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SPECIFIC HEALTH ISSUES - London Health Observatory

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Health & Healthcare in London
Key Facts
September 2006
Overview of London’s Health
•
•
•
•
•
•
•
•
The geography of London
London’s population and diversity
Health determinants
Key lifestyle issues
Health inequalities
Key health issues
Health care use
Health care resources
LONDON’S GEOGRAPHY
London Boroughs and Acute Trusts
•
•
There are 33 Main Acute Trusts in London
There are 31 Primary Care Trusts coterminous with all 32 London Boroughs
LONDON’S POPULATION AND DIVERSITY
Key Facts
• 7.5 million resident population in Greater London
• Highly ethnically diverse with 40% from an ethnic minority
group (including White Irish and Other White minority
groups)
• More than 90 different ethnic groups and 300 different
languages spoken
• Largest religious groups are Christian, Muslim, Hindu,
Jewish, Sikh and Buddhist
• Home to many refugees and asylum seekers
• Highly mobile (20-40% turnover on GP lists every year)
• 1 million daily commuters
• 13.1 million tourists every year
LONDON’S POPULATION AND DIVERSITY
Population Age Structure
•
London is relatively young with 16
- 44 years olds accounting for
36.5% of the population compared
to England average of 28%.
London, 2005
90+
85-89
80-84
75-79
70-74
•
The proportion of people of
retirement age is the lowest of all
regions (12 %) as wealthier
people tend to move out of the
Capital at retirement age.
65-69
Males
60-64
Females
55-59
50-54
45-49
40-44
35-39
•
Black and minority ethnic
populations are relatively younger
but are fast growing and ageing.
There are large variations in the
demographic structure of different
ethnic groups.
30-34
25-29
20-24
15-19
10-14
5-9
1-4
<1
Source: ONS population estimates 2005
England average, 2005
Number of people .
LONDON’S POPULATION AND DIVERSITY
Population Growth
2200000
2000000
1800000
1600000
1400000
1200000
1000000
800000
600000
400000
200000
0
00-04
'05-15
16-29
30-44
45-64
65-74
75+
1994
2004
2026
Year
Source: GLA population projections
•
•
•
•
London’s population increased by 550,000 (8%) between 1994 and 2004
London’s population is expected to increase by 600,000 (8%) by 2016, and by
900,000 (12%) by 2026.
Only the 16-29 age group is projected to decrease in numbers by 2026
The 45-64 age group will increase by more than 500,000 (36%) by 2026
LONDON’S POPULATION AND DIVERSITY
Number of people in each minority ethnic group, London 2001
Other Ethnic Group
•
Almost 3 million Londoners
are from an ethnic minority
group (40% of the
population).
•
45% of the England & Wales
population from an ethnic
minority group live in London.
•
The largest minority ethnic
group is White Other followed
by Indian, Black African and
Black Caribbean.
•
The Black African group has
more than doubled in the last
ten years, and the number of
Bangladeshis has increased
by nearly three quarters since
1991.
Chinese
Black Other
Black African
Black Caribbean
Asian Other
Bangladeshi
Pakistani
Indian
Mixed Other
White & Asian
White & Black African
White & Black Caribbean
White Other
White Irish
0
100000 200000 300000 400000 500000 600000 700000
Number of people
Source: Census 2001
LONDON’S POPULATION AND DIVERSITY
HEALTH DETERMINANTS
Health Determinants in London compared to England average
This slide shows how
London is doing in terms
of the main socioeconomic influences on
health
Deprivation
Air quality
Poor quality
housing
•
Children in poverty
•
GCSE achievement
•
•
•
Violent crime
Older people
supported at home
England
Worst LA
England Average
England
Best LA
•
GCSE achievement is close
to the England average
More older people are
supported to live at home,
but 1/3 pensioners live in
poverty.
Violent crime is high.
Air quality is poor.
Over 40% of London’s
children are living in poverty,
much greater than average.
