Appendix 7a
The Annual Public Health Report forBlackpool, 2009
A Joint Strategic Needs Assessment
by NHS Blackpool and Blackpool Council
Forward
We are delighted to present this year’s annual report on the health of the people of Blackpool. As ever, the report seeks to provide a picture of the health of the local population, highlighting the key health improvement challenges and promoting action for better health. These are significant challenges; tackling them will require concerted effort from all. Health is everyone’s business. Therefore, this year the report includes a broad picture not just of health problems, but also the underlying social and economic conditions across the town that contribute to health. This ‘broad picture’ is taken from a much more detailed source, the Joint Strategic Needs Assessment (JSNA) for Blackpool. JSNA is a joint venture by NHS Blackpool and Blackpool Council that aims to promote a common understanding of health and the causes of poor health within Blackpool. This common understanding is the first step in enabling suitable services to be commissioned that will improve the health and wellbeing of the people of Blackpool. Already it has led to the identification of the ten priority areas of NHS Blackpool’s Five Year Commissioning Strategic Plan. For those who wish to read more, a comprehensive summary of the data held in the JSNA is available via NHS Blackpool’s website at
Appendix 2 provides an update on progress towards life expectancy and mortality targets. Although there has been a slight improvement since last year’s report, progress in Blackpool continues to fall behind the national average and rates in Blackpool need to improve faster if we are to narrow the gap.
During 2009, the National Support Team for Health Inequalities visited Blackpool,reviewed progress and plans relating to addressing health inequalities and produced recommendations to improve life expectancy, reduce mortality and reduce inequalities.
The impact of the economic downturn is likely to be felt most by the more disadvantaged and vulnerable people in society, and public services too are facing economic pressures. It is more important than ever to continue with action to promote good health and improve underlying social and economic conditions if we are to improve health in Blackpool. The current Area Action Plans for the regeneration of the central neighbourhoods will be critical in achieving improved health in Blackpool.
Nationally, a number of important national challenges for public health are emerging. In recent months we have seen the spread of a new strain of H1N1 influenza (‘Swine flu’). Much is still to be learnt about the behaviour of the virus and the projections of the numbers of cases that might occur remain uncertain. Nevertheless, there is a great deal of work ongoing to ensure that anti-viral medicines are available for people who need them, and plans are underway for an H1N1 vaccination programme to commence in the autumn. This H1N1 vaccination programme will be in addition to the routine seasonal vaccination campaign.
This year’s report includes contributions from a wide range of people. We must acknowledge the work of the Joint Strategic Needs Assessment working group, in particular public health analysts from NHS Blackpool and information colleagues from the Children and Young People’s, and Adult Social Care and Housing and Culture and Communities Directorate of Blackpool Council. Thank you to Dr Steve Gee, (Consultant in Health Protection] from the Health Protection Agency for the section on Communicable Diseases and Paul Walker, Executive Director of Culture and Communities, Blackpool Council. We are keen to receive feedback from readers of the report and any comments can be sent to Dr Rajpura at NHS Blackpool, Blackpool Stadium, Seasiders Way, BlackpoolFY1 6JX or .
Dr Arif RajpuraExecutive Director of Public Health, NHS Blackpool / Steve Pullan
Executive Director of Adult Social Care and Housing, Blackpool Council / David Lund
Executive Director of Children’s Services, Blackpool Council
Contents
Forward......
Overview of health and wellbeing in Blackpool: the Joint Strategic Needs Assessment
A)Population
B)Health & Well-being
C)Lifestyles
D)Social and Community Environment
E)Living and working in Blackpool
Communicable disease and health protection ......
Recommendations......
Appendix 1 Progress over the past year......
Appendix 2 Public health targets ......
Finding out more ......
Additional copies of this report are available from:
NHS Blackpool, Blackpool Stadium, Seasiders Way, BlackpoolFY1 6JX
01253 651200
Overview of health and wellbeing in Blackpool: the Joint Strategic Needs Assessment
What is Joint Strategic Needs Assessment (JSNA) and why is it important? In essence, JSNA is about a shared understanding of ‘the big picture’ in terms of current and future health and wellbeing needs and inequalities of a local population. This understanding will enable organisations in Blackpool to commission services and interventions that will achieve better health and wellbeing outcomes and reduce inequalities. The responsibility for undertaking JSNA lies jointly with the Director of Public Health, alongside the Directors of Children and Young People’s services, and of Adult Social Care and Housing from Blackpool Council.
This section summarises the key points, interventions, and considerations for commissioners emerging from the JSNA. The key points are grouped into fives themes: population, health and wellbeing, lifestyles, social and community environment, and living and working in Blackpool
1.Population
Population size, births and deaths
The current population of Blackpool is estimated to be approximately 142,500 (mid-2007 population estimates, ONS), and is projected to reach to 148,006 by 2014 and 152,280 by 2019.
