dph annual report 2013 dr carol davidson, director of public health nhs ayrshire and arran dph...

DPH Annual Report 2013

Dr Carol Davidson, Director of Public HealthNHS Ayrshire and Arran

DPH Annual Report 2013/14

Dr Carol Davidson, Director of Public HealthNHS Ayrshire & Arran

Public Health Seminar11 November 2014

Director of Public Health Annual Report 2013/14

• Introduction• Population Profile• Deprivation and Health Inequalities• Public Health Priorities – ATOM+• Public Health Screening Programmes

Director of Public Health Report 2013/14


Percentage change in population by age group, East, North and South Ayrshire compared to Scotland, 2001 to 2011

Source: www.scotlandscensus.gov.uk/en/censusresults/downloadablefiles.html

Population change between 2001 and 2011 Census

aged under 15 aged 15 to 64 aged 65 and over-15

-10

-5

0

5

10

15

20

25Scotland

East Ayrshire

North Ayrshire

South Ayrshire

Perc

enta

ge

http://www.scotlandscensus.gov.uk/en/censusresults/downloadablefiles.html

Projected population of Ayrshire & Arran by age group, 2010 - 2035

2010 2015 2020 2025 2030 20350

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

110,000

0-15 16-29 30-49 50-64 65-79 80+

Popu

latio

n


Year


• Mid year population 2012 = 373,189• Live births 2012 = 3,807• Deaths in 2012 = 4,231

Make up of population at 2010 and projected to 20350 -15 year old group 17% 16%16-64 year old group 64% 54%65 + group 19%

30%

Population Profile


• Dialogue on sustaining wellbeing and equity in the long-term

• Shifting funding towards prevention to lower the burden of disease

• Co-production will be an important approach to building assets of individuals and communities

• Shifting care closer to home• Caring for the carers

Key messages and recommendationsdemography

Local and national share of 15% most deprived data zones, Ayrshire and Arran, SIMD 2006,2009 and 2012

SIMD 2006 % SIMD 2009 % SIMD 2012 % 0

5

10

15

20

25

16

18.319.8

7.9 99.7

Local share

National share

Perc

enta

ge

% babies underweight by deprivation, Ayrshire & Arran, 2012

Quintile 1 Quintile 2 Quintile 3 Quintile 4 Quintile 50

1

2

3

4

5

6

7

8

9

10

1500-2499g

<1500g

Perc

ent U

nder

wei

ght


% of all women with a known smoking status at first antenatal booking appointment by deprivation,

(2008,2009,2010 combined)


Quintile 1 most deprived

Quintile 2 Quintile 3 Quintile 4 Quintile 5 least deprived

0

5

10

15

20

25

30

35

40

45

40

29

18

119

35

25

18

12

7

Ayrshire & Arran percentage

Scotland average per-centage

Perc

enta

ge (f

rom

3-y

ear c

ombi

ned

tota

ls)

% of women smoking at first antenatal appointment, 2001 - 2012

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012p10

13

16

19

22

25

28

31

34

Ayrshire & Arran

Scotland

Perc

enta

ge o

f wom

en


% smoking quit rate at one month follow-up by deprivation, Ayrshire and Arran and Scotland, 2012

Quintile 1 - most deprived

Quintile 2 Quintile 3 Quintile 4 Quintile 5 - least deprived

0

2

4

6

8

10

12

14

16

13.712.9

9.7

6.6

4.4

12.8

9.8

7.4

5.4

3.5

Ayrshire and Arran per-centage

Scotland average percentage

Quit rate at one month follow-up

Perc

enta

ge

Main causes of death, males and females, all ages for Ayrshire and Arran, 2012

29%

31%

14%

5%

6%

5%

11%

Cancer

Circulatory diseases

Respiratory diseases

Digestive diseases

External causes

Mental & Behavioural

Other

Males

25%

30%16%

6%

3%8%

11%

Females


Main causes of death in under 75 year olds, 2006 – 2012, Ayrshire and Arran

2006 2007 2008 2009 2010 2011 20120

50

100

150

200

250

300

Cancer

Circulatory diseases

Respiratory diseases

EASR

rate

per

100

,000

pop

ulati

on



• Socioeconomic deprivation continues to be a major public health issue in Ayrshire and Arran

• Health inequalities result in a significant loss of years and quality of life for most of society.

• Health inequalities are not inevitable but with tightening public sector budgets, welfare reforms hitting the poorest hardest, the challenge is huge and requires a massive collective effort.

• Circulatory disease, cancer, respiratory disease, digestive disease and intentional/unintentional injury are significant current contributors to inequalities in life expectancy.

