6. Health and Wellbeing Headlines

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1 6. Health and Wellbeing Headlines The residents of West Sussex have a relatively high life expectancy, with male life expectancy at 79.9 years and female life expectancy at 83.5 years, both slightly higher than the figures for England as a whole. From 2009 to 2011, there were over 25,000 total deaths in West Sussex. Of these, about 6,500 deaths were premature. Circulatory diseases including heart disease and stroke are the main cause of mortality accounting for 32.3% (8,180) of deaths. The 2011 Census self-assessment of general health measure showed young people in West Sussex tended to be in good health, with 98% of those 0-15 years of age indicating good or very good health across all districts. This rating drops as age increases, with 56% of those 65 years and over rating their health as very good or good. Survey results showed 13.4% of West Sussex residents aged 16 and over participate in moderate sport or recreation at the recommended level, and 30.1% of adults in West Sussex eat the recommended five portions of fruits and vegetables per day. In West Sussex, an estimated one in four adults are obese. Obesity in children was also assessed, with 7.8% of reception class pupils and 15.6% of Year 6 pupils measured as obese. These figures are lower than the regional and national figures. From 2006/07 to 2010/11, alcohol-related hospital admissions have continued to rise. The Lifestyle Survey in 2010 revealed that over a third of 14 and 15 year olds reported that they occasionally drink alcohol with the principal aim of getting drunk and that at least 10% are reported to regularly do this. 2011/12 survey data shows that in West Sussex, 18.5% of adults aged 18 and over currently smoke, 41.1% are ex-smokers and 40.4% have never smoked. Young people aged 14 to 15 who live in deprived areas of West Sussex are twice as likely to be a regular smoker compared to those in other areas of West Sussex. The number of teenage pregnancies is falling in West Sussex although there is variation across different parts of the county, with Adur, Arun, Crawley and Worthing all above the regional average for teenage conception rates. It is estimated that there are more than 80,000 adults aged between 16 and 74 with mental health problems in West Sussex, most commonly anxiety or depressive episodes. According to the Annual Population survey by the Office for National Statistics, 79.8% of people in West Sussex feel satisfied with life compared to 78.5% in the South East and 75.7% in England as a whole. 97

2 Health and Wellbeing - Life Expectancy Description Life expectancy is a useful summary indicator of the mortality and health of a nation, an area, or a group of people. The most commonly used measure of life expectancy is period life expectancy at birth. This is the average number of years people would live if mortality rates at the time of their birth remain constant throughout their lifetime. However, period life expectancies do not necessarily indicate how long someone is likely to live, as mortality rates change over time. Differences in life expectancy are strongly associated with social deprivation and lifestyle, including factors such as socio-economic status, genetic and biological factors, health behaviours, and environmental conditions. Performance The residents of West Sussex have a relatively high life expectancy, with male life expectancy at 79.9 years and female life expectancy at 83.5 years, both slightly higher than the figures for England. Since , average life expectancy has increased by around two years for both males and females in West Sussex. There are, however, disparities between the districts within West Sussex. Crawley has the longest average life expectancy for men at 81.8 years, and for women, Chichester has the longest life expectancy at 84.4 years. Worthing shows the lowest average life expectancy for both males and females at 77.6 and 82.5 years respectively. While life expectancy has been increasing in all areas, residents born in some parts of the county are expected to live about 12 years less than those in other Table 6.1: Life expectancy at birth by gender Figure 6.1: West Sussex male and female life expectancy at birth over time Table 6.2: Rank of wards by lowest life expectancy at birth, Life expectancy (years) Male Female Adur Arun Chichester Crawley Horsham Mid Sussex Worthing West Sussex South East England Source: Office for National Statistics Life expectancy (years) Source: Office for National Statistics Females Males West Sussex rank Ward District Life expectancy (years) 1 River Arun Marine Arun Heene Worthing Central Worthing Hotham Arun Harting Chichester Rogate Chichester Donnington Chichester Pound Hill North Crawley Pound Hill South & Worth Crawley Maidenbower Crawley 85.4 Source: West Sussex JSNA, 2011 Ward Profiles 98

3 Health and Wellbeing - Life Expectancy parts. River ward in Arun has the lowest life expectancy at 72.8 years, while Maidenbower in Crawley has the highest at 85.4 years. Most wards with the lowest life expectancy were in either Arun or Worthing, while wards with the highest life expectancies were in Chichester or Crawley. Figure 6.2: Life expectancy at birth for persons by ward, Although there are difficulties in trying to disentangle the impact of individual and area-level factors on life expectancy, those living in deprived areas are more likely to drink, smoke, have a poor diet, exercise too little and access health services less often. Additionally, the effect of living in areas of deprivation on life expectancy has been observed to be stronger in men than in women. Map to go here Source: West Sussex JSNA, 2011 Ward Profiles 99

