Life expectancy, healthy life expectancy and well-being ... · Life expectancy, healthy life expectancy and well-being ... disease and mental disorders account for 55% of the life

Source: Greenwich JSNA 2013/14 “Closing the Gap.” Public Health & Well-Being, Royal Borough of Greenwich.

Life expectancy, healthy life expectancy and well-being

Summary

Life expectancy in Greenwich is substantially shorter than the national average. This is true

at birth and at age 75, and is true for both males and females.

Healthy life expectancy estimates the average number of these life years that are lived

without illness or disability. Again, it is substantially shorter in Greenwich than it is in

England on average, for both males and females.

Local preventative initiatives aimed at addressing risk factors including smoking, physical

activity, hypertension, diet and obesity have been effective in improving outcomes amongst

men, and the challenge will be to replicate this success in women.

Well-being is complex to measure, but Greater London Authority data show that well-being

is also likely to be substantially poorer in Greenwich than it is on average in London.

However, the Adult Social Care Survey shows that people receiving social care in Greenwich

report a higher quality of life than the London average for people receiving social care. They

are also more likely to feel that they have control over their daily life.

Significant inequality runs as a strong theme across these measures. A male baby who lives

in the most deprived 20% of the borough can expect to live a full 7.4 years less than a male

born in the least deprived 20%. For his sister, this figure is 5.6 years. The most deprived

males can expect 7.6 years less of healthy life, and the females 7.0 years.

There are also great inequalities in well-being. Two of the 17 Greenwich wards have greater

well-being than the London average; in the remainder, it is lower. The poorest well-being is

in Woolwich Riverside: only six of London’s 625 wards are worse.

The continued regeneration of the borough (in particular of those areas which currently

achieve low wellbeing scores) will be key to improving the economic security, access, living

environment and safety of its residents – all of which contribute towards improving

wellbeing.

Some causes of death are potentially amenable to healthcare. Mortality due to these causes

is slightly worse in Greenwich than the national and London average for males, and

moderately worse for females. This does not explain the difference entirely.

The major disease contributors to poor life expectancy and healthy life expectancy in

Greenwich are circulatory disease (coronary heart disease and stroke), cancers (with lung

cancer being particularly important), respiratory disease (particularly chronic obstructive

airways disease).

The greatest burden reducing healthy life expectancy is mental disorders, particularly

depression and anxiety. These also have an impact on life expectancy, but that impact is

smaller.

Taken together, coronary heart disease, stroke, lung cancer, chronic obstructive airways

disease and mental disorders account for 55% of the life expectancy gap between

Greenwich males and the London average, and 47% for females.


Life expectancy, healthy life expectancy and well-being The aim of this section is to provide an overview of three key summary measures of health and

quality of life in Greenwich. These are life expectancy, healthy life expectancy, and well-being.

Each of the three Outcomes Frameworks (for the NHS, for Adult Social Care, and for Public Health)

contains key indicators related to these measures.

The vision of the Public Health Outcomes Framework is to “improve and protect the nation’s health

and well-being, and improve the health of the poorest fastest”. It sets two outcome measures allied

to this:

1. Increased healthy life expectancy, ie taking account of the health quality as well as the

length of life

2. Reduced differences in life expectancy and healthy life expectancy between communities

(through greater improvements in more disadvantaged communities)

It also includes the indicator ‘self-reported quality of life’.

The NHS Outcomes Framework has three overarching indicators that are relevant here:

Potential Years of Life Lost from causes considered amenable to healthcare

Life expectancy at age 75

Health-related quality of life for people with long-term conditions

The Adult Social Care Outcomes Framework includes, in the domain “Enhancing quality of life for

people with care and support needs”:

Social care-related quality of life, as the overarching measure

Carer-reported quality of life

The proportion of people who use services who have control over their daily life

This section of the JSNA establishes the current position in Greenwich in terms of life expectancy,

healthy life expectancy and well-being, drawing on these Outcome Framework indicators (where

data is available) and on other data sources.

Life expectancy

In Greenwich and in England as a whole, life expectancy has tended to increase over the last decade.

