To receive a presentation on the Annual report of the Director of Public Health and consider issues arising from it.

The Committee received a presentation on the Annual Report of the Director of Public Health 2007 and issues arising from it.

Dr Frances Howie, Associate Director of Public Health gave a presentation on the report.  She said that she would be happy to report to the Committee in greater depth on any of the key issues.

The presentation focused on general health, health inequalities, risk-taking (smoking, drinking, obesity); and other challenges (ageing, climate change).  The main points made in the presentation are summarised below. 

General health

Generally health is good in Herefordshire and people have a higher life expectancy compared with national averages.

Childhood mortality rates are low, infant mortality is also low. Standard Mortality Ratios (SMR) are generally below average.  However, they are above average in three key areas: stroke, all accidents and land transport accidents.

Although, small in number the statistics for years of life lost showed 7% of all years of life lost up to 75 come from land transport accidents, and 11% from all accidents.  There was scope for the Health Service and its partners to influence  these areas.

Cancer deaths account for 36% of all years of life lost. 

Circulatory diseases account for 24%.

The female SMR for stroke was 133 against the SMR for England of 100 and had proved resistant to change: there had been SMR of 131 in 1993.

Dental health of children is poor.  The mean number of decayed, missing or filled teeth in 5-year olds in 2005/2006 was 1.78, compared with 1.02 in the West Midlands.  There were significant differences between different social classes.

Health inequalities

These exist in Herefordshire as elsewhere with a 4 year life expectancy gap between the well-off and less well-off quartiles. SMRs are higher in the socio-economically deprived areas.  SMR = 133 for men in South Wye (compared with the Herefordshire figure of 100). SMR = 129 for men in 18 most deprived Super Output Areas (SOAs). Gender differences: for women in South Wye SMR =110, and 102 in SOAs.

Perinatal mortality: 4 years data, rate of 4.71 in least deprived quartile; 9.43 in most deprived quartile; and 13.8 in South Wye.  Inequalities are reflected at a low age.

Hospital admission rates per 1,000 – men 177.2 for whole county, 234.7 for D18, 248.4 for South Wye.  Especially high admission rates for coronary heart disease, respiratory, psychiatric and paediatric from D18 and South Wye.

Key risk taking behaviours (Smoking Drinking, and Obesity) are more likely in the deprived areas.  Action directed at these behaviours would have the most significant impact on health.

Risk-taking:  smoking

2005 Adult Regional Lifestyle Survey - 21% of adult population in Herefordshire smokes - 25% of men and 19% of women. Highest rate here is among 35-44 year olds (29%) (regional average of 22%).

2006 Teenage Lifestyle Survey (Years 7, 8, 9 and 10) - 10% of 15 year old boys, 25% of 15 year old girls smoke.  44% of children said at least one person at home smokes.

Risk-taking:  drinking

Recommended: no more than 21 units a week for men; 14 for women: binge is 8 units a day for men, 6 for women. 17% of adults here (23% of men, 11% of women) drink above those levels.  23% drank at binge levels at least one day a week in the week before the survey (32% of men, 15% of women). Highest binge drinking rates among men aged 18-34.   16% of Year 10 boys and 25% of Year 10 girls got drunk on at least one day in the week before the survey. Hospital admissions are up. Alcohol related admissions: 204 in 2002; 516 in 200. Men account for 70% of these. 46.8% of these come from the most deprived quartile (17.5% in the least deprived). 9 under 16 years in 2002, 30 in 2006.  Average 4 females a year aged 14/15 years; 19 in 2006. 2005, 348 admissions; 516 in 2006.  Nationally, alcohol is implicated in 70% of stabbings and beatings.

Risk-taking: obesity

Being obese reduces life expectancy by 9 years. Summer 2006, all Reception and Year 6 children were weighed and measured.  8.7% of Reception and 16.3% of Year 6 were obese.  14.2% of Reception and 14.9% of Year 6 were overweight. 22.9% of Reception and 31.2% of Year 6 were either overweight or obese. Correlation between obesity and living in an area of high social deprivation (not evident in terms of overweight). About 58% of adults are overweight or obese.  The World Health Organisation states obesity is a global epidemic.