4 Health and Wellbeing - Disability-free Life Expectancy Description Disability- free life expectancy (DFLE) is defined as the average number of years that a person can expect to live free from a limiting long-standing illness or disability if current mortality and disability figures continue to apply. Performance Disability-free life expectancy in West Sussex is 66.5 for males and 69.3 for females. These figures are about 14 years less than life expectancy figures for West Sussex, suggesting that the average person will live for an average of 14 years with some type of limiting illness or disability. Mid Sussex District has the highest number of years that both males and females can, on average, expect to live without a limiting or long-standing illness at 71.6 and 73.0 years respectively. Worthing has the lowest number of DFLE years for males at 63.6 years and Adur has the lowest number of DFLE years for females at 66.6 years. When comparing wards, River in Arun District has the lowest DFLE at 56.2 years, compared to Funtington in Chichester District which has the highest at 71.6, a notable difference of 15.4 years. Table 6.3: Disability-free life expectancy at birth for males and females Disability-free life expectancy (years) Male Female Adur Arun Chichester Crawley Horsham Mid Sussex Worthing West Sussex South East Source: Office for National Statistics Table 6.4: Disability-free life expectancy at birth by ward, West Sussex rank Ward District Disability-free life expectancy (years) 1 River Arun Central Worthing Marine Arun Heene Worthing Bewbush Crawley Bramber, Upper Beeding Horsham Donnington Chichester Rudgwick Horsham East Grinstead Herontye Mid Sussex Forest Horsham Wisborough Green Chichester Funtington Chichester 71.6 Source: Office for National Statistics 100

5 Health and Wellbeing - Disability-free Life Expectancy Figure 6.3: Disability-free life expectancy at birth for persons by ward, Source: Office for National Statistics 101

6 Health and Wellbeing - Causes of Mortality Description The primary causes of death within the county s population are compiled by the Office for National Statistics (ONS) and made available via their Vital Statistics tables. Public Health England (PHE) has also provided statistics for premature mortality, defined as death before the age of 75. Performance Between 2009 and 2011 there were 25,326 total deaths in West Sussex. Circulatory diseases including heart disease and stroke are the biggest cause of death accounting for 32.3% (8,180) of deaths. Four lifestyle risk factors are particularly associated with circulatory disease: smoking, poor diet, sedentary lifestyle and drinking alcohol at unsafe levels. The mortality rate from heart attacks has halved over the last 20 years due to improvements in lifestyle and the availability of new treatments such as thrombolysis and angioplasty. Cancers are the second largest cause of death, accounting for 27.7% of deaths (7,020): lung cancer is the most common cancer and caused 4.8% of deaths (1,226). Colorectal cancer (3.1%), breast cancer (2.3%), prostate cancer (2.2%), pancreatic cancer (1.8%) and oesophageal cancer (1.4%) all caused more than 1% of deaths over the three year period. Respiratory diseases including Chronic Obstructive Pulmonary Disease (COPD) were the cause of 13.8% of deaths (3,504). COPD is caused by long term damage to the lungs, usually associated with smoking. Digestive diseases including alcoholic liver disease caused 4.7% of deaths (1,178). A further 2.0% (513) of deaths were caused by accidents including road traffic accidents, and there were 146 suicides over the three years, accounting for 0.6% of deaths. According to Public Health England, one in three people will die prematurely, with the leading causes of premature deaths being heart disease and stroke, lung disease, liver disease, and cancer. In West Sussex from 2009 to 2011, there were 6,594 premature deaths, which is a rate of 229 out of every 100,000 people. This prevalence rate ranks West Sussex as 23rd best out of 150 local authorities on this measure (i.e. 23rd lowest premature death rate). 102 Table 6.5: Causes of mortality in West Sussex, Number of Cause of death deaths Certain infectious and parasitic diseases 262 Diseases of the digestive system 1,178 Diseases of the genitourinary system 572 Diseases of the musculoskeletal system and connective tissue 304 Diseases of the nervous system 935 Diseases of the respiratory system 3,504 Endocrine, nutritional and metabolic diseases 288 External causes of morbidity and mortality 697 Mental and behavioural disorders 1,427 Accidents 513 Suicides 146 All Other Causes 300 Lung Cancer 1,226 Colorectal Cancer 788 Breast Cancer 579 Cancer of the Pancreas 445 Cancer of the Oesephagus 358 Brain Cancer 177 Prostate Cancer 546 Ovarian Cancer 203 Cancer of the Bladder 229 Other Cancers 2,469 Stroke 2,184 Coronary Heart Disease 3,339 Other circulatory diseases 2,657 Total 25,326 Source: Office for National Statistics

7 Health and Wellbeing - Self-assessment of General Health Description The 2011 Census provides a self-assessment measure for general health on a five-point scale from very bad to very good. These data provide a perceived rating of health and are not based on actual health data over a specific period of time. Performance Young people in West Sussex tended to be in good health, with 97.7% of those aged 0-15 years indicating good or very good health across all districts. This proportion drops as age increases, with 90.7% of year olds, 78.4% of year olds, and 56.3% of those over 65 years rating their health as good or very good. Self-assessment ratings of good health were fairly similar across districts for those in the 0-15 and year age groups. However, variations in general health ratings across districts were more evident for both the and 65+ age categories. Crawley showed the lowest percentage of residents aged 65 and over rating their health as good or very good at 49.0%, while Horsham had the highest percentage at 60.5%. Though districts in West Sussex varied on this measure, all districts, with the exception of Crawley, fell above the England average of 49.4% of those 65 and over indicating being in good health. Figure 6.4: Self-assessment of general health in West Sussex by age, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0.5% 2.3% 1.8% 7.1% 97.7% 90.7% 5.9% 15.7% 78.4% Source: Office for National Statistics, 2011 Census 11.4% 32.2% 56.3% 0 to to to Bad or very bad health Fair health Very good or good health Table 6.6: Percentage of residents rating their health as very good or good by age, years years years 65+ years Adur 97.2% 89.1% 73.5% 51.7% Arun 97.4% 89.2% 75.3% 55.1% Chichester 97.9% 91.8% 80.3% 60.0% Crawley 97.3% 89.9% 73.1% 49.0% Horsham 98.1% 92.4% 83.4% 60.5% Mid Sussex 98.0% 92.5% 82.6% 60.1% Worthing 97.4% 88.8% 75.6% 52.0% West Sussex 97.7% 90.7% 78.4% 56.3% South East 97.5% 91.0% 77.8% 55.2% England 97.2% 89.7% 72.5% 49.4% Source: Office for National Statistics, 2011 Census 103

