NATIONAL PUBLIC HEALTH SERVICE FOR WALES / SUMMARY OF THE POPULATION OF NORTH WALES
CJ/Designed for Life/Summary Profile of the population of North Wales v6 / FINAL

Summary Profile of the Population of Wales

An initial summary of the key points relevant to the North Wales region arising from currently available baseline documents.

Key Messages

  • The demography of North Wales is predicted to change over the next 20-30 years with large growth in the numbers of older people.
  • Tackling inequalities in health is a key issue, almost one fifth of the population living within the most deprived wards in Wales are located in North Wales.
  • There is evidence to show that people with chronic conditions are more likely to use secondary care services. Reducing admissions requires partnership working across sectors.
  • The birth rate in North Wales is falling with the biggest decline seen in the North West area.
  • North Wales has a lower number of young people at all ages compared to the Welsh average.
  • Diseases of the circulatory system are the main cause of death in North Wales.

Background

The project to review secondary care services across North Wales, requires an understanding of the current health needs and the projected health needs of the population over the next 20 -30 years.

This initial summary identifies key messages which are relevant to the review. It has been produced by the National Public Health Service for Wales (NPHS) and has involved staff from the North Wales region and National Health Information and Analysis Resource Team.

The summary has drawn upon detailed information previously produced by the NPHS, new information prepared for the purpose of this review and other national reports from the Welsh Assembly Government. Reference and access links to these detailed reports are summarized in Appendix 1.

The report summarises information as it relates to the North Wales geographical boundary, which includes the population covered by the Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham Local Health Boards (LHBs) and their coterminous Unitary Authorities (UAs). However, it is important to point out that detailed health needs assessment information is also included in the needs assessments prepared in support of the Local Health, Social Care and Wellbeing Strategies and Community Strategies which have been prepared and adopted by the LHB/ UA partnerships in each of the six areas.

Demography

Population Structure

In 2003 the population of North Wales was 670,800. Flintshire in the North East has the largest population of 149,400 and Anglesey in the North Westhas the smallest population, 68,400.

18.5% of the current resident population is aged 65 and over. This is slightly higher than the Welsh average of 17.5%.

Conwy and Denbighshire have the highest proportions of people aged 65 years and over in Wales, 23% and 20%.

Conwy and Denbighshire have the highest proportions of people aged 85 years and over in Wales, 3.3% and 2.8%.

Compared to Wales as a whole, North Wales also has a lower proportion of people aged 16 and under and people of working age (16 – 65 years old), 19.20% and 62.25% respectively.

Conwy has:

  • the lowest proportion of people aged 16 and under, 17%
  • the lowest proportion of people of working age, 60%
  • the highest proportion of people aged 65 and over, 23%

Population figures available in Appendix 2 Tables 1 & 2.

Population Projections

By 2023 the North Wales population is set to increase by 3.6% overall to 695,000.

AllUA areas will experience population growth, with the exception of Anglesey.

Conwy, Wrexham and Denbighshire are expected to experience the largest growth (North Wales Population and Housing Group, 2005).

There are major differences between the age groups, which will alter the demography of the area, notably:

  • The 0-4 year old age group is predicted to fall by 10% and the 16-24 year old age group by 9%.
  • The 65-74 year old age group is projected to rise by 35%, and the over 75 year old age group by 50%.

Key Message: The demography of North Wales is predicted to change over the next 20-30 years with large growth in the numbers of older people.

Population density

Population density varies across the region. Wrexham and Flintshire are the most densely populated areas. Denbighshire, Conwy and Anglesey are more sparsely populated and Gwynedd has the most sparsely distributed population in North Wales.

Further information on population density is available in Appendix 2 Tables 3 & 4.

Households

The proportion of one person households could impact of the demand for formal care service provision.

  • 29.1% of households in North Wales are one person households.
  • Conwy has the highest proportion and one persons households, 32.7%.

Further household data are available in Appendix 2, Table 5.

Ethnicity

Race and ethnicity are important issues reflecting the need for and uptake of health services.