But for both men and women, life expectancy in Greenwich has remained below the England

average (see figure 1). The most recent data (2008-2010) show that women in Greenwich have a life

expectancy at birth of 81.8 years, 0.8 years less than the national average of 82.6 years. The gap for

men is greater. Men have a life expectancy of 76.7 years in Greenwich, 1.9 years less than the

national average of 78.6 years.

In 2005-2007, women in Greenwich could expect to live 0.4 years less than the national average. The

most recent data show this gap increasing to 0.8 years in 2008-10. The trend for men is different.

The gap was narrowing slowly between 2005 and 2008. The most recent data show a more marked

reduction. In 2005-2007, men in Greenwich could expect to live 2.8 years less than the national

average. The most recent data show that the gap has been closed by nearly one year, to 1.9 years;


This is likely to be a direct result of targeted interventions via local preventative initiatives (including

through primary care) aimed at addressing risk factors including smoking, cholesterol, physical

activity, hypertension, diet and obesity.

Figure 1: Life expectancy at birth, Greenwich and England, 1996-2010

Source: NHS Information Centre using Office for National Statistics data

‘Life expectancy at age 75 years’ is a measure of how many more years an individual can expect to

live, on average, having reached their 75th birthday. As with life expectancy at birth, males in

Greenwich have consistently lagged behind England as a whole in this measure (see figure 2). In

recent times, this gap was greatest in 2005-07, at which time Greenwich men aged 75 years could

expect to live 1.2 years less than the national average. The most recent data, for 2008-10, show that

this gap has narrowed to 0.8 years. The trend for females has been more complex. Over the last

decade, female life expectancy at age 75 years in Greenwich has been similar to the national average

(see figure 3). In some years it has been higher, in some lower. The most recent data show

Greenwich dipping below the national average by 0.3 years. These changes have been small and are

not likely to be significant, so the safest conclusion is that female life expectancy at age 75 years in

Greenwich is similar to the national average. For both males and females, Greenwich lags behind the

London average for life expectancy at age 75 years.


Figure 2: Male life expectancy at age 75 years, 1996-2010

Source: NHS Information Centre, using Office for National Statistics data

Figure 3: Female life expectancy at age 75 years, 1996-2010

Source: NHS Information Centre, using Office for National Statistics data


There is major inequality in life expectancy in Greenwich for both men and women. Those who live

in the more deprived parts of the borough live shorter lives than those who live in the more affluent

parts. The difference is marked (see Figures 4 and 5). Women in the most deprived 20% of the

borough can expect to live for five years less than women in the least deprived 20%. The trend for

men is worse still. Men in the most deprived 20% have a life expectancy that is seven years less than

men in the least deprived 20%.

The measure of deprivation used here is the Index of Multiple Deprivation (IMD). This combines

indicators of deprivation that illustrate seven dimensions of deprivation: income, employment,

health deprivation and disability, education/skills and training, barriers to housing and services,

crime, and living environment. Areas within the borough have been divided into five quintiles based

on their IMD score. Quintile 1 is the most deprived 20%, and quintile 5 the least deprived 20%. This

allows us to explore the impact of deprivation on health outcomes.

Figure 4: Male life expectancy in Greenwich by deprivation quintile, 2007-2009

Source: ONS Public Health Mortality Files 2007-09, ONS mid 2007-09 population projections for

LSOAs


Figure 5: Female life expectancy in Greenwich by deprivation quintile, 2007-2009

Source: ONS Public Health Mortality Files 2007-09, ONS mid 2007-09 population projections for

LSOAs

The Slope Index of Inequality (SII) provides another informative measure of the extent to which life

expectancy is related to socio-economic deprivation. The SII shows the difference in life expectancy

between the best-off and worst-off in a borough. A difference between the best-off and worst-off is

seen in every borough, but the SII helps to quantify how great this difference is. A low SII value

indicates a small gap in life expectancy. A high SII value indicates a large gap, and therefore greater

health inequality.

