FOR THE PEOPLE OF ATTENTION BRIGHTON OF THE & HOVE R Annual Report ROF THE DIRECTOR Rof PUBLIC HEALTH R FOR THE YEAR 2009 1 Copyright ©2010 NHS Brighton and Hove 2 R CONTENTS Foreword R Executive Summary Chapter 1 Introduction .............................................................................................. 15 Chapter 2 Public Health in Brighton and Hove ....................................................... 21 2.1 The rush to the sea for thalassotherapy ............................................... 23 2.2 Public health in 19th century Brighton ................................................. 26 2.3 Public health in 20th century Brighton ................................................. 30 2.4 Public health in the latter part of the 20th century in Brighton and early 21st century in Brighton... and Hove ...................... 36 Chapter 3 The population of Brighton and Hove ................................................... 41 3.1 The growth of population of Brighton and Hove ................................. 43 3.2 Age profile through the ages ............................................................... 44 3.3 Population density ............................................................................... 49 Chapter 4 Wider Determinants of Health in Brighton and Hove .......................... 53 4.1 Housing and urban development ........................................................ 55 4.2 The recession and unemployment ....................................................... 67 4.3 Transport .............................................................................................. 72 4.4 Environment ........................................................................................ 76 Chapter 5 Lifestyle Determinants of Health in Brighton and Hove ...................... 83 5.1 Alcohol ................................................................................................ 85 5.2 Drug use .............................................................................................. 94 5.3 Smoking .............................................................................................. 97 5.4 Obesity .............................................................................................. 101 5.5 Sexual behaviour ................................................................................ 110 Chapter 6 Ill Health in Brighton and Hove ............................................................ 123 6.1 Coronary heart disease ...................................................................... 125 6.2 Cancer ............................................................................................... 130 6.3 Mental health & suicide ..................................................................... 137 6.4 Infectious diseases ............................................................................. 145 Chapter 7 Health Inequalities ................................................................................. 157 7.1 National policy on health inequalities ................................................. 159 7.2 Deprivation, health and coastal resorts .............................................. 161 7.3 Infant mortality Mortality ................................................................... 162 7.4 Mortality rates and health inequalities ............................................... 164 7.5 Life expectancy and health inequalities .............................................. 166 References Appendices 3 List of contributers Annie Alexander Kate Lawson Justin Pursaill Public Health Programme Manager Head of Health Promotion Graphic Design Team, Brighton & Hove City Council Kevin Claxton Barbara Hardcastle Resilience Manager Public Health Specialist Martin Reid Head of Housing Strategy Kerry Clarke Susie Haworth Commissioner for Teenage Pregnancy and School meals manager Andrew Renaut Substance Misuse Principal Transport Planning Officer Alistair Hill Kate Gilchrist Consultant in Public Health Samuel Rouse Head of Public Health Research and Analysis Senior Technical Officer, Air Quality Kerry Hone Thurston Crocket Graphic Design Team, Jo Sage Head of Sustainability and Environmental Brighton & Hove City Council Independent Consultant Policy Anna-Marie Jones Miranda Scambler Dr Katie Cuming Performance Analyst, Children and Young Public Health Information Specialist Specialist Registrar in Public Health and People’s Trust General Practitioner Annie Sparks Michelle Kane Divisional Environmental Health Officer Michelle Doll Health Promotion Specialist Public Health Administrator Graham Stevens Lydie Lawrence Drug and Alcohol Action Team Coordinator Chris Dorling Public Health Programme Manager Public Health Information Specialist Carolyn Syversen Dr Geoff Mead Health Promotion Specialist David Earls Convenor for Local History and Landscape Graphic Design Team, short courses CCE University of Sussex Andy Staniford Brighton & Hove City Council Housing Strategy Manager Dr Anjum Memon Dr Olu Elegbe Consultant in Public Health Liz Tucker Public Health Practitioner Drug and Alcohol Action Team Analyst Clare Mitchison Anna Fairhurst Clinical Assurance & Audit Manager Angeline Walker Smoking Cessation Team Manager Public Health Specialist Tim Nichols Rob Fraser Head of Environmental Health, Licensing & Dr Peter Wilkinson Head of Planning Strategy Public Safety Consultant in Public Health Betty Gillett Stephen Nicholson Yolande Watson Brighton Resident Lead Commissioner HIV & Sexual Health Health Promotion Specialist Doreen Harrison Martina Pickin Becky Woodiwiss PA to Director of Public Health Public Health Improvement Principal Health Promotion Specialist Susie Haworth Brenda Packham And other local residents... School Meals Manager Brighton Resident Liz Hegarty Maurice Packham Public Health Administrator Brighton Resident Tim Earthey Graham Osborne Public Health Administrator Housing Sustainability Project Manager Kirsty Hewitt Mita Patel Specialist Trainee in public health Sustainability Co-ordinator 4 R FOREWORDR Welcome to the Annual Report of the Director of Public Health for 2009.This year my Report is slightly unusual in that it takes a very long term view of health in Brighton and Hove and makes frequent reference to the Annual Reports of previous Medical Officers of Dr Tom Scanlon Health and Directors of Public Health in Brighton, and in Brighton and Hove. The Report covers the history of Public Health in Brighton and Hove and some of the long-term wider determinants of health: housing, transport, environment and employment – including the potential health effects of the current recession. The main lifestyle factors that contribute to health in Brighton and Hove are discussed: smoking, alcohol, drugs, sexual behaviour, diet and exercise; as are the main causes of ill health in Brighton and Hove: coronary heart disease, cancer and mental health. The year 2009 has been an unusual year for infections and so there is a section covering the effects of the global flu pandemic in Brighton and Hove, and the depressing recent measles outbreak. I would like to be remembered as the last Director of Public Health to have a measles outbreak in Brighton and Hove, but as things stand that is by no means certain. And, of course there is a section on health inequalities with some in-depth discussion on whether or not inequalities are increasing or decreasing. A list of contributors is included opposite and I would like to thank them all. These include, unusually, members of the public and colleagues from Brighton University who have help give this Report its distinctive style. Any mistakes or inaccuracies are, however, entirely down to me. Dr Tom Scanlon Director of Public Health NHS Brighton and Hove Brighton & Hove City Council 5 Photograph courtesy of The Royal Pavilion and Museums, Brighton & Hove City Council Brighton & Hove and Museums, Pavilion The Royal courtesy of Photograph 6 R EXECUTIVE SummaryR The population of Brighton and Hove The wider determinants of health in Brighton and Hove Lifestyle determinants of health in Brighton and Hove Ill health in Brighton and Hove Health inequalities in Brighton and Hove 7 8 Executive Summary THE POPUlation OF decent, affordable homes. Houses of Multiple Occupation bring service and social tensions, Brighton AND Hove vulnerable people are sometimes placed in less than adequate housing and homelessness Brighton is historically renowned for being figures remain worryingly higher than average. densely populated and overcrowded. In contemporary Brighton, we can find evidence of this in the narrow streets of Hanover, lined The recession and with densely packed Victorian mews cottages unemployment now housing a mixture of families, students and The relationship between individual and older people living cheek-by-jowl. In recent years population health and the economy is complex. the population of Brighton and Hove has been The relationship between unemployment characterised by a relatively large proportion and health has been extensively studied and of young, working-age people. Many health is clearer than that between an economic and quality of life issues today reflect these recession and health. characteristics. We find evidence of this in A recession that results in a moderate housing pressures; environmental health issues increase in unemployment will see a mixed such as difficulties in storing and disposing of picture with regard to health in Brighton and refuse; pressures on green spaces and local Hove. Adverse