Health & Healthcare in London Key Facts January 2009 Overview of London’s Health • • • • • • • The geography of London London’s population and diversity Health determinants Key lifestyle issues Health inequalities Key health issues Health care use LONDON’S GEOGRAPHY London Boroughs and Acute Trusts Enfield 31 2 3 Barnet Harrow Haringey Waltham Forest 7 Redbridge 11 30 27 Islington Hackney Camden Hillingdon 4 Havering 19 1 22 Brent 24 28 23 Ealing 15 Newham 20 21 CityTower Hamlets Westminster 13 K&C 25 Southwark 6 Hounslow Barking & Dagenham H&F 8 9 29 Greenwich 18 26 Lambeth Richmond Lewisham 17 5 12 Merton 16 Kingston K & C - Kensington and Chelsea H & F - Hammersmith and Fulham Bexley 14 Wandsworth Bromley 32 10 Sutton Croydon 1 - Royal Free Hampstead 2 - Royal National Orthopaedic Hospital 3 - North Middlesex University Hospital 4 - The Hillingdon Hospital 5 - Kingston Hospital 6 - Ealing Hospital 7 - Barking, Havering And Redbridge Hospitals 8 - West Middlesex University 9 - Queen Elizabeth Hospital 10 - Bromley Hospitals 11 - Whipps Cross University Hospital 12 - Queen Mary's Sidcup 13 - Guy's And St Thomas' 14 - The Lewisham Hospital 15 - Imperial College 16 - Mayday Healthcare 17 - St George's Healthcare 18 - King's College Hospital 19 - The Whittington Hospital 20 - Newham Healthcare 21 - Barts And The London 22 - Tavistock And Portman 23 - Great Ormond Street Hospital 24 - Moorfields Eye Hospital 25 - The Royal Marsden 26 - Chelsea And Westminster Healthcare 27 - Homerton University Hospital 28 - University College London Hosp 29 - Royal Brompton And Harefield 30 - North West London Hospitals 31 - Barnet And Chase Farm Hospitals 32 - Epsom And St Helier University Hospitals © Crown Copyright. All rights reserved. [LHO 100042264, 2006] • • There are 32 Main Acute Trusts in London There are 31 Primary Care Trusts coterminous with 33 London Boroughs LONDON’S POPULATION AND DIVERSITY Key Facts • • • • • • • • 7.55 million resident population in Greater London (ONS 2007) Highly ethnically diverse with 42% from an ethnic minority group (including White Irish and Other White minority groups) (ONS 2006) More than 90 different ethnic groups and 300 different languages spoken Largest religious groups are Christian, Muslim, Hindu, Jewish, Sikh and Buddhist (2001 Census) Home to many refugees and asylum seekers Highly mobile (20-40% turnover on GP lists every year) 1.1 million daily commuters (CAPC 2006) 15.6 million visits were made to London by overseas residents in 2006 (Travel Trends 2006) LONDON’S POPULATION AND DIVERSITY Population Age Structure • London is relatively young with 15 - 44 years olds accounting for 49.5% of the population compared to England average of 41.6%. (ONS 2007) • The proportion of people of retirement age is the lowest of all regions (13.8 %) as wealthier people tend to move out of the Capital at retirement age. (ONS 2007) • Black and minority ethnic populations are relatively younger but are fast growing and ageing. There are large variations in the demographic structure of different ethnic groups. Source: ONS population estimates 2007 Number of people . LONDON’S POPULATION AND DIVERSITY Population Growth 2200000 2000000 1800000 1600000 1400000 1200000 1000000 800000 600000 400000 200000 0 00-04 '05-14 15-29 30-44 45-64 65-74 75+ 2001 2008 2031 Year Source: GLA PLP LOW projection 2008 • • • London’s population increased by 228,000 (3.1%) between 2001 and 2008 London’s population is expected to increase by 9.46 thousand (12.5%) by 2031 The 45-64 age group will increase by more than 463,000 (29%) by 2031 LONDON’S POPULATION AND DIVERSITY Number of people in each minority ethnic group, London 2006 ONS Ethnic Estimates 2006 (excluding White British) • Almost 3.2 million Londoners are from an ethnic minority group (42% of the population). • 39% of the England & Wales population from an ethnic minority group live in London. • The largest minority ethnic group is White Other followed by Indian, Black African and Black Caribbean. • The Black African group has more than doubled in the last ten years, and the number of Bangladeshis has increased by