8 Health and Wellbeing - Long-term Health Problems or Disability Description The 2011 Census also assessed self-reported long-term health problems and disabilities. For the purposes of the Census, a long-term health problem or disability was defined as one that limits a person s day-to-day activities, and has lasted, or is expected to last, at least 12 months, including problems that are related to old age. All respondents were asked to assess whether their daily activities were limited a lot or a little by such a health problem, or whether their daily activities were not limited at all. Performance In West Sussex, 82.8% of the population indicated that their day-to-day activities were not limited, which closely compares to the average for England (82.4%). 96.6% of those aged 0-15 were not at all limited by a disability or long-term illness, while 52.5% of residents aged 65 and over were not at all limited. Across districts there was little variation in the percentage of people limited by disability or long-term illness for those under 50 years of age. However, for the and 65+ age groups, there were some differences between districts. Adur, Crawley, and Worthing had a smaller than average percentage of older people indicating that their day-to-day activities were not limited, while Chichester, Horsham, and Mid Sussex showed higher ratings than the West Sussex average for this measure. Figure 6.5: Limitations on day-to-day activities for West Sussex residents, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1.3% 3.2% 2.1% 4.7% 96.6% 92.1% 7.2% 10.8% 82.1% Source: Office for National Statistics, 2011 Census 21.8% 25.7% 52.5% 0 to to to Day-to-day activities limited a lot Day-to-day activities limited a little Day-to-day activities not limited Table 6.7: Percentage of residents reporting not being limited by disability or long-term illness, years years years 65+ years Adur 95.7% 90.5% 78.1% 49.2% Arun 96.2% 90.8% 79.4% 51.2% Chichester 96.9% 93.1% 83.5% 55.5% Crawley 96.6% 92.2% 78.7% 47.4% Horsham 97.0% 93.2% 86.0% 56.2% Mid Sussex 96.9% 93.5% 85.7% 55.9% Worthing 96.4% 90.5% 79.2% 47.5% West Sussex 96.6% 92.1% 82.1% 52.5% South East 96.4% 92.5% 81.7% 52.0% England 96.3% 91.4% 76.7% 46.9% Source: Office for National Statistics, 2011 Census 104

9 Health and Wellbeing - Healthy Eating and Exercise Description Engaging in a healthy lifestyle, including healthy eating and exercise can help to promote general health. Exercise has been proven to reduce the risk of major illnesses, such as heart disease, stroke, diabetes and cancer by up to 50% as well as lowering the risk of early death by up to 30%. Research also shows that physical activity can also boost self-esteem, mood, sleep quality and energy, as well as reducing the risk of stress, depression, and dementia. Districts in West Sussex varied quite markedly, with Adur and Crawley showing lower than average percentages at 8.8% and 9.4% respectively, while Chichester has a much higher than average percentage at 17.7% of adults. West Sussex was not significantly different from England on the healthy eating measure, with 30.1% of adults indicating that they eat five or more portions of fruit and vegetables per day, compared to 28.7% of adults across England. Chichester was the only district to be significantly better than the England average, with 33.5% of its adult resident population eating the recommended amount of fruit and vegetables. No other districts showed a statistically significant difference from the England average. A healthy diet is also an important aspect of healthy living. Part of a healthy diet involves eating at least five portions of fruit and vegetables a day. Fruit and vegetables are a vital source of vitamins and minerals and evidence shows that people who eat at least five portions a day are at lower risk of heart disease, stroke and some cancers. Figure 6.6: Estimated participation in recommended physical activity levels (aged 16 and over), % Performance The Active People Survey, an annual survey run by Sport England, identifies the proportion of residents that participate in the recommended levels of physical activity, which is defined as moderate intensity sport and active recreation on 20 or more days in the previous 4 weeks. Combined survey results from provide an estimate that 13.4% of West Sussex residents aged 16 and over participate in the recommended amount of physical activity which is slightly above the average for England and the South East. 8.8% Adur 11.8% Arun Chichester 9.4% Crawley 12.8% Horsham 11.9% Mid Sussex 12.1% Worthing 13.4% West Sussex 12.1% South East 11.2% England Source: Association of Public Health Observatories (APHO) 105

10 Health and Wellbeing - Healthy Eating and Exercise Figure 6.7: Percentage of adults who eat a healthy diet Chichester Horsham 32.6% Crawley 26.1% 33.5% WEST SUSSEX 30.1% Mid Sussex 32.3% Arun 28.5% Worthing 28.8% Adur 26.0% Source: Association of Public Health Observatories (APHO) 106