Challenges to health: ageing

20% of the population is 65+ years (35,400). By 2020, this may be 28% (53,000)

Healthy life expectancy has not increased in line with total life expectancy. Rurality(55% in a rural area; 1/5 in market towns, 1/3 in Hereford City).Moderate or severe dementia (7.3% of 65+ have dementia, of which 57% are moderate or severe). Stroke. Hipfracture (780 per 100,000 locally, 565 regionally)

Challenges to health: climate change

The climate is changing: severe weather is becoming more common, temperatures are rising, and there is more flooding. There is an impact on local agricultural employment with an ncrease in skin cancer rates. There are excess deaths from heatwaves (23% increase in mortality among 75+ years in England in 2003). Older people are especially vulnerable.

Conclusion

Dr Howie said that the Primary Care Trust’s response to the findings had not yet been dealt with.  She emphasised that an adequate response could  only be made in partnership with the Council and hoped that it was an aspiration that this work would be facilitated by the work to develop a Public Service Trust.

In the course of discussion the following principal points were made:

·         Noting the health issues affecting 15yr olds it was asked whether any research had been undertaken to see if following the development of the National Curriculum basic health education was being neglected.  Dr Howie said that she was not aware of any published research but the Government was strengthening the healthy schools initiative in response to issues that had emerged.  Cooking skills and nutritional advice no longer formed part of formal education.  In the County the rating for the Healthy Schools Programme had moved from red to green and a part time Community Food Worker had been employed.

·         The potential impact of an increased number of people smoking in the street was raised.  Dr Howie observed that the aim of legislation on smoking had been to protect the health of workers.  Smoking in the street might be annoying to passers by but was not a significant health risk to them.  It was to be hoped that smoking in general would reduce over time.  In response to further points on smoking she referred back to the fact that 44% of households contained someone who smoked.  The Regional objective was to reduce the level but the decline in numbers smoking was slow.   She noted that whilst statistical information was collected on admissions for bronchial difficulties, there was no specific data on the effects of passive smoking.

·         The issue of obesity was discussed, noting the PCT had employed a Health Skills Co-ordinator and a Health Improvement Manager.  Various ways to communicate the risks to people were being explored.  Dr Howie also referred to work the PCT was doing with school governors on the new national standards for school meals.  She agreed that there was a balance to be struck and there was resistance to take up of some of the healthier meals provided in schools.  It was important, however, to make clear that there were a set of principles for a healthy lifestyle and to create an environment that allowed healthy choices to be made.  Schools had powers available to them that could help in creating that environment, such as restricting pupils from leaving the school premises at lunchtime, and preventing fast food vendors operate from vans parking on school premises.

·         It was acknowledged that there were mixed health messages with stop smoking advisors being sent to leisure centres while vending machines installed there sold unhealthy foods.

·         The availability of cheap alcohol in supermarkets and the sale of alcohol to those under the legal age limit was discussed.  Dr Howie suggested that this was an aspect where the Council could exert influence through use of its licensing and enforcement powers.  Mystery shopping by the Council was the only realistic way to exercise enforcement.  She noted that two extra enforcement officers had been employed to enforce the law on sale of tobacco and suggested there might be benefit in targeting illegal alcohol sales in a similar sustained way.

·         In response to a question about the link between unwanted pregnancies in the 15-16 age Group Dr Howie noted that when someone reported to a clinic with a sexually transmitted disease or an unplanned pregnancy the clinical staff did not record whether drink was a factor. She added that sexual health was an issue that she would like to report on to the Committee in greater depth.

·         A more detailed report on stroke services was requested.

·         Regarding the uptake of the MMR vaccine Dr Howie responded that there had been a slight increase in uptake over the previous year to 83%.  However, this was still well below the 95% uptake required to achieve herd immunity.

RESOLVED:  That further reports be made to the Committee providing greater depth on the following issues: stroke services and sexual health.