nearly three quarters since 1991. Chinese or Other Ethnic Group: Other LONDON Chinese or Other Ethnic Group: Chinese ENGLAND Black or Black British: Other Black Black or Black British: Black African Black or Black British: Black Caribbean Asian or Asian British: Other Asian Asian or Asian British: Bangladeshi Asian or Asian British: Pakistani Asian or Asian British: Indian Mixed: Other Mixed Mixed: White and Asian Mixed: White and Black African Mixed: White and Black Caribbean White: Other White White: Irish 0.0 500.0 1,000.0 1,500.0 2,000.0 LONDON’S POPULATION AND DIVERSITY HEALTH DETERMINANTS Health Determinants in London compared to England average This slide extracted from the Health Profile 2008 shows how London is doing in terms of the main socio-economic influences on health. Red is significantly worse than England, Green significantly better • • • • Deprivation, including long term unemployment, is a lot higher than average. Over 33.9% of London’s children are living in poverty, much greater than average. GCSE achievement is close to the England average Violent crime is high. HEALTH DETERMINANTS Inequalities in Health Determinants in London • • • • • • Within London there are wide inequalities in living conditions, and other socioeconomic factors that have an influence on health. These inequalities exist between people living in different parts of London, between different ethnic groups, age groups and other groups. Over half of London boroughs are in the top 30% most deprived boroughs in England, and 24% of boroughs are in the top 10% most deprived, with nearly all boroughs having pockets of deprivation. Newham, Tower Hamlets and Hackney have some of the highest unemployment rates in the country, whereas other boroughs have rates well below average. The Bangladeshi population has the highest unemployment rate, and the White British the lowest. Educational (GCSE) attainment is highest in Chinese children and lowest in Black Caribbean children. People from a minority ethnic group are more likely to live in an unfit home than the White population. HEALTH DETERMINANTS KEY LIFESTYLE ISSUES Lifestyle influences on health in London compared to England average This slide extracted from the Health Profile 2008 shows how London is doing in terms of the main lifestyle factors influencing health. Red is significantly worse than England, Green significantly better. – More people eat healthy food in London than England – Fewer people binge drink in London than England – There are fewer obese adults, but London has higher rates of childhood obesity than the rest of England. – Smoking levels are slightly below the national average. KEY LIFESTYLE ISSUES Obesity – key facts for London In London every year, obesity accounts for • 4,000 deaths (7% of all deaths) : – 300 deaths and 2,700 hospital admissions for cancers – 450 deaths and 1,300 hospital admissions for stroke or raised blood pressure – 600 deaths and 2,500 hospital admissions for angina or heart attack – 250 deaths and 2,400 hospital admissions for diabetes – 1,300 hospital admissions for osteoarthritis or gout • Adult obesity is related to social class, and is higher among more deprived populations, particularly for women. • London has higher rates of childhood obesity than the rest of England. Source ‘Choosing health. A briefing on nutrition, physical activity and obesity in London’ LHO Feb 2005 KEY LIFESTYLE ISSUES Smoking in London • • • • • • • Smoking is a major cause of cancer, respiratory disease, circulatory and ischemic heart disease. In London, smoking causes: – more than 10,000 deaths each year (1 death/hour) – 200 deaths per week among people aged 35 and over in London are attributable to smoking – 46,000 hospital admissions and more than 400,000 bed days a year Smoking costs the NHS in London >£105 million a year. Least affluent populations are most likely to smoke. Highest smoking prevalence is amongst Bangladeshi, Turkish and Irish men. Over a million Londoners are affected by smoking in the workplace There are marked social inequalities in smoking rates between the most affluent (who smoke least) and the