Risks

Risks-2

Population Health Risks

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Air quality

Key statistics

Indicators of air quality for our region have been drawn from air pollution background concentration maps (DEFRA) and Public Health Profiles (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information
Discussion

The outdoor air pollutants of concern in our region include NO2 and particulate matter (PM), specifically very fine PM2.5 µm (2.5/1,000,000 m) and PM10 µm. Although the annual pollution levles are below the the WHO limits, there is significnat variation, with the highest polluting areas being where the poorest people live. Additionaly there is no safe limilt for PM2.5.

Both PM2.5 and NO2 have the ability to get into the deepest reaches of your lungs and directly into your blood stream, which can then cause blockages, increasing the risk of heart and lung diseases, as well making life worse for people already living with these conditions.

Unfortunately, these pollutants come from many sources, from the chimneys on factories, energy plants and car exhausts, to industrial and garden fires and wood burning stoves.

To try to understand the different levels of pollution different people across Dorset are exposed to, we have used modelled pollution estimates from the Department for Environment, Food and Rural Affairs to map the background concentrations of PM2.5 and NO2.

Alcohol

Key statistics

Indicators are drawn from three datasets: Local Alcohol Profiles for England, Health Behaviours in Young People, and the Public Health Outcomes Framework (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information
Discussion

Harmful levels of drinking have both health and social consequences. According to the World Health Organisation (WHO), harmful use of alcohol is a causal factor in several diseases and injury types, as well as being causally linked to a range of mental and behavioural disorders and infectious diseases. Reducing alcohol-related harm is a key priority for Public Health.

Locally, the percentage of adults who drink over 14 units of alcohol a week is similar to that of England. In Bournemouth, the rate of hospital admissions for alcohol-related conditions is higher than England – the rates are lower for Poole and Dorset. The percentage of children aged 15 who are regular drinkers is also higher in Bournemouth.

Crime and violence

Key statistics

Indicators of crime and violence for our region have been drawn from Public Health Outcomes Framework (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information
Discussion

Crime and antisocial behaviour affects health in a number of ways – directly, indirectly and by influences on the healthcare system. Public Health, through working with partners in the community, such as the police, NHS and trading standards, can play a key role in in assisting the Community Safety Partnerships (CSPs) to deliver on their strategy.

Althought the number of firstime offenders has dropped in all areas since 2014, the reoffending rates have changed little. Additonaly, in recent years, the number of violent offencece has increased in all areas (and across England). However, this is likley due to a change in the recording practices by the police, lowering the threshold of what constitues a reportable violent offence. In contrast to this local Cardiff model data sugests that there has been little chang in the number of assault victims being seen by emergency departments.

Cardiff Model – violence surveillance system: This is a local violence survaillence system that informs stratagies that attempt to reduce the potential of physical harm in the community. Our model is based on a local interpretation of the original Cardiff Model and the national Information Sharing to Tackle Violence (ISTV) standard (see ISTV).

How it Works:Information is collected from patients who have been the victim of an assault and sought treatment in an emergency department. This information is anonymised, and is shared with community safety partners. It is set up as a population level preventative programme so that no identifiable data is shared, and there is no risk of an individual being identified from the data set.

The data collected includes the date and time the violence occurred, location of violence, if weapons were used and how many assailants there were. These key pieces of information help to identify violence ‘hot spots’, which enable partners to take appropriate  action to prevent further harm. This may include challenging the practices of a licensed venue, altering policing patterns or introducing an intervention such as street pastors into the night time economy.

Making the Night Time Economy Safer: This approach has been repeatedly demonstrated to reduce levels of violence and also hospital admissions.  To be effective the information from the hospitals needs to be accurate and it must be shared correctly to inform licensing, policing and crime prevention interventions.

Locally we have been successful in adding conditions to a number of licensed premises to ensure they are protecting the health of people who use them and even in supporting the closure of a pub with evidence of poor management practices causing harm.

The information is used with police data to show a fuller picture, it can influence local policy, and it may provide support for the implementation of things such as cumulative impact policy.

