23rd March 2011NHS South Birmingham Board Seminar

Jim McManusJoint Director of Public Health, Birmingham City Council

Health Inequalities – some challenging issues

National Audit Office 2010not on course!

Leading causes of death

Common Risk Factors

Don’t wait for change or direction…move now

Life Expectancy by WardStill there whatever the back office system

Nothing new under the sun?

Age Structure

Population Change 2000-2007

Population Change 2000-2007

Age Structure 2

Life Expectancy

Males - PSA Target 77.56 Years by 20100.6 years under trajectory in 2005-07, 0.7 years under trajectory in 2006-08

Birmingham BEN HOB SOUTH

1995-1997 72.1 73.5 71.2 73.7

2005-2007 75.6 76.01 73.65 76.32

2006-2008 75.9 76.3 74.2 76.6

Females – PSA Target 81.70 Years by 20100.18 years under trajectory in 2005-2007, 0.1 years under trajectory in 2006-2008

Birmingham BEN HOB SOUTH

1995-1997 78.0 78.5 77.6 78.8

2005-2007 80.8 80.44 80.13 81.62

2006-2008 81.0 80.6 80.6 81.8

Male life expectancy - 3 years rolling average

70.00

71.00

72.00

73.00

74.00

75.00

76.00

77.00

78.00

79.00

80.00

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009

2008-2010

2009-2011

Years

Ye

ars

of

ag

e

Birmingham England PSA trajectory*

Projection

PS

A t

arg

et b

asel

ine

year

Lat

est

Tar

get

yea

r

Data source: England and Birmingham MLE - ONSEngland MLE Projection - Government Actuary's DepartmentTrajectories - PHIT

Female life expectancy - 3 years rolling average

75.00

76.00

77.00

78.00

79.00

80.00

81.00

82.00

83.00

84.00

85.00

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

2004-2006

2005-2007

2006-2008

2007-2009

2008-2010

2009-2011

Years

Ye

ars

of

ag

e

Birmingham England PSA trajectory*

Projection

Bas

elin

e ye

ar

Lat

est

Tar

get

yea

r

Data source: England and Birmingham MLE - ONSEngland MLE Projection - Government Actuary's DepartmentTrajectories - PHIT

Male AAACM by IMD Quintile in Birmingham 1995 - 2008

Three year rolling average

0.00

200.00

400.00

600.00

800.00

1000.00

1200.00

1400.00

1995

/ 19

97

1996

/ 19

98

1997

/ 19

99

1998

/ 20

00

1999

/ 20

01

2000

/ 20

02

2001

/ 20

03

2002

/ 20

04

2003

/ 20

05

2004

/ 20

06

2005

/ 20

07

2006

/ 20

08

Years

DS

R

Affluent Less Affluent Average Less Deprived Deprived

Data source: ONS death registrationsPHIT calculation

Female AAACM by IMD Quintile in Birmingham 1995 - 2008

Three year rolling average

0.00

100.00

200.00

300.00

400.00

500.00

600.00

700.00

800.00

900.00

1995

/ 19

97

1996

/ 19

98

1997

/ 19

99

1998

/ 20

00

1999

/ 20

01

2000

/ 20

02

2001

/ 20

03

2002

/ 20

04

2003

/ 20

05

2004

/ 20

06

2005

/ 20

07

2006

/ 20

08

Years

DS

R

Affluent Less Affluent Average Less Deprived Deprived

Data source: ONS death registrationsPHIT calculation

Birmingham by Cadbury Neighbourhood Classifications

Understanding these as drivers and intervening variables

Transit or Escalator– move to more deprived areas

Isolate – move to equally or more deprived areas

Gentrifier -

CVD Mortality and Cost

• There is an opportunity across City to avoid £12.8 million (annual) worth of admissions to hospital through moderately ambitious preventive interventions chosen well

• Doing case finding would give us the potential to reduce CVD risk and we can then model this against life expectancy

