Headline
- Life expectancy in the North East is less than the national average, but the gap is narrowing.
Introduction – National Policy Context
The government is committed to delivering the best possible health and well-being outcomes for everyone, helping people to live healthier lives, empowering them to stay independent for longer and tackling inequalities. The Department of Health centres around three strategic objectives.
- Better health and well-being for all: helping people stay healthy and well; empowering people to live independently; tackling health inequalities.
- Better care for all: the best possible health and social care that offers safe and effective care, when and where people need it; and empowering people in their choices.
- Better value for all: delivering affordable, efficient and sustainable services; contributing to the wider economy and the nation.
This chapter relates primarily to the first of these three strategic objectives.
The Strategic Review of Health Inequalities in England was published in February 2010. Theis review proposed a series of evidence-based strategies for reducing health inequalities in England.
The Spearhead Group
Tackling health inequalities is a government priority and there is a national target to reduce the relative gap in life expectancy at birth between the fifth of areas with the worst health and deprivation indicators (the Spearhead Group) and England as a whole by 10%. There are related targets for cancer and heart disease.
The Spearhead Group is a fixed list consisting of 70 Local Authorities (15 in the North East) in the bottom fifth nationally for three or more of the following five factors:
- Male life expectancy at birth
- Female life expectancy at birth
- Cancer mortality rate in under 75s
- Cardio Vascular Disease mortality rate in under 75s
- Index of Multiple Deprivation 2004 (Local Authority Summary), average score
The 62 Primary Care Trusts which map these authorities are Spearhead PCTs and all but one of the North East PCTs are in this group. It is worth noting that the determinants of health are wide and include employment, wealth, education, housing, transport and the environment.
Two regional strategies give regional context to these national objectives. Better Health Fairer Health is the North East Regional Health and Well-being Strategy which include tackling the broader determinants of health such as employment, wealth, education, housing, transport and the environment..
Life expectancy is one of the key measures for the health inequalities national target. Life Expectancy at birth is a theoretical measure derived from death rates of different age groups with the current population[1]
Life expectancy for women is higher than for men. The difference between men and women in the North East is 4.1 years, similar to the national value of 4.5 years.
The North East’s gap in life expectancy with the rest of the UK has narrowed from 1991-93 data. The gap for males has narrowed from 1.4 years to 1.0 years, but the for females the gap rose in 2006 - 2008 from 1.1 years to 1.4 years after many years of the gap narrowing.
Deaths from Cancer
Another key measure for the health inequalities national target is cancer mortality rates in the under 75s. The Standardised mortality rate of deaths from all forms of cancer in persons under 75 years is higher in the North East than in any other English region. The regional rate has decreased over the past few years, to around 133 deaths per 100,000 people each year. This level is about 19 percentage points above the rate for England as a whole. The rate for males is significantly higher than that for females, and the disparity between regional and national rates is also higher for males than females. Both regionally and nationally, cancer mortality rates have been in decline. But the data suggests that in recent years the gap between regional and national cancer mortality rates has begun to increase.
Deaths from coronary Heart Disease
The standardised mortality rate of deaths from coronary heart disease in persons under 75 years is higher in the North East than in any other region in England with the exception of the North West. In 2008, the annual rate in the region was just under 48 deaths per 100,000 people, around 19% above the rate for England as a whole. Incidence rates are very much higher for males, at approximately three times the rate for females.
The period from 1995 to 2008 has seen major reductions in the death rate from coronary heart disease, more than halving the rate over the period. Regionally the reduction has been slightly greater than the national average, reducing the regional rate from over 30% above the national average in 1993 to approximately 19% above 15 years later.
Despite this, the region still has the second highest death rate from coronary heart disease of all the English regions.
Cervical Screening Programme Coverage
Cervical screening is a method of detecting early abnormalities, which, if left untreated, could lead to cancer in a woman’s cervix (neck of womb). Early detection and treatment can prevent 80% to 90% of cancers developing. National policy is that eligible women aged 25-64 years should be screened every 3-5 years. The ‘programme coverage’ measure shows the proportion of eligible women.[2]
The data reported is for 2007- 2008. Coverage in the North East is 80% and is higher than the average for England as a whole (78.6%). Even allowing that the national average is depressed by the low coverage rate in London, the North East’s coverage rate is firmly amongst the better half of the English regions. The short term trend (over the last three years) shows that both regionally and nationally the coverage rate has been falling.
