1. Joint Strategic Needs Assessment 2015 Hampshire County Council Hampshire Public Health Team

2. Contents Demography – how is our population changing? Starting Well – the health and life chances of our children Staying Well – the health of our adult population Ageing Well – the health of our older population

3. Population headlines Children (0-19 years) – 309,234 (23.1%) (23.7% England) Older people 65 and over – 271,886 (20.3%) (17.6% England) 85 and over – 39,341 (2.9%) (2.4% England) Total Hampshire Population 1,339,007 Key Issues for Hampshire Long term conditions /multi- morbidity: Diabetes Cardiovascular Disease Chronic Obstructive Pulmonary Disease Mental Health (including Dementia) Musculoskeletal (including Falls/Fractured hips) Lifestyle risks – activities contributing to poorer health outcomes Smoking Obesity Alcohol Inactivity Poor diet Demographic Growth by 2021 Aged 0-19 years – increase by 17,533 (5.7%) Aged 65 and over – increase by 42,909 (15.8%) Aged 85 and over – increase by 14,413 (36.6%) Working age: Healthy carers, Workplace health Community Resilience Health and social inequalities Education Employment Isolation Life Expectancy and Healthy Life expectancy Gap Men – 15.5 years Women – 17.9 years

4. Demography

5. The OADR provides an idea of the relationship between the working age population compared to those of pensionable age. A higher OADR value indicates a fewer people of working age Ratio of people of state pension age is increasing compared to working age population By 2030 for every 2 people of working age there will be 1 person of pensionable age in Hampshire Variation in Ethnic Groups and diversity across the County – necessitating changing needs

6. Demography Life expectancy is increasing; healthy life expectancy is reducing

7. Demography Life expectancy for women; the increase is much slower, beginning to plateau Healthy life expectancy is decreasing

8. Inequality in Hampshire Gap in life expectancy due primarily to Circulatory Disease, Cancer and Respiratory disease Scarf Chart showing the breakdown in life expectancy gap between most deprived and least deprived quintiles across Hampshire, by broad cause of death 2010-12

9. Inequality in Hampshire Life expectancy gap for men and women between most and least deprived is increasing

10. Starting Well A wide number of factors influence and determine good health No single definitive measure Infant and child mortality, and birth weight are good indicators of health now and in the future

11. Starting Well: Infant and Child Mortality Child Mortality Hampshire Child mortality by age band - Hampshire residents - 2012 to 2014 Source: ONS Primary Care Mortality Database Underlying cause of death description (% of total deaths) Age band <1 year 1 to 4 years 5 to 9 years 10 to 14 years 15 to 19 years 0 to 19 years Perinatal Deaths62%3%0% 32% Congenital malformations16%3%10% 2%10% Diseases of the nervous system1%13%15%24%19%9% Diseases of the respiratory system1%17%15%14%2%5% External causes1%3%5% 49%12% Neoplasms1%27%45%19%11% Other19%33%10%29%18%20%

12. Starting Well: Low Birth Weight Births with birth weight less than 2500g as a proportion of live and still births with valid weight, 2008-2012 Source: ONS © Crown Copyright 2013 Babies born with low birth weight (LBW) at risk of poorer health developmental issues Risk factors for LBW include maternal smoking and deprivation

13. Starting Well: Healthy Weight Breastfeeding Hampshire Child weight good predictor of future health 50% increase in excess weight between ages of 5 and 11 Higher levels of breast feeding linked to better child health County and districts have a role in supporting healthy eating and increased activity

14. Starting Well: Education

15. Good overall educational attainment at 5 and 16 years But variation exists across county Achievement of 5 GCSEs (A*-C) including English and Math for 2011/12 (Source DfE) Source: ONS © Crown Copyright 2013 % of Pupils achieving a good level of development at the age of 5 years for 2011/12 - (Source DfE)

16. While improving, unemployment for more than 12 months can affect employment chances later in life Partnership required with county and district to support longer term unemployed into work Starting Well: Employment

17. Starting Well: Injuries Need to understand better social and emotional factors affecting young people that impact on these indicators

18. Starting Well Key issues for the Health of Children and Young People –Working with families on minimising excess weight gain to achieving a healthy weight (improving healthy eating and physical activity) –Develop and target social and emotional interventions to support emotional wellbeing of children and young people –Understanding needs of vulnerable children (Children with Disabilities and SEN) –Supporting vulnerable children improve educational attainment and health –Supporting long term unemployed young people into education, training and employment –Maximising the impact of Public Health 0-5 services to improve healthy eating, reducing accidents, identifying families at risk of poorer health and emotional wellbeing

19. Staying Well Prevalence of factors or conditions that cause premature mortality or illness indicate how healthy our population is For adults –the main causes of premature death are Cancer, Heart disease and respiratory disease. –Certain illnesses (e.g. mental health and diabetes) not only cause morbidity but can also cause significant disability impacting on employment and future wellbeing

