1. Major Patterns of Life, Death and Wellbeing a lightning tour of some interesting aspects of population health

2. Learning Objectives Overview Major causes of death Life expectancy Life course epidemiology Infant mortality Road traffic injuries Ageing Cross cutting issues Alcohol Obesity Smoking Ethnicity 2Major patterns of life, death and wellbeing Inequalities

3. Which of the following currently causes most deaths in England? a)Cancer b)Respiratory disease c)Circulatory disease d)Infections 3Major patterns of life, death and wellbeing

4. Male Age-Standardised Mortality Rates, for 3 Categories of Cause of Death, 2002-2012 4Major patterns of life, death and wellbeing

5. 5 Female Age-Standardised Mortality Rates, for 3 Categories of Cause of Death, 2002-2012 Major patterns of life, death and wellbeing

6. Age-Standardised Mortality Rates for CVD, 1961 to 2009, Great Britain 6Major patterns of life, death and wellbeing ABCABC ABCABC Males Females Source: BHF 19612009 Years

7. Percentage of Deaths from Cancer by CCGs in the South West 7Major patterns of life, death and wellbeing Source: NEoLCIN

8. Percentage of Deaths for the 10 leading causes of Death for Males and Females, 2002-2012 8Major patterns of life, death and wellbeing Females Males

9. 9Major patterns of life, death and wellbeing Age Standardised Mortality Rates by Sex, UK and Constituent Countries

10. 10Major patterns of life, death and wellbeing Percentage Distribution of all Deaths by Age Group for Selected Years, UK

11. Age Distribution of the Population in the UK, Actual (2010) and Projected (2035) 11Major patterns of life, death and wellbeing

12. What can you see as the potential issues with an ageing population? 1.Increase in the dependency ratio. 2.Increased government spending on health care and pensions. 3.Those in work may have to pay higher taxes. 4.Shortage of workers. 5.Changing sectors within the economy. 6.Higher savings for pensions may reduce capital investment. 12Major patterns of life, death and wellbeing

13. In England, what is the current life expectancy at birth for females? 13Major patterns of life, death and wellbeing … and what was life expectancy at birth for females in 1900? 83 years 50 years

14. Life Expectancy at Birth: by Gender, 1900 to 2011 14Major patterns of life, death and wellbeing

15. But the variations in life expectancy in England are unacceptable… 15Major patterns of life, death and wellbeing Life Expectancy for males at birth by local authority district in England and Wales, 2010-12 Life Expectancy for females at birth by local authority district in England and Wales, 2010-12

16. 16Major patterns of life, death and wellbeing Major Causes of Death by Age: Numbers of Deaths, England 2006 FemalesMales

17. 17Major patterns of life, death and wellbeing Major Causes of Death by Age: Percentage Deaths in each Age-Group FemalesMales

18. 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 18Major patterns of life, death and wellbeing Now has been replaced by Public Health Outcomes Framework (PHOF) Vision: To improve and protect the nation’s health and wellbeing, and improve the health of the poorest fastest  Outcome 1: Increased healthy life expectancy  Outcome 2: Reduced differences in life expectancy and healthy life expectancy between communities http://www.phoutcomes.info/

19. 19Major patterns of life, death and wellbeing Life Course Epidemiology – Approach to Prevention

20. Infant Mortality Rates in England and Wales, 1981 to 2011 20Major patterns of life, death and wellbeing

21. Neonatal, Postneonatal, Childhood, and Under-5 Mortality in Western Europe, 1970-2010 21Major patterns of life, death and wellbeing “When you get these low levels of child mortality seen in the high income countries, healthcare probably is an important component in the variation. Most of the deaths in places like the UK are neonatal and you would have to look in more detail at what aspects of healthcare might explain the difference.” Dr Christopher Murray – study leader

22. 22Major patterns of life, death and wellbeing Source: WHO Male Deaths from Motor Vehicle Traffic Accidents, all ages, UK, EU-15 Countries and Selected Averages