  • Less than 1.2% of the population of North Wales belongs to a Black, Minority or Ethnic Community (BME).
  • Most BME communities are concentrated around the Bangor, Rhyl and Wrexham areas.

Ethnicity data is available in Appendix 2, Table 6.

Determinants of Health

Socio-economic deprivation

Despite improvements in health, the gap between the least and most deprived appears to be widening at a national level. A key challenge for organisations is to ensure that sufficient focus is placed on the longer term aims of tackling health inequalities.

Across Wales electoral wards have been grouped from worst to best into fifths (quintiles). On an all Wales basis 705,118 people are recorded as residing within the most deprived wards. 122,181 people are recorded as living within such wards which are located within North Wales (i.e. approx 17% of the total population living within the most deprived wards in Wales).

The numbers and proportions of the population living in themost deprived wards in North Wales are as follows.

Table 1: Percentage of people living in most deprived wards in North Wales
Number / %
Gwynedd / 32,900 / 28
Isle of Anglesey / 11,622 / 17
Denbighshire / 12.335 / 13
Conwy / 18,849 / 17
Wrexham / 28,544 / 22
Flintshire / 17,931 / 12

Source: ONS 2001 Census

Educational Achievement

Poor educational achievement has been linked to poorer health in adulthood.

  • Denbighshire and Wrexham have significantly higher numbers of 16-24 year olds with no qualifications, compared to the average forWales.
  • Wrexham has a significantly lower number of pupilsgaining 5 GCSEs, compared to the average for Wales.

Economic Infrastructure

People in employment are generally healthier than those who are unemployed.

  • Around 59.3% of the North Wales population is of working age. This is slightly lower than the Welsh average of 59.6%.
  • North Wales has a higher proportion of economically active people, 76.9%, compared to the Welsh average, 74.2%.
  • North Wales has ahigher proportion of people in employment, 74.7%, compared to the Welsh average, 70.5%.
  • North Wales has a lower proportion of unemployment, 3.27% compared to the Welsh average, 5.1%.

However, rates of economic activity vary across the region.

  • Flintshire has the highest proportion of economically active people, 80.7%; people in employment, 78.3%; and employees, 69.3%.
  • Anglesey has the lowest proportion of economically active people, 74.3%; and people in employment, 70.8%; and the highest proportion of unemployment, 4.7%.
  • Wrexham has the lowest proportion of unemployment, 2.3%.

22.9% of the people of working age in North Wales are economically inactive (people who are neither in employment nor unemployed, such as people who look after a home or who have retired).

Again, rates of economic inactivity vary considerably across the region.

  • Anglesey has the highest proportion of economically inactive people, 25.7%.
  • Flintshire has the lowest proportion of economically inactive people, 19.3%.

Employment data available in Appendix 2, Tables 7 & 8.

Transportation

Car ownership can have significant advantages to an individual and household. Owning a car can improve access to services such as healthcare, employment and leisure activities.

  • Wrexham and Conwy have the highest proportion of households in North Wales with no car or van, 24%, although they are below the average for Wales, 26%.

Further information is available on transport networks in Appendix 2.

Lifestyle

People’s lifestyles greatly influence their health and the risk of developing chronic diseases.

Results of self-reported lifestyles from the Welsh Health Survey are shown below.

Table 2: Self-reported lifestyle factors, Welsh Health Survey 2003-04
North Wales
% / Wales
%
Smoking rates / 28 / 26
Levels of obesity / 52 / 54
Consumption of fruit and vegetables / 40 / 39
Physical activity levels / 31 / 29
Consumption of alcohol above recommended guidelines / 18 / 20

Source: Welsh Health Survey 2003/04

Improving health is a key national and local policy objective of Welsh Assembly Government, Local Health Boards and their partners. Implementation of national initiatives such as Health Challenge Wales and Local Health Social Care and Wellbeing Strategy Action Plans will aim to address key determinant of health issues, including lifestyle, over the next period which may have a positive impact on long term health status.

Key Message: Tackling inequalities in health is a key issues, almost one fifth of the population living within the most deprived wards in Wales are located in North Wales.