The Slope Index of Inequality shows that Greenwich has very high inequality for both men and

women (see figures 6 and 7). The degree of inequality is greater in Greenwich than it is in London or

England as a whole. It is also greater in Greenwich than it is on average in boroughs of similar

deprivation1. In terms of trend, the most recent data suggest that this life expectancy inequality is

widening slightly for women, but narrowing for men. As referred to above, local preventative

initiatives aimed at addressing risk factors including smoking, physical activity, hypertension,

cholesterol, diet and obesity have been effective in improving outcomes amongst men. The

challenge will be to replicate this success in women. Differences in the age at which women develop

disorders such as CHD (on average 7 years later than men) mean that we would predict a delay in

seeing the same effects in women.

1 Boroughs with similar deprivation to Greenwich are Haringey, Brent, Lewisham, Lambeth, Southwark, Hammersmith and Fulham (based on the rank of average ranks of IMD scores)


Figure 6: Slope Index of Inequality (SII) showing the difference in life expectancy between the

most deprived and least deprived: Males, 2001-2010

Source: APHO

Figure 7: Slope Index of Inequality (SII) showing the difference in life expectancy between the

most deprived and least deprived: Females, 2001-2010

Source: APHO

Although this section of the JSNA has identified widening health inequalities, other sections

document the preventive programmes that appear to be resulting in some marked improvements in

the health outcomes amongst the male population. We are currently undertaking a needs

assessment for coronary heart disease (CHD) (as one of the major contributors to reduced female


life expectancy) to understand where along the pathway of prevention, recognition of symptoms by

patients and professionals, management of the acute episode and rehabilitation, we can gain better

health outcomes. We would currently expect to see the improvements from prevention as the result

of NHS Health Checks 5-10 years later than in men, and so are expecting to see improvements in the

next couple of years as the programme will have run for 5 years this year. [LINK THROUGH TO

SMOKING SECTION, PHYSICAL INACTIVITY (ADULTS), DIET (ADULTS), OBESITY AND DIET (CHILDREN)]

Healthy life expectancy

As well as increasing life expectancy and reducing the inequalities in life expectancy, we are also

interested in quality of life and in health during life. ‘Healthy life expectancy’ provides one measure

of this. It illustrates the years of life lived without disability and illness. The most recent data about

this are from 1999-2003, having been recorded as part of the 2001 Census2They showed healthy life

expectancy in Greenwich to be 59.6 years for men, and 62.5 years for women. For both men and

women, this is lower than the England and London averages by around two years. As with life

expectancy, there is considerable inequality (see figures 8 and 9). Women living in the 20% most

deprived parts of the borough could expect a full seven years less of healthy life than those in the

20% least deprived. The figure for men was 6.6 years.

Figure 8: Average healthy life expectancy (years lived free of disability and illness) for males by

ward deprivation quintile, Greenwich, 1999-20033

Source: ONS Experimental Statistics

2 Data from the 2011 Census are expected in 2013 3 Healthy Life Expectancy data were provided by the Office for National Statistics experimentally and there are no more recent data available


Figure 9: Average healthy life expectancy (years lived free of disability and illness) for females by

ward deprivation quintile, Greenwich, 1999-20033

Source: ONS Experimental Statistics

Well-being

Alongside life expectancy and healthy life expectancy, the third in the trio of important summary

measures is well-being.

Well-being is a complex concept, more difficult to measure than life expectancy. The Greater London

Authority calculates well-being scores for every ward in London. These take account of a wide range

of factors that affect people’s well-being. The score is calculated based on 12 separate indicators,

relating to ten different aspects of life that can affect well-being (see figure 10). Different people

would weigh the importance of these differently. To some, health is more important than safety, for

example. To others, the reverse is true. As a construct, well-being is relatively novel. The science of

well-being is therefore very much under development. There is no clear answer about how these

different aspects should be weighed to accurately reflect the well-being of the population. It is also

worth noting that these indicators do not attempt to measure well-being directly. Instead, they

measure aspects of life that are known to have an impact on well-being. Examples of data that do

measure well-being directly are included in the Positive Mental Health section of this JSNA. [LINK

THROUGH TO POSITIVE MENTAL HEALTH SECTION


Figure 10: Indicators used in calculation of Greater London Authority Ward Well-Being Score

