lots of stuff about wellbeing - belfast healthy cities cox 12... · lots of stuff about wellbeing...
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Lots of stuff about wellbeing
Dr Derek CoxDirector of Public HealthDumfries and Galloway
Summary
• Why wellbeing?• What is wellbeing?• What have we done?• What’s next?
20th century trends in life expectancy in Scotland and 16 other Western European countries
Males
30
40
50
60
70
80
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000Year of birth
Life
exp
ecta
ncy
Trends in life expectancy Trends in life expectancy -- malesmales
The determinants of illness?
• Income inequality• Smoking• Diet
Deprivation in 1981
Deprivation in 1991
Deprivation in 2001
Excess Standardised Mortality (Scotland v. E&W)
0
2
4
6
8
10
12
14
16
1981 1991 2001
Exce
ss M
orta
lity
(%)
Age & SexAge, Sex & Deprivation
The redistribution of wealth and resources for the sole purpose of reducing inequalities in health would be a long term strategy of uncertain success.’
How to improve healthHow to improve health
J Bunker 1995
World Health Organization (1997 and 2003) www.heartstats.org
Prevalence of smoking by country, in 15 year olds by sex, 2000/01, Europe
0
5
10
15
20
25
30
35
40
45
50
Ukraine
Lithu
ania
German
yEsto
niaSlov
enia
Czech
Rep
ublic
Latvi
aFinl
and
Hunga
ry
Russia
n Fed
eratio
n Aus
triaFran
cePola
nd
Switzerl
and
Spain
Belgium
- Flem
ish sp
eakin
gCroa
tia
Netherl
ands
Belgium
- Fren
ch sp
eakin
gIta
ly
United
Kingdo
m - Eng
land
Irelan
dNorw
ayPort
ugal
DenmarkIsr
ael
Malta
United
Kingdo
m - Sco
tland
United
Kingdo
m - Wale
s
Maced
onia,
FYRGree
ceSwed
en%
regu
lar s
mok
ers
Boys
Girls
Male smoking prevalence -Europe
Males
Female smoking prevalence -Europe
Females
Comparison of lung cancer mortality in West of Scotland
and 3 major cohorts
0
100
200
300
400
500
0 10 20 30 40
Average number of cigarettes smoked daily
West of Scotland
UK doctorsAmerican Cancer Society volunteers
US veterans
Average
annual
death rate
/100,000
Coronary heart disease mortalityMen aged 15-74 years
100
200
300
400
500
600
1950 1960 1970 1980 1990
DenmarkFinlandNorwaySwedenScotland
Age
-sta
ndar
dise
d m
orta
lity
per 1
00,0
00
Risk of death by level of hopelessness
00.5
11.5
22.5
33.5
4
All cause CVD Non CVD Cancer
LowMediumHigh
Deprivation and inflammatory status
0
0.5
1
1.5
2
2.5
3
3.5
1 2 3 4 5 6 7
Non smokersSmokers
CRPMg/dl
Affluent Depcat Deprived
• What do we mean by wellbeing?• Do we know how to measure it?• Would measuring it help us to know how
to advance it?
• Subsistence• Protection/security• Affection• Understanding• Participation
• Leisure/idleness• Creativity• Identity• Freedom• (Transcendence)
The survey
• 2502 people• 16 years and upwards• Representative sample• Postal questionnaire• Internet option• Home visit option• 51.2% response• Poor response in young men• Poor response from deprived areas
Wellbeing and SIMD Zone
0
10
2030
40
50
6070
80
1 2 3 4 5SIMD zone
Self reported healthPercentage worse than expected
0
5
10
15
20
25
30
35
40
45
1 2 3 4 5
WellbeingSIMD
Quintiles
WeightPercentage obese
0
5
10
15
20
25
30
1 2 3 4 5
WellbeingSIMD
Quintiles
Waist circumferencePercentage over threshold
0
5
10
15
20
25
30
35
1 2 3 4 5
WellbeingSIMD
Quintiles
Percentage problem drinkers
0
2
4
6
8
10
12
14
16
18
1 2 3 4 5
WellbeingSIMD
Quintiles
Job controlPercentage low
0
10
20
30
40
50
60
1 2 3 4 5
WellbeingSIMD
Quintiles
Moderate exercisePercentage never
0
5
10
15
20
25
1 2 3 4 5
WellbeingSIMD
Quintiles
Ability to cope with stressPercentage negative
0
10
20
30
40
50
60
70
1 2 3 4 5
WellbeingSIMD
Quintiles
DepressionPercentage with any level
0
10
20
30
40
50
60
1 2 3 4 5
WellbeingSIMD
Quintiles
AnxietyPercentage with any level
0
10
20
30
40
50
60
70
80
1 2 3 4 5
WellbeingSIMD
Quintiles
Conclusions
• Physical regeneration projects are doomed to failure if they do not go hand in hand with addressing the psycho-social environment
• At least in rural areas, target people not places
Next steps
• CRP, Interleukin-6 and cortisol study• Randomised intervention trial• Depression/anxiety project
Depression and Wellbeing
0
10
20
30
40
50
60
70
80
90
100
Normal Mild Moderate Severe
Q1Q2Q3Q4Q5
%
Wellbeing
• John Witherspoon• American Declaration of Independence• The pursuit of happiness
Self rated health (SRH)
05
1015202530354045
Q1 Q2 Q3 Q4 Q5
SRH - crudeSRH - adjusted
% worse than expected
Wellbeing quintiles
Relative risk of death from coronary heart disease among civil servants according to employment grade
(Proportions of differences explained by risk factors)
Source: Rose G, Marmot M. Social class and coronary heart disease. British Heart Journal. 1981; 13-19
Relative risk of death from coronary heart disease among civil servants according to employment grade
(Proportions of differences explained by risk factors)
Source: Rose G, Marmot M. Social class and coronary heart disease. British Heart Journal. 1981; 13-19