JSNA Life Expectancy. Headline It s important because. The key facts are. Who is affected. What will happen if we do nothing differently

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1 JSNA Life Expectancy Headline It s important because Life Expectancy at birth in Suffolk county Life expectancy is an important measure of population health and provides a mechanism for identifying areas with poor health outcomes and higher need. Healthy or disability free life expectancy provides a quality measure of life by estimating the number of years lived free from disability and ill health. The key facts are Who is affected What will happen if we do nothing differently What works / What can be done Life expectancy ( ) for Suffolk males (79.4 years) was higher than the East of England (78.9 yrs) and England (77.8 yrs) average. Life expectancy for Suffolk females (83.4 years) was also higher than the East of England (82.8 yrs) and England (82.0 yrs) average. Life expectancy among both males and females increased continually between and Ipswich borough has the lowest life expectancy for males (77.9 years) and females (82.6 years) in Suffolk. Males living in the most deprived areas of Suffolk live on average 5.4 years less, and females 4.9 years less, than those living in the least deprived areas. Kirkley ward in Lowestoft has the lowest life expectancy for males in Suffolk (72.0 years). Hoxne ward in Mid Suffolk has the lowest life expectancy for females (73.4 years). This figure may be skewed by the presence of a large nursing home. Bridge ward in Ipswich has the second lowest life expectancy (77.3 years) A low life expectancy is not a cause of ill health but rather an outcome. Areas with shorter life expectancy experience higher levels of premature deaths and infant mortality. The groups and communities within Suffolk who experience shorter life expectancy include those living in deprived areas and from marginalised groups, where the consequence of lifestyle behaviours and challenges in accessing services can cause ill health and premature death. The trend for life expectancy is currently increasing across Suffolk, however poor lifestyle choices may have an adverse impact on this in the future, if these are not addressed. A review of the wider determinants of health is available in the 2010 Annual Public Health Report at The Marmot Review looks at the impact of addressing 1

2 inequalities in health at Who needs to take action What are the achievable benefits Introduction Life expectancy is influenced by lifestyle behaviour, which in turn is influenced by the wider determinants of health. Organisations in Suffolk will need to work in partnership and with local communities, to begin to address these. An increase in healthy life expectancy, to improve quality of life in older age and reduce costs for health and social care. Life expectancy at birth is an important measure of population health. Over the last 8 years there has been a continued increase in life expectancy both nationally and in Suffolk. This increase reflects recent developments in medicine and the changes in lifestyle factors, such as the reduction in smoking prevalence. The historic increase in life expectancy is not guaranteed in the future, as higher levels of obesity and lower levels of physical activity are leading to poorer health, which may lead to a reversal in the trend. Within the population there are inequalities in life expectancy, with some communities and groups experiencing lower life expectancy compared to the rest of the population. By identifying this we can actively work with these groups to address the underlying causes of inequalities and support them in tackling the issues. Although it is important to add years to the lives of the Suffolk population it is also essential to add life to years. In other words, living longer without significant health problems. This is measured by healthy and disability free life expectancy, estimating the number of years a person is expected to live free of disability and health problems. 1) Who s most at risk Communities and groups have a lower life expectancy because they experience a higher level of premature death (death under 75 years) and higher levels of infant mortality compared to the population as a whole. The reasons for this can be partly explained by differences in lifestyle behaviours such as smoking, eating and physical activity, for which the long term consequences can be diabetes, chronic obstructive pulmonary disease (COPD), coronary heart disease and stroke. Genetics can also play a role, with minority groups suffering from a higher prevalence of disease e.g. diabetes in the Afro Caribbean population and coronary heart disease in Bangladeshis. The underlying causes of adverse lifestyle decisions are related to a complex intermix of social factors (employment, early child development, social inclusion etc) and physical factors (housing, transport, planning etc) which influence individuals decision making and ultimately their health outcomes. 2) The level of need in Suffolk 2

3 In life expectancy at birth for males in Suffolk county was 79.4 years which was higher than the East of England (78.9 years) and England and Wales (77.8 years) average. During the same period life expectancy at birth for females in Suffolk county was 83.4 years. This was also higher than the East of England (82.8 years) and England and Wales (82.0 years) average. In life expectancy at age 65 years for males in Suffolk county was 18.5 years. This was higher than the East of England (18.2 years) and England and Wales (17.7 years) average. In life expectancy at age 65 years for females in Suffolk county was 21.2 years. This was higher than life expectancy at age 65 years for females in East of England (20.7 years) and England and Wales (20.3 years). The gap in life expectancy between males and females in Suffolk in was 4 years. Although the overall level of life expectancy is good there are significant inequalities in Suffolk where groups and areas experience lower life expectancy than the rest of the population. Among local authority districts and boroughs in there was a 2.7 year gap in life expectancy for males between the authority with the lowest life expectancy (Ipswich, 77.9 years) and the highest (Suffolk Coastal, 80.6 years). The difference among females was 1.4 years. Life expectancy for Ipswich is similar to the England average (77.8 years). Between 2004 and 2008 males living in the most deprived areas* in Suffolk were found to live 5.6 years less than those living in the least deprived areas of Suffolk. Females living in the most deprived areas of Suffolk were estimated to live 4.8 years less. * Most deprived areas in Suffolk include parts of Harbour, Kirkley, Pakefield, Normaston, St Margaret s, Whitton, Beccles South, Felixstowe west, Whitton, Whitehouse, Priory heath, Gainsborough, Stoke park, Bridge, Alexandra, Gipping & Westgate wards There are large differences in life expectancy among wards in Suffolk. The methodology for calculating life expectancy can be influenced by external factors, therefore care should be taken when interpreting the data. For example, wards containing large nursing or care homes and a small population will experience higher levels of deaths than would normally be experienced for the population size. This can lead to an artificially low life expectancy. Among males in the lowest life expectancy in Suffolk was in Kirkley ward in Lowestoft where life expectancy was 72.0 years. This was 12.5 years less than the ward with the highest life expectancy (Melton and Ufford, 84.4 years). 3

