1. Major patterns of life, death and wellbeing A lightning tour of some interesting aspects of population health Presenter Carole Furlong

2. Acknowledgements This presentation has been adapted from the original presentation provided by –the East Midlands Public Health Observatory and –the South West Public Health Observatory

3. What we hope to cover Overview –Major causes of death –Life expectancy Life course epidemiology –Infant mortality –Road traffic injuries –Sexual health –Ageing Cross cutting issues –alcohol –obesity –smoking –education –wider determinants Inequalities

4. Overview What are the main causes of death in England?

5. Major causes of death by age (1) numbers of deaths, England 2006 malesfemales

6. Major causes of death by age (2) % deaths in each age-group males females

7. A few targets Our Healthier Nation targets –Reduce deaths under 75 from cardiovascular disease and cancers –Reduce deaths in all ages from accidents and suicides Inequalities targets –Reduce inequalities in life expectancy –Reduce inequalities in infant mortality

8. Trends in the big killers (1) England 1993-2005 all ages Source: NCHOD

9. Trends in the big killers (2) England 1993-2005 under 75

10. Age-standardised all-cause mortality rates for Social Classes I and V by country and region, males aged 20-64 United Kingdom 1991-1993

11. Life expectancy - trend

12. But the variations in life expectancy in England are unacceptable

13. Male life expectancy at birth inequality gap

14. Female life expectancy at birth inequality gap

15. Lifecourse epidemiology

16. Infant mortality

17. Infant mortality England and Wales 1846-2004 Infant deaths per 1,000 live births

19. Infant mortality rates by socio-economic group 2002-4

20. Prevalence of breastfeeding at six weeks by mother’s socio-economic classification UK 2000

22. UK rates of Chlamydia diagnoses in GUM clinics 1997 - 2006 Routine GUM clinic returns Males Females

23. New HIV and AIDS diagnoses and deaths among HIV-infected persons, UK HIV/AIDS diagnoses and death reports

25. Age-standardised suicide rates by deprivation quintile men aged 15 and over 1999-2003

26. High-risk groups for suicide in Britain Young men Men from the Republic of Ireland Unemployed people People who have been in local authority care during childhood and adolescence People who have suffered bereavement or loss People detained in prison, particularly young men Vets, farmers, pharmacists, doctors, nurses etc People with a previous episode of deliberate self harm People with severe mental illness Source Donaldson & Donaldson

27. Total world population 65+ http://www.worldmapper.org/display.php?selected=2

28. Compression of morbidity: two possible scenarios Poor health habits Good health habits Fries and Crapo: Vitality and Aging (San Francisco: WH Freeman 1981

29. Compression of morbidity: dynamic equilibrium Pressures increasing health needs –Obesity and alcohol related morbidity –Healthy life expectancy is increasing, but slightly less fast than life expectancy –More disabled children surviving and for longer –No observed change in need for eg hips, knees, cataracts means more procedures in an ageing population –Not enough funding for preventive medicine Pressures decreasing health needs –Improved adaptive technology decreases dependency –Decreasing smoking –Decreasing lung cancer and cardiovascular disease –Many chronic diseases could be prevented, deferred or managed better resulting in lower care costs and better health

30. Social inequalities persist as health inequalities in old age Physical health deteriorated more rapidly with age among men and women from the lower occupational grades. The average physical health of a 70 year old man or woman who was in a high grade position was similar to the physical health of a person from a low grade around eight years younger. In mid-life, this gap was only 4.5 years. Although mental health improved with age, the rate of improvement is slower for men and women in the lower grades. BMJ, doi:10.1136/bmj.39167.439792.55 (published 27 April 2007)

31. Projected increases in the number of people with dementia in the UK (2005–2051) (assuming current prevalence)

32. Carers 5.2 million carers in England and Wales over a million providing more than 50 hours a week 225,000 people providing 50 or more hours of unpaid care per week state they are in 'not good health' themselves. Many carers in all age-groups state that they themselves are in 'not good health'

34. The settlement health map Hugh Barton 2006

35. Cross-cutting issues Lifestyle-related conditions –Smoking –Alcohol –Obesity –Mental health Ethnicity Wider determinants Education Job security

36. Cigarette smoking prevalence all ages 1972-2006 UK

37. Proportion of women who smoked during pregnancy, England 2005

39. Groups at risk of harmful drinking Males from lower socio-economic groups African-Caribbeans, especially males Women in professional occupations Young people 18-24 Homeless people People using illegal drugs People with mental health problems Refugee populations Source: Purser et al (2001)

41. Prevalence of “obese and overweight” combined children by school year and SHA England 2006/7

43. Prevalence of doctor-diagnosed diabetes, 16+ England 1994-2006 Source: Health Survey for England 2003 and 2006 are unweighted for consistency

44. Prevalence of mental disorders in children by educational qualification of parent, Great Britain 2004 See Larkin

45. Ethnicity or lifestyle? Migrant studies First wave, or subsequent settlers? Don’t confuse ethnicity with socio-economic issues

46. Lifestyle issues

47. Prevalence of breastfeeding at birth and six weeks by mother’s ethnic group UK 2000

48. Prevalence of ‘bad’ or ‘very bad’ self-reported health aged 16 or over, England 2004

49. Percentage of 16 year olds achieving five or more GCSE grades A*- C (or equivalent) by ethnicity England 2005

50. Work Self-reported level of job control and incidence of coronary heart disease in men and women Adjusted for age, sex, length of follow-up, effort/reward imbalance, coronary risk factors and negative psychological disposition

51. Effect of job insecurity and unemployment on health

52. Environmental issues Communicable disease control Clean water Sanitation Housing Clean air Transport

53. What I hope we have covered Inequalities Overview –Major causes of death –Life expectancy Life course epidemiology –Infant mortality –Road traffic injuries –Sexual health –Ageing Crosscutting issues –alcohol –obesity –smoking –education –wider determinants

54. references Compendium of Clinical and Health Outcomes NCHOD nww.nchod.nhs.uk www.euro.who.int/InformationSources/Publications/Catalogue/20020808_2 Social Determinants of Health: the solid facts Wilkinson & Marmot Wanless: Securing Good Health for the Whole Population - Population Health Trends www.doh.gov.uk/wanless/wanless_health_trends.pdf Tackling Obesity in England: National Audit Office 2001 Essential Public Health, second edition L J Donaldson & R J Donaldson 2000 Petroc Press Health Profile for England, DH 2007