Key messagesDeprivation and Health inequalities


• Alcohol-related deaths East, North and South Ayrshire, 1979-83 to 2008-12

• Reducing alcohol availability is associated with a reduction in alcohol-related harm, including medical harms, intentional and unintentional injury and crime. Local Licensing Boards have a key role in the reduction of harm associated with alcohol. All Community Planning Partners must prioritise work to support the Licensing Boards and Licensing Fora in this role.

• Alcohol consumption has also been shown repeatedly to be price sensitive and the

introduction of minimum pricing for alcohol is a landmark policy widely supported by the public health community.

Public Health Prioritiesalcohol

1979

-83

1980

-84

1981

-85

1982

-86

1983

-87

1984

-88

1985

-89

1986

-90

1987

-91

1988

-92

1989

-93

1990

-94

1991

-95

1992

-96

1993

-97

1994

-98

1995

-99

1996

-00

1997

-01

1998

-02

1999

-03

2000

-04

2001

-05

2002

-06

2003

-07

2004

-08

2005

-09

2006

-10

2007

-11

2008

-12

- 5

10 15 20 25 30 35 40 45 50

East Ayrshire North Ayrshire South Ayrshire

Num

ber o

f alco

hol r

elat

ed d

eath

s (5

-yea

r mov

ing

annu

al a

vera

ge)

Alcohol-related hospital discharge rates, Ayrshire and Arran and Scotland, 1997 - 2012

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20112012

0

200

400

600

800

1000

1200

Ayrshire Scotland

EASR

rate

per

100

,000

pop

ulati

on


Public Health Prioritiestobacco

29%

14%

14%

13%

7%

5%

18%

Male cancer deaths, 2012Trachea, bronchus and lung

Bowel (colon, rectum and anus)

Oesophagus and stomach

Prostate

Malignant neoplasm of lymphoid, haematopoietic and related tissue

Pancreas

Other

31%

10%

7%16%

9%

9%

18%

Female cancer deaths, 2012Trachea, bronchus and lung

Bowel (colon, rectum and anus)

Oesophagus and stomach

Breast

Malignant neoplasm of lymphoid, haematopoietic and related tissue

Pancreas

Other

• Tackling tobacco control, and the associated socio-economic and health inequalities, needs to be taken forward in partnership. Health services are best placed to deal with cessation, but collaboration is required with other agencies such as Trading Standards and Education to address the issues of prevention and protection.

• It is vital in moving forward with this agenda that the Pan-Ayrshire Tobacco Control Steering

Group acts as an alliance in sharing information and best practice and lobbying government with regards to future policy and legislation.

• Concerted effort is required by all agencies to help Scotland meet their endgame target of a

smoking prevalence of 5% of the population by 2034. Director of Public Health Report 2013/14


• Percentage of adult population, obese and morbidly obese in Ayrshire and Arran, 1999 to 2012 by age group

• All agencies, NHS, HSCPs, LAs and the third sector will need to work alongside other partners, such as government and businesses to tackle obesity.

• Scale of change – although individuals do need to take responsibility for their own health, simply targeting individuals

to change their behaviour will be insufficient to solve the problem. The scale of the change required to the environment and the way we live our daily lives is such that a multi-faceted approach over several decades is needed.

• Working together with the Scottish Government – the Healthy Weight action plan must be set in the broader context

of action being taken by the Scottish Government such as altering national transport and planning policies, working with the food industry to reformulate food and drink products, and developing standards on responsible marketing of food and drinks.

Public Health Prioritieshealthy weight

BMI 30+ (obese)

BMI 40+ (morbidly

obese)

BMI 30+ (obese)

BMI 40+ (morbidly

obese)

BMI 30+ (obese)

BMI 40+ (morbidly

obese)

BMI 30+ (obese)

BMI 40+ (morbidly

obese)15-34 years 35-64 years 65-74 years 75+ years

0%

5%

10%

15%

20%

25%

30%

35%1999200420092012


Children and young people's mental wellbeing using WEMWBS by deprivation quintile, Ayrshire and Arran compared to Scotland, 2010

• Mental health is a public health priority and it is often said that there is no health without mental health. • The Mental Health and Wellbeing strategy should inform the plans of all agencies • From conception onwards, children’s early life circumstances and experiences shape their physical, social, mental,

emotional and cognitive development and provide a foundation for their future attainment and health. • Positive mental health and wellbeing provides individuals with the resources to enjoy life and with the resilience to

manage life’s challenges. It is a protective factor against mental health problems and is associated with better physical health and the adoption of associated positive lifestyle choices.