least affluent who are most likely to smoke. Source ‘Choosing health. A briefing on tobacco in London’ LHO 17 Feb 2005 KEY LIFESTYLE ISSUES Standardised rate of deaths attributable to smoking in London by Borough, 2004-2006 Source APHO Health Profiles 2008 KEY LIFESTYLE ISSUES Alcohol in London • • • • • • • On average Londoners drink less often and fewer drink above sensible levels compared to the England average. People on high incomes and the unemployed are most likely to drink above sensible levels and to binge drink. People from many ethnic minority groups are more likely to be non-drinkers. More Londoners are dependent alcohol users compared to England. The death rate due to alcohol in London is slightly lower than nationally. (Table7.7 Focus on London 2008) Alcohol misuse impacts on health care at all levels. Alcohol consumption contributes significantly to the volume of injuries in London. Main source ‘Choosing health. A briefing on reducing alcohol-related harm and encouraging sensible drinking in London’ LHO Apr 2006 HEALTH INEQUALITIES Life expectancy and causes of death This slide extracted from the Health Profile 2008 shows how London is doing in terms of the major killers. Red is significantly worse than England, Green significantly better. – – – – Road injury rates, life expectancy and early cancer are better than the England average Infant mortality and deaths from smoking are similar to the England average in London. More people die prematurely from heart disease and stroke than the England average. However, these figures mask wide inequalities between London’s Primary Care Trusts. HEALTH INEQUALITIES The life expectancy PSA target The PSA target for life expectancy aims to see faster health improvement compared to the average in the “fifth of areas with the worst health and deprivation indicators” – The Spearhead PCTs/LAs. The Spearhead LAs are indicated on this map. HEALTH INEQUALITIES Life expectancy in London, 2004-06 • Male Female England 77.3 81.6 • London 77.4 82.0 • London Spearhead group 75.6 80.8 Source: ONS • For males in 2004-2006, life expectancy in England was 77.3. This is very similar to the average for London, but 2.3% higher than in the London Spearhead Group. For females, life expectancy in England was 81.6, 1% higher than in the London Spearhead Group. These gaps have to be reduced by 10% for the life expectancy target to be achieved. London as a whole is on track to reach this target, but not all spearhead areas are on track. Differences in Life Expectancy within a small area in London Travelling east from Westminster, each tube stop represents nearly one year of life expectancy lost –Data revised to 2002-06 Male Life Expectancy 78.6 (CI 76.0-81.2) Canning Town Female Life Expectancy 84.6 (CI 82.5-86.7) Male Life Expectancy 72.8 (CI 71.1-74.6) Female Life Expectancy 81.4 (CI 79.3-83.6) Westminster London Bridge River Thames Canada Bermondsey Water Canary Wharf North Greenwich Waterloo Southwark Has this been updated? Yes London Underground 1 Jubilee Line Electoral wards just a few miles apart geographically have life expectancy spans varying by years. For instance, there are eight stops between Westminster and Canning Town on the Jubilee Line – so as one travels east, each stop, on average, marks nearly a year of shortened lifespan. 1 Source: Analysis by London Health Observatory using Office for National Statistics data revised for 2002-06. Diagram produced by Department of Health HEALTH INEQUALITIES Infant mortality rates (deaths < 1 year),2004-2006 • • • • The infant mortality PSA target aims for a reduction in the gap in mortality rate among those with fathers in the “routine and manual” groups and the population as a whole. This target is difficult to measure at local levels due to the small number of deaths involved. Within London as a whole the infant mortality rate is falling. There is a more than three fold differential in the infant mortality rates for different London boroughs. This differential can be measured as a proxy for the PSA target. SPECIFIC HEALTH ISSUES IN LONDON Key Facts • London has highest number of new