Equality Strategy Attachment 2 Population and Health Inequalities Data

Equality Strategy Attachment 2 – Population and Health Inequalities Data

Purpose

This supporting document to the equality strategy provides population data by protected characteristic and information about known health inequalities affecting protected characteristic groups. This is a developing resource and should be updated as new or better information becomes available.

Last updated: October 2013

1.1Age

2011 Census data for the population of the Vale of York:

VoY / UK
Total / 336,330
0-15 / 56,472
16-34 / 84,933
35-44 / 45,403
45-54 / 47,441
55-64 / 42,163
65+ / 59,918

1.2Disability

2011 Census data:

Long-Term Health Problem or Disability
All Usual Residents / 336,330 / % / UK %
Day-to-Day Activities Limited a Lot / 22,824 / 6.79
Day-to-Day Activities Limited a Little / 30,386 / 9.03
Day-to-Day Activities Not Limited / 283,120 / 84.18

Commissioners should consider applying the social model for disability rather than solely focusing on the medical model. The social model for disability focuses on whether a person’s environment enables or disables them, rather than how a person’s impairment disables them. The emphasis should be on removing barriers to make services accessible and engaging with disabled people to find out whether adjustments are working. Suggested further reading:

The categorisation by impairment group in this document is to give commissioners an insight into need, rather than to re-enforce the medical model.

1.2.1Physical Disability

15.5% of the district’s population stated that their day- to-day activities were limited by a disability – this can be compared to 17.6% nationally (2011 Census).

Census Category / Year / York % / England & Wales %
Long Term Health Problem or Disability / 2011 / to be determined / 17.6%
Limiting Long Term Illness / 2001 / to be determined / 18.2%

Table 1 - Disability Profile 2001 & 2011

Sensory Impairment

Figure 1 below indicate the number of people in North Yorkshire diagnosed as sight impaired or severely sight impaired currently on the North Yorkshire and the prevalence by age group(figures are not available at a District level). The data shows that the prevalence of sight loss increases with age, and the UK population is ageing. This needs to be considered when commissioning services, particularly with regards to accessible communication.

Figure 1

Hearing Impairment

Hearing Impairment’ is used here to represent the key different groups of population with ahearing loss: Deaf British Sign Language (BSL) users, deafened people, Deafblind people (otherwise referred to as people with a dual sensory loss) and hard of hearing people.

Hearing loss includes a smaller number of people whose first language is British Sign Language. Whilst this is the smallest group, it is a group that faces a large number of barriers in society due to lack of language access to English in all its forms. BSL is a gestural language used in the deaf community. It is not related to English or any other spoken language.

Many people born deaf or who become deaf in early life use sign language to communicate. The British Deaf Association estimates that the number of people who use BSL on any given day may total 250,000 (nationally).

Learning Disability

GP population aged 18+ on the learning disability register (476.9 per 100 000 people).

Mental Ill Health

The incapacity claims rate for people with mental health or behaviour problems is 16.7 per 1000 working age adults. This is lower than the national average, however the JSNA also uncovers some other statistics relating to mental and emotional health:

It is estimated that in North Yorkshire, 52,790 people aged 16-74 experience common mental health problems including phobias, depression, anxiety, obsessive-compulsive disorder and panic disorder.
During 2010/11, there were 60,789 people on the GP depression disease register in

North Yorkshire, equivalent to a prevalence of 13.3%, above the national average of 11.2%.

1.2.2North Yorkshire’s Equal Lives Strategy

The North Yorkshire Strategic Partnership publication Equal Lives sets out North Yorkshire’s five-year strategy for people with physical and sensory impairments and should be considered when commissioning services[1], in particular relevant priorities are:

Improved Health:“ Peoplewith physical and sensory impairments are supported to enjoy good physical and mental health, and have access to appropriate treatment and support in managing long term conditions.”
Making a positive contribution: “People with physical and sensory impairments are able to actively participate in thecommunity, and be involved in policy development and decision making.”
Carers are supported: “To enable carers to have choice and control in their own lives, through the provision of information, breaks and services.”
Freedom from discrimination and harassment: “People with physical and sensory impairments are free from discrimination and harassment, and have access the necessary support where this occurs.”
Personal dignity: “People with physical and sensory impairments are able to keep clean and comfortable, enjoying a clean and orderly environment.”