Preventive Health

Preventive ill health or reduction of the effects of illness can be achieved through many different measures. Some involve broad based initiatives – for example addressing inequalities in health or achieving reductions in smoking. More specific initiatives include screening services and immunisation programmes.

In August 2005, MMR uptake, as at 2nd birthday, was 86.5% in North Wales and 83.7% across Wales. Anglesey has the highest uptake, 89.7% and Denbighshire had the lowest, 81.6%.

Health Services in North Wales

North Wales has a total of 123 GP Practices, most of which are in Flintshire and Wrexham. Anglesey has the least amount of GP Practices.

Table 3: Number of GP Practices in North Wales by UA Area, 2004
Anglesey / 11
Gwynedd / 27
Conwy / 19
Denbighshire / 16
Flintshire / 26
Wrexham / 24
North Wales / 123

Source: Welsh Assembly Government 2005

There are 42 hospitals in North Wales. Three of these – Ysbyty Gwynedd (Bangor), Ysbyty Glan Clwyd (Bodelwyddan) and Ysbyty Maelor (Wrexham) – are major acute hospitals, and a further two – Ysbyty Llandudno and Ysbyty Abergele – are acute hospitals.

Table 4: Number of Hospitals in North Wales by NHS Trust, 2004
North WestWales NHS Trust / Conwy & Denbighshire NHS Trust / North East Wales NHS Trust / North
Wales
Hospitals-major acute / 1 / 1 / 1 / 3
Hospitals-acute / 1 / 1 / 0 / 2
Hospitals-community / 7 / 7 / 5 / 19
Hospitals-community (geriatric) / 2 / 1 / 4 / 7

Source: Welsh Assembly Government 2005

There are three NHS Trusts in North Wales, all providing a range of secondary care services. The North West Wales NHS Trust serves the Unitary Authority areas of Gwynedd and Anglesey, the Conwy and Denbighshire NHS Trust serves the Unitary Authority areas of Conwy and Denbighshire and the North East Wales serves the Unitary Authority areas of Flintshire and Wrexham. Whilst these are the main secondary care services provides in the region, some people access secondary care services elsewhere (such as in Powys, Ceredigion and Cheshire) depending on their geographical location.

North Wales has an average of 3,140 beds available on a daily basis, of which 1,891 are dedicated for acute services.

Table 5: Average Daily Beds* in North Wales by NHS Trust, 2003/04
North WestWales NHS Trust / Conwy & Denbighshire NHS Trust / North East Wales NHS Trust / North
Wales
Acute / 666 / 663 / 562 / 1891
Maternity / 42 / 44 / 44 / 130
Geriatrics / 200 / 158 / 272 / 630
Non-psychiatrics / 907 / 865 / 879 / 2651
Psychiatrics / 268 / 139 / 82 / 489
All Beds / 1175 / 1004 / 961 / 3140

Source: Welsh Assembly Government, 2005

*the average daily beds is the average number of staffed beds available daily during the year including beds set up temporarily and beds borrowed from other specialties but excluding beds loaned to other specialties.

Morbidity

Long Term and Chronic Conditions

It has been highlighted that people with chronic conditions are more likely to use secondary care. Evidence has shown that older people with chronic respiratory conditions and ‘acute on chronic’ disease accounted for greatest use of bed days, particularly during the winter months.

A recent review of chronic illness showed that, for the population of Wales as a whole, about one third of people over the age of 16 self report having at least one chronic condition. This rises to two thirds of people over the age of 65 years. 23% of people report having some form of limiting long term illness (LLTI) in Wales, higher than in England (18%) and the other home nations (20%).

Table 6: Percentage of persons reporting having a LLTI
LHB Area / % reporting LLTI*
Ynys Mon / 22.4
Conwy / 23.5
Denbighshire / 23.4
Flintshire / 19.2
Gwynedd / 20.6
Wrexham / 21.5

Source: ONS 2001 Census / HIAT

* The numbers are not standardized for age and sex therefore variation may be due to differences in population structure rather than true variations in LLTI.

