Review of Health Inequalities at the local level

Review of Health Inequalities at the local level Maggie Rae Head of Health Inequalities & Head of Local Delivery 11 May 2006

Setting the target in context

Interpreting the evidence What are the causes of early death in Spearhead areas? The pattern of causes of deaths contributing to the life expectancy gap in Spearhead areas is broadly. Males similar for both males and. Females females with cancers, circulatory and respiratory diseases accounting for over 65% in each. Main causes of deaths contributing to the Life Expectancy gap in Spearhead areas 35% 30% All circulatory diseases 18% 16% All cancers 15% Respiratory diseases 21% 10% 5% 2% 10% 5% Digestive 9% External causes of injury and poisoning Infectious & parasitic diseases Other Deaths under 28 days 5% 2% 11% 6% Contribution to Life Expectancy Gap in Males Contribution to Life Expectancy Gap in Females Breakdown by disease, 2003 Circulatory diseases account for the largest proportion of excess deaths in Spearhead areas, most of which is attributable to coronary heart disease (CHD) (70% in males and 63% in females). Cancers and respiratory diseases, particularly lung cancer and chronic obstructive airways disease respectively, then account for a major proportion of the remainder of deaths. The remaining third are attributable to a range of causes including injury, digestive, poisoning, infectious and parasitic diseases, and deaths under 28 days. The target can be delivered if actions are targeted at these causes of early death…

Interventions to reduce the gap Actions to reduce deaths caused by cardiovascular disease (CVD) can reduce the gap in life expectancy but these will not be sufficient to deliver the targets. There is evidence that actions targeted at other cases of early death will be able to contribute enough to enable the target to be delivered but further work is needed to complete this modelling. It is, however, clear that the NHS can deliver the target if it uses this model (and later refinements to it) to reduce early deaths. The Impact – for females The Interventions The Impact – for males Targeted: 10. 4% 1. 0% 1. 4% 1. 6% • Secondary prevention of CVD: additional 15% coverage of effective therapies in Spearhead areas 35 -74 yrs 2. 3% • Primary prevention of CVD in hypertensives under 75 yrs: 40% coverage antihypertensives 1. 0% statin therapy • Primary prevention of CVD in hypertensives 75 yrs +: 40% coverage antihypertensives 1. 2% statin therapy 5. 6% • Other*, including: Early detection of cancer Respiratory diseases Alcohol related diseases Infant mortality Universalist: 16% 0. 7% 0. 4% 1. 0% 0. 2% • Smoking reduction in clinics – as at present • Secondary prevention of CVD: 75% coverage of 35 -74 yrs • Primary prevention of CVD in hyptensives under 75 yrs: 20% coverage antihypertensive statin therapy 0. 7% 2. 1% 8. 9% Further modelling of Other actions will 3. 2% 1. 0% need to contribute the remaining 2. 1% Further modelling of Other actions will need to contribute the remaining 5. 6% 0. 9% 0. 5% • Smoking cessation clinics: double capacity in Spearhead areas for 2 years 0. 2% 1. 4% 0. 2% 11%

Community engagement • We need clinical interventions to save people’s lives, but we also need to engage with people and give them a reason for living The professionals said… Life expectancy? It’s the Cinderella target. Local people don’t talk about life expectancy, the news is so grim. The words are there from DH and then there’s real life. The public said… I’m not ill, I’m just getting old (49 year old patient). Doctor told me ‘I have other patients to see’. You feel like a nuisance. Expectation in the community is very low, we don’t demand.

60% of Spearhead areas are making some progress towards the target 13 Spearhead areas are on track to deliver both male and female elements 29 are on track to deliver one element, less than 20% are on track 28 are off track for both elements 28 areas are off track for both elements of the target 14 areas are on track to deliver the female element of the target 13 areas are on track to deliver the target Note: The changes needed in life expectancy vary but are very small in all areas. 15 areas are on track to deliver the male element of the target

Summary of life expectancy delivery status as of 2002 -04

Life Check Initiatives to help reduce Health Inequalities Communities for Health Trainers Health Champions

IMPACT OF INTERVENTIONS TO REDUCE THE LIFE EXPECTANCY GAP NHS/OGD 2006 2010 PSA TARGET ALL INTERVENTIONS START NHS/OGD 2015 NHS/OGD 2020

Too many people in Spearhead areas are dying early • There were approximately 13, 700 additional deaths for 30 to 59 year olds in Spearhead groups, between 2002 -04, compared to the national average for England • The focus needs to be on reducing adult early deaths • Action on the overall PSA target to reduce infant mortality will also help deliver the reduction in life expectancy gap target