The Equal Lives strategy goes on to identify the following objectives to support the priorities:

To implement clear comprehensive pathways with consistent outcomes for a range oflong-term conditions
To provide services which take account of the needs of disabled people
To develop easy accessible information so that all people are aware of how/when/wherethey can get treatment and the services they need

1.2.3Gender Re-assignment

There are no official statistics nationally or regionally regarding transgender populations, however, GIRES (Gender Identity Research and Education Society - estimated that, in 2007, the prevalence of people who had sought medical care for gender variance was 20 per 100,000, i.e. 10,000 people, of whom 6,000 had undergone transition. 80% were assigned as boys at birth (now trans women) and 20% as girls (now trans men). However, there is good reason, based on more recent data from the individual gender identity clinics, to anticipate that the gender balance may eventually become more equal.

Transitioning is still high risk for most gender variant people. Nonetheless, better social, medical and legislative provisions for gender variant people, coupled with the "buddy effect" of mutual support among them, appear to be driving growth in the number who have sought medical treatment. According to GIRES, organisations should assume that 1% of their employees and service users may be experiencing some degree of gender variance. Many are unlikely to wish to be detected. The only persons who cannot escape detection are the very few who undergo transition.

The community’s main health needs are access to gender reassignment services, includingassessment, counselling or psychotherapy, hormonal treatments, and gender reassignmentsurgeries (hair removal, vaginoplasty and breast enhancement for trans women, andmastectomies, hysterectomies and genital surgery for trans men).

Trans people will of course also have routine health care needs, including screening. Physicalexaminations and screening tests should be offered to patients on the basis of the organspresent rather than their perceived gender.

Confidentiality is of paramount importance: the Gender Recognition Act 2004makes it unlawful to disclose the fact that someone has applied for a Gender Recognition Certificate (GRC) or disclosure of someone's gender prior to the acquisition of the GRC.

1.2.4Marriage and Civil Partnership

This protected characteristic generally only applies in the workplace. Data from the Office of National Statistics covering the period 2008-2010 indicates that there were 18,049 Civil Partnerships in England and Wales during this three-year period – 52% men and 48% women.

1.2.5Ethnicity and Nationality

Census Data

VoY / VoY % / UK
White / 311,182 / 92.5%
White Other / 11,707 / 3.5%
Mixed / 3,376 / 1.0%
Asian / 7,526 / 2.2%
Black / 1,479 / 0.4%
Other / 1,060 / 0.3%

Ethnic Groups

There is a rapidly growing black and minority ethnic population in York, due in part to the continuing expansion of university and higher education facilities within the city. Another factor is seasonal work in York‟s tourism and agricultural industries.

The 2011 Census tells us that 86% of residents of England and Wales belong to the “White” ethnic group, which is a 5% point decrease since 2001. In Yorkshire and Humber 89% of the population identified itself as “White”. The York the “White” British population is 90.2% . The highest non white group is Chinese which counts for 1.2% of the population.
The most recent socio-economic analysisof black and minority ethnic households in York found that that this population group is mostly made up of younger, settled black and minority ethnic people (aged 25-39), living in rented accommodation (mainly houses) and of whom the largest identified ethnic group is “Asian”. There is a significant secondary group of migrant workers who are mostly from Eastern European countries, aged18-39 years old, and living in private rented flats and converted houses.

Gypsy, Roma and Traveller People (GRT)

The term Gypsies and Travellers or travelling people can refer to people from a number of different backgrounds, including:

‘Gypsies’ who may be of English, Welsh or Scottish descent, and who have Romany ancestry.
‘Irish Travellers’ who are a nomadic Irish ethnic group with a separate identity, culture, language and history. There are many Irish Travellers resident in Britain for all or part of the year.
‘Scottish Travellers’ who like Irish Travellers have musical traditions, language and other histories that date back at least to the twelfth century.
The Roma people who have moved to Britain from Central and Eastern Europe (of which Britain’s Romany Gypsies are members).
People with a long family history of travelling because they work with fairgrounds and circuses (also known as ‘Travelling Show people’).
So-called ‘New Travellers’. Some of whom may be second or third generation Travellers and/or may have Gypsy ancestry.[2]

York’s Gypsy, Roma and Traveller Strategy 2013-18 says: “There are approximately 350 Gypsy and Traveller families in York, living on traveller sites, houses and on the roadside (Gypsy and Traveller Area Assessment 2009). Data from the 2011 Census reports a figure of 269- White: Gypsy or Irish Travellers, although it is widely recognised that members of the community are very reluctant to self identify due to perceptions that they will be discriminated against.”The JSNA Topic Summary for Gypsy, Traveller and Show People estimates just over 1100 GRT people in York. In Selby, the figure is estimated at 478 living in 151 households. In Ryedale: 318 people living in 100 households[3].

