are high levels of low skill and low aspiration. SIMD indicates that one of the datazones in Helensburgh and Lomond ranked the worst in Argyll and Bute for education, skills and training. This measurement combines information on pupil performance, pupils aged 16+ who enter fulltime education, adults with no qualifications and school absences. This highlights the inequalities that exist as students in Argyll and Bute have traditionally performed above the national averages on standardised testing in all but the Primary 4 level. Secondary school students performed even better when compared to the national scores, with an average of 10% more students achieving or exceeding the standardised score. Population sparseness in the rural areas (see Figure 2.16) gives rise to much of the Helensburgh and Lomond locality being classified as accessible rural or remote rural (see Figure 2.17). As a result geographic access to services is problematic and SIMD places Argyll and Bute in the most deprived 10% for this domain (see Figure 2.18). With the health domain the worst areas swing back to the urban centres rather than the rural areas.