Deprivation, including long
term unemployment, is
higher than average.
HEALTH DETERMINANTS
Inequalities in Health Determinants in London
• Within London there are wide inequalities in living conditions, and
other socio-economic factors that have an influence on health.
These inequalities exist between people living in different parts of
London, between different ethnic groups, age groups and other
groups.
• Over half of London boroughs are in the top 30% most deprived
boroughs in England, and 24% of boroughs are in the top 10% most
deprived, with nearly all boroughs having pockets of deprivation.
• Newham, Tower Hamlets and Hackney have some of the highest
unemployment rates in the country, whereas other boroughs have
rates well below average.
• The Bangladeshi population has the highest unemployment rate,
and the White British the lowest.
• Educational (GCSE) attainment is highest in Chinese children and
lowest in Black Caribbean children.
• People from a minority ethnic group are more likely to live in an unfit
home than the White population.
HEALTH DETERMINANTS
KEY LIFESTYLE ISSUES
Lifestyle influences on health in London compared to England
average
This slide shows how
London is doing in
terms of the lifestyle
factors that influence
health compared to
nationally
People who smoke
– Fewer people binge
drink.
Binge drinking
– More people eat
healthy food.
– There are fewer obese
adults, but London has
higher rates of
childhood obesity than
the rest of England.
Healthy eating
– Smoking levels are
average.
Obese adults
England
Worst LA
England Average
England
Best LA
KEY LIFESTYLE ISSUES
Obesity – key facts for London
In London every year, obesity accounts for
• 4,000 deaths (7% of all deaths) :
– 300 deaths and 2,700 hospital admissions for cancers
– 450 deaths and 1,300 hospital admissions for stroke or raised
blood pressure
– 600 deaths and 2,500 hospital admissions for angina or heart
attack
– 250 deaths and 2,400 hospital admissions for diabetes
– 1,300 hospital admissions for osteoarthritis or gout
• Adult obesity is related to social class, and is higher
among more deprived populations, particularly for women.
• London has higher rates of childhood obesity than the rest
of England.
KEY LIFESTYLE ISSUES
Smoking in London
• Smoking is a major cause of cancer, respiratory disease, circulatory
and ischemic heart disease.
• In London, smoking causes:
– more than 10,000 deaths each year (1 death/hour)
– 200 deaths per week among people aged 35 and over in London are
attributable to smoking
– 46,000 hospital admissions and more than 400,000 bed days a year
• Smoking costs the NHS in London >£105 million a year.
• Least affluent populations are most likely to smoke.
• Highest smoking prevalence is amongst Bangladeshi, Turkish and
Irish men.
• Over a million Londoners are affected by smoking in the workplace
• There are marked social inequalities in smoking rates between the
most affluent (who smoke least) and the least affluent who are most
likely to smoke.
KEY LIFESTYLE ISSUES
Percentage of all deaths attributable to smoking in London by
PCT, 1998-2002
KEY LIFESTYLE ISSUES
Alcohol in London
• On average Londoners drink less often and fewer drink
above sensible levels compared to the England average.
• People on high incomes and the unemployed are most
likely to drink above sensible levels and to binge drink.
• People from many ethnic minority groups are more likely
to be non-drinkers.
• More Londoners are dependent alcohol users compared
to England.
• The death rate due to alcohol in London is higher then
nationally.
• Alcohol misuse impacts on health care at all levels.
• Alcohol consumption contributes significantly to the
volume of injuries in London.
HEALTH INEQUALITIES
Life expectancy and causes of death
This slide shows how
London is doing in
terms of the major
killers
It is estimated that
compared to nationally
Life expectancyMale
Life expectancyFemale
Premature deaths
from smoking
–
Premature deaths
from heart disease
and stroke
–
–
Premature deaths
from cancer
Infant deaths
–
Road injuries and
deaths
England
Worst LA
England Average
England
Best LA
More people die
prematurely from heart
disease and stroke.
More people are injured
or die on the roads per
kilometre travelled.