Partnership approach: The scheme is coordinated by Public Health and delivered in partnership with three emergency departments; the Royal Bournemouth, Poole General and Dorset County Hospital, as well as licensing and community safety officers in all of the local authorities and Dorset police. The steering group meets on a quarterly basis and communication between partners is encouraged at all times to ensure timely sharing of relevant information.

Data: We continue to work closely with our hospitals and partners to make Dorset a safer place. We are pleased to be able to display some of the data trends here.

Information in this visualisation is from all three hospitals who have approved its use in this way in line with their data protection and patient confidentiality policies. No individuals can be identified from the data shown.

Drug use

Key statistics

Indicators are drawn from three datasets: Health behaviours in young people, Public Health profiles, and the Public Health Outcomes Framework (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information
Discussion

Misuse of drugs is a significant cause of premature mortality, has impacts on the users physical and mental health, as well impacting on the people around the user and wider society.

In England and Wales, there were 3,744 drug poisoning deaths in 2016 – the highest number since comparable statistics began to be collected in 1993. Sixty-nine percent of these deaths were related to drug misuse, and this was highest for people aged 40 to 49 years. Over half of deaths related to drug poisoning (54%) involved an opiate drug.

Locally, the rate of deaths from drug misuse in Bournemouth is higher than that of England. For younger people, the rate of hospital admissions for substance misuse aged 15-24, and the percentage of 15 year olds who have taken cannabis in the last month is significantly higher in Poole, compared to England.

Excess weight

Key statistics

Indicators of excess weight and/or obesity for our region have been drawn from Health Profiles (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information

 

Discussion

Having excess weight or being obese has significant implications for both physical and mental health. It increases the risk of several diseases such as heart disease, Type-II diabetes and some cancers, which in turn increases the likelihood of premature death. Obesity is a key public health issue, as it is widespread nationally, prevalence remains high and it has significant impact on health and social care costs, as well as economic and societal impacts.

Obesity is also an issue in childhood, with 22% of children in reception and 34% of children in Year 6 being overweight. As well as increasing risk of disease, obesity in childhood is linked to poor mental health and sleep. Children who are obese are more likely to be obese in adulthood, with the associated risk of disease and premature mortality.

The causes of obesity are complex, from individuals unhealthy lifestyle and eating choices through to wider issues such as the local environment and food availability. There is not a single effective intervention – a variety are needed to tackle the issue.

Although our local areas are doing better or no worse than national indicators, the figures are still of great concern and are trending upward.

Greenspace accessibility

Key statistics

Indicators of greenspace accessibility were drawn from the Wider Determinants of Health and Health Assets profiles (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information
Discussion

Contact with the natural environment and urban greenspace has positive impacts on health in a variety of ways; DEFRA’s Evidence Statement on the links between natural environments and human health (2017) concluded that:

  • Living in greener environments is associated with reduced mortality
  • There is strong and consistent evidence for mental health and wellbeing benefits from exposure to natural environments
  • Use of accessible, better quality natural environments is associated with a higher likelihood and rate of physical activity

The potential of greenspace to deliver health benefits at scale is obvious. From trips to beaches, parks and nature reserves to a moment of calm on a tree lined commute to work we encounter it every day, but access to the high quality green and blue spaces which bring the greatest benefit is not equally distributed.

Housing quality

Key statistics

Indicators of housing quality for our region have been drawn from three datasets: Wider determinants of health, Public Health profilesPublic Health Outcomes Framework (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information
Discussion

Housing is a key determinant of people’s health and wellbeing. Living in a suitable home also enables people to access education or employment, and to contribute to society. Living in cold, damp overcrowded or otherwise unsuitable homes increases the risk of physical and mental health (e.g. for disabled or older people) or through unstable living circumstances / homelessness.

People unable to keep their home warm enough are more likely to use health and social care services. Poor housing is linked to an increased risk in cardiovascular and respiratory disease (in both children and older people) and can lead to falls and injuries, requiring specialist housing or residential care. Public Health has been working with other partners in local authorities to help improve the housing stock and enable people to live in their own home for longer.

