7993 - Divided by Health D3 10/10/08 14:17 Page 1 Divided by health: a city profile key findings November 2008 7993 - Divided by Health D3 10/10/08 14:17 Page 2 Photographs © Belfast Healthy Cities and Mike Hartwell Maps: Publishing Permit Number 80191. The maps is this document are based upon Crown Copyright and are reproduced with the permission of Land and Property Services under delegated authority from the Controller of Her Majesty’s Stationery Office, © Crown copyright and database rights 2008 7993 - Divided by Health D3 10/10/08 14:17 Page 3 Preface Health is a measure of personal quality of life, but it is also a yardstick of a healthy community, city or society. Our health and wellbeing is shaped above all by our social environment, and differences in factors such as income, employment and educational attainment can therefore result in inequitable health outcomes. As such, it is the responsibility of policy makers to create conditions that both enable health improvement for all our citizens, and reduce inequalities in health. This Profile makes a valuable contribution to the policy process by providing a single resource that collates available information on health and wellbeing in the Belfast Health and Social Care Trust area. It focuses on the social determinants of health and also places figures in a wider geographical context of the United Kingdom, the Republic of Ireland and Europe. The Profile highlights important positive change over the last decade, including improvements in life expectancy, reduced unemployment, improving quality of housing and increases in the proportion of school leavers achieving at least five GCSEs at grades A*-C. There has also been an increase in the number of people in higher education, especially in areas where participation in higher education traditionally has been low. However, the Profile also shows that there is still much work to do: smoking levels remain high, economic inactivity in Belfast is among the highest across the UK and has not changed markedly over the last decade, and in too many local areas over half of young people leave school with less than five good GCSEs. Most importantly, the available figures show that inequalities in health within the Trust area have not reduced and indeed in some cases the gap has increased. Most fundamentally, this affects life chances: a boy born today into the least disadvantaged conditions can expect to live for six years longer than a boy born into the most disadvantaged conditions. A high proportion of local areas also tend to have poorer health outcomes than Northern Ireland as a whole or cities elsewhere in the UK and Europe. So much has been achieved, but to continue to improve health and wellbeing overall, tackling inequalities in health must be a core policy priority. At the same time, increasing priority must be given to health more generally, to enable efficient prevention of ill health. This requires continually improving collaboration across sectors, which can be done particularly effectively at local level. Page 3 7993 - Divided by Health D3 10/10/08 14:17 Page 4 Divided by health: a city profile This Profile is a welcome, timely and important document that highlights some of the key issues that policy and decision makers must tackle in order to achieve our goal of a fair and prosperous society for all. I am pleased to endorse it and encourage its use in strategic discussion and priority setting. Michael Mc Gimpsey MLA Minister for Health, Social Services and Public Safety Page 4 7993 - Divided by Health D3 10/10/08 14:17 Page 5 Foreword This Profile presents a comprehensive picture of health and wellbeing in the Belfast Health and Social Care Trust area, and of the key social factors influencing health and wellbeing. It provides an outline of change over the last decade, which has been a period of major social, economic and political change across Northern Ireland. It builds on the first city health profile Towards a City Health Plan: A Statistical Profile, which was published by Belfast Healthy Cities in 1998, and also coincides with the 20th anniversary of Belfast as a WHO European Healthy City. For the first time, this Profile places health and wellbeing in Belfast and Castlereagh in a wider context with cities in the UK, the Republic of Ireland and Europe. It will also contribute to a Europe wide analysis of urban health, as a key product required of all cities in the WHO European Healthy Cities Network. This report refers to Local Government District boundaries current in 2008 and does not consider the proposals for new boundaries published in September 2008. The full Profile is published online only, and is available at www.belfasthealthycities.com. A summary Key Findings report is also available. This report fulfils an important function in that it brings existing statistics relevant to health