Emergency admissions are a particular concern in Wales and North Wales and chronic conditions have been highlighted as a cause or contributory factor in a large proportion of admissions.

Admissions can be prevented if patients with a chronic condition are well managed in primary, community and intermediate care. This requires health communities to work together across the sectors.

Key Message: There is evidence to show that people with chronic conditions are more likely to use secondary care services. Reducing admissions requires partnership working across sectors.

Mental Health

The determinants of mental health and well being are multi-factorial and risk factors for experiencing poor mental health can be associated with where you live, ethnic background, socio-economic status and lifestyle.

Welsh Health Survey data has shown:

  • The highest proportion of respondents who reported that they suffered from depression is highest amongst people aged 45-64 years and older people aged 85 years and over.
  • A statistically significant association between poorer mental health and lower social class.
  • A higher proportion of females reported being treated for depression than males.

Sexual Health

Sexually transmitted infections are an important cause of mortality and morbidity and the consequences of some of these infections can be devastating for the patient and involve lifelong service utilization.

The past decade has seen both a substantial increase in high-risk sexual behaviours and a significant increase in new diagnoses of STI’s, particularly in chlamydia, syphilis and gonorrhoea. Sub-groups within the population tend to experience a disproportionate burden of disease, for example, young people, gay and bisexual men and some ethnic minorities

Children & Young People

Births

  • The birth rate has fallen in the last decade in Wales. Anglesey and Gwynedd have seen the greatest decline in North Wales of around 15%, with Wrexham experiencing the smallest decline of 4%.
  • Traditionally most mothers are in the 20–30 age groups although there are older mums. There is likely to be a 10% fall in these age groups in the coming decade, which may be reflected in maternal age falling or rising with the consequent health care issues.
  • There may be a slightly significant upward trend in low birth weight babies generally in Wales. However North Wales has experienced a lower percentage of low birth weight babies compared to Wales.
  • The number of infant mortalities in North Wales is low. Denbighshire has a higher rate than Wales for 1999-2001 although this is not statistically significant. Gwynedd had a significantly lower rate than Wales during this period.
  • Wrexham has a significantly higher rate of reported congenital malformations.
  • Approximately 25% of children in Wales live in lone (single) parent households. North Wales has a significantly lower proportion of lone parent households compared to the average for Wales.

Key Message: The birth rate in North Wales is falling with the biggest decline seen in the North West area.

Young People

North Wales has a lower number of young people at all ages, compared to the average for Wales. This is partly accounted for by the college/university availability elsewhere in Wales.

Key Message: North Wales has a lower number of young people at all ages compared to the Welsh average.

Older People

Chronological age is a poor indicator of health need.

The post war baby boom will reach retirement in the next decade.

The preponderance of females in the older age group has decreased over the past 40 years with mortality rates for males falling at a faster rate than for women.

Life expectancy

Life expectancy at birth is above average in North Wales.

There are however variations across the region and by sex

  • Life expectancy is significantly higher for males in Flintshire and Gwynedd.
  • Life expectancy for women is lower than average in Wrexham but significantly higher for Gwynedd.

Inward migration

There is a significant retirement population on the North Wales coast. 56% of Conwy and of 52% Denbighshire residents over the age of 65 were born in England.

There are high numbers of first language Welsh speakers in North West Wales but the high inward migration may well affect this.

Lifestyle

In the 70 years and over age group, 21% of male and 15% of female deaths are smoking related. The prevalence of smoking is declining and it is hoped this will be reflected in the next 20 years.

Income

Pension income will be a major issue but may not hit until the existing 40 year olds reach retirement in 15 – 20 years time. Income is known to have direct effects on health and well being. Retirement age may well increase over the next decade.

Wrexham has a significantly higher number of income support claimants over the age of 65.

Transport

Most older people in North Wales have access to a car, apart from Wrexham where the rates are low in comparison.

Housing

Wrexham, Flintshire and Anglesey have significant numbers of the over 65 in non owner occupied housing.

Care

Older people are healthy and enjoying retirement. Only 4% of the over 65 require residential or nursing care. This does go up with advanced age but the future pattern may be different.