4 Top ten wards in Suffolk county with the lowest life expectancy at birth for males 2003/07 Ward LE Kirkley 72.0 Eastgate 72.8 Bridge 73.6 Alexandra 73.9 Sudbury South 74.1 Harbour 74.5 Whitehouse 74.9 Gipping 74.9 Gainsborough 75.3 Red Lodge 75.4 Among females the ward with the lowest life expectancy was Hoxne, where in life expectancy was 73.7 years (caution should be taken with this figure as it is 3.6 years less than the next ward. It is known that Hoxne contains a large care home which may skew the figures) The ward with the second lowest life expectancy was Bridge ward in Ipswich where life expectancy for females was 77.3 years which is 15.9 years less than Rougham ward (highest life expectancy 93.2 years) Top ten wards in Suffolk county with the lowest life expectancy at birth for females 2003/07 Ward LE Hoxne 73.7 Bridge 77.3 Felixstowe South 77.5 Kirkley 77.8 Brook 78.2 Risby 78.8 Onehouse 78.9 Market 79.0 Westgate 79.2 Oulton 79.2 There is no current local data available on healthy or disability free life expectancy. National estimates suggest that there are large inequalities in healthy life expectancy, with people from routine and manual backgrounds experiencing years less disability free years of life compared to those from professional backgrounds. 4

5 3) Trends - Between and life expectancy at birth for males increased by 1.73 years, which is a larger increase than that for East of England and England Life expectancy at birth Residents of Suffolk County Males Life expectancy (years) Suffolk County East of England England and Wales In the same period life expectancy at birth for females increased by 1.61 years 5

6 Life expectancy at birth Residents of Suffolk County Females Life expectancy (years) Suffolk County East of England England and Wales The gap in life expectancy between males living in the most and least deprived areas in Suffolk county has reduced from 6.5 years in to 5.6 in Among females the trend is less clear. 6

7 Gap in years of life expectancy between most deprived and least deprived in Suffolk County (2001/ /08) Males Females 4) Evidence of what works To improve healthy life expectancy, there is a need to tackle the social and structural wider determinants of health which influence individuals life styles. A literature review on the wider determinants of health, along with further information can be found in the 2010 Annual Public Health Report for Suffolk at The Marmot Review presents evidence to address inequalities in health 5) Recommendations for action There are 10 recommendations within the 2010 annual public health report Recommendation 1 Many organisations in Suffolk have the potential to improve the social and physical 7

8 environment of their local community. Healthy Ambitions Suffolk (HAS) and agencies with a responsibility for health improvement should develop plans to support this work by new approaches including; creating new ways to share and recognise best practice, supporting networks to implement new local wellbeing plans, and supporting innovation and evaluating its impact, so that new evidence can be generated to inform future initiatives. Recommendation 2 Many communities have already made progress in improving health locally with the help of statutory, voluntary or commercial agencies. Agencies working with communities should consider how best to achieve long-lasting, community owned change. This will involve identifying and maximising the major strengths and opportunities of each community, and investing in local people so that they can become community champions or facilitators. Recommendation 3 Healthy Ambitions Suffolk and agencies with a responsibility for health improvement should consider how a community based approach can address two intractable problems, reducing health inequalities and maximising mental wellbeing. This will need new approaches to improve the social and physical environment, and to empower communities to find locally-owned, culturally appropriate solutions. Recommendation 4 Healthy Ambitions Suffolk and agencies with a responsibility for health improvement need to recognise that the health inequalities gap will not be closed by targeting the most deprived communities alone. Specific initiatives will also be needed for the wider community and to address rural health issues. Recommendation 5 GP commissioning already delivers many clinical health improvement services, which address health behaviours such as smoking. With the advent of full GP commissioning, GPs will have greater freedom to work innovatively with communities to improve their health. NHS Suffolk and NHS Great Yarmouth and Waveney should work closely with GP commissioners to support their efforts to improve the long-term health of their communities, as well as continuing their support for clinical health improvement services. Recommendation 6 The evidence that non-statutory agencies are often more successful than the NHS in delivering key health messages to communities, needs to be taken into account. Healthy Ambitions Suffolk and statutory agencies with a responsibility for health improvement need to find better ways to engage with the public so that health messages are appropriate, motivating and clearly understood. Recommendation 7 Healthy Ambitions Suffolk, Greenest County, and agencies with a responsibility for health improvement need to strengthen their alliance, to influence areas which deliver both a sustainable environment and better health. More emphasis should be put on good urban and rural planning, good quality housing and improving opportunities for cycling, walking and outdoor exercise activity Recommendation 8 Local employers have great potential to improve the health of their employees and improve the profitability of their businesses by decreasing sickness rates. An expansion of the HAS business awards scheme, which promotes health and mental wellbeing in the workplace by supporting local businesses, should be considered. Middle-aged, older and lower paid employees may particularly benefit from such schemes. Recommendation 9 Reducing inequality early in life is particularly important in securing the future health of 8

9 the Suffolk population. The Children's Trust and Healthy Ambitions Suffolk need to consider how the health of children aged 0 to 2 years can be maximised. Recommendation 10 There are specific groups who may have difficulty in accessing facilities and initiatives which aim to improve health, for reasons such as language, cultural belief or disability. Particular attention needs to be given to address the needs of these groups, for example, through outreach projects. Key contacts Dr Peter Bradley, Director of Public Health for Suffolk County and NHS Suffolk peter.bradley@suffolkpct.nhs.uk 9