Admissions avoided with 3-4% reduction in risk factors

Admissions avoided with 5-6% reduction in risk factors

Children Key Points

• From topic to geography• Geographical clusters with longitudinal affect-

cumulative challenges • Focus on outcomes and not outputs- Brighter

futures Logic model• Focus on Inequalities- reduction in rates

between geographical areas and target groups • Engaging with children and young people on

the results

Childrens Composite Scores

See detailed Map and Sheet

Pupil Census-Somali Speakers

Pupil Census-Pashto/Pakto Speakers

Pupil Census-Polish Speakers

Income Deprivation Affecting ChildrenIndex 2007

Child and Adolescent Mental Health Services Tier 3

Social Gradient for Accessing CAMHS Tier 3 services by CWI Decile 2008BCH

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%

1.60%

1 2 3 4 5 6 7 8 9 10

Child Wellbeing Index Decile (Where 1 is Most Deprived)

Add Trendline

Economic well being: Children's centres registrations

Social Gradient for Childrens centres registration by CWI Quintile2008/9

BCC: Children data

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

1 2 3 4 5

Child Wellbeing Index Quintile(Where 1 is Most Deprived)

Add Trendline

Rates of Chlamydia infection

Rates of Positive Chlamydia tests by Birmingham ward 2006Source: HPU 2008

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

Os

co

tt

Ne

ch

ell

s

As

ton

Sh

ard

En

d

Kin

gs

bu

ry

Pe

rry

Ba

rr

Lo

ng

bri

dg

e

We

ole

y

So

ho

Su

tto

n F

o-u

r O

ak

s

Ha

nd

sw

ort

h

Kin

gs

tan

din

g

Su

tto

n V

es

ey

Ho

dg

e H

ill

Mo

se

ley

Erd

ing

ton

Bra

nd

wo

od

Kin

g's

No

rto

n

La

dy

wo

od

Sa

nd

we

ll

Bo

urn

vil

le

Sh

eld

on

No

rth

fie

ld

Sto

ck

lan

d G

ree

n

Su

tto

n N

ew

Ha

ll

Ed

gb

as

ton

Wa

sh

wo

od

He

ath

Sp

ark

hil

l

Ba

rtle

y G

ree

n

Ha

ll G

ree

n

Sm

all

He

ath

Fo

x H

oll

ies

Qu

into

n

Se

lly

Oa

k

Ac

oc

k's

Gre

en

Ha

rbo

rne

Sp

ark

bro

ok

Bil

les

ley

Ya

rdle

y

Birmingham Average

Hospital admissionsfor accidents

Stay Safe: Impact of deprivation

Social Gradient for Children in Need by CWI Quintile2009

Source: Birmingham City Council

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

50.00

1 2 3 4 5

Child Wellbeing Index Quintile(Where 1 is Most Deprived)

The space for emotional intelligence

The Challenge for most of usand the opportunity!

• We are doing tertiary prevention first because of where we are epidemiologically

• Understand REALLY which levers pull short, medium and long term

Short Term – primary care

Medium to Long Term – LA and other players

Our Burdens of Disease

Primary Secondary Tertiary

Domains of Public Health

Health Improvement

Health Protection

Service Public Health

Where does this go and when will it stop being entirely NHS focused?

Diverse accountabilities

What about the PH role in Commissioning?

Principles

Evidence: Housing and CVD

Evidence: Neighbourhood Economics and CVD

From Neighbourhood Disadvantage to Disease

Life StyleKey figures for life style Deprivation in Birmingham, West Midlands and England

Year Birmingham West Midlands England

Adults who smoke 2003/5 24.9% 24.0% 24.1%

Binge drinking adults* 2003/ 2005 17.8% 17.9% 18.0%

Healthy eating adults** 2003/ 2005 25.1% 25.1% 26.3%

Physically active adults***2007/8

16.9% 19.1% 21.3%

Obese adults**** 2003/ 2005 23.4% 26.5% 23.6%

Population Change 2000-2007

CVD Mortality and Cost

• There is an opportunity across City to avoid £12.8 million (annual) worth of admissions to hospital through moderately ambitious preventive interventions chosen well

• Doing case finding would give us the potential to reduce CVD risk and we can then model this against life expectancy

Admissions avoided with 3-4% reduction in risk factors

Admissions avoided with 5-6% reduction in risk factors