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Joint Strategic Needs Assessment 2015 Basingstoke and Deane Borough Council Hampshire Public Health Team Slide 2 Contents Demography how is our population changing? Starting Well the health and life chances of our children Staying Well the health of our adult population Ageing Well the health of our older population Slide 3 Population headlines Children (0-19 years) 41,643 (24.4%) (23.7% England) Older people 65 and over 28,097 (16.5%) (17.6% England) 85 and over 3,468 (2.0%) (2.4% England) Total Basingstoke & Deane Population 170,407 Key Issues for Basingstoke & Deane Long term conditions /multi- morbidity: Diabetes Cardiovascular Disease Chronic Obstructive Pulmonary Disease Mental Health (including Dementia) Musculoskeletal (including Falls/Fractured hips) Lifestyle risks activities contributing to poorer health outcomes Smoking Obesity Alcohol Inactivity Poor diet Demographic Growth by 2021 Aged 0-19 years increase by 2,839 (6.8%) Aged 65 and over increase by 6,224 (22.2%) Aged 85 and over increase by 1,688 (48.7%) Working age: Healthy carers, Workplace health Community Resilience Health and social inequalities Education Employment Isolation Life Expectancy and Healthy Life expectancy Gap Men 15.5 years Women 17.9 years Slide 4 Demography Slide 5 The OADR provides an idea of the relationship between the working age population compared to those of pensionable age. A higher OADR value indicates a fewer people of working age Ratio of people of state pension age is increasing compared to working age population By 2025 for every 3 people of working age there will be 1 person of pensionable age in Basingstoke and Deane Variation in Ethnic Groups and diversity across the County necessitating changing needs Slide 6 Demography Life expectancy is increasing; healthy life expectancy is reducing Slide 7 Demography Life expectancy for women; the increase is much slower, beginning to plateau Healthy life expectancy is decreasing Slide 8 Inequality Gap in life expectancy due primarily to Circulatory disease, Cancer and Respiratory disease for both men and women Scarf Chart showing the breakdown in life expectancy gap between most deprived and least deprived quintiles across Basingstoke & Deane, by broad cause of death 2010-12 Basingstoke and Deane Life expectancy gap between most deprived and least deprived quintiles, by broad cause of death 2010-12 Slide 9 Starting Well A wide number of factors influence and determine good health No single definitive measure Infant and child mortality, and birth weight are good indicators of health now and in the future Slide 10 Starting Well: Infant and Child Mortality Child Mortality Hampshire Child mortality by age band - Hampshire residents - 2012 to 2014 Source: ONS Primary Care Mortality Database Underlying cause of death description (% of total deaths) Age bandSlide 11 Starting Well: Low Birth Weight Births with birth weight less than 2500g as a proportion of live and still births with valid weight, 2008-2012 Source: ONS Crown Copyright 2013 Babies born with low birth weight (LBW) at risk of poorer health developmental issues Risk factors for LBW include maternal smoking and deprivation Slide 12 Starting Well: Healthy Weight Child weight good predictor of future health 50% increase in excess weight between ages of 5 and 11 Higher levels of breast feeding linked to better child health County and districts have a role in supporting healthy eating and increased activity Slide 13 Starting Well: Education Slide 14 Good overall educational attainment at 5 and 16 years Greater variation at GCSE Achievement of 5 GCSEs (A*-C) including English and Math for 2011/12 (Source DfE) Source: ONS Crown Copyright 2013 % of Pupils achieving a good level of development at the age of 5 years for 2011/12 - (Source DfE) Slide 15 While improving, unemployment for more than 12 months can affect employment chances later in life Partnership required with county and district to support longer term unemployed into work Starting Well: Employment Slide 16 Starting Well: Injuries Need to understand better social and emotional factors affecting young people that impact on these Slide 17 Starting Well Key issues for the Health of Children and Young People Working with families on minimising excess weight gain to achieving a healthy weight (improving healthy eating and physical activity) Develop and target social and emotional interventions to support emotional wellbeing of children and young people Understanding needs of vulnerable children (Children with Disabilities and SEN) In partnership, supporting vulnerable children improve educational attainment and health Supporting long term unemployed young people into education, training and employment Maximising the impact of Public Health 0-5 services to improve healthy eating, reducing accidents, identifying families at risk of poorer health and emotional