and wellbeing into one coherent resource. These highlight some very serious messages about persistent inequalities in health within the Belfast Trust area, which can only be tackled by addressing their root causes. What is required is joint leadership across sectors, based on an understanding of how non health policy impacts on health. This is, indeed, a recommendation of the WHO Commission on the Social Determinants of Health, which recently published findings from a three year study of global inequalities in health and effective solutions under the challenging title Closing the Gap in a Generation. Health equity will be a key theme for the WHO European Healthy Cities Network in its next five year Phase. We see the Profile as an essential resource and basis for agreeing future policy priorities for Belfast, and the ongoing reform of the public administration structures offers a timely opportunity for this. In particular, the profile can help target action and resources in a way that is most likely to improve health and reduce inequalities in health. Our aim is that the Profile will be updated regularly in future, and as such it can also provide a baseline and support tool for monitoring progress. Page 5 7993 - Divided by Health D3 10/10/08 14:17 Page 6 Divided by health: a city profile This significant and extensive project has been a major focus of Belfast Healthy Cities’ work over the last year. It has been conducted in partnership with data providers, in a way which we hope will continue in order to support improved intersectoral relationships between information specialists and statistical experts. We would like to thank the members of the working group, who provided invaluable guidance and support throughout the project. Special thanks go to Cathryn McBurney of the NINIS team in the Northern Ireland Statistics and Research Agency, who acted as statistical advisor to the Belfast Healthy Cities project team. Finally, sincere thanks go to Jonna Monaghan for managing the process and compiling the final Profile. Dr Bernadette Cullen Joan Devlin Chair, Belfast Healthy Cities Programme Director Page 6 7993 - Divided by Health D3 10/10/08 14:17 Page 7 Contents Rationale for geographical and comparative basis 9 The context How social conditions determine health and wellbeing 12 Executive Summary Health and wellbeing in Belfast widening inequalities despite improvements 16 Part 1 1 Demographic trends 22 2 Health and mortality 28 3 Health and wellbeing of children and young people 40 4 Health and wellbeing of older people 48 5 Lifestyle 52 Part 2 6 Housing 60 7 Income and employment 66 8 Education 71 9 Transport 76 10 Crime 11 Environment 83 12 Social networks and assets 87 Appendix 1 Working Group 91 Appendix 2 Sources 92 Page 7 7993 - Divided by Health D3 10/10/08 14:17 Page 8 Divided by health: a city profile 7993 - Divided by Health D3 10/10/08 14:17 Page 9 Rationale for geographical and comparative basis Geographical structure The key geographies of this Profile are Local Government District (LGD) level for overall analysis and where possible Parliamentary Constituency level for more local level analysis. Where statistics are given for the Belfast Trust area, this is defined as Belfast and Castlereagh Local Government Districts combined. The boundaries are those current in 2008. This Profile has not considered proposals for new Local Government District boundaries published in September 2008. As figure i shows, the four Belfast Parliamentary Constituencies do not overlap exactly with Belfast and Castlereagh LGDs. However, analysis at this level helps highlight inequalities. Many statistics are also routinely published at this level, which is likely to facilitate future comparative analysis. Selected ward level data are included to emphasise differences, where data are available and can be analysed meaningfully. Figure i. Belfast and Castlereagh Local Government District boundaries and Belfast Parliamentary Constituency boundaries Source: NISRA Page 9 7993 - Divided by Health D3 10/10/08 14:17 Page 10 Divided by health: a city profile Some survey findings, primarily related to lifestyle, are only available at Health Board level. In this case figures are given for the Eastern Health and Social Services Board (EHSSB) area, which is in existence until April 2009. The EHSSB area covers the Local Government Districts of Ards, Down, Lisburn and North Down as well as Belfast and Castlereagh. Data sources The Profile is a compilation of existing primarily public sector statistics. There is no single consistent model for data collection across sectors, and therefore there is some variation in the years and geographical levels at which data is presented. Many organisations have also changed the way data is collected over the last ten years, which has limited the availability of data over the full period 1996-2006.