Overcrowded housing is associated with increased risks of respiratory and infectious disease, and also poor mental health and child development / educational attainment. Locally, Bournemouth has a higher rate of overcrowded housing compared to the England average.

Inequality

Key statistics

Indicators of inequality for our region have been drawn from the Wider determinants of health and the Public Health Outcomes Framework (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information
Discussion

We often refer to socioeconomic deprivation and health inequality without distinguishing between them. Although they are interrelated, socioeconomic deprivation in the UK is usually measured using the Index of Multiple Deprivation (IMD), of which one element is ‘health deprivation’. Health inequality is characterised variously as the relative difference between groups of people (defined usually by some small area geography) in terms of Life Expectancy, or Healthy Life Expectancy or one of a number of other measures.

The interplay between socioeconomic deprivation and health inequality is complex. There are four areas in our region that have merited specific community development efforts due to being both deprived and having poorer health outcomes than other communities.

Risks to health and wellbeing are not evenly distributed across the population, but instead conspire to form patterns of inequality with people in poverty more likely to experience poor health, partly because of living in poorer environmental conditions.

If inequalities are to be reduced, it is critical that risks are identified early on in their development and, where possible, action is taken to lessen their impact on health and wellbeing. This requires services to actively seek out groups of people known to be at heightened risk, as they may be the ones least likely to seek help from services or participate in health programmes. The earlier that these risks can be identified and preventative measures put in place, the better the outcomes for health and wellbeing.

As well as impacting on biological health, society affects health in a number of ways, directly and indirectly and by influences on the healthcare system:

  • Directly, through violence, injury, rape and other offences against the person.
  • Indirectly, through the psychological and physical consequences of injury, victimisation and isolation because of fear.
  • As a determinant of illness, along with poverty and other inequalities, which increases the burden of ill health on those communities least able to cope.
  • By causing preventable health burdens, such as alcohol-related crime, motor vehicle incidents and drug dependency.
  • Structurally by limiting the choices people are able to make – healthy food costs more, working life makes it difficult to access services unless out-of-hours, poor education makes it difficult to access health information and reduces social-mobility chances etc.

There are well established links between health, employment, productivity and poverty. Being in work provides purpose, promotes independence and is a factor in preventing physical and mental health problems.

 Promoting health and well-being for all will raise employment, reduce child poverty and poverty later in life, and raise the growth in productivity of the British economy. Similarly, increasing employment and opportunity of employment will directly promote better health and well-being for all.

The Economy (JSNA April 2016) is one of seven narratives of the Dorset Joint Strategic Needs Assessment that aim to understand the health and wellbeing needs of our local population [LINK to LEES ECONOMY DASHBOARD]. Key findings from the Economy JSNA are:

  • Over 34,000 people of working age in Dorset claim out of work benefits 8% of Dorset’s working age population are claiming out of work benefits. (Department for Work and Pensions, May 2015).
  • Of those claimants, 26,000 people claim Employment Support Allowance/Incapacity Benefit and are likely to face significant barriers to employment.
  • 49% of those claiming sickness-related benefits had mental and behavioural disorders as their primary health condition. Bournemouth (59%) had the highest rate of claimants with Dorset (45%) and Poole (44%) having similar rates.
  • Ill-health and injuries cost an estimated £180 million to Dorset LEP economy during 2012/13. (Health and Safety Executive, 2014/15)
  • Dorset’s workforce is ageing. 109,600 people or 32% of the workforce population were aged 50 or over in the Dorset LEP area. In comparison, for England it was 28%.
  • In 2015, there were some 76,000 employee jobs paid less than the living wage in the Dorset LEP. At least 46,000 of these jobs were part-time jobs.

Bournemouth, Poole and Dorset are part of the Dorset Local Economic Partnership (LEP). Dorset LEP is led by the private sector and aims to promote local economic growth and prosperity. For further information about the LEP and its economic strategy please see the website Dorset Local Enterprise Partnership.

