D Sheffield - Where Everyone’s Health Matters Sheffield Director of Public Health Report 2009 1 Contents Page Welcome and Introduction 3 Profiles of Health: Community Assemblies 7 South East CA 10 South CA 14 South West CA 18 Central CA 22 Northern CA 28 North East CA 32 East CA 38 Recommendations 43 Sheffield Health and Well Being Atlas 56 More Information 57 2 Welcome and Introduction Welcome to my Annual Report for 2009. The main body of the report this year presents an overview of the health status of the 7 Community Assemblies in Sheffield. The establishment of Community Assemblies is a major new initiative undertaken by Sheffield City Council. The assemblies have responsibilities devolved to them for making decisions which affect services in their areas. As part of this, they have scope to take decisions which will impact on the health of the population they serve. It is therefore important that Communities Assemblies should be fully informed about the health of those populations. All the information on the health of the community assembly populations is available on the website – www.publichealthsheffield2009.nhs.uk . I strongly recommend that anyone interested in the detail should go to this website to find it. Information is available there in both tabular and graphical form. For each Community Assembly, the Public Health Consultant lead for that assembly has analysed the data available and identified the most important health issues. These analyses are the bulk of the written report (and are also available on the website). In each case, recommendations are made to the Community Assembly as to what each should consider investing in to further improve the health of the local population. Last year, my annual report was a vehicle for publishing the Joint Strategic Needs Assessment (JSNA). I have not done that again this year because the JSNA is developing as a continuing process by which our joint stock of needs assessment work is continually being expanded. A position statement will be published this autumn, and the full range of needs assessments will be available on-line. Work included in the JSNA will inform the revision of NHS Sheffield’s Strategy, Achieving Balanced Health 3 . The health of Sheffield Mortality rates continue to fall and life expectancy continues to increase in Sheffield, as shown in the table below. This is of course absolutely to be welcomed. Health Outcome Sheffield England Male life expectancy at birth (years) 77.2 77.7 Female life expectancy at birth (years) 81.2 81.8 Early deaths from heart disease and strokes per 100,000 83.8 79.1 population Early deaths from cancer per 100,000 population 122.6 115.5 Infant deaths per 1,000 live births 6.0 4.9 Road traffic injuries and deaths per 100,000 population 54.3 54.3 All figures relate to the average over the period 2005-2007 3 However, last year I reported that the gap in life expectancy between the most deprived quintile (one fifth) of the population and the City average had started to increase for men and was levelling off for women. The latest data shows that for both men and women that gap has stayed constant. This is demonstrated in figures 1 and 2. Figure 1 Male Life Expectancy - Gap between Most Deprived Neighbourhood Quintile and Sheffield 4.0 3.5 3.0 2.5 2.0 1.5 1.0 Life Expectancy Life Expectancy Gap (Years) 0.5 0.0 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Actual gap 3.4 3.4 3.1 2.9 2.8 3.0 3.2 3.2 Exponential projection 3.0 2.9 2.9 2.9 2.8 2.8 2.7 2.7 2.7 2.6 Linear projection 2.9 2.9 2.9 2.8 2.8 2.7 2.7 2.7 2.6 2.6 2010 Target Gap 3.4 3.4 3.4 3.3 3.3 3.3 3.2 3.2 3.2 3.1 3.1 3.1 Actual gap Exponential projection Linear projection 2010 Target Gap Source: Public Health Analysis Team, Sheffield PCT ( 5 year rates) Figure 2 Female Life Expectancy Gap between Most Deprived Neighbourhood Quintile and Sheffield 3.5 3.0 2.5 2.0 1.5 1.0 0.5 Life Expectancy Life Expectancy Gap (Years) 0.0 -0.5 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Actual gap 2.9 2.4 2.3 2.2 2.0 1.8 1.8 1.8 Exponential projection 1.5 1.3 1.2 1.0 0.9 0.7 0.6 0.4 0.3 0.1 Linear projection 1.5 1.3 1.1 1.0 0.8 0.7 0.5 0.3 0.1 0.0 Target Gap 2.9 2.9 2.9 2.8 2.8 2.8 2.8 2.7 2.7 2.7 2.6 2.6 Actual gap Exponential projection Linear projection Target Gap Source: Public Health Analysis Team, Sheffield PCT( 5 year rates) 4 This is because whilst mortality rates are on average falling, mortality rates in the more deprived parts of the population, particularly in men aged 55 to 70, are not falling as fast as they have done in the past or as fast as elsewhere in the City. Linked to this, we are not making as much progress towards preventing premature death (i.e. below the age of 75 years) as we need to, if we are to meet NHS Sheffield’s ambitious target of saving 400 lives (i.e. avoiding 400 premature deaths) by 2012. Figure 3 shows what progress is being made. Figure 3 Target Annual Lives to be Saved NHS Sheffield Saving 400 Lives Ambition: Baseline Number of under 75 MDQ Deaths, Sheffield, 2000 onwards Baseline Projection Saving 400 Lives Target Post 2006 Actuals 600 500 32 62 400 91 119 147 163 178 193 207 300 220 200 Number of < 75 MDQ Deaths MDQ 75 < Numberof 100 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 SOURCE: PH Mortality Year NOTE: All data extracted 2007 for Saving 400 lives baseline, except extracted June 2009 MDQ = Most Deprived Quintile of Sheffield Neighbourhoods based on % households claiming IS/JSA/PC during year NHS Sheffield, Public Health Analysis team (GA), 09/06/2009 Recommendation: Work to address the major causes of mortality in the more socio-economically deprived parts of the City should be re-invigorated in order to get the reduction in health inequalities in the City back on track and to hit the target of saving 400 lives. This must in particular include every effort to reduce smoking prevalence, including aggressive actions to reduce the availability of smuggled tobacco. During the course of this year, the new H1N1 strain of the influenza virus – swine flu – has emerged and caused a pandemic. There were many cases in Sheffield in July, but numbers fell substantially through August. With the start of the new school term, the number of cases in children has increased again, and it is clearly possible that this may be the start of a second wave of infection. It remains the case that this is a new strain of influenza, to which the vast majority of the younger population have no immunity. It is therefore likely that during the course of the coming “flu season” we will see large numbers of people being infected. Although the majority of people suffer a relatively mild self limiting illness, a small minority need hospital care, and of these a number are likely to die. We are therefore working hard to ensure that the health and social care system in the City is as well prepared as possible for this likely second wave 5 of infection. Key to this will be a vaccination programme (once a vaccine is available) but everyone can contribute to minimising spread of infection through personal hygiene measures. Recommendation: All front line health and social care staff should take up the offer of vaccination when it is available, as should those vulnerable members of the public who are in priority groups. For all of us, personal hygiene remains of paramount importance: - ‘Catch it, bin it, kill it.’ As is customary, this report also contains an update on actions taken following the recommendations made in previous year’s reports. There is one issue which I highlighted in my annual report in 2006 which remains a major concern and is arguably the largest single public health threat to human 1 populations for the medium and longer term. Although climate change has moved well up the national and health agendas over the last 3 years, all the evidence is that we are not, collectively, doing enough to address it. During the course of this year the NHS nationally has started to address this, and NHS Sheffield has adopted a carbon management plan. Sheffield City Council has led the development of the City's Carbon Reduction Framework which sets out a route map for emissions reduction in the medium term. The City has seen a reduction in carbon emissions since 2005, but sustained effort will be needed in both the short and medium term to ensure continuing progress.