diagnoses of sexually transmitted infections (STI) out of all regions. (29% of all English new diagnoses in 2007)(HPA) • The London average teenage pregnancy rate was higher than the England average in 2006 (and very much higher in Inner London). (ONS and Teenage Pregnancy Unit 2008) • In 2007 London accounted for 48.3% of HIV cases in contact with services in the UK. (HPA) • On the basis of measures of need such as MINI and NPMS London has significantly higher demand for mental health services than England, and specifically for people with severe Mental Health problems. (APHO Indications: Mental Health Section 2.2) • London has the highest tuberculosis (TB) rate out of all regions and the number of case reports per 100,000 population rose from 36.5 per 100,000 population in 2000 to 44.8 per 100,000 in 2006. (HPA 2008) • Many diseases such as tuberculosis, diabetes, HIV, renal disease and coronary heart disease are more common in specific ethnic groups who are more commonly resident in London. (APHO Indications: Ethnicity and Health) • 5.2% of 16-59 year olds reporting having used Class A drugs in the last year in London compared to 3.4% in England & Wales (Fig 4.10 2005/06 British Crime Survey) SPECIFIC HEALTH ISSUES - SEXUAL HEALTH Number of newly diagnosed STI’s reported from genitourinary (GU) clinics in London 1999 - 2007 25,000 20,000 gonorrhea 15,000 Chlamydia herpes first attack 10,000 warts first attack 5,000 Source: HPA 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 • Chlamydia diagnoses have more than doubled since 1998 and are highest in the young. • New syphilis episodes sharply increased in London between 2003 and 2007(33.0%). (HPA) • The presence of STIs can facilitate HIV transmission. • The percentage of people offered an appointment to be seen at a GUM clinic within 48 hours in London has increased steadily from an average of 68.9% in 2005 to 97.9% in 2008 (Sexual Health Indicators Report, LHO) SPECIFIC HEALTH ISSUES - SEXUAL HEALTH HIV - a growing burden in London • • • • • • • London accounted for 48.3% of cases in contact with care in the UK in 2007. (HPA) In 2007 – 3175 new infections were diagnosed in London. (HPA) In 2008 – an estimated 27% of HIV infections may be undiagnosed. (HPA website) Nearly all new heterosexual HIV infections have been among Black Africans – three quarters acquired in Africa. (See New Diagnoses National Overview HPA website) Men who have sex with men are the largest group to have acquired infection in London. They represent about 50% of cumulative new diagnoses of HIV in London since 1992 or earlier. (UK HIV New Diagnoses June 2008 Table 4) Heterosexual transmission is largest group of current new diagnoses nationally but the number of new diagnoses of this type in the UK appears to have peaked . (UK HIV New Diagnoses June 2008 Table 5) 4.0% of injecting drug users in 2006 contacting specialist services in London have HIV infection (0.7% Rest of England). (Unlinked Anonymous Survey of Injecting Drug Users: data to the end of 2006 HPA) SPECIFIC HEALTH ISSUES – SEXUAL HEALTH Teenage Pregnancy 2006 Under 18 Conception Rate 2006 90.0 80.0 London England 70.0 60.0 50.0 40.0 30.0 20.0 10.0 Kingston upon Thames LB Harrow LB Richmond upon Thames LB Barnet LB Redbridge LB Bromley LB Sutton LB Ealing LB Bexley LB Havering LB Brent LB Merton LB Hillingdon LB Hounslow LB Waltham Forest LB Enfield LB Croydon LB Greenwich LB Barking and Dagenham LB Kensington and Chelsea LB Westminster City of LB Camden LB Hammersmith and Fulham LB Tower Hamlets LB Newham LB Islington LB Hackney LB & City of London Wandsworth LB Haringey LB Lewisham LB Southwark LB Lambeth LB 0.0 Source: TPU, DfES, 2006 • Teenage Pregnancies (TP) include all conceptions to women aged <18 years of age. • In 2006 the London TP rate was 45.6/1000 females aged 15-17 compared with 40.6/1000 nationally with the highest number of TP occurring in deprived areas. • Rates fell between 1998 and 2006 in 28 boroughs but there were large increases in 5 boroughs. SPECIFIC HEALTH ISSUES – MENTAL HEALTH Mental Health • In London an estimated 14.8% of adults had a GHQ12 score of 