Infant mortality,
premature deaths from
cancer and smoking,
and life expectancy are
all average in London.
However, these figures
mask wide inequalities
between London’s
Primary Care Trusts.
HEALTH INEQUALITIES
The life expectancy PSA target
The PSA target for life expectancy aims to see faster health improvement
compared to the average in the “fifth of areas with the worst health and
deprivation indicators” – The Spearhead PCTs/LAs. The Spearhead LAs are indicated on
this map.
HEALTH INEQUALITIES
Life expectancy in London, 2002-04
•
Male
Female
England
76.6
80.9
London
76.5
81.1
London
Spearhead
group
Source: ONS
74.6
79.9
•
•
•
For males in 2002-2004, life
expectancy in England was 76.6.
This is very similar to the average
for London, but 2.5% higher than
in the London Spearhead Group.
For females, life expectancy in
England was 80.9, 1.3% higher
than in the London Spearhead
Group.
These gaps have to be reduced
by 10% for the life expectancy
target to be achieved.
London as a whole is on track to
reach this target, but not all
spearhead areas are on track.
HEALTH INEQUALITIES
Differences in Life Expectancy within a small area in London
Travelling east from Westminster, each tube stop represents nearly
one year of life expectancy lost
Male Life
Expectancy
77.7 (CI 75.5-79.9)
Canning Town
Female Life Expectancy
85.2 (CI 82.2-88.2)
Male Life
Expectancy
70.7 (CI 69.0-72.5)
Westminster
London Bridge
River Thames
Canada
Bermondsey
Water
Female Life
Expectancy
78.4 (CI 76.7-80.2)
Canary
Wharf
North
Greenwich
Waterloo
Southwark
London Underground
1
Jubilee Line
Electoral wards just a few miles apart geographically have life
expectancy spans varying by years. For instance, there
are eight stops between Westminster and Canning Town
on the Jubilee Line – so as one travels east, each stop, on
average, marks nearly a year of shortened lifespan. 1
Source: Analysis by London Health Observatory using Office for National Statistics data. Diagram produced by Department of Health
HEALTH INEQUALITIES
Infant mortality rates (deaths < 1 year),1998-2002
•
•
•
•
The infant mortality PSA target aims for a reduction in the gap in mortality rate among those with
fathers in the “routine and manual” groups and the population as a whole.
This target is difficult to measure at local levels due to the small number of deaths involved.
Within London as a whole the infant mortality rate is falling.
There is more than a two fold differential in the infant mortality rates for different London boroughs.
This differential can be measured as a proxy for the PSA target.
SPECIFIC HEALTH ISSUES IN LONDON
Key Facts
•
•
•
•
•
•
•
London has highest number of new diagnoses of sexually transmitted
infections (STI) out of all regions.
London has the second highest teenage pregnancy rate out of all regions.
London accounts for 57% of HIV infections in the UK.
London has significantly higher demand for mental health services than
England, and specifically for people with severe Mental Health problems.
London has the highest tuberculosis (TB) rate out of all regions and the
number of cases per 100,000 population rose from 32 per 100,000
population in 1999 to 48 per 100,000 in 2005.
Many diseases such as tuberculosis, diabetes, HIV, renal disease and
coronary heart disease are more common in specific ethnic groups who are
more commonly resident in London.
The prevalence of problem drug use is estimated to be higher in London
than average for England.
SPECIFIC HEALTH ISSUES - SEXUAL HEALTH
Number of newly diagnosed STI’s reported from genitourinary
(GU) clinics in London 1995 - 2003
25000
20000
Chlamydia
15000
Gonorrhoea
Herpes
10000
Warts
5000
0
1995
1996
1997
1999
1999
2000
2001
2002
2003
Source: HPA
•
•
•
•
Chlamydia diagnoses have more than doubled since 1995 and are highest in the
young.
Syphilis diagnoses have sharply increased in London since 1999.