Typically there are around 1,700 births and 1,800 deaths each year. However, the annual number of deaths is expected to fall below the annual number of births within the next few years.
The biggest contributor to Blackpool’s increasing population is migration from within England, with approximately 700 net gain in population expected per year.
Blackpool has a smaller proportion of people aged 20-39, and a greater proportion of people aged 65 and over compared with England and Wales. Over the next 5-10 years there will be an increase in the number of people in two broad aged groups, 45-64 year olds and over 65s. The number of people aged under 20 and 20-44 will remain steady.
Blackpool has a relatively small minority ethnic population compared with England and Wales (3% compared to 11%)
Deprivation
Blackpool experiences considerable levels of disadvantage, and in 2007 ranked as the 12th most deprived of 354 local authorities in England. 41 out of 94 small areas within Blackpool are amongst the 20% most deprived areas of the country and there are no areas amongst the 20% most affluent. Blackpool’s relative position in the national deprivation rankings has worsened over the last 5 years.
Social groups
Blackpool had a greater proportion of people in Mosaic Group D than England and Wales, accounting for over 46% of Blackpool households in comparison to 16% in the UK overall. Typical features of this group are single adults, low income families with young children, families on modest incomes, and older people preferring to live in familiar surroundings.
Considerations for commissioners- Future service and capacity requirements for an increasingly older population, for example dementia, social care, stroke, social isolation
- Use of social marketing techniques for effective targeting of health messages
- Effective partnership working is key to improving the quality of life in Blackpool
2.Health and wellbeing
Life expectancy
Life expectancy for men in Blackpool is 73.2 years and is the lowest in England. Women can expect to live longer than men and life expectancy for women is 78.8 years. There are considerable differences in life expectancy within Blackpool. Men in the least deprived areas can expect to live nearly 10 years longer than men in the most deprived areas. Similarly, for women this difference is eight and a half years.
Not only do people in Blackpool live shorter lives, but they also spend a smaller proportion of their lifespan in good health and without disability.
What do people die from?
The key causes of shorter life expectancy in Blackpool are alcohol related diseases, circulatory diseases, cancers (especially lung cancer), accidents and self harm, and respiratory diseases. Deaths in younger people contribute to a larger proportion of the gap, as more years of life are lost. Infant mortality rates, particularly amongst babies aged between one month to one year, are currently higher than the national average.
Overall death rates (for all ages and all causes together) have been falling in recent years. Death rates have also been falling for the two most common causes of death, circulatory diseases and cancer which jointly make up almost 60% of all deaths. Although this is good news, death rates in Blackpool are higher than average and rates have not been falling as quickly as elsewhere. We need to reduce death rates more quickly than average in Blackpool.
Long term conditions and mental health
Prevalence of chronic disease in Blackpool is high. According to the 2001 Census 24.6%(33,857 people) of the population of Blackpool reported limiting long term condition.
The estimated prevalence of diabetes in Blackpool (for people 17 years and older) is significantly greater than England and the North West (4.5% - 6621 people).
Prevalence of Chronic Obstructive Pulmonary Disease (COPD) in Blackpool is greater than England and the North West (2.5%).
Prevalence of stroke and Transient Ischaemic Attack (TIA) in Blackpool (2.0%) is significantly greater than England and the North West. In addition, mortality from stroke is significantly higher in Blackpool than in England and the North West (Directly Standardised Rate (DSR): 23.15 per 100,000 population – 116 deaths 2005-2007).
Currently in Blackpool 11,400 people are in receipt of Disability Living Allowance (DLA). This represents 9.9% of the local population and is nearly twice the figure of 5.5% for Great Britain. The allowance is payable to people under 65 who are disabled and who have care needs, mobility needs or both. People with learning difficulties or mental health problems typically make up about 30% of this total. This would suggest that around 3,000 people under 65 may be receiving DLA because of learning disabilities or mental health problems.
The burden of mental health problems is likely to increase with population growth. This is especially important amongst the growing population of older people. Amongst the over 65s the two most common mental health problems are depression and dementia.
Blackpool has the highest suicide rate in England. There are above average levels of depression requiring treatment in the over 65s (an estimated 34%). Around 3,000 people in Blackpool are receiving DLA because of mental health problems.
Considerations for commissioners- Reducing premature mortality from cardiovascular disease. This will need to include improved case finding, improvement management and treatment, and rehabilitation services
- Improve early detection of cancers, especially in the most vulnerable groups and people living in disadvantaged areas. Examples of action include better uptake of national cancer screening programmes and vaccination for Human Papilloma Virus (HPV) to protect against cervical cancer.