11 Health and Wellbeing - Obesity Description Performance Obesity has serious consequences for health and life expectancy with people who are obese dying on average nine years earlier than those of normal weight. Overweight and obese children are more likely to become obese adults and have a higher risk of mortality, disability and morbidity (disease or illness) in adulthood. Metabolic changes such as raised blood pressure and cholesterol may be seen in obese children and teenagers. Obesity increases the risk of several diseases including: In West Sussex, an estimated one adult in every four is obese (25.0%) compared to the South East region at 23.7% and England at 24.2% of adults. The estimated prevalence of obese adults in Crawley (28.4%) and Adur (27.8%) are significantly higher than both the West Sussex and regional average, while Chichester has the lowest proportion at 22.8% estimated to be obese. Type 2 Diabetes Heart disease and stroke Hypertension (high blood pressure) Osteoarthritis Some cancers such as breast cancer and colon cancer The consequences of obesity are not limited to direct impacts on health. It can also have adverse social effects through discrimination, social exclusion and loss of or lower earnings. Childhood obesity is linked to psychological problems such as low self-esteem, anxiety and depression which are often seen by children themselves as the most serious effects. Figure 6.8: Modelled estimates for obese adults (16+), % Adur Adur 26.0% Arun Arun 22.8% Chichester Chichester 28.4% Crawley Crawley 23.3% Horsham Horsham 23.4% Mid Sussex Mid Sussex 25.1% Worthing Worthing 25.0% West Sussex West Sussex 23.7% 24.2% South East South East England England Source: National Obesity Observatory 107

12 Health and Wellbeing - Obesity The National Child Measurement Programme measures the height and weight of children in reception year (aged between 4 and 5) and Year six (aged 10) in maintained schools in England. The programme began in 2005 and provides the most robust source of childhood obesity data in England. In West Sussex, for the school year , the National Child Measurement Programme showed that 7.8% of reception class pupils and 15.6% of Year 6 pupils were measured obese. Both of these proportions are lower than the regional and England averages. Compared to the West Sussex average of obesity in reception year, Adur and Arun are well above the average at 9.9% and 10.3% respectively, while Mid Sussex is well below the average at 5.3%. For Year 6 children, Crawley and Arun showed the highest obesity prevalence at 19.2% and 18.2% respectively, yet these figures remain at or below the average for England. Horsham and Mid Sussex had the lowest obesity rates for those in Year 6 at 12.7% and 13.0% respectively. Table 6.8: Weight prevalence by area and age, Overweight Obese Number of Children Measured Participation Rate Reception Year 6 Reception Year 6 Reception Year 6 Reception Year 6 Adur 14.6% 14.4% 9.9% 17.0% % 89.5% Arun 12.6% 14.6% 10.3% 18.2% 1,160 1, % 89.1% Chichester 13.4% 14.0% 6.8% 14.8% 1, % 89.5% Crawley 10.4% 15.2% 8.4% 19.2% 969 1, % 93.9% Horsham 12.7% 14.1% 8.1% 12.7% 814 1, % 91.5% Mid Sussex 12.9% 12.1% 5.3% 13.0% 1,405 1, % 90.7% Worthing 13.4% 15.5% 7.5% 14.8% % 88.1% West Sussex 12.7% 14.2% 7.8% 15.6% 6,868 6, % 90.5% South East 12.5% 14.3% 8.3% 16.5% 88,053 76, % 91.1% England 13.1% 14.7% 9.5% 19.2% 565, , % 92.4% Source: National Obesity Observatory, National Childhood Measurement Programme 108

13 Health and Wellbeing - Obesity Figure 6.9: Proportion of weight by children in reception year in West Sussex, Figure 6.10: Proportion of weight by children in year 6 in West Sussex, % 1.0% 12.7% 7.8% Underweight 15.6% Underweight Healthy 14.2% Healthy 78.6% Overweight 69.2% Overweight Obese Obese Source: National Obesity Observatory, National Childhood Measurement Programme 109 Source: National Obesity Observatory, National Childhood Measurement Programme

14 Health and Wellbeing - Alcohol Description Performance The impacts of harmful drinking on individuals, families and society are wide ranging, including: health, e.g. deaths from liver disease and accidents as well as increased cardiovascular disease; crime, including domestic abuse, assault or drinkdriving and; employment or a lack thereof. Figure 6.11: Alcohol related hospital admissions per 100,000 population, 2006/07 to 2010/11 Admissions per 100,000 population 12,000 10,000 8,000 6,000 4,000 2, / / / / /11 Source: North West Public Health Observatory, 2011 Over the last 5 years, alcohol related admissions to hospital have continued to show annual increases in all districts and boroughs apart from Chichester which saw slight decreases in 2008/09 and 2009/10. The largest increase in alcohol related hospital admissions over the past five years was seen in Mid Sussex, which had a 49.2% increase from 2006/7 to 2010/11. Adur also showed a larger than average increase at 46.1%. Chichester has seen the smallest increase over the past five years, up 14.1%, followed by Crawley at 24.1%, which saw levels of alcohol related hospital admissions remain static from 2009/10 to 2010/11. Worthing Mid Sussex Horsham Crawley Chichester Arun Adur Note: Includes admissions for chronic conditions as well as injuries related to alcohol. 110 Table 6.9: Alcohol related hospital admissions per 100,000 population Increase 2006/07 to 2010/11 Percentage increase Adur % Arun % Chichester % Crawley % Horsham % Mid Sussex % Worthing % South East % England % Source: North West Public Health Observatory, 2011 Note: Includes admissions for chronic conditions as well as injuries related to alcohol.