Physical activity (inactivity)

Key statistics

Indicators of physical activity and inactivity for our region have been drawn from physical activity profile (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional Information
Discussion

A key risk factor for death and poor health, physical inactivity contributes to one in six deaths in the UK. People who lead physically active lifestyles have reduced risk of many diseases such as coronary heart disease, stroke and diabetes, as well as lower levels of obesity and improved mental health. For older adults, physical activity helps to maintain physical and cognitive abilities. Guidelines for physical activity vary by age; young people are recommended to do at least one hour of physical activity every day, while for adults 150 minutes of moderate activity per week is recommended.

Young people who spend more time sedentary (i.e. activity with very low energy expenditure, undertaken primarily sitting or lying down) have greater fat mass, higher BMI and an increased risk of being overweight or obese, irrespective of their levels of physical activity when not sedentary. Therefore it is important to track levels of sedentary behaviour as well as physical activity.

Regular moderate-to-vigorous physical activity (MVPA) has significant benefits to health: It is associated with increased musculoskeletal and cardiovascular health and has also been linked with psychological benefits, such as reduced anxiety and depression among children and adolescents.

Good physical activity habits established in childhood and adolescence are likely to be carried through into adulthood, while lower levels of activity are associated with obesity, a serious public health issue in Europe and North America.

In England, 65% of adults meet the physical activity guidelines. Locally, the rate of adults meeting physical activity guidelines is better in Dorset (68% physically active). In Poole, 26% of adults physically inactive, which is significantly worse than the England rate. The rate of young people meeting activity guidelines is much lower – in England, 13.9% of young people meet the recommended 1 hour of activity a day, and local rates are similar.

Smoking (tobacco use)

Key statistics

Indicators of smoking/tobacco use for our region have been drawn from Public Health Outcomes Framework (PHOF). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional Information
Discussion

As a modifiable lifestyle choice, smoking is the most preventable cause of death and ill health in the UK. Smoking is a major risk factor for diseases such as lung cancer, chronic obstructive pulmonary disease (COPD), heart disease and it is also linked to cancers in other parts of the body. Smoking is not just a risk factor for an individual; exposure to second hand smoke (passive smoking) is also recognised as a hazard, particularly to the health of children. Additionally, smoking in pregnancy can cause health problems for both mother and baby, such as a higher risk of miscarriage, labour complications, premature birth and sudden unexpected death in infancy.

In the UK, adult smoking prevalence rates are declining. In 2016, 15.8% of adults were smoking (rate of ‘adult current smokers’), which is a statistically significant decrease from 20.1% in 2010. Smoking is more prevalent among those aged 25 to 34. Men are more likely to smoke than women. Locally, only adult smoking rates in Dorset are better than the average rate across England.

The latest government target is to reduce the adult smoking rate in England to 12% or less by 2022.

In England, child smoking rates are lower than that of adults, with 8% of young people thought to be current smokers. Girls were more likely to be current smokers than boys. Rates also vary by deprivation, with young people from the most deprived areas being more likely to be regular smokers. Locally, smoking prevalence at age 15 in Bournemouth and Poole are higher than England, for both current and regular smokers.

The latest government target is to reduce the rate of 15 year olds who regularly smoke to 3% or less.

Unsafe sex

Key statistics

Indicators are drawn from two datasets: Sexual and reproductive health profiles and Public Health Outcomes Framework (PHE). Bold figures in the table below indicate a statistically significant difference from the respective English Average; * indicates missing data.

Additional information
Discussion

Sexual health covers advice and support around contraception, relationships, sexually transmitted infections (STIs) and abortion.

Patterns of sexual behaviour and relationships have been changing, and many different factors influence safer sex behaviour such as; personal beliefs, social norms, peer pressure, culture, misuse of drugs and alcohol, coercion and abuse. Vulnerable groups include young people, sex workers, men who have sex with men and some BME groups.

Child Sexual exploitation is a form of sexual abuse where an individual or group take advantage of an imbalance of power to coerce, manipulate or deceive a child or young person into sexual activity. Sexual exploitation has long lasting consequences in all aspects of the child’s life including their physical and mental health and wellbeing.

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