Living in Tower Hamlets

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Living in Tower Hamlets

Findings and Conclusions from Tower Hamlets JSNAPresentation to HWB Strategy Subgroup

Dr Somen Banerjee, DPH3rd April, 2012

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What is Health?

‘Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’

WHO Constitution, 1946

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What makes for a healthy life?

Throughout life• Having an income that is

enough for healthy living• Living in quality housing• Living in an environment that

supports health• Having strong social networks• Living in a place with a sense of

community• Staying fit, eating healthily,

sensible drinking• Living in a place with high

quality public services

Being born• The health of your mother• High quality maternity services

Growing up• Good parenting• High quality preschool

provision• High quality education

Being an adult• A sense of control of one’s life• Secure and decent employment

Growing old• Staying fit and eating healthily• Maintaining strong family and

social relations• Services that are integrated and

built around your needs

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What will improve health?• Giving every child the best possible

start in life• Enabling all to make the most of

their capabilities and have control over their lives

• Creating fair employment and good work for all

• Ensuring a healthy standard of living for all

• Creating and developing healthy and sustainable places and communities

• Strengthen the role and impact of ill-health prevention

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What will make this happen?• Getting vision and strategy clear• High level strategic engagement

across the partnership• Making partnership work at all levels• Doing things systematically and at the

right scale• Getting the workforce right• Identifying the missing thousands• Meaningful and systematic

community engagement• Being ambitious about achievement

overall and for those in greatest need• Being driven by high quality

information

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Simplifying the approach..

Tower Hamlets• People• Place

Life in Tower Hamlets• Being born • Growing up – early years• Growing up – childhood and adolescence• Being an adult• Growing old

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People in Tower HamletsHeadlines Determinants Evidence of effective

interventionStrategy Conclusions

Life expectancy remains lower than rest of country but continues to improve:

Male life expectancy 75.3 years compared to 77 years nationally

Female life expectancy 80.4 years compared to 81.1 years nationally

Life expectancy gap between least and most deprived deprivation is 11.2 years in males and 6.5 in females

Amonst highest emergency admission and lowest elective rates in London

Growing population (expected to increase by 25000 in 5 years from 242,000 in 2010)

Young population (37% aged 20-39 cf 27% E)

High population churn (24% around, into or out of borough/ year)

51% non white (34% Bangadeshi)

33% families live on income less than £20,000 (22% E)

12% working age unemployed (9% L)

3.7% provide 20 hr or more unpaid care (50% provide 50 hrs +)

Marmot review- Give every child

the best possible start in life

- Enable all to maximise capabilities and have control over their lives

- Create fair employment and good work for all

- Ensure health standard of living for all

- Create and develop healthy and sustainable places and communities

- Strengthen role and impact of ill-health protection

Community Plan and all that sits under it

‘Reducing the inequalities and poverty that we see all around us, strengthening cohesion and making sure our communities live well together’

Tower Hamlets Community Plan, One Tower Hamlets Vision

Encouraging that life expectancy continues to increase but inequality persists

The major vehicle for improving health and wellbeing in the long term is the community plan through its impact on wider determinants – imperative to continually evaluate its impact on health and wellbeing and threats to delivery

Current economic climate and welfare reform will impact on physical and mental health

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Tower Hamlets as a placeHeadlines Determinants Evidence base for

effective interventionStrategy Conclusions

Ward life expectancy varies by 8 years in males and 6 years in females

The clearest difference is between the two most affluent wards and the variation is less marked between the other 15 wards

3rd highest rate of people killed or seriously injured on the roads in London

16 of 17 wards in 20% most deprived wards (12 in lowest 5%)

54% living in social housing compared to 37% in London

Higher levels of overcrowding

Substantial housing growth

1.1 hectares green space per 100 people compared to 2.4 nationally

42 fast food outlets per secondary school(2nd highest in London)

46% residents perceive high levels ASB (27% L)

Create and develop healthy and sustainable places and communities

- Improve active travel

- Improve availability of green spaces

- Improve food environment

- Integrate planning, transport, housing, environmental and health systems to address social determinants of health in locality

- Support community regeneration in increase participation and reduce isolation

Community Plan and all that sits under it

Particularly:

- Localisation agenda- Local Development

Framework- Housing strategy- GP networks- CHS localisation

The Local Development Framework is a major vehicle for shaping Tower Hamlets into a place that builds health and wellbeing into everyday life - it is critical that health and wellbeing impacts are factored into signficant developments in the borough

There is a significant opportunity to drive more integrated and innovative working at the locality level between the NHS and LA as both move towards more locality and sublocality planning arrangements

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Being born in Tower HamletsHeadlines Determinants Evidence base for


Infant mortality not significantly different to London (4.4 per 1000 live births < 1 year)

Higher percentage of low birth weight babies to London (9% compare to 7.5%)