Contributor to wellbeing Indicator(s) included

Health - Life expectancy

- Incapacity Benefits claimant rate

Economic security - Unemployment rate

- Income Support claimant rate

Safety - Crime rate

- Deliberate fires

Education - GCSE point scores

Children - Unauthorised pupil absence

Families - Children in out-of-work families

Access - Public transport accessibility scores

Environment - Access to public open space and nature

Community - Elections turnout

If we assume that each of the indicators in the GLA Ward Well-Being score impacts well-being

equally, we can calculate a single score for each ward in Greenwich. In contrast with life expectancy

in years, the score itself is difficult to interpret. But the relative scores illustrate how well-being

differs between places. The score is scaled such that the average well-being in London is called ‘0’.

Positive scores are therefore better than average, and negative scores are worse.

According to this GLA Ward Well-Being Score, just two of the 17 wards in Greenwich have better

well-being than the London average (see figure 11). These are Eltham North and Blackheath

Westcombe. At the other end of the spectrum is Woolwich Riverside, with a well-being score of -14.

Only six of London’s 625 wards score lower.


Figure 11: Well-being score by ward, Greenwich, 2010

Source: Greater London Authority. 2010 data, compiled in 2012. Composite measure reflecting

indicators of economic security, safety, education, families, children, environment, access, health,

and community.

Regeneration and Wellbeing

The continued regeneration of the borough (in particular of those areas which currently achieve low

wellbeing scores) will be key to improving the economic security, access, living environment and

safety of its residents – all of which contribute towards improving wellbeing. More information can

be found in the JSNA chapter “About Greenwich”. LINK THROUGH TO “ABOUT GREENWICH

SECTION”

Figure 12 examines how each aspect included in the ward well-being score varies by ward. This

shows that there is a high level of correlation between many of the different aspects – wards that

have poor health tend to have poor economic security, poor safety, and poor education, family and

community measures. The access and environment measures are the exception to this. They do not

correlate closely with the others. Woolwich Riverside, for example, scores more highly than any

other ward for access, but has the lowest score of all wards on several other measures.



Figure 12: Contributors to well-being by ward, as per GLA Ward Well-Being Score


The Outcomes Frameworks include a number of indicators of well-being and quality of life:

The Public Health Outcomes Framework includes, in the Health Improvement domain, self-

reported well-being

The NHS Outcomes Framework includes, as the overarching indicator for one of its five

domains, healthcare-related quality of life of people with long-term conditions

The Adult Social Care Outcomes Framework includes, in the domain “Enhancing quality of

life for people with care and support needs”:

Social care-related quality of life, as the overarching measure

Carer-reported quality of life

The proportion of people who use services who have control over their daily life

At the time of writing, data are only available for two of these five indicators. These are ‘social care-related quality of life’ and ‘the proportion of people who use (social) services who have control over their daily life. Both of these measures are captured through the Adult Social Care Survey. The Personal Social Services User Experience Survey of Carers 12-13 has recently been completed in the borough. This is the first official collection of a statutory survey undertaken to be undertaken annually by all local authorities nationwide. The survey will be used to populate outcome measures for carers in the Adult Social Care Outcomes Framework (ASCOF) and the results have been given to social care commissioners who are developing a more responsive support offer to carers in the borough. More information is available in the JSNA chapter on carers. ‘Social care-related quality of life’ is scored based on the responses that social care recipients give to

eight key questions in the Adult Social Care Survey (ASCS). These questions gauge whether the

individual’s needs are met in the following areas: control, dignity, personal care, food and nutrition,

safety, occupation, social participation and accommodation. This information is used to calculate a

score, with a high score representing better quality of life than a low score. Greenwich performance

across all these measures is encouraging; scoring 18.5 on this measure, Greenwich is placed above

the London average of 18.1 and improved on all comparable measures used in the 2010/11 ASCS.

In Greenwich, London and England, reported quality of life is slightly higher (0.1 in each case)

amongst male social care users than females. Greenwich scores better than the national and London

average for quality of life amongst social care users aged 65 years and over, but less well for those

aged under 65 years (see figure 13).


