Health and Wellbeing – A Summary
The Council and its partners are committed to improving health and wellbeing and encouraging healthy lifestyles for all residents of Wolverhampton. A vision has been developed for the city which is set out in the City Strategy which all partner agencies in the city have signed up to, including the Wolverhampton Partnership, City Council, Primary Care Trust and West Midlands Police etc. The Strategy sets out three main themes and health and wellbeing features within the ‘empowering people and communities’ theme. The strategy covers promoting healthier childhood diets, tackling adult obesity, encouraging participation in sports and recreation and supporting vulnerable adults to live independently. By 2026 the aspiration is that the City will be home to residents who are active, healthy members of a large community that are encouraged to have a voice to shape services and their futures.
People in Wolverhampton are living longer than ever before and the gap between life expectancy in the city and the national figure is closing. We know that socio-economic factors affect life expectancy. In Wolverhampton and similarly disadvantaged communities, the determinants of health such as skills, jobs and housing, are well below the national average. There are six conditions which account for over half of the difference in life expectancy that exists between Wolverhampton and England. These are heart disease, stroke, infant mortality, lung cancer, suicide and alcohol. This is seen disproportionally in the most disadvantaged communities. Deaths due to alcohol and those occurring in infancy are the major reasons why life expectancy has not improved.
As such the council, primary care trust and other public agencies in the city are working to improve the lives of Wolverhampton residents.
Life Expectancy – Life expectancy refers to the average length of time people can expect to live. Men in Wolverhampton currently live an average of 76.5 years, which is lower than the England average of 78 years.
Male Life Expectancy
Life expectancy for women in Wolverhampton is 81 years whilst the national average is 82. At a city level, the gap between men and womens life expectancy in Wolverhampton appears to be closing.
Female Life Expectancy
Life Expectancy – Life expectancy varies across the city and has changed over the past five years. Men in Tettenhall Wightwick live six years longer than those in East Park, a distance of only a few miles. Men in only five of the 20 wards live as long as the average man in England.
Cardiovascular disease (CVD) – Cardiovascular disease (CVD) mortality has more than halved over the last 15 years. Data for 2007-09 suggests this trend is continuing. Wolverhampton still has higher mortality rates than the national average but this gap is closing. Wolverhampton has a lower mortality rate than peer authorities. In Wolverhampton, women have half the mortality rate of men, and the local mortality rate for women is also closer to the national average than the corresponding figure for men.
CVD Mortality per 100,000 People Aged Under 75
Healthy Lifestyle Services support people to reduce their risk of CVD and other health problems through helping people to change their behaviour in relation to smoking, alcohol consumption, diet or physical activity. To tackle CVD, NHS Health Checks have been introduced for adults aged 40 to 74 who have not already been diagnosed with heart disease, diabetes, kidney disease, or had a stroke. The check assesses the risk of developing CVD. Medication may be prescribed to reduce risk or referral to the Healthy Lifestyle Services. GPs have provided 11,000 Health Checks in the last two years. People who have had one CVD event, such as heart attack or stroke, are at the highest risk of having another in the future. There is good evidence that some long-term treatments including flu vaccination and aspirin reduce the chance of further CVD. We also know that excellent management of blood pressure, blood fats (cholesterol), as well as stopping smoking, help people who have CVD to live longer.
Infant mortality is consistently one of the biggest cause of years of life lost. Reducing infant mortality has the biggest potential to increase life expectancy. Local evidence shows that the majority of infant deaths occur around birth and the first few days afterwards. Babies born before 29 weeks are considered to be extremely premature and survival for babies born before 24 weeks is very low.
As you will note, although infant moratlity rates have reduced from a high of 12 per 1000 births, the trend seems to show an increase from 2005 – 2007.
Infant Mortality Rate per 1000 Births
Suicide Rate – The local suicide rate has dropped and is now just over the national average. Since 1997, the highest rate has been in men aged 15-44. From 2005, the highest suicide rate among women has been in those aged 45-74. Wolverhampton Healthy Minds is a psychological therapies service for people who are experiencing common mental health problems. This new industrial scale service started in January 2009. Since then nearly 3,000 people have completed treatment. The service has been used by people across the city and by different groups including all ethnic groups. Good mental health and resilience are fundamental to our physical health, relationships, education, training, work and to achieving our potential. The ‘Five Ways to Wellbeing’ suggests that people: connect, be active, take notice, keep learning and give. Wolverhampton Healthy Minds will continue to grow with 6,000 interventions a year being provided by 2013. The mental wellbeing resources will be launched and a programme will be developed to target the wider population. Both these pieces of work will be implemented within the context of a new strategy to improve access to and quality.