High deprivation linked to low birth weight

45% of births to Bangladeshi mothers

3.3% smoke in pregnancy but 16% white mothers

Substance misuse, problem drinking, poor diet , poor mental health general issues 17% reduction teenage pregnancy since 1998 (now average for London)

Average early access to maternity services (improving but only 65%), patient experience issue

Ensure women have adequate income in pregnancy to maintain health and nutrition

Access to strong midwifery workforce ensuring early access and avoiding unnecessary intervention

Address behavioural risk factors eg smoking, diet, substance misuse

Intensive home visiting programmes during and after pregnancy

Community Plan

Children and Young Peoples Plan

Healthy Improvement Strategy for Maternity Services

Antenatal elements:• HWHL• Tobacco Control• Substance Misuse

Child Death Overview Panel

The evidenc e base highlights the importance of the prenatal period for future health

Whilst overall there is encouraging progress eg early access, improvements in patient experience and birth outcomes are relatively good, this could mask particularly poor outcomes in certain population segments

Equality impact assessment is therefore essential in monitoring outcomes

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Growing up in Tower HamletsEarly years

Headlines Determinants Evidence base for effective intervention

Strategy Conclusions

By the age of 5 only 46% of Tower Hamlets infants have achieved a good level of cognitive development compared to 56% nationally

13.3% are obese - 7th highest in the country

39% have experience of tooth decay compared to 31% nationally - declining

55% children in Tower Hamlets classified as living in poverty

80% mothers initiate breast feeding at birth and 68% are still breast feeding at 6-8 weeks (cf 72% and 45% England)

Immunisation uptake in under 5s is amongst the highest in the country (94% have second dose MMR)

40% of under 16s are estimated to have Vit D deficiency

Early years experience has lifelong effect on health and wellbeing

Supporting families to achieve improvement in early child development

Providing good quality early education and childcare

Good nutrition important for future health: breast feeding, good feeding practices

Benefits of childhood immunisation far outweigh any adverse effects

Community Plan


Healthy Improvement Strategy for Maternity Services

Immunisation Action Plan

Early years elements:• Healthy Weight,

Healthy Lives• Tobacco Control• Substance Misuse

The Marmot review is unequivocal in stating the critical importance and need to prioritise early years.

Despite some encouraging outcomes, there is strong evidence Tower Hamlets infants have outcomes at age 5 that are linked to poorer health and wellbeing outcomes in later life.

Good early education, access to childcare and support to family are evidence based interventions to give Tower Hamlets infants the best start in life

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Growing up in Tower HamletsChildren and Young People

Headlines Determinants Evidence base for effective intervention

Strategy Conclusions

25.7% 10-11 year olds are obese (3rd highest in the country) - plateaued

8th highest incidence of sexually transmitted infections in the country

2nd highest rate of injuries (deliberate and unintentional) to children and young people

17% reduction teenage pregnancy since 1998 (now average for London)

1 in 10 children are estimated to have a mental health disorder

55% children in Tower Hamlets classified as living in poverty

52% pupils entitled to free school meals (highest in country)

Improvement at key stages 1, 2 and 4 to above national average

49% pupils (yrs 1-13) participate in at least 3hrs high quality PE/Sport in week (69% nationally)

1 in 5 children under 15 have tried a cigarette 3 in 10 an alcoholic drink by age 15

Extending the role of schools in support families and communities

Developing schools-based workforce to support the health and wellbeing of children

Support and advice for 16-25 year olds on life skills, training and employment

Whole systems approaches to tackling obesity

Peer led approaches in supporting behaviour change

Health/social care tailored to CYP needs

Community Plan


CYP elements- HWHL- TH Healthy Borough- Tobacco Control- Substance Misuse- Sexual Health

Educational attainment is a major determinant of health. The improvement in educational outcomes in Tower Hamlets is a fantastic achievement in the context of the levels of child poverty in the Borough

It is good news that the rise in childhood obesity in plateauing but it remains 1 in 4

There have been improvements in the extent to which schools have promoted health within schools but there remains significant scope for further improvement

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Being an adult in Tower HamletsHeadlines Determinants Evidence base for


Amongst the highest premature death rates from the major killers in London- 3rd highest CVD- Highest Cancer- 5th highest COPD

12,000 adults with diabetes and increasing (17,000 by 2020)

Amongst highest rates of HIV, TB and sexually transmitted infections

5th highest admission rates for mental health reasons in London

Levels of long term illness/disability 34% higher than national average (2001 census)

People and place factors outlined previously

27% smokers compared (21%)

43% drinkers (50%) have hazardous or harmful patterns (21%)

68% do not do recommended levels physical activity (68%)

88% do consume recommended 5 a day (70%)

Highest rate of problem drug users (23/1000 cf 12/1000)