In 2008 the teenage conception rate was 49.0 conceptions per 1,000, compared to the national rate in England and Wales of 40.7 conceptions per 1,000. The region’s rate is the highest amongst the countries or regions of England and Wales and this situation has prevailed since 2003.
The policy of the current government has been to halve the under-18 conception rate by 2010 (using 1998 as the baseline year). Over the period from 2001 to 2008 the national rate reduced by approximately 5%, while the regional figure was approximately 1.5% higher in 2008 than in 2001. The effect of these increases has been to maintain the gap between the North East and the rest of the country and this gap is now 1.3 times what it was in 2001.
The proportion of the population aged 16 years and over who smoke represented in this report is measured by General Household Survey. Other major survey data is also available from the NHS Health and Social Care Information Centre and the Clinical and Health Outcomes Database (NCHOD). These data provide a different picture to that presented in the General Household Survey due to different survey methodologies. Links to these sources are available at the bottom of this section of the report.
The General Household Survey for 2008 indicates that smoking rates in the North East are the same as in England and Great Britain as a whole, with estimates indicating that 21% of the population in the North East are smokers, compared to the same percentage nationally.
Evidence shows that in England as a whole smoking rates amongst men are higher than for women, by around 1 percentage point. The North East an exception to this. Smoking rates for women are higher than for men – with female smoking rates 6 percentage points higher than that of males.
Whilst evidence points to a gentle decline in national smoking rates, the evidence shows that North East rates are much more volatile. This is partially due to the effect of survey sample sizes at regional level, but they do show that the overall smoking rate has fallen significantly over the period 2000 - 2008, despite wider fluctuations when looking at the gender split.
Immunization Uptake by Children
The Health Protection Agency publishes a schedule of childhood vaccinations, listing vaccinations against various diseases and the ages at which each is currently provided within the childhood vaccine schedule. The proportion of children who have received the MMR (measles, mumps and rubella) ‘triple shot’ vaccine by their second birthday is used as a proxy for childhood immunisation uptake. It is important to monitor vaccine uptake, as coverage of 95% of the population at risk of a particular disease is required to prevent the circulation of disease within those who are unvaccinated or not immune. 88% of children living in the North East whose second birthday occurred in 2008-09 had received the MMR vaccine by that birthday. This is higher than the national average for England of 85%. Even allowing that the national average is depressed by an extremely low rate in London the region’s performance is the second highest of all the English regions. MMR vaccination was introduced at the beginning of the 1990s. It is recognised that the decrease in vaccine uptake up to 2003-04 is due to the controversial association between the MMR vaccine and autism, which has been disclaimed by the scientific community. As a result there was a general decline in coverage rates up untill 2003-04. Between 2003-04 and 2006-07 the vaccination rate increased steadily in the region – by six percentage points, a pattern which has been mirrored nationally to a slightly lesser extent. The latest year’s data shows that there has been little change in the vaccination rate both in the region and nationally.
Immunisation against Influenza: Older People
The take up of immunisation against Influenza by people aged 65 and over provides an indication of the provision and use of preventative services at the upper end of the population age range.
In 2008 - 2009, 75.5% of people aged 65 and over living in the North East were immunised against influenza. This is above the national rate for England of 74.1%, though like other preventative indicators the national rate is depressed by comparatively low rates in London. When London is ignored, the regional figure remains above the national and is the highest rate of all the English regions
Footnotes
[1]Consequently, life expectancy at birth does not measure how long on average someone born today will live. It does, however, provide a measure of ‘survivability’ and that is derived from the current population – in effect it is a general measure of health. With generally falling death rates, life expectancy at birth will significantly underestimate the average lifespan of someone born today.
[2]Women who are ineligible are those whose recall testing has been ceased for clinical reasons