15 Health and Wellbeing - Alcohol National research suggests that the cost of alcohol related harm in England exceeds 2.7 billion every year. The biggest cost is from hospital in-patient admissions, followed by A&E attendances. Of the recorded in-patient and day visits, million was for patients with directly attributable alcohol misuse and million for those whose hospitalisation was partly attributable to alcohol misuse. To put these figures into context, estimates provided by the Cabinet Office Strategy Unit suggest that alcohol related harm costs every household in England & Wales an average 925 a year. The North West Public Health Observatory produced modelled synthetic estimates of the levels of drinking at the local authority level based on lifestyle survey data, hospital admissions, mortality data and population characteristics. Estimates were calculated based on four groups: abstainers, lower risk drinkers, increasing risk drinkers and higher risk drinkers. On average throughout England, it is estimated that 16.5% of people abstain from drinking alcohol. Districts in West Sussex vary on this measure, with Crawley showing the highest percentage of abstainers at 18.2% and Horsham and Mid Sussex the lowest at 13.4% and 13.5% respectively. Table 6.10: Cost of alcohol related harm in England Figure 6.12: Percentage of residents abstaining from alcohol use, modelled estimates 2011 Cost of Alcohol Harm (NHS England) Cost estimate ( millions) Hospital Inpatient & Day Visits 1,190.3 Hospital Outpatient Visits Accident & Emergency Visits Ambulance Services % 14.9% 14.3% 18.2% 13.4% 13.5% 15.3% 14.7% 16.5% NHS GP Consultations Practise Nurse Consultations 9.5 Laboratory Tests n/a Dependancy Prescribed Drugs 2.1 Specialist Treatment Services 55.3 Other Health Care Costs 54.4 Total 2,704.2 Source: NHS Information Centre Adur Arun Chichester Crawley Horsham Mid Sussex Worthing South East England Source: Local Alcohol Profiles for England (LAPE) 111

16 Health and Wellbeing - Alcohol Of those members of the England population that do engage in drinking in some capacity, 73.3% were estimated to be in the low risk category, 20.0% in the increasing risk category, and 6.8% in the higher risk category. Districts in West Sussex did not vary greatly from the England averages on this measure. It is important to note that as these data are based on modelled estimates, the information should be treated with caution. Binge drinking is broadly defined as drinking a large amount of alcohol in a short space of time, also drinking to get drunk or to feel the effects of alcohol. The Association of Public Health Observatories created synthetic estimates of binge drinking rates throughout England. It is important to note that as modelled synthetic estimates these data should be treated with caution. In West Sussex, it was estimated that 16.6% of the adult population engages in binge drinking, as compared to the national average of 20.1%. While all districts fell below the England average, Worthing was found to have the highest percentage in West Sussex with 18.8% of its adult population engaging in binge drinking and Arun showed the lowest percentage at 15.1%. Table 6.11: Percentage of drinkers by risk category, 2011 Figure 6.13: Percentage of adults engaging in binge drinking, modelled estimates 2011 Lower Risk Confidence Interval Increasing risk Confidence Interval Higher Risk Confidence Interval Adur %-86.5% %-38.2% %-20.2% Arun %-86.7% %-39.0% %-21.7% Chichester %-85.2% %-39.8% %-22.6% Crawley %-87.0% %-37.8% %-22.2% 16.1% 15.1% 16.2% 16.0% 17.3% 17.1% 18.8% 16.6% 18.1% 20.1% Horsham %-85.4% %-40.7% %-20.7% Mid Sussex %-86.4% %-41.5% %-20.1% Worthing %-86.1% %-40.1% %-22.1% South East %-86.0% %-39.9% %-21.6% England %-86.4% %-38.5% %-21.8% Source: Local Alcohol Profiles for England (LAPE) Adur Arun Chichester Crawley Horsham Mis Sussex Worthing West Sussex South East England 112 Source: Local Alcohol Profiles for England (LAPE)

17 Health and Wellbeing - Alcohol In West Sussex, the Lifestyle Survey 2010 revealed that over a third of 14 and 15 year olds reported that they occasionally drink alcohol with the principal aim of getting drunk and that about 10% reported they regularly binge drink. Crawley showed the highest percentage of young people that never binge drink at 68%, while Arun showed the lowest at 53%. The results of the survey also highlighted a connection between alcohol consumption and self-reported health, as those reporting to drink alcohol regularly also believed their general health was worse than those who drank less. Figure 6.14: Self-perceived health of 14 to 15 year olds who regularly drink or rarely/never drink Regularly Drink Good 36.8% Fair 49.6% Bad 13.6% Rarely/never Drink Good 58.3% Fair 38.6% Bad 3.2% Source: Lifestyles of 14 to 15 year-olds in West Sussex, 2010 survey Figure 6.15: year-olds reporting binge drinking, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 33.3% 59.7% Source: Lifestyles of 14 to 15 year-olds in West Sussex, 2010 survey Table 6.12: Self-perceived health compared to the frequency of alcohol consumption Good 58.3% 50.6% 36.8% 51.9% Fairly good 38.6% 44.6% 49.6% 43.0% Not good 3.2% 4.8% 13.6% 5.1% Number of respondents 1,174 1, ,361 Source: Lifestyles of 14 to 15 year-olds in West Sussex, 2010 survey % 10.8% 9.3% 5.5% Adur Self-Perceived Health 36.1% 53.1% Arun 33.5% 57.2% Chichester Never/rarely consume alcohol 26.8% 67.7% Crawley Occasionally consume alcohol 10.9% 8.7% 8.6% 32.8% 56.2% Horsham 30.4% 60.9% Mid Sussex Regularly consumed alcohol 32.9% 58.5% Worthing All Pupils Regular Occasional Never