Suicide Mortality Rate
Alcohol Related Mortality – Excessive alcohol consumption does not just cause alcohol liver disease; it causes a range of health harms including injury due to alcohol-related assaults and increases the risk of developing hypertension, stroke, coronary heart disease and cancers. To reduce these risks it is recommended that men drink no more than 3-4 units and women 2-3 units of alcohol a day. It is estimated that over 50,000 people in Wolverhampton drink to a level which increases their risk of ill health.
The figures illustrate that alcohol related mortality for Wolverhampton has increased over the last 15 or so years. The city as a whole has more than double the national alcohol death rate. Fifty people die each year directly from alcohol in the city. This is twice as many as the national average. Alcohol-related mortality is highest in the most deprived areas. Most life years lost are in the same areas especially in the south east.
Alcohol Related Mortality per 100,000 people
Alcohol is a leading cause of premature death of people who are in their 40s and 50s. Alcohol was a major cause of death in 2001-05. Since then the avoidable mortality has doubled in men and risen fivefold in women. It is now the single greatest cause of avoidable life lost in the city. Alcohol takes its greatest toll in the most disadvantaged communities. The most disadvantaged have a death rate four times greater than the most advantaged. This is an extreme example of how health experience is strongly linked to socio-economic status.
Alcohol admissions account for nearly three per cent of the total bed stays across all admissions in New Cross Hospital. Most admissions for alcohol-related harm occur between the ages of 30-59 years old. Men, especially Asian men, have the highest number of admissions.
New alcohol treatment services have been introduced which will completely change the face of alcohol services in Wolverhampton. This will help prevent people from dying and from having to go into hospital.
The provision of the Alcohol Identification and Brief Advice (IBA) tool in the community will be expanded. A programme of IBA training will also be provided to health and front line staff in statutory and voluntary organisations, as well as community groups.
Its clear that motivational therapies, which are similar to our successful talking therapies, help people to reduce problem drinking. There will be an increase in access to these motivational therapies including for those whose alcohol misuse has led to problems of domestic abuse or other forms of violence.
An integrated alcohol team will work in the community and at the hospital. Specialist nurses will screen, assess, manage and provide treatments to those admitted with severe alcohol problems. In the A&E department, these nurses will screen to identify people with possible alcohol problems, offer brief, extended advice or onward referral to other alcohol services within the A&E department or at an outpatients clinic.
Lung Cancer Mortality – Lung cancer mortality remains amongst the big 6 killers in Wolverhampton. Since 2002-04 after several years of falling rates lung cancer mortality has remained static in Wolverhampton. The gap to the national average has remained about the same. Rather worryingly there is an upward trend in the number of lung cancer deaths in women aged under 65. The main initiative to reduce lung cancer mortality in Wolverhampton is centred on getting people to quit smoking. Strong evidence exists to suggest the benefits of quitting smoking on lower likelihoods of developing cancer. The ‘Wolverhampton Stop Smoking’ service is a part of the health life styles team which last year supported nearly 2000 people to quit smoking. Another initiative recently undertaken by public health is the launch of a social marketing campaign “Cough Check ? which aims to encourage earlier presentation of lung cancer patients, by encouraging those who have had a 2 week cough to ask their GP to send them for an x-ray. Earlier detection of lung cancer significantly improves survival chances for patients.
Lung Cancer Mortality per 100,000
Teenage pregnancy – Rates of teenage pregnancy continues to be above the national average in Wolverhampton. National trends demonstrate a number of key facts about teenage pregnancy which show that around 75% of teenage pregnancies are unplanned, and 47% of under 18 conceptions end in abortion. Furthermore, Sexually-Transmitted Infections (STIs) are highest in 16 – 19 year old women. Early motherhood is associated with a range poor immediate and long-term outcomes, for both mother and child.
Childhood Obesity – Rates for childhood obesity in Wolverhampton for year R (R refers to Reception) and 6 pupils remain above national average. The trend in Year 6 is broadly flat but is increasing for year R. Further analysis of the data shows that high levels of obesity are found amongst the most deprived wards particularly the Bilston area of the city. In order to tackle childhood obesity a number of services to help address this issue have been commissioned for the city. ‘Food Dudes’ is a programming that runs across primary schools in Wolverhampton promoting healthier snacks with the aim of embedding health eating behaviour from an early age. So far the programme has shown a strong ability to displace unhealthy snacks such as chocolates and crisps for healthier options of fruit and vegetables. Another programme that has been commissioned is a weight management programme aimed at children called the ‘WISH’ scheme. This scheme engages both children and their families in a healthy eating and exercise to encourage healthier eating and build self-esteem in overweight children, with the ultimate goal of halting the childhood obesity epidemic.