- Improve access to mental health services including psychological therapies, and dementia services for older people
3.Lifestyles
Smoking
Smoking is the single most important factor explaining the difference in death rates between the most and least affluent areas, and is a major factor in ill health. Around 400 people die prematurely every year in Blackpool, and a further 8,000 will suffer from a smoking related disease. The proportion of people smoking varies widely between social groups. The highest rates are seen amongst the most disadvantaged groups where typically three out of four families smoke and spend one seventh of their income on tobacco. The rate of smoking in pregnancy is the worst in the country.
Alcohol and substance misuse
Blackpool has some of the highest levels of alcohol related harm in the country, not only direct health effects such as premature death and chronic liver disease but other consequences such as disorder and violence. There are an estimated 40,000 Blackpool residents who drink at hazardous or harmful levels, equating to 28% of the adult population. Alcohol is a factor in more than three quarters of domestic violence incidents and is a major contributing factor in violent crime.
Locally, in 2006, 3,300 people aged 18-44 had an alcohol related admission to A and E.
The average annual incidence of hospital admissions in Blackpool primarily caused by alcohol during 2000-2005 was 965. By 2006 this had increased to 1,481. 70% of patients were aged 35–64, and cases of advanced liver disease are increasing in even younger age groups (BFWFHT data 2005).
Blackpool has over 1,900 on licensed premises, including hotels and small guest houses, to support the visitor economy. Blackpool also has approximately 180 off licences, mostly concentrated in the poorest wards. Bloomfield Ward, where alcohol related deaths are the highest, is served by 30 off licences, one for every 250 residents (all ages).
The town also sees high levels of substance misuse, and has the highest levels of problematic heroin and crack cocaine use in the North West. An estimated 2,325 residents of Blackpool are considered problematic drug users.
Sexual health and teenage pregnancy
Blackpool continues to have amongst the highest prevalence of HIV in the North West, though the number of new infections is falling. Of new cases recorded in 2007 in Blackpool, 55% were men who had sex with men, and 81% of total infections in Blackpool were through men who had sex with men. This is significantly higher than the North West average of 52% and national average of 45%.
Diagnoses of uncomplicated Chlamydia infection in Blackpool have shown a large increase since 2005 following the introduction of a screening testand awareness campaign.
Blackpool has amongst the highest teenage pregnancy rate in the UK (under 18 conception rate of 60.9 per 1000). Though rates of teenage pregnancy in Blackpool have fallen after a peak in 2004, the rate in 2007 was broadly similar to the rate in 1998. Although significant improvements have been made in the last three years, teenage pregnancy remains an important problem for Blackpool.
Rates for termination of pregnancy amongst under 18s in Blackpool are lower than average and have not changed since 2006. More teenage conceptions in Blackpool result in live births compared with the national average.
Diet, nutrition and physical activity
Levels of adult obesity in Blackpool (26.4%) are similar to those in the North West and England.
There is compelling evidence to clearly demonstrate that an inactive lifestyle has a substantial negative effect on both individual health and public health. Physical activity levels amongst the adult population in Blackpool are significantly worse than the England average, 7.4% compared with a national average of 10.8%. Estimates have shown that 37% of all Coronary heart Disease (CHD) deaths can be attributed to physical inactivity. As quoted by the Chief Medical Officer in his report on the evidence on the impact of physical activity and its relationship to health ‘At least Five a Week’, there are few public health initiatives that have greater potential for improving health and wellbeing than increasing physical activity levels. Small increases in activity levels can have significant impact on the reduction of premature mortality, help to control many long term conditions and promote health improvement and quality of life.
As referred to in last year’s Annual Report the prevention and management of CHD remains an important strand of work for the Trust and partner organisations. Although the number of people under the age of 65 who die from heart disease or stroke has fallen, it is still significantly higher than the national average. Increasing levels of physical activity remains one of the ‘best buys’ in public health and in a recent statement the Health Secretary, Andy Burnham, states that ‘the promotion of active lifestyles is the simple answer to many big challenges facing our country today’ and that ‘the promotion of active lifestyles should be a core part of our business’. This underpins the need to continue providing quality programmes that promote the health benefits of a physically active lifestyle and also provides opportunities to support and encourage our local population to become more physically active.
Projections of the numbers of Blackpool’s older population (65+) with a BMI above 30 indicate that sizeable increases are to be expected, from 6,645 in 2008 to 88,044 in 2025.It is important to note that obesity, and health problems related to obesity, are often more damaging to older people, particularly as they may have other health problems.
Children in Blackpool are more physically active than average and levels of childhood obesity are no different to the national average. In Blackpool, within Reception Year, 12.5% and 10.1% of children were recorded as being overweight and obese respectively and in Year 6, 14.7% and 18.3% of children were similarly recorded (Source: NCMP, 2007/2008).