wellbeing Slide 18 Staying Well Prevalence of factors or conditions that cause premature mortality or illness indicate how healthy our population is For adults the main causes of premature death are Cancer, Heart disease and respiratory disease. Certain illnesses (e.g. mental health and diabetes) not only cause morbidity but can also cause significant disability impacting on employment and future wellbeing Slide 19 CCGCHD Recorded Prevalence CHD Estimated Prevalence Diabetes Recorded Prevalence Diabetes Estimated Prevalence Hyper- tension Recorded Prevalence Hyper- tension Estimated Prevalence Hampshire District North Hampshire 2.6% (1 in 38) 3.6% (1 in 28) 5.7% (1 in 18) 6.2% (1 in 16) 12.3% (1 in 8) 22.9% (1 in 5) Basingstoke and Deane East Hampshire (part) Hart (part) England 3.3% (1 in 30 ) 4.7% (1 in 21) 6.2% (1 in 16 ) 7.3% (1 in 14) 13.7% (1 in 7) 24.7% (1 in 4) Staying Well: Morbidity Decreasing preventable mortality - in line with regional figures Slide 20 Staying well: Potential Years of Life Lost Conditions of focus: CHD Stroke and IHD Cancer Breast and Colon Respiratory Pneumonia Slide 21 Staying Well: Mortality (CVD) District figures beginning to plateau Risk factors include smoking and obesity Slide 22 Staying Well: Mortality (Cancer) Significant difference between men and women Slide 23 Staying Well: Mortality (Cancer) Malignant Melanoma incidence in Basingstoke and Deane is high Disproportionally affects younger adults 89% preventable Slide 24 Staying Well: Mortality (Respiratory) Rate of mortality increasing Smoking prevalence rising Slide 25 Staying Well: Diabetes Poor control and management of diabetes leads to complication/disability District role is in partnership with Health and County to support healthy lifestyles especially diet and exercise Slide 26 Staying Well: Mental Health Contributing factors to poorer mental health; employment, social exclusion, access to services Support needed to improve social inclusion and employment chances Slide 27 Staying Well: Employment Data indicates conditions that have greatest impact on need for disability support Personal Independence Payments (PIP) by Disability Basingstoke and Deane Slide 28 Staying Well: Employment A good measure of independence is the number of people with disabilities who are in employment Partnership between County and Districts needed to support more people with disabilities into employment Slide 29 Staying Well Proportion of working aged population is reducing; pressure on services and caring Reducing healthy life expectancy; focus on improving lifestyles and self management of health conditions, particularly diabetes Reducing Cancer mortality; improving early diagnosis and screening uptake; Higher levels of preventable mortality for SMI; improving access to services and social inclusion and employment chances Understanding impact of health conditions on disability (Mental health, cancer, neurological conditions, MSK) Slide 30 Ageing Well Life expectancy at 65 and disability-free life expectancy at 65 give us a measure of the health of our older population Falls and fractures in older people can lead to loss of independence and death preventing falls has a major impact on health and wellbeing Social isolation and loneliness impact on health and wellbeing particularly for conditions such as dementia reducing isolation can improve outcomes for all ages but particularly our older population Slide 31 Ageing Well: Life expectancy Life expectancy at 65 is increasing for men but plateauing for women Healthy life expectancy for men and women is decreasing Slide 32 Although reducing absolute numbers will impact on resources/outcomes for older people Ageing Well: Falls Slide 33 Ageing Well: Physical Disability Slide 34 The UK has one of the highest Excess Winter Death (EWD) rates in Europe In 2013/14, 78% of EWD in people over 75 years Fuel poverty and keeping warm, major factor in increasing susceptibility Link to social isolation and fuel poverty identification of individuals at risk is key issue Ageing Well: Excess Winter Deaths Slide 35 Ageing Well: Dementia Focus on Improving independence and reducing isolation Prevention Slide 36 Ageing Well: Isolation % of Pensioners who live alone 2011 Census Source: ONS Crown Copyright 2013 % of people over 60 living in pension credit households (IDAOP 2010 DCLG) Source: ONS Crown Copyright 2013 Need to understand scale of the problem and what data sources can help Partnership approach needed to develop interventions to reduce impact of isolation Strategic use of voluntary sector to support Slide 37 Ageing Well Focus on falls prevention; Return on Investment for evidence-based exercise classes, improving independence (opportunity for joint commissioning) Focus on preventable disabilities; blindness (AMD/Reducing Smoking, Diabetic Retinopathy/Screening) Focus on impact of social isolation; partnership working on initiatives to reduce impact