Improving health and social care outcomes

Addressing wider determinants of health

Environmental intervention to make healthy living easier

Structured behavioural change programmes

Screening /early awareness programmes

At risk/ disease registers providing systematic, person centred care

Structured rehabilitation programmes

High quality health and social care services

Community Plan/ Improving HWB strategy

Healthy Lives Strategy:

Tobacco control, Healthy Weight, Health Lives (obesity), Tower Hamlets Healthy Borough, Substance Misuse, Sexual Health

Health and social care:

Transforming Adult Social Care, Primary Care Investment Programme Care Closer to Home, Cancer Strategy, Mental Health Whole System review, Carers Strategy

Sustaining peoples income, housing and employment through the economic downturn is a critical health intervention

Remains scope to further embed healthy lifestyles into frontline services and target at risk groups

Successful implementation of new substance misuse strategy

Improving health and wellbeing strategy needs to be refreshed-Care packages-Prevention emphasis-Personalisation-Integration

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Growing old in Tower HamletsHeadlines Determinants Evidence base for


56% of 65-84 year olds report long term limiting illness compared to 48% nationally

80% of over 65s have at least one chronic condition of which 35% have at least 3 comorbid conditions

Underdiagnosis of dementia

2nd highest stroke mortality in London

Falls admissions lower than London average high in some wards

Most people do not die in their place of choice (over 60% in hospital)

People and place factors outlined previously

Higher proportion living alone

80% of TH residents aged 65+ do not meet recommended physical activity levels

Service data- At least 20% have

significant hearing loss?

- 60-75% on DN caseloads have incontinence problems?

- Adult protection need?

As for adults (root out age discrimination)

Promotion of healthy lives and social contact to delay onset and reduce impact of mental and physical illness and disability

Integrated services for complex needs- Single assessment- Integrated

commissioning- Integrated service

provision

Integrated pathways: falls, stroke, continence, dementia, end of life

Community Plan/ Improving Health and Wellbeing Strategy

Older People’s Housing Strategy

Transforming Adult Social Care

Promoting Independence Strategy- Information- Linkage Plus- Reablement- Telecare- Carers Support

Older People’s Delivery Group- Integrated model of

care

Community Virtual Ward

Older people in Tower Hamlets are a smaller proportion of the population but the evidence suggests their health is generally worse than elsewhere

There is some distance to go to get to level of integration and the targeting of resources to meet their needs more effectively

It is recommended that this is an area for focussed review across the partnership

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Top 10 considerations from JSNA (1)

1. The economic downturn will impact on health and particularly the health of those who already have the worst health outcomes in the borough

2. Tower Hamlets is not an easy place to be healthy. If it is to become an easier place, health needs to be at the heart of housing and planning strategy

3. There is a big opportunity to drive more integrated and innovative partnership working at a very local level and to involve local people much more in improving local services

4. There are 20,000 under 5s in Tower Hamlets and what is happening to them right now will have far reaching impacts on how healthy they will be for the rest of their lives

5. Education is a major determinant of health. The improvements in educational attainment this year mean that today’s Tower Hamlets school children are likely to have better health in their adult lives

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Top 10 considerations from JSNA (2)

6. Young adulthood is when despite an absence of disease, problems accumulate that manifest in later life. The high levels of smoking, problem drinking, drug use, poor diet and sedentary lifestyles mean people get disease earlier and die younger in Tower Hamlets.

7. Diabetes outcomes in primary care are improving but numbers are increasing. This is particularly an issue in Tower Hamlets because of ethnicity. Diabetes can be prevented and if this trend continues costs to health and social care services will become unsustainable

8. Death rates and survival from cancer are amongst the worst in the country and this is driven by both high levels of smoking resulting in lung cancer and also late presentation to health services

9. One in five over 65s in Tower Hamlets have at least four chronic conditions at the same time. This means services need to be integrated around their needs across health and social care services and wider council services . Patient are asking for better integration too.

10. Older people in Tower Hamlets are more socially isolated, have higher level of poverty, poorer housing quality and this is manifest in poorer health. There is a lot going on across the PCT and council to support older people but should there be an overarching strategy?

JSNA Process and Accountability

Health and Wellbeing Board

JSNA Programme Board

JSNA PMOSenior level partnership group NHS/LA/THInK

Officer group: corporate, adults, childrens, public health

JSNA ProductsSummary Document

Topic specific factsheets

Data Repositary (quantitative, qualitative, evidence base)

What is the local picture?What should we be doing?What are we doing?What is the user/community perspective?What more do we need to know?What are the priorities?

Disaggregation of data by :Place (locality, LAP, ward)Socioeconomic determinantsEquality dimensionsPredictive variables (eg social marketing)Provider (eg primary care, CHS, social care, polysystems, acute trusts)

Summmary- People- Place- Being born, growing up, adult

life and growing old in TH

(setting out local picture, evidence base, strategy, recommendations)

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Documents

Living in Tower Hamlets