Public Health Prioritiesmental health and wellbeing

Quintile 1 - most deprived

2 3 4 Qintile 5 - least deprived

46

47

48

49

50

51

52

53Scotland

Ayrshire and Arran

Mea

n W

EMW

BS sc

ore

(min

=

14, m

ax =

70)


• The wellbeing of children and young people must remain a priority for NHS Ayrshire & Arran and our planning partners. The scale of the challenge is significant as the overall health and wellbeing of the population needs to improve and we also need to reduce health inequalities.

• Tackling threats to wellbeing and inequalities requires a sustained focus on behaviour change. Perinatal smoking cessation, promoting a positive message around abstinence from alcohol in pregnancy, promoting breastfeeding, a healthy diet and physical activity and acting to improve maternal and child mental health remain the central issues.

• To reflect the changing partnership arrangements, we will refresh our shared vision for protecting and improving the health and wellbeing of children and young people. This vision will link together all planning partners across Ayrshire and Arran.

Key messages and recommendationschildren and young people

Key messages and recommendationschildren and young people

• In tandem, we will develop a framework for measuring the health and wellbeing of children and young people across the population in Ayrshire and Arran.

• We recommend that a holistic approach to child health and wellbeing is adopted, underpinned by the National Practice Model. This model and the new Children and Young People (Scotland) Act should be implemented consistently across the acute sector and the three health and social care partnerships in order to move services to a progressive universalism. This approach should include early, systematic identification of needs and early, proportionate intervention in order to improve the outcomes for children.

• In order to achieve cultural change, we recommend that all partners agree a common approach to staff training which equips them to support children’s rights across the public sector and wider society.


The UK National Screening Committee defines screening as:“…a process of identifying apparently healthy people who may be at increased risk of a

disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.”

Detect Cancer Early• Cancer survival in Scotland is poor compared to the rest of the UK and Europe. In

Scotland poor survival is mainly due to cancers being detected at a later stage. • Bowel screening uptake is low among men living in the most deprived areas

(particularly working age men).• Women living in deprived areas are less likely to respond to an invitation for breast

screening and more likely to have breast cancer detected later.

Public health screening programmesCervical – bowel – breast – diabetic retinopathy and abdominal aortic aneurysm

Public health screening programmes

Screening Programmes

Screening programme

Target population

Time frame Uptake outcomes

cervical Eligible Women 20-60 years

2011-12 81.1% 21 – invasive ca576 referrals colposcopy

bowel Adults 50 – 70 years

Nov 2010 to Oct 2012

54.8% 2.8% positivity rate ; 0.2% ca

breast Eligible Women 50 – 70 years

2011 74% 123 ca detected (1.0%)

Diabetic retinopathy

People over 12 years with diabetes

April 2012 to March 2013

80.1% 3.4% positivity rate

Abdominal Aortic Aneurysm

Men in 65th year

June 2013 to Dec 2013

78.4% 31 under surveillance


• Babies and infants are routinely immunised against a range of diseases including diphtheria, tetanus, polio, pertussis and Haemophilus influenzae type b, pneumococcal infection and later against Meningitis C, measles, mumps and rubella. Where appropriate, they may also be immunised against hepatitis B and tuberculosis.

• Uptake of childhood immunisation at 24 months in Ayrshire and Arran remains at a consistently high level of 98% and continues to exceed national targets.

• The past variation in immunisation uptake between East, North and South Ayrshire Council areas has reduced and the rates continue to be higher than the Scottish average.

• Uptake of MMR 1 at age 24 months has reached the target of 95% for the first time and is above the national average of 95%.

Childhood Immunisation in Ayrshire and Arran

Summing up• This report provides a broad picture of the health and wellbeing of the population

in Ayrshire and Arran, with a substantial focus on inequality.

• As we consider how we sustain public services we need to be mindful of the impact of population change on demand for services.

• Government legislation is resulting in unprecedented change in the way health and social care services are organised in Ayrshire and Arran, providing opportunities for change.

• A key element is the importance of community engagement so that services are delivered with communities rather than to them.

• The population is growing older with people living longer, often with multiple health and social care needs. Changes in the population are therefore everyone’s business.

• The changes are also a chance to focus organisations and the communities which they represent to work towards the common goal of living healthier, happier lives.Director of Public Health Report 2013/14

dph annual report 2013 dr carol davidson, director of public health nhs ayrshire and arran dph...

Documents

arran health inequalities

major public health

arran dph annual report

south ayrshire

mid year population

socioeconomic deprivation

year olds

year old group17