Nationality

Although the total number of BME people identified in the Census is lower than the UK average, the report Mapping rapidly changing minority ethnic populations: a case study of York by the Joseph Rowntree Foundation[4], reports that York has a very diverse BME population with 78 different first languages spoken by its residents. People from different nationalities may come to York as migrant workers (mainly from Central and Eastern European) or as asylum seekers – this has resulted in the Polish and Turkish/Kurdish becoming the largest ethnic minority group in York. York also attracts a large number of overseas students making up 17% of their student population[5].

1.2.6Religion & Belief

Census data

Religion

All Usual Residents / 336,330 / VoY% / UK %
Christian / 216,306 / 64.3
Buddhist / 1,285 / 0.4
Hindu / 1,101 / 0.3
Jewish / 284 / 0.1
Muslim / 2,231 / 0.7
Sikh / 191 / 0.1
Other Religion / 1,118 / 0.3
No Religion / 88,849 / 26.4
Religion Not Stated / 24,965 / 7.4

1.2.7Gender

Census data

All Usual Residents / 336,330 / %
Males / 163,880 / 48.7
Females / 172,450 / 51.3

1.2.8Sexual Orientation

Local population data is not available for sexual orientation. In part, this is because until recently national and local surveys of the population and people using services did not ask about an individual’s sexual orientation. However, Stonewall estimates that 5 - 7% of the national population are lesbian, gay or bisexual.

1.3Health inequalities and protected characteristic groups

As part of our duty to pay due regard to equality, as commissioners of health services we need to be aware of the key health inequalities affecting groups who share protected characteristics. We have identified the following issues based on the JSNA, local engagement and other research data.

Protected characteristic / Health inequalities / Issues / Priorities
Ethnicity / nationality / There are well documented inequalities regarding BME people accessing mental health (particularly early intervention services)[6].
Biological diversity can have an impact on peoples’ susceptibility to certain diseases. These can make an impact on the need for health services. Examples include:

Thalassaemia is more prevalent in people of certain races, the type and prevalence varying between places of origin.
Diabetes is more common amongst people who originate from the Indian subcontinent.
People with darker skin who habitually cover up may lack vitamin D in the UK climate, and rickets has been reported.

Life expectancy for Gypsy and Traveller men and women is 10 years lower than the national average.
Gypsy and Traveller mothers are 20 times more likely than the rest of the population to have experienced the death of a child.
In 2004 Parry et al conducted a census of Gypsy and Traveller people in Leeds and found that only 2.3% of the population was over the age of 65, compared with 20% in the Leeds Metropolitan District population indicating stark health inequalities.
Age / Older people (65 +): this is one of the most significant groups in terms of size of population and service need, compared to other groups who share protected characteristics.

Dementia affects 30% of the over 65s and this has a significant impact on their carers in terms of their health and wellbeing. [7]
Isolation was regarded as one of the key concerns, based engagement input into the JSNA, which affects particularly affects older people.
Reliance on public transport is significantly higher in this group[8]. This has an impact on accessibility of services for this group.

Young people:

Mental Health: 1 in 10 children and young people aged 5 - 16 suffer from a diagnosable mental health disorder - that is around three children in every class (nationally).

Research shows[9]that the transition to adult services for disabled young people and those with complex health needs is problematic mainly due to lack of co-ordination between different agencies and insufficient good information to young people and parents.
Although child poverty is lower than the national and regional index, The North Yorkshire Child Poverty Needs Analysis, compiled in 2011, shows that child poverty is most prevalent around urban areas like Scarborough, Northallerton, Thirsk, Skipton, Selby, the Harrogate/Knaresborough conurbation, and in Catterick Garrison. Child poverty is also found in some rural locations, most particularly in Central Ryedale, Wolds/Filey, and Whitby areas, but also in North Craven, the northernmost area of Swaledale, and the southernmost area of the Selby locality.