The widening gap in life expectancy across the city is a great concern. We have to re-examine our approach to tackling the determinants of health as well as the immediate health problems.
Long term improvements in public health outcomes such as life expectancy will only occur through changes in those determinants of health, such as education, employment, skills and housing. Fair Society, Healthy Lives is a recent review of interventions to address health inequalities undertaken by Marmot. The current government has responded to this report by producing a new strategy called Healthy Lives, Healthy People. The evidence contained in these reports is compelling. Marmot showed that life chances can be improved dramatically by addressing these determinants.
Wellbeing is a term which is difficult to define. It could be considered to being happy and healthy and prosperous. However, a sense of wellbeing is something we all want in our lives The Government when it gave local authorities the “power of well being recognised that it has as much to do with environment, leisure services etc as it is to with hospitals and GP’s.
Open space, sport and recreation strategy – The City Council and it’s partners are committed to encouraging healthier lifestyles and general health and well being. As part of this they are making the most of every opportunity by using open spaces, green areas, play and recreational facilities to achieve this.
Wolverhampton is also working in partnership with The Black Country Sports Partnership to create better quality of life through sport and physical activity by establishing the Black Country as a world class sporting environment. The provision of open spaces and sport and recreation facilities contribute to the achievement of wider governmental objectives such as social and community cohesion and promoting a healthy and enjoyable life.
Wolverhampton Children and Young People’s Plan – The Wolverhampton Children and Young People’s Plan 2011 has been produced by the Children’s Trust Board and sets out how services, individually and together, will work to improve the lives and outcomes of children, young people and families.
The strategy looks at early intervention and prevention; narrowing the gap and reducing inequalities as well as tackling child poverty. Nine key priorities have been identified in the plan, these are, to: improve the health of babies; promote healthy lifestyles; improve outcomes for vulnerable children and young people, including those that are looked after, homeless, have learning difficulties and/or are vulnerable to crime or exploitation; improve learning outcomes in particular areas of underperformance; ensure young people are motivated to make a positive contribution to their communities, including the rejection of bullying and crime and activity that is gang related; improve access to services and leisure resource for young people in locations which best suit their needs; reduce teenage conceptions; improve the number of young people who are in education, training and/or employment aged 18, and reduce the number of children affected by family poverty.
Deprivation – Wolverhampton remains one of the most deprived areas in the Country according to the 2010 Index Multiple Deprivation (IMD). The City is ranked 20th most deprived area out of 326 nationally. Worklessness, particularly in the present financial climate, is a reality for many families and, for some, the challenge to adapt to the changing economy of the city and the region continues to be an issue. This has inevitably lead to many families experiencing poverty which in turn can negatively impact other aspects of their lives such as educational underperformance, employment and impact on health and well-being etc.
Child Poverty – The Child Poverty Needs Assessment demonstrated the extent and nature of child poverty in Wolverhampton:
There are 15,570 (33.4%) children and young people living in poverty in the city. (DWP Family Incomes Data 2010)
Wolverhampton has the second equal highest level of child poverty in the West Midlands, behind Birmingham, and was the only place in the region where child poverty increased between 2007 and 2008.
Based on analysis by the Joseph Rowntree Foundation, child poverty in Wolverhampton costs the city’s public services over £31 million a year and the national treasury over £90 million per year in benefits and taxes.
Every ward and neighbourhood in the city has an area within it that contains significant numbers of children living in poverty.
17 Local Super Output Areas (LSOAs) in the city have more than 50% of their children living in poverty. It should be noted that the two LSOAs with the highest level of poverty in the city also have the highest number of children living in them. These are both within the Low Hill area.
A young person living in poverty in Wolverhampton is half as likely to gain 5 GCSEs including Maths and English, than a child ineligible for free school meals although this gap is narrower than elsewhere in the region.
There is a high correlation between child poverty and poor health, unemployment, teenage pregnancy, criminality, obesity in later life.
Every Adult Matters and Older Peoples Strategy – Wolverhampton’s older people population (those who are of pensionable age) continues to increase in line with the national picture. Due to improved health care, this trend is predicted to continue.