18 Health and Wellbeing - Smoking Description Smoking is the largest single preventable cause of illhealth and premature death in the UK. Smoking increases the risk of a variety of health conditions including lung cancer, heart attacks, stroke, complications during pregnancy and impotence. Children and young people who start smoking are more likely to continue smoking as adults and are less likely to give up than those who start smoking later in life. Additionally, there are marked differences in sections of the community in smoking prevalence and consumption, varying by factors such as age, sex, social class and ethnicity. Table 6.13: Smoking prevalence among adults (18+), 2011/12 Sample Size Current smoker Smoking Status, April 2011-March 2012 Ex-smoker Never smoked England 201, % 33.2% 46.8% 19.8% % Source: Office for National Statistics, Integrated Household Survey; Public Health England Figure 6.16: Adult (18+) smoking prevalence in West Sussex, 2011/12 Source: Office for National Statistics, Integrated Household Survey; Public Health England Confidence interval; current smoker Adur % 43.1% 40.0% 10.2% % Arun % 49.4% 38.4% 8.7% % Chichester % 38.2% 40.8% 16.4% % Crawley % 35.5% 43.3% 16.1% % Horsham % 41.0% 44.3% 10.7% % Mid-Sussex % 36.7% 39.1% 19.6% % Worthing % 42.0% 37.5% 15.1% % West Sussex 1, % 41.1% 40.4% 16.7% % South East 30, % 36.3% 45.1% 18.1% % Smoker 19% Ex-Smoker 41% Performance 19% Never Smoked 40% Integrated Household Survey data suggests that smoking prevalence in England for adults is 20.0%. This compares with 33.2% of the population who are classified as exsmokers and 46.8% indicate never having smoked. For West Sussex, the survey data indicates that 18.5% of adults aged 18 and over currently smoke, 41.1% are ex-smokers and 40.4% have never smoked. Smoking prevalence rates vary by district, but these variations should be considered with caution due to the small number of people surveyed when viewing the data at district level. Figure 6.17: Smoking habits of 14 and 15 year-olds in West Sussex, % 65.5% 6.2% 7.6% 16.8% 12.9% Boys (1,674) Girls (1,708) 7.8% 10.1% Never Stopped Occassionally Regularly Source: Lifestyles of 14 to 15 year olds in West Sussex, 2010 survey Young people taking part in the 2010 Lifestyles of 14 to 15 year olds in West Sussex survey were asked to describe their smoking status by indicating whether they had never smoked, used to smoke, smoke occasionally or smoke regularly. The responses show that although 69.3% reported never having smoked cigarettes, over 10% of girls and 8% of boys were regular smokers by the age of 15. The survey found that the age pupils were first exposed to cigarettes was an important factor in predicting future smoking behaviours with those who first smoke at a younger age being more likely to be regular smokers and less likely to give up smoking in later life. Research shows that over 70% of current smokers had their first cigarette between the ages of 12 and

19 Health and Wellbeing - Sexual Health and Teenage Pregnancy Description Sexually transmitted infections (STIs) are diseases passed on through unprotected sex (sex without a condom) or sometimes through genital contact. They affect both men and women and do not always have obvious symptoms but can have long lasting consequences. An estimated 63 million a year is spent by the NHS on dealing with the effects of teenage pregnancies. Information about under-18 conceptions is produced by the Office for National Statistics and compiled using information from registrations of births and notifications of legal abortions. At a local level rates are generally produced per 1,000 female population aged 15 to 17 years, and presented as three year aggregations to overcome problems of fluctuation in the numbers from year to year. Table 6.14: Rates of selected STI diagnoses per 100,000 population, 2011 Chlamydia Total Gonorrhoea Syphilis Herpes Warts Acute STIs Adur 1, Arun 1, Chichester 1, Crawley 1, Horsham 1, Mid Sussex 1, Worthing 2, South East 1, England 2, Source: Health Protection Agency Performance Over the past decade, there has been an increase in STIs, with teenagers at particular risk. However, districts in West Sussex tend to have lower rates of STIs than in the rest of the South East and England, with the exception of Crawley. In 2011, Crawley showed the highest level of diagnosed STIs per 100,000 in the county with cases of chlamydia, 48.3 of gonorrhoea, 6.5 of syphilis, of herpes, of warts, and of other acute STIs. 115

20 Health and Wellbeing - Sexual Health and Teenage Pregnancy The overall rate of conception in girls aged 15 to 17 in West Sussex is lower than for the South East and England. In the period from 2009 to 2011, there were 26.7 conceptions per 1,000 girls, compared to the rate for England of There is considerable variation in the rate of teenage pregnancies across the county, with the highest rate in Crawley (37.7 per 1,000), followed by Arun (33.6 per 1,000) and Worthing (32.7 per 1000). Mid Sussex and Horsham showed the lowest rates at 18.8 and 15.9 per 1,000 respectively. From 2005/07 to 2009/11, there has been a general decrease in conception rates of women aged 15 to 17 in West Sussex. In the period from 2009 to 2011, the percentage of conceptions leading to abortions for women under 18 was 57.2%, compared to 49.6% in England. Adur had the highest proportion with 66.8% of teenage conceptions leading to abortion, whilst Chichester had the lowest at 51.0%. Table 6.15: Conception rates per 1,000 women aged 15 to 17, 2005/07 to 2009/ Rate per 1, Rate per 1, Rate per 1, Rate per 1, Adur Arun Chichester Crawley Horsham Mid Sussex Worthing West Sussex 1, , , , , South East 15, , , , , Rate per 1,000 England 119, , , , , Source: East Midlands Public Health Observatory (EMPHO) Table 6.16: Percentage of conceptions leading to abortion (under 18s), % of conceptions leading to abortion (under 18s) Adur 49.6 Arun 51.2 Chichester 57.2 Crawley 57.3 Horsham 52.9 Mid Sussex 51.0 Worthing 54.2 West Sussex 64.6 South East 66.8 England 57.1 Source: Office for National Statistics 116