Disability / Physical and sensory impairments:

Disability does not necessarily equate to ill health, however disabled people are more at risk of ill health[10] than those who do not have disabilities. This means that people with disabilities are likely to be disproportionately affected by commissioning decisions relating to all health services.
A key barrier to Deaf people is access to language and communication. BSL does not have a written form and BSL speakers often have very low rates of literacy in written English. 24% of Deaf people have missed appointments due poor communication.[11]

Learning Disabilities:
There are numerous health inequalities associated with learning disabilities (see ).
In summary, people with learning disabilities have poorer health than their non-disabled peers, differences in health status that are, to a large extent, avoidable.[12] Mortality rates for this group are starkly higher than other groups. People with learning disabilities not associated with any other condition (such as Down’s Syndrome) average age of death is 65, compared to age 80 in the general population.[13]
Action: Sign Mencap’s charter for CCGs
Sexual orientation / Lesbian and Bisexual Women
Stonewall’s Prescription for Change (> 6000 respondents) showed:

Less than half the women surveyed[14] had taken up any screening for STI’s.
The percentage of women over 25 who had never been for cervical screening was double that of straight women
The rates of self-harm in this population group are significantly higher
Half of the women in the survey reported negative experiences in the health sector

Gay and Bisexual Men
In Stonewall’s Gay and Bisexual Men Health Survey (6 861 respondents) showed:

Smoking prevalence is higher in this group compared to straight men
Gay and bisexual men are more likely to attempt suicide, self-harm and have depression than their straight peers. They are more likely to take illegal drugs.
There is a lower uptake of cancer screening services
Gay men have indicated concern at coming out to their GPs (more so than their managers, work colleagues and family)

Gender reassignment / Patient safety and confidentiality are particularly significant to people who are gender variant and / or who are undergoing gender reassignment.
Trans gender people are 25 times more likely to commit suicide than non-Trans people - this should be considered in mental health and primary care services.
Our providers have policies in place for trans gender people to avoid issues under the mixed sex accommodation guidance
How aware are service providers of the particular needs and issues that affect Trans people? How can commissioners of services require providers to make services safe and accessible for Trans people?
Religion or belief / Religious observances can have an impact on health, potentially affecting the health and lifestyle choices people make. The information given below will help commissioners to understand the health needs of people who follow different religions and ensure that providers are meeting those needs where possible (particularly regarding nutrition).
Influences on diet. For example:

Muslim and Jewish people have beliefs affecting the eating of meat (Halal and Kosher respectively).
People of Hindu and Buddhists faiths are usually, but not necessarily, vegetarian.
Hindus have festivals involving fasting or restricted diet.
Islam has a fast called Ramadan that lasts for a month. The time of year varies, as it is based on the lunar calendar. During the hours of daylight, which might be quite extensive in the summer, people refrain from ingesting anything. This may cause problems with regard to medication or the control of diabetes. However, those who are ill are not expected to conform. Ramadan ends with the festival of Eid al-Fitr.

Blood transfusion and organ transplantation:
Jehovah's Witnesses believe that the spirit is in the blood and hence it is unacceptable to perform blood transfusions and organ transplantation.
If parents refuse a blood transfusion for a child and the doctors maintain that it is necessary to save the child's life, it is possible to have the child made a ward of court to give the court the right to make that decision.
Circumcision is a norm for some faiths (e.g. Muslim, Jewish). However, Vale of York CCG does not fund non-medical circumcision. Although this decision is likely to have a greater impact on people from those faiths that practice non-medical circumcision, this is seen as a proportionate means of meeting a legitimate aim. This is inline with guidance given by the Department of Health.

Pregnancy and Maternity / Fortunately, North Yorkshire has a lower than national average rate of infant mortality and low birth weight.

1.4References

Title / Weblink
City of York Health and Wellbeing Strategy, 2013 – 2015 /
Health and Wellbeing in York, Joint Strategic Needs Assessment 2012 /
North Yorkshire JSNA 2012 /
Vale of York Integrated Operational Plan, 2013 /
JSNA Topic Summaries: Physical and Sensory Impairment Physical Disabilities /
City of York Local Account for Adult Social Care 2012 /
Vale of York Public Health Report, July 2013 /
The York Gypsy, Roma and Traveller Strategy , 2013- 2018 /
Topic Summaries
Lesbian, Gay, Bisexual
and Transgender communities /

Univer

/ Transition to adult services for disabled young people and those with complex health needs, University of York 2011-12 /
Prescription for Change: Lesbian and bisexual women's health check 2008 /
Mapping rapidly changing minority ethnic populations: a case study of York by the Joseph Rowntree Foundation /
York LGBT Health and Wellbeing Document 2013 - 2017 / (local drive)
Health Profile of Selby 2012 /
Selby Migration Profile 2012 /
Selby District Council Traveller Needs Assessment, 2013 /
NYCC JSNA Topic Summary: Gypsy, Traveller and Show People /
City of York Children and Young Peoples Mental Health Strategy 2013 – 2016 /

/ NYCC JSNA Topic Summary Child Poverty /

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