20. CCGCHD Recorded Prevalence CHD Estimated Prevalence Diabetes Recorded Prevalence Diabetes Estimated Prevalence Hyper- tension Recorded Prevalence Hyper- tension Estimated Prevalence Hampshire District North East Hampshire and Farnham 2.6% (1 in 38) 3.5% (1 in 29) 5.2% (1 in 19) 6.3% (1 in 16) 12.8% (1 in 8) 22.7% (1 in 5) Rushmoor Hart (part) Waverley (part) North Hampshire 2.6% (1 in 38) 3.6% (1 in 28) 5.7% (1 in 18) 6.2% (1 in 16) 12.3% (1 in 8) 22.9% (1 in 5) Basingstoke and Deane East Hampshire (part) Hart (part) West Hampshire 3.4% (1 in 29 ) 4.6% (1 in 22) 5.3% (1 in 19) 7.0% (1 in 14) 14.5% (1 in 7) 26.2% (1 in 4) Test Valley New Forest Winchester (part) Eastleigh East Hampshire (part) South Eastern Hampshire 3.8% (1 in 26) 5.3% (1 in 19) 6.2% (1 in 16 ) 7.5% (1 in 13 ) 15.4% (1 in 6) 27.2% (1 in 4) Havant East Hampshire (part) Winchester (part) Fareham & Gosport 3.6% (1 in 28) 4.5% (1 in 22) 6.2% (1 in 16 ) 6.8% (1 in 15) 15.5% (1 in 6) 26.0% (1 in 4) Fareham Gosport England 3.3% (1 in 30 ) 4.7% (1 in 21) 6.2% (1 in 16 ) 7.3% (1 in 14) 13.7% (1 in 7) 24.7% (1 in 4) Staying Well: Morbidity

21. Staying well: Potential Years of Life Lost Conditions of focus: CHD – Stroke and IHD Cancer – Breast and Colon Respiratory – Pneumonia

22. Staying Well: Mortality (CVD) Rate of decline in preventable mortality for CVD has slowed – starting to plateau

23. Staying Well: Mortality (Cancer) Difference between men and women Rates starting to plateau in Hampshire for men

24. Staying Well: Mortality (Cancer) Malignant Melanoma incidence in Hampshire is high Disproportionally affects younger adults 89% preventable

25. Staying Well: Mortality (Respiratory) Rate of mortality plateaued and most recently rising

26. Staying Well: Diabetes Poor control and management of diabetes – leads to complication/disability County role is in partnership with Health and Districts to support healthy lifestyles especially diet and exercise

27. Staying Well: Mental Health Contributing factors to poorer mental health; employment, social exclusion, access to services Support needed to improve social inclusion and employment chances

28. Staying Well: Employment Data indicates conditions that have greatest impact on need for disability support Economically Active - Hampshire Personal Independence Payments (PIP) by Disability - Hampshire

29. Staying Well: Employment A good measure of independence is the number of people with disabilities who are in employment Partnership between County and Districts needed to support more people with disabilities into employment

30. Staying Well Proportion of working aged population is reducing; pressure on services and caring Reducing healthy life expectancy; focus on improving lifestyles and self management of health conditions, particularly diabetes Plateauing levels of Cancer mortality; improving early diagnosis and screening uptake; Higher levels of preventable mortality for SMI; improving access to services and social inclusion and employment chances Understanding impact of health conditions on disability (Mental health, cancer, neurological conditions, MSK)

31. Ageing Well Life expectancy at 65 and disability-free life expectancy at 65 give us a measure of the health of our older population Falls and fractures in older people can lead to loss of independence and death – preventing falls has a major impact on health and wellbeing Social isolation and loneliness impact on health and wellbeing particularly for conditions such as dementia – reducing isolation can improve outcomes for all ages but particularly our older population

32. Ageing Well: Life expectancy Life expectancy has been increasing, starting to plateau Healthy life expectancy is decreasing

33. Rates show small increase Absolute numbers will impact on resources/outcomes for older people Ageing Well: Falls

34. Ageing Well: Physical Disability

35. The UK has one of the highest Excess Winter Death (EWD) rates in Europe In 2013/14, 78% of EWD in people over 75 years Fuel poverty and keeping warm, major factor in increasing susceptibility Link to social isolation and fuel poverty – identification of individuals at risk is key issue Ageing Well: Excess Winter Deaths

36. Ageing Well: Dementia Focus on Improving independence and reducing isolation Prevention

37. Ageing Well: Isolation % of Pensioners who live alone 2011 Census Source: ONS © Crown Copyright 2013 % of people over 60 living in pension credit households (IDAOP 2010 DCLG) Source: ONS © Crown Copyright 2013 Need to understand scale of the problem and what data sources can help Partnership approach needed to develop interventions to reduce impact of isolation Strategic use of voluntary sector to support

38. Ageing Well Focus on falls prevention; Return on Investment for evidence-based exercise classes, improving independence (opportunity for joint commissioning) Focus on preventable disabilities; blindness (AMD/Reducing Smoking, Diabetic Retinopathy/Screening) Focus on impact of social isolation; partnership working on initiatives to reduce impact