4 or more indicating a possible psychiatric disorder in 2004. England’s value was 13.2%. (APHO indications of mental health) • Current trends suggest London is on track to meet London’s PSA target rate of 7.2 suicides per 100,000 by 2009-11(LHO using NCHOD data to 2005-07) • • Mental health problems are more prevalent in deprived areas (Many studies show this relation) • London has a significantly higher demand for mental health services than England, and specifically for people with severe mental health problems. • According to ‘Mental Health in London’ Briefing LHO Nov 2005 London has: – Higher admission rates – Higher proportion of inpatients with severe mental illness – Higher occupancy rate despite more beds – Higher use of forensic beds – Highest rate of compulsory admissions – Highest spend on mental health services – Higher crude caseload rates in some community services – Large populations at risk of mental health problems e.g. asylum seekers SPECIFIC HEALTH ISSUES – TUBERCULOSIS (TB) London sector TB rate per 100,000 resident population 50 45 40 35 30 London 25 England 20 15 10 5 0 2000 • • • 2001 2002 2003 2004 2005 2006 London tuberculosis (TB) rate per 100,000 population rose from 36.5/100,000 in 2000 to 44.8/100,000 in 2006. (Source: HPA London Regional Unit, 2006) Nationally 66% of newly diagnosed cases in 2006 were among foreign born populations. (HPA) The highest number of new cases occurs among the Asian and Black African populations. (HPA Enhanced Tuberculosis Surveillance 2007) smr 2004-2006 140 london 120 england 100 80 60 40 Standardised Mortality Ratio SPECIFIC HEALTH ISSUES – ETHNICITY Mortality from diabetes by London Borough 2004-06 180 160 20 0 Westminster, City of LB Kensington and Chelsea LB Havering LB Bexley LB Sutton LB Bromley LB Camden LB Hammersmith and Fulham LB Kingston upon Thames LB Richmond upon Thames LB Harrow LB Redbridge LB Barnet LB Enfield LB Southwark LB Wandsworth LB Barking and Dagenham LB Greenwich LB Croydon LB Ealing LB Merton LB Hillingdon LB Islington LB Lewisham LB Brent LB Waltham Forest LB Hounslow LB Lambeth LB Tower Hamlets LB Newham LB Haringey LB Hackney LB Source: Compendium of Clinical Indicators There are wide inequalities in mortality from diabetes. Boroughs with large populations from ethnic minority groups such as Hackney, Haringey, Tower Hamlets and Newham have the highest rates. HEALTH CARE USE Age standardised admission rates by PCT, fin06/07 Kensingt on and Chelsea Richmond upon Thames Hounslow West minst er Havering Croydon Camden Harrow Kingst on upon Thames Barnet Bromley Redbridge M ert on Bexley Sut t on Brent Wandswort h Hillingdon Hammersmit h and Fulham Sout hwark Ealing Barking and Dagenham Islingt on Lambet h Enf ield Haringey Tower Hamlet s Walt ham Forest Lewisham Cit y & Hackney Greenwich Newham 0 5000 10000 15000 20000 25000 Directly age standardised admission rate per 100000 Source: Hospital episode statistics and LHO 30000 HEALTH CARE USE Healthcare Commission Inpatient Survey 2004 Londoners are less satisfied with the NHS; BME patients are particularly dissatisfied NB risks of Patient Choice. Source: Healthcare Commission Patient Survey SUMMARY OF LONDON’S KEY HEALTH CHALLENGES • Ethnically diverse population with high mobility and population growth • London as a whole has slightly below average mortality rates and slightly higher life expectancy than England as a whole, but has above average rates of premature mortality from circulatory disease, and wide inequalities between boroughs/PCTs • Key lifestyle issues such as obesity, smoking and alcohol are contributing to poor health in London’s more deprived areas • London has high rates of teenage pregnancy and sexually transmitted infections such as HIV • The incidence of tuberculosis is rising and is more common among ethnic minority groups • London has significantly higher than average demand for mental health services, particularly for people with severe mental illness. • Primary care services are performing relatively poorly. (Darzi report on London) • Londoners are more dissatisfied with the NHS, especially those from BME groups.