23. Total World Population 65+ 23Major patterns of life, death and wellbeing Source: http://www.worldmapper.org/posters/worldmapper_map2_ver5.pdfhttp://www.worldmapper.org/posters/worldmapper_map2_ver5.pdf Sudan South Africa Tanzania Egypt Ethiopia Nigeria

24. Compression of Morbidity: Two Possible Scenarios 24Major patterns of life, death and wellbeing Poor health habits Good health habits Fries and Crapo: Vitality and Aging (San Francisco: WH Freeman 1981)

25. Compression of Morbidity: Dynamic Equilibrium 25Major patterns of life, death and wellbeing 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 e.g. 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

26. Projected Increases in the Number of People with Dementia in the UK, 2012-2051 26Major patterns of life, death and wellbeing

27. Health and Social Care Costs of Major Diseases 2008 Prices 27Major patterns of life, death and wellbeing 821,884 people in the UK live with dementia (about one third of all people over 90) http://dementiachallenge.dh.gov.uk/map/?map=3

28. Social Inequalities Persist as Health Inequalities in Old Age 28Major patterns of life, death and wellbeing  Lower occupational grades – physical health deteriorates quicker  High grade position – better average physical health especially in later years  Mental health – slower rate of improvement in lower grades BMJ, doi:10.1136/bmj.39167.439792.55 (published 27 April 2007)

29. Cross-Cutting Issues Lifestyle-related Conditions Smoking Alcohol Obesity Ethnicity 29Major patterns of life, death and wellbeing

30. What is the current prevalence of cigarette smoking among adults in Great Britain… …and what was it in 1972? 30Major patterns of life, death and wellbeing 20% 45%

31. Prevalence of Cigarette Smoking by Sex, 1974 to 2012, Great Britain 31Major patterns of life, death and wellbeing

32. Smoking Rates Throughout Pregnancy by Type of Job, England, 2000-2010 32Major patterns of life, death and wellbeing Source: NHS

33. Which of the following are risk factors for harmful alcohol consumption? Males from lower socio-economic groups Women in professional occupations Young people 18-24 People with mental health problems Refugee populations 33Major patterns of life, death and wellbeing

34. 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) 34Major patterns of life, death and wellbeing

35. 35Major patterns of life, death and wellbeing Source: WHO/Europe, European HFA Database, April 2014 Age-Standardised Mortality Rate Standardised Death Rate, Chronic Liver Disease and Cirrhosis, all ages, per 100,000

36. Rank the following counties in order of prevalence of adult obesity (highest prevalence first) USA Scotland Mexico Spain England 36Major patterns of life, death and wellbeing USA Mexico Scotland England Spain

37. Worldwide Adult Obesity Prevalence 37Major patterns of life, death and wellbeing Percentage of total population who have a BMI greater than 30 http://www.oecd.org/health/

38. Trend in the Prevalence of Obesity and Excess Weight in Children aged 2-15 years, 1995-2012 38Major patterns of life, death and wellbeing Child excess weight BMI ≥ 85 th centile, child obesity BMI ≥ 95 th centile of the UK90 growth reference. 95% confidence intervals are displayed on the chart Source: HSE

39. 39Major patterns of life, death and wellbeing Adult (aged 16+) obesity: BMI ≥ 30 Source: HSE Trend in Obesity Prevalence among Adults, 1993-2012 (3-year average) Source: Foresight Report Probability of Females aged 21-60 belonging to a Specific BMI Group in a given Year [95% Confidence Intervals]

40. What do you think the obesity prevalence would show by socioeconomic status? 40Major patterns of life, death and wellbeing

41. 41Major patterns of life, death and wellbeing Source: NCMP Obesity Prevalence of Children in Year 6 (aged 10-11 years) by Region, 2012/13 Child obesity: BMI ≥ 95 th centile of the UK90 growth reference