The presence of STIs can facilitate HIV transmission.
68% of people in London obtain an appointment with GU clinics within 48 hours,
compared with the target of 100% by 2008.
SPECIFIC HEALTH ISSUES - SEXUAL HEALTH
HIV - a growing burden in London
• London accounts for 57% of infections in the UK.
• In 2003 – 3190 new infections diagnosed in London.
• In 2003 – estimated 27% of HIV infections may be
undiagnosed (8,600 Londoners).
• Nearly all new heterosexual HIV infections have been
among Black Africans – three quarters acquired in Africa.
• Men who have sex with men are the largest group to have
acquired infection in this country.
• Sharpest increase is in heterosexual transmission.
• 2.9% of injecting drug users contacting specialist services
in London have HIV infection (higher than elsewhere).
SPECIFIC HEALTH ISSUES – SEXUAL HEALTH
Teenage Pregnancy
Source: TPU, DfES, 2006
• Teenage Pregnancy (TP) are all conceptions to women aged <18 years of age.
• In 2004 the London TP rate was 48.1/1000 females aged 15-17 compared with
41.5/1000 nationally with the highest number of TP occurring in deprived areas.
• Rates have fallen recently in 19 boroughs but large increases in 6 boroughs.
SPECIFIC HEALTH ISSUES – MENTAL HEALTH
Mental Health
•
•
•
•
Estimated 1 million London residents experienced a common mental health
problem during 2003.
The most common cause of death of young men under 35 is suicide and
London is not on track to meet the suicide target of a 20% reduction in
overall suicide rates by 2010.
Mental health problems are more prevalent in deprived areas
Significantly higher demand for mental health services than England, and
specifically for people with severe mental health problems
–
–
–
–
–
–
–
–
Higher admission rates
Higher proportion of inpatients with sever mental illness
Higher occupancy rate despite more beds
Higher use of forensic beds
Highest rate of compulsory admissions
Higher crude caseload rates in some community services
Highest spend on mental health services
Large populations at risk of mental health problems e.g. asylum seekers
SPECIFIC HEALTH ISSUES – TUBERCULOSIS (TB)
London sector TB rate per 100,000 resident population
Source: HPA London Regional Unit, 2006
•
•
•
London tuberculosis (TB) rate per 100,000 population rose from 32/100,000 in 1999 to
48/100,000 in 2005.
Nationally 70% of newly diagnosed cases in 2004 were among foreign born populations.
In London the highest number of new cases occurs among the Asian and Black African
populations.
G re e n w ic h
E a lin g
L a m b e th
K in g s to n u p o n T h a m e s
100
H a v e rin g
B e x le y
W e s tm in s te r, C ity o f
R ic h m o n d u p o n T h a m e s
S u tto n
B a rk in g a n d D a g e n h a m
M e rto n
W a lth a m F o re s t
B ro m le y
H a m m e rs m ith a n d F u lh a m
B a rn e t
H a rro w
C am den
C ro y d o n
K e n s in g to n a n d C h e ls e a
Source: Compendium of Clinical Indicators
R e d b rid g e
W a n d s w o rth
S o u th w a rk
E n fie ld
B re n t
Is lin g to n
L e w is h a m
H o u n s lo w
H illin g d o n
H a rin g e y
N ew ham
H ackney
T o w e r H a m le ts
S ta n d a rd is e d M o rta lity R a tio (S M R )
.
SPECIFIC HEALTH ISSUES – ETHNICITY
Mortality from diabetes by London Borough
250
200
150
London
E n g la n d
50
0
There are wide inequalities in mortality from diabetes, boroughs with large populations from ethnic
minority groups such as Tower Hamlets, Hackney and Newham have the highest rates.
HEALTH CARE USE
Total QOF points scored for coronary heart disease 2004-05 by
PCT in London
•
•
This map shows points achieved under the Quality and Outcomes Framework for
PCTs in London in 2004/05.
Lighter shaded areas are performing better than others.
