Health & Wellbeing in Oldham Alan Higgins Director of Public Health Oldham

Health & Wellbeing in Oldham How does Oldham rate for Health & Wellbeing? Why is it worse than other places? What can we do to make it better?

Fixed – Gender, age, ethnicity, genetics Social & Economic – Poverty, employment, education, income, social exclusion Environment – Housing, water & air quality, transport, crime. Lifestyle – Smoking, physical inactivity, diet, alcohol. Access to clinical services – Availability of services, accessibility, effectiveness of interventions. Factors that Impact on Health & Wellbeing

Life Expectancy  Life Expectancy has been steadily increasing across Oldham over the last 10 years, but the gap between Oldham and England does not appear to be narrowing.  Oldham experiences the 13th worst life expectancy in England  Oldham has a diverse range of communities from the very affluent to the very deprived and this will therefore always produce wide inequalities in health outcomes. Source: Primary Care Mortality Database (Open Exeter) and PHBF and ONS mid year population estimates Please note: Denominators for life expectancy used 2001 and 2007 respectively mid year population estimates for wards.

Life expectancy (Oldham)

CVD  Around 700 people die across Oldham each year from CVD related conditions  Oldham has a higher rate of deaths in people under 75 than the national average  The Health Checks will help identify missing CVD patients  CVD contributes 31% to life expectancy gap  Programme Budgeting Spend for CVD in 2009/10 was £33.7 million Prevalence Disease Management % adults, modelled estimate using Health Survey for England Outcomes QOF: CHD 2009/10 Local health profiles 2010

Cancer Incidence ScreeningOutcomes  Programme budgeting spend for Cancer in 2009/10 was £27.26 million  Early diagnosis is key to survival rates  NHS screening programmes save lives, it is therefore important to increase screening uptake Information sources: NCIS cancer registry LASCA: breast screening coverage Primary care mortality database (Open Exeter)  Around 560 people die in Oldham each year from Cancer  Cancer contributes 28% to the life expectancy gap

COPD Prevalence Disease ManagementOutcomes  Around 336 people die from COPD in Oldham a year  COPD is strongly related to smoking  It is estimated that over 4000 people are missing off the COPD register  Programme Budgeting spend for respiratory disease in 2009/10 was 25.9 million  COPD contributes 5% to the life expectancy gap  Increasing smoking quitters in wards with the highest smoking prevalence will have high impact on COPD outcomes Source: QOF data: Information Centre and ERPHO predicted prevalence modelling NCHO and Primary Care mortality database OCHS Stop Smoking Service

Mental Health  It is estimated that around 17,000 people are registered with depression in Oldham  Recent local survey results show a correlation between mental distress and financial circumstances  There are approximately 2,400 people over 65 with dementia in Oldham  By 2020 there will be an estimated 22% increase in people age over 65  Over the past 12 months the spend on dementia drugs was over £546k  Programme budgeting spend on all mental health conditions in 2009/10 was £5.1 million  Programme budgeting spend is low in comparison to peer groups and overall need.  Of the people known to have a mental health condition only 12% are estimated to have been referred to psychological therapies  Over the past 12 months the spend on anti-depressants across Oldham was over £947k QOF 2009/10 You and Your Community Survey 2010

Smoking  Smoking is the single biggest cause of preventable illness and death in the UK  Around 410 people die each year from smoking attributable conditions across Oldham  It is estimated that 49,000 people smoke in Oldham (28%) of the population  Widening access to stop smoking interventions is essential if we are to increase smoking quitters across Oldham Prevalence OutcomesManagement Information sources: % adults, modelled estimate using Health Survey for England Oldham’s JSNA 2010 Stop smoking Services Oldham

Obesity Prevalence OutcomesManagement Source: NCMP childhood obesity database, Local Health profiles: APHO 2010) NICE In Children  Targeting parents and children-family based interventions  Multi-faceted family based behaviour modification programmes  Support in the use of laboratory based exercise programmes In Adults  Dietary interventions  Clinically prescribed low calorie diets  Increased physical activity programmes  Behaviour modification interventions  It is estimated that 41,000 adults in Oldham are obese  Obesity increases the risk of diabetes, CHD, hypertension, osteoarthritis and some cancers  People who are obese die on average 9 years earlier than those of normal weight  Excess deaths (2009) among people with diabetes type II across Oldham was 156  Determining the cause of obesity is the key to tackling it

Physical Activity Prevalence OutcomesManagement  It is estimated that around 28.3 thousand adults participate in sport across Oldham  Currently 63% of men and 76% of women are not physically active enough to meet national guidelines  Obesity is strongly linked to physical activity  Is effective in the treatment of clinical depression and has benefits for mental health  % reduced risk of premature death and up to 50% reduced risk of major chronic disease  Levels of walking and cycling have fallen in the last decade  Children are also increasingly sedentary  Increased physical activity programmes  Increased active travel through urban and rural planning  Develop and maintain public open spaces that are safe and accessible and encourage physical activity.  For most people, the easiest and most acceptable forms of physical activity are those that can be incorporated into everyday life Source: Sport England's Active People Survey and The Child Health Profiles for England 2010

Alcohol Source: NWPHO Alcohol profiles 2010 Source: NI39 NWPHO Source: NWPHO Alcohol profiles 2010 Source: SUS/CDS through NHS Oldham data warehouse  40 deaths occurred across Oldham in 2009 that were directly attributable to alcohol  Over 38 thousand people are estimated to drink unsafely  Digestive disorders are on the increase  Oldham has significantly higher hospital admission rates for people under 18yrs than the England average  It is clear from the data that people from deprived areas are more likely to be admitted to hospital for alcohol related conditions Prevalence Outcomes

How does Oldham rate? Generally worse – Life expectancy, mortality statistics, morbidity statistics – Health is better than it was but…… – MIND THE GAP

Why is it worse than other places? Near determinants – Lifestyle factors Main determinants – Poverty – Inequality in income – Education – Environment

What should we do to make it better? If it was easy….. Good performance on – Smoking cessation – Childhood immunisation – Teenage pregnancy – Chlamydia screening – Smoking in pregnancy Success is more likely from combined impact of complementary programmes.

The Social Prescription Give every child the best start in life Enable everyone to maximise their capabilities and control over their lives. Create fair employment and good work for all. Ensure healthy standard of living for all. Develop healthy and sustainable places and communities. Strengthen the role and impact of ill health prevention.