21 Health and Wellbeing - Mental Health and Wellbeing Description Over the course of a year, it is estimated that one in four people in the UK will suffer a mental health problem. Mental health is estimated to cost the economy 105 billion in England alone, and treatment costs are expected to double in the next 20 years. Anxiety and depression are the most common forms of mental illness with about one in ten people in the UK affected at any given time according to the Mental Health Foundation. Performance It is estimated that there are more than 80,000 adults aged between 16 and 74 years in West Sussex suffering from a mental health disorder, most commonly mixed anxiety disorder, which covers a range of anxiety and depressive feelings. Community Mental Health Profiles were produced for each of the local authorities by the North East Public Health Observatory. These profiles are designed to provide local authorities with an overview of mental health risk factors and prevalence, with information comparable at the local, regional and national level. In 2011/12, the prevalence of depression for those aged 18 and over in West Sussex was 12.4%, compared to 11.6% in the South East and 11.7% in England. This value indicates that West Sussex is significantly worse than the England average for this measure. The dementia prevalence rate in 2011/12 in West Sussex was 0.7% of adults aged 18 and over. This rate is significantly higher than the England average of 0.5%, indicating that West Sussex has a slightly larger than average Table 6.17: Mental health disorders of adults (16+) in West Sussex Mental Health Disorder Any neurotic disorder 81,775 Source: Mental Health Observatory, Briefing 4 Note: Figures do not sum as individuals may suffer from more than one type of mental health disorder number of people suffering from dementia, which is mainly due to the large size of the older population in West Sussex. Learning disabilities were also assessed in the Community Mental Health Profiles, as those with learning disabilities have a higher prevalence of mental health problems than those without learning disabilities. It was found that 0.5% of adults 18 and over in West Sussex have a learning disability, roughly the same proportion as seen across England. Younger people The Lifestyles of 14 to 15 year olds in West Sussex 2010 survey included a range of questions designed to assess the self-perceived emotional wellbeing of young people. Pupils were asked how often they suffered from stress, how often they felt depressed or held themselves 117 Number in West Sussex (16-74 year olds) Mixed anxiety disorder 45,375 Generalised anxiety disorder 21,830 Depressive episode 11,360 All phobias 6,660 Panic disorder 4,350 Obsessive compulsive disorder 4,245 Figure 6.18: The emotional wellbeing of young people in West Sussex Deprived area Non-deprived area 8.1% 6.2% 17.7% 12.3% 20.1% 17.9% Regularly depressed Regularly feel stressed Low self-esteem Source: Lifestyles of 14 to 15 year olds in West Sussex 2010 in low esteem. Key findings from the report showed that the levels of mental wellbeing have remained consistent with those reported in the 2007 survey, with girls being twice as likely as boys to report poor mental or emotional wellbeing. Young people living in more deprived areas were more likely to report negative levels of emotional wellbeing than those who did not, with girls from deprived areas being the highest risk of suffering from poor self-esteem or depression. The survey also established that there was a link between feeling depressed or stressed and whether the individual participated in moderate physical activity at least three times a week. In general, higher levels of depression and stress were associated with lower levels

22 Health and Wellbeing - Mental Health and Wellbeing Table 6.18: Feelings of stress, depression and self-esteem compared with levels of physical activity Never/hardly ever Never/hardly ever How High self-esteem stressed High self-esteem depressed stressed Active? Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Very 69.1% 56.3% 55.4% 31.4% 39.8% 20.3% Very 69.1% 56.3% 55.4% 31.4% 39.8% 20.3% Moderate 53.7% 42.3% 41.3% 25.0% 23.0% 8.8% Moderate 53.7% 42.3% 41.3% 25.0% 23.0% 8.8% Not 41.8% 28.6% 30.4% 16.7% 16.7% 4.8% Not 41.8% 28.6% 30.4% 16.7% 16.7% 4.8% Source: Lifestyles of 14 to 15 year olds in West Sussex 2010 of activity. Boys tended to record a higher level of activity and were also less likely to experience feelings of depression or stress, and the majority of boys also reported higher levels of self-esteem than girls regardless of their level of activity. Older People Alongside child wellbeing, mental health and wellbeing in older people is also an important consideration. It is estimated that in West Sussex approximately 15,100 older people have depression, which is expected to rise to 17,600 older people by 2020 due to the ageing population. In West Sussex, women aged 65 and over are nearly twice as likely to have depression compared to men, with 5,000 males classed as depressed compared to 10,100 females in However, variations in diagnoses between men and women may be due to men being less likely to seek medical care than women. Table 6.19: Rates of depression in older people, by gender Age Group Males Females % 10.9% % 9.5% % 10.7% % 9.2% % 11.1% Source: McDougall et al, Prevalence of depression in older people in England and Wales Figure 6.19: People aged 65 or over predicted to have depression in West Sussex 15,144 15,892 16,470 17,036 17,618 By 2020 it is predicted that there will be a 22% increase in the number of over 65s with depression in Horsham, whilst Adur is predicted to have an increase of 11%. All other districts and boroughs in West Sussex are expected to have a rise of between 14-18% over the next 8 years due the ageing population Source: Protecting Older People Population Information System (POPPI), v8.0