Figure 13: Social care-related quality of life score, as per Adult Social Care Outcomes Framework,

2011-12

Source: NHS Information Centre, from Adult Social Care Survey 2011-12

Having control over daily life is one key element of quality of life. This is the second Adult Social Care

Outcomes Framework indicator for which data are available. In Greenwich, 73% of those receiving

social care services report having control over their daily life (see figure 14). This is below the

national average but better than the London average.


Figure 14: Percentage of people who use social care services who have control over their daily life,

2011-12

Source: NHS Information Centre, from Adult Social Care Survey 2011-12

What is impacting life expectancy, healthy life expectancy and well-being in Greenwich?

The NHS Outcomes Framework includes the indicator ‘Potential Years of Life Lost from causes

considered amenable to healthcare’. This will illustrate the potential to improve life expectancy by

improving healthcare quality. Data for this indicator are not yet available. Data are available for a

related measure - ‘mortality from causes amenable to healthcare’. These data relate to people aged

under 75 years only.

For both males and females, in Greenwich and in England as a whole, mortality from causes

considered amenable to healthcare has fallen by approximately half over the last fifteen years (see

figures 15 and 16). It has, however, been consistently higher in Greenwich than the England average.

Over the five year period 2005-2010, there have been an average of 40 excess male deaths and 12

excess female deaths per 100,000 people per year, relative to the England average. Thus over this

period, mortality from causes amenable to healthcare has been 35% higher than the England

average for males and 15% for females. Year-to-year trends in such data are difficult to interpret and

may not be significant, but there has been a notable improvement for males over the last three

years for which data are available, and a worsening for females in the most recent year.


Figure 15: Male mortality from causes considered amenable to healthcare, directly standardised

rate, <75 years

Source: NHS Information Centre

Figure 16: Female mortality from causes considered amenable to healthcare, directly standardised

rate, <75 years

Source: NHS Information Centre


The next question is: What is limiting life expectancy and healthy life expectancy in Greenwich?

Understanding the relative impact that different medical conditions have on the population’s health

can help in prioritising focus in efforts to improve health. Disability-adjusted life years (DALYs) are a

way of summarising the years of life lost due to both premature death in the population (YLL) and

the years lost due to disability or illness (YLD) for specific health conditions. One DALY represents the

equivalent of one year of full health. Years of life lost (YLL) data are available for Greenwich

specifically. Years of life lost due to disability or illness (YLD) figures can be estimated based on a

World Health Organization analysis4. Summing the two (YLL and YLD) illustrates the total impact of a

range of conditions (see figures 17 and 18).

4 Dodhia H, Phillips K. Measuring burden of disease in two inner London boroughs using Disability Adjusted Life Years. Journal of Public Health 2008; 30(3): 313-21


Figure 17: Disability-adjusted life years lost in Greenwich for men, 20115

Source: PCMD mortality data 2011/12 (YLL), WHO Global Burden of Disease (EURO A) 2005 and

Census 2011 population figures (YLD)


Figure 18: Disability-adjusted life years lost in Greenwich for women, 20115

Source: PCMD mortality data 2011/12 (YLL), WHO Global Burden of Disease (EURO A) 2005 and

Census 2011 population figures (YLD)

For men in Greenwich, in order of impact, the most DALYs are lost due to:

1. Mental disorders (mainly depression)

2. Circulatory disease

3. Cancers (neoplasms)

4. Respiratory disease

The same four condition types also have the greatest impact on women, but in a different order:

1. Mental disorders (mainly depression)

2. Cancers (neoplasms)

3. Circulatory disease

4. Respiratory disease

Cancers and circulatory disease have most of their impact by causing premature death, whereas

mental illness has most of its impact by impairing quality of life (years lost to disability). It is useful

that this DALY analysis, which combines both types of health impact, illustrates the immense impact

of mental disorders on the health of the people of Greenwich. This would not be seen in an analysis

that focused on life expectancy alone.

5 YLD data are WHO 2005 rates of YLD applied to 2011/12 Greenwich population.


The question might also be asked: what is causing the gap in life expectancy between Greenwich and

the England average? The London Health Observatory Health Inequalities Tool analyses this

question. The most recent data available are for 2006-08 (see figures 19 and 20).