42. Prevalence of Overweight (including Obese) in the South West compared to England, 2012-13 42Major patterns of life, death and wellbeing

43. Infographics Up and coming tool for data presentation Data visualisation – more meaningful than numbers Example from World Health Organisation on better health for people with disabilities 43Major patterns of life, death and wellbeing

44. Prevalence of Doctor-Diagnosed Diabetes, 16+ England 1994-2006 44Major patterns of life, death and wellbeing Source: HSE (2003 and 2006 are unweighted for consistency)

45. Prevalence of Diabetes Compared to Other Diseases 45Major patterns of life, death and wellbeing

46. Prevalence of Diabetes in England and the Projected Figures for 2020 and 2030 by PCT 46Major patterns of life, death and wellbeing Source: ONS 2010 2020 2030

47. Ethnicity or Lifestyle? Migrant studies First wave, or subsequent settlers? Don’t confuse ethnicity with socio-economic issues 47Major patterns of life, death and wellbeing

48. Rank the following minority ethnic groups in order of prevalence of ‘bad/very bad’ self reported health (highest prevalence first) Bangladeshi Chinese Black Caribbean 48Major patterns of life, death and wellbeing Bangladeshi Black Caribbean Chinese

49. 49Major patterns of life, death and wellbeing Prevalence of ‘Bad’ or ‘Very Bad’ Self-reported Health aged 16 or over, England 2004 Source: HSE

50. Percentage of 19 year olds Attaining Level 2, Level 2 with Maths and English, and Level 3 by Ethnicity, England 2013 50Major patterns of life, death and wellbeing Source: Department of Education

51. 51Major patterns of life, death and wellbeing Effect of Employment and Health CHD Risk Whitehall Study: http://www.ucl.ac.uk/whitehallII/pdf/Whitehallbooklet_1_.pdf

52. 52Major patterns of life, death and wellbeing CHD Mortality Rates by Socioeconomic Status, England and Wales 2001/03 Source: BHF

53. Learning Objectives Revisited Overview Major causes of death Life expectancy Life course epidemiology Infant mortality Road traffic injuries Ageing Cross cutting issues Alcohol Obesity Smoking Ethnicity 53Major patterns of life, death and wellbeing Inequalities

54. References Child and Maternal Health Intelligence Network (CHIMAT) http://www.chimat.org.uk/http://www.chimat.org.uk/ Department of Health (DoH) https://www.gov.uk/https://www.gov.uk/ Donaldson & Donaldson: Essential Public Health, second edition (2000) Petroc Press Health and Social Care Information Service (HSCIC) http://www.hscic.gov.uk/http://www.hscic.gov.uk/ Health Survey for England (HSE) http://www.hscic.gov.uk/article/3741/Health-Survey-for-England-Health-social-care-and- lifestyleshttp://www.hscic.gov.uk/article/3741/Health-Survey-for-England-Health-social-care-and- lifestyles National Child Measurement Programme (NCMP) http://www.hscic.gov.uk/ncmphttp://www.hscic.gov.uk/ncmp National End of Life Care & Intelligence Network (NEoLCIN) http://www.endoflifecare-intelligence.org.uk/homehttp://www.endoflifecare-intelligence.org.uk/home National Health Service (NHS) http://www.nhs.uk/Pages/HomePage.aspx Office for National Statistics (ONS) http://www.ons.gov.uk/ons/index.htmlhttp://www.ons.gov.uk/ons/index.html Public Health England (PHE) http://datagateway.phe.org.uk/http://datagateway.phe.org.uk/ Wanless: Securing Good Health for the Whole Population - Population Health Trends www.doh.gov.uk/wanless/wanless_health_trends.pdf Wilkinson & Marmot: Social Determinants of Health: The Solid Facts World Health Organisation (WHO) http://www.who.int/en/http://www.who.int/en/ 54Major patterns of life, death and wellbeing

55. Any Questions? 55Major patterns of life, death and wellbeing