Source: QPID
HEALTH CARE USE
Age standardised admission rates by PCT, April 2005-September 2005
K e n s in g to n A n d C h e ls e a
W e s tm in s te r
C am den
B re n t
R ic h m o n d A n d T w ic k e n h a m
W a n d s w o rth
H a rro w
H a m m e rs m ith A n d F u lh a m
B a rn e t
L a m b e th
C ro yd o n
R e d b rid g e
S o u th w a rk
Is lin g to n
W a lth a m F o re s t
K in g s to n
H a rin g e y
H a ve rin g
E a lin g
T o w e r H a m le ts
H o u n s lo w
B a rk in g A n d D a g e n h a m
G re e n w ic h
B ro m le y
C ity A n d H a c k n e y
E n fie ld
H illin g d o n
B e x le y
L e w is h a m
N ewham
0
5000
10000
15000
20000
A g e s ta n d a rd is e d a d m is s io n ra te
Source: Hospital episode statistics
25000
30000
HEALTH CARE USE
Healthcare Commission Inpatient Survey 2004
Londoners are less satisfied with the NHS; BME patients are particularly
dissatisfied NB risks of Patient Choice.
Source: Healthcare Commission Patient Survey
Potential Bed days saved based on national mean
Top 50 HRGs by Trust
Acute
Specialist
Small Acute London
Large Large
Medium Acute Multi- Acute
London Service London
Acute Teaching London
0
RJZ
RNJ
RAL
RRV
RJ7
RQN
RJ1
RQM
RJ5
RF4
RV8
RVL
RVR
RG2
RGC
RJ6
RAX
RJ2
RG3
RAS
RQX
RGZ
RKE
RAP
RNH
RC3
RFW
RAN
RPY
RT3
RP4
RP6
HEALTH CARE USE
Length of Stay
5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000
King’s/Bart’s
Whipps Cross
In 2004-5 there were
about 800,000 excess
bed days, or 2,100
excess beds, in
London hospitals
compared to the
national mean, with a
Reference Cost value
of ВЈ216 million. This
represents over 13%
of all bed days. Most
were in acute
teaching or small
acute trusts.
Source: Admitted patient care data for London October 2004 – September 2005
HEALTH CARE RESOURCES
Wanless underestimates likely growth?
While population changes will have some impact on resources and financial stability, this will be largely
compensated for by the Resource Allocation Formula, although time lags may cause problems in rapidly
growing PCTs. Future pressures on resources will above all be critically dependent on the proportion of
GDP allocated to healthcare, and demand for that care.
HEALTH CARE RESOURCES
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The SHA will need to ensure that PCTs in affluent areas reduce demand for healthcare, and
that, in order to meet the health inequalities life expectancy target, NHS resources are directed
proactively (as their populations will not demand them) to deprived areas and Spearhead PCTs
to find new cases of disease and reduce disease risks.
SUMMARY OF LONDON’S KEY HEALTH
CHALLENGES
• Ethnically diverse population with high mobility and population growth
• London as a whole has average mortality rates and life expectancy,
however it has high rates of premature mortality from heart disease and
stroke, and wide inequalities between boroughs/PCTs
• Key lifestyle issues such as obesity, smoking and alcohol are
contributing to poor health in London’s more deprived areas
• London has high rates of teenage pregnancy and sexually transmitted
infections such as HIV
• The incidence of tuberculosis is rising and is more common among
ethnic minority groups
• London has significantly higher than average demand for mental health
services, particularly for people with severe mental illness and is not on
track to meet the required suicide reduction target.
SUMMARY OF LONDON’S HEALTH CARE
CHALLENGES
• Primary care services are performing relatively poorly.
• Length of stay is excessive in many hospitals.
• Londoners are more dissatisfied with the NHS,
especially those from BME groups.
• 4/5 sectors are overspending, partly because of
demanding populations and providers.
• NE London has low demand and spending- primary
care resources should be proactively developed to
reduce inequalities.
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