Figure 19: Relative contributions to the gap between male life expectancy in Greenwich and

average life expectancy in England by disease, 2006-08

Source: London Health Observatory Health Inequalities Tool


Figure 20: Relative contributions to the gap between female life expectancy in Greenwich and

average life expectancy in England by disease, 2006-08

Source: London Health Observatory Health Inequalities Tool

There is a high degree of overlap between the conditions that contribute most to the life expectancy

gap and the condition types illustrated shown by the DALYs analysis above to have the greatest

overall impact on life expectancy and healthy life expectancy in Greenwich:

Circulatory disease

o Coronary heart disease (Males: largest contributor to life expectancy gap,

responsible for 17% of gap; Females: 3rd largest gap contributor, 13%)

o Stroke (Males: 4th ranked gap contributor, 8%)

Cancers (neoplasms)

o Lung cancer (Males: 2nd largest gap contributor, 12%; Females: largest gap

contributor, 16%)

Respiratory disease

o Chronic obstructive airways disease (Males: 3rd largest gap contributor, 12%;

Females: 6th largest gap contributor, 8%)

Mental disorders

o ‘Mental and behavioural disorders’ (Males: 7th largest gap contributor, 6%; Females:

4th largest gap contributor, 10%)

The five causes listed here are together responsible for 55% of the life expectancy gap between

Greenwich and the London average for males, and 47% of the same gap for females.


Conclusions

Taken together, the data in this chapter paint a clear picture of life expectancy, health and well-

being in Greenwich.

Life expectancy is perhaps the ultimate measure of the health of a population. Life expectancy in

Greenwich is substantially shorter than the national average. This is true at birth and at age 75, and

is true for both males and females.

Healthy life expectancy estimates the average number of these life years that are lived without

illness or disability. Again, it is substantially shorter in Greenwich than it is in England on average, for

both males and females.

These measures are summarised in figure 21.

Figure 21: Summary measures of health in Greenwich

Males Females

Life

expectancy

at birth

Life

expectancy

at 75

Healthy life

expectancy

at birth

Life

expectancy

at birth

Life

expectancy

at 75

Healthy life

expectancy

at birth

Greenwich 76.7 10.5 59.6 81.8 12.8 62.5

England 78.6 11.3 61.7 82.6 13.1 64.2

Difference -1.9 -0.8 -2.1 -0.8 -0.3 -1.7

Well-being is complex to measure, but Greater London Authority data show that well-being is also

likely to be substantially poorer in Greenwich than it is on average in London. However, the Adult

Social Care Survey shows that people receiving social care in Greenwich report a higher quality of life

than the London average for people receiving social care. They are also more likely to feel that they

have control over their daily life.

Significant inequality runs as a strong theme across these measures. A male baby who lives in the

most deprived 20% of the borough can expect to live a full 7.4 years less than a male born in the

least deprived 20%. For his sister, this figure is 5.6 years. The most deprived males can expect 7.6

years less of healthy life, and the females 7.0 years.

There are also great inequalities in well-being. Two of the 17 Greenwich wards have greater well-

being than the London average; in the remainder, it is lower. The poorest well-being is in Woolwich

Riverside: only six of London’s 625 wards are worse.

Why is life expectancy shorter than elsewhere? Some causes of death are potentially amenable to

healthcare. Mortality due to these causes is slightly worse in Greenwich than the national and

London average for males, and moderately worse for females. This does not explain the difference

entirely. The major disease contributors to poor life expectancy and healthy life expectancy in


Greenwich are circulatory disease (coronary heart disease and stroke), cancers (with lung cancer

being particularly important), respiratory disease (particularly chronic obstructive airways disease).

The greatest burden reducing healthy life expectancy is mental disorders, particularly depression

and anxiety. These also have an impact on life expectancy, but that impact is smaller.

Taken together, coronary heart disease, stroke, lung cancer, chronic obstructive airways disease and

mental disorders account for 55% of the life expectancy gap between Greenwich males and the

London average, and 47% for females.

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Life expectancy, healthy life expectancy and well-being ... · Life expectancy, healthy life expectancy and well-being ... disease and mental disorders account for 55% of the life