23 Health and Wellbeing - Mental Health and Wellbeing Dementia is another important mental health consideration for older people. Dementia is a syndrome that is associated with mental decline and may include problems such as memory loss, reduced comprehension skills, and slower speeds of thinking. It primarily affects people aged 65 and older. There are around 800,000 people in the UK living with dementia, and it is estimated that one in three people over the age of 65 will develop dementia at some stage. In West Sussex, it is estimated that there are about 12,600 people over the age of 65 with dementia. There are about twice as many women than men that Figure 6.20: Estimated dementia prevalence in West Sussex, by age and gender experience dementia, which is partly due to women having a longer life expectancy than men as well as the higher prevalence rates of dementia for women aged 75 and older. The number of people experiencing dementia is also expected to rise in West Sussex, again due to the ageing population. According to estimates, by 2020 there will be around 16,000 older people living with dementia in West Sussex. District variations were predicted, with Horsham showing the largest percentage increase from 2012 to 2020 at 31% and Worthing showing the smallest percentage increase at 13%. Figure 6.21: People aged 65 and over predicted to have dementia, by district Figure 6.22: People aged 65 and over predicted to have dementia, in West Sussex, projected to ,268 13,810 14,458 15,226 16, Source: Protecting Older People Population Information System (POPPI), v8.0 Note: Figures used are Adjusted National Dementia Prevalence estimates using GP patient list numbers ,127 1,061 2, ,429 Source: NHS Dementia Prevalence Calculator v ,515 Male Female ,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 Adur Source: Protecting Older People Population Information System (POPPI), v Worthing Mid Sussex Horsham Crawley Chichester Arun Table 6.20: Rates of dementia in older people, by gender Age Group Males Females % 1.5% 1.0% 1.0% % 2.4% % 2.4% % 6.5% % 6.5% % 13.3% % 16.7% 13.3% 22.2% % 16.7% 30.7% 22.2% % 30.7% Source: Dementia UK (a report into the prevalence and cost of dementia), 2007

24 Health and Wellbeing - Subjective Wellbeing Description Wellbeing and health are intrinsically linked. While wellbeing is often a loosely defined term, there has been a recent interest in defining and measuring wellbeing, including social, environmental, and economic factors. One such measurement is the ONS Annual Population survey of subjective wellbeing, which measures wellbeing by asking people to rate how they think and feel about their own lives. The survey included questions about overall life satisfaction, the extent to which respondents feel their life is worthwhile, how happy the person felt yesterday, and how anxious the person felt yesterday. Performance This data presents experimental estimates from the first subjective wellbeing Annual Population Survey (APS) dataset, April 2011 to March 2012, with overall estimates of people s views about their own wellbeing provided. Overall, West Sussex had a slightly higher proportion of people giving a high or very high rating for the majority of wellbeing indicators compared to the South East and England as a whole. 79.8% of people in West Sussex felt satisfied with life compared to 78.5% for the South East and 75.7% for England. More people in West Sussex felt that the things they do in their life are worthwhile (84.7%) when compared to both the South East (82.2%) and England (79.9%) and more people in West Sussex were feeling happy yesterday (73.9%) than in the South East (72.8%) and England (71.0%) also. A slightly higher proportion of people in West Sussex gave a low/very low rating for feeling anxious yesterday (62.0%) than in the South East (61.2%) and England (59.9%). Figure 6.23: Proportion of respondents with high life satisfaction, feeling worthwhile and happy yesterday ratings and low anxious yesterday ratings 80% 79% 76% 85% 82% 80% 74% 73% 71% 62% 61% 60% West Sussex South East England Life satisfaction high/very high Feeling worthwhile high/very high Happy yesterday high/very high Anxious yesterday low/very low Source: Office for National Statistics, Annual Population Survey 120

25 Health and Wellbeing - Subjective Wellbeing Figure 6.24: Comparison of the mean average score for life satisfaction across the South East Figure 6.25: Comparison of the mean average score for worthwhile across the South East Bracknell Forest 7.41 Bracknell Forest 7.59 Brighton and Hove 7.57 Brighton and Hove 7.77 Buckinghamshire East Sussex Buckinghamshire East Sussex Hampshire Isle of Wight Kent Hampshire Isle of Wight Kent Medway 7.21 Medway 7.74 Milton Keynes 7.32 Milton Keynes 7.59 Oxfordshire 7.49 Oxfordshire 7.61 Portsmouth 7.38 Portsmouth 7.5 Reading Slough Reading Slough Southampton 7.45 Southampton 7.62 Surrey 7.53 Surrey 7.78 West Berkshire 7.42 West Berkshire 7.79 West Sussex Windsor and Maidenhead Wokingham South East West Sussex Windsor and Maidenhead Wokingham South East Source: Office for National Statistics, Annual Population Survey Source: Office for National Statistics, Annual Population Survey 121

26 Health and Wellbeing - Subjective Wellbeing Figure 6.26 Comparison of the mean average score for happy yesterday across the South East Figure 6.27 Comparison of the mean average score for anxious yesterday across the South East Bracknell Forest Brighton and Hove Buckinghamshire East Sussex Hampshire Isle of Wight Kent Medway Milton Keynes Oxfordshire Portsmouth Reading Slough Southampton Surrey West Berkshire West Sussex Windsor and Maidenhead Wokingham South East Bracknell Forest Brighton and Hove Buckinghamshire East Sussex Hampshire Isle of Wight Kent Medway Milton Keynes Oxfordshire Portsmouth Reading Slough Southampton Surrey West Berkshire West Sussex Windsor and Maidenhead Wokingham South East Source: Office for National Statistics, Annual Population Survey Source: Office for National Statistics, Annual Population Survey 122