Key health issues in
Southampton (and Wessex)
Dr Andrew Mortimore
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A bit of context
A backward glance
Five challenges
A forward look
A Plea to Stop Reorganising
...[T]he leaders of the NHS and government have sorted
and resorted local, regional and national structures into
a continual parade of new aggregates and agencies.
Each change made sense, but the parade doesn’t make
sense. It drains energy and confidence from the
workforce....[T]he time has come for stability, on the
basis of which, paradoxically, productive change
becomes easier and faster for the good, smart,
committed people of the NHS.
Don Berwick (2008)
New public health system for England
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Secretary of State
Public Health England
NHS Commissioning Board
Local Authorities
Clinical Commissioning Groups
• Health and Wellbeing Boards
The only way is Wessex
• a population of 2.7 million people
• local authorities: two county, five unitary and 22
district/borough
• six health and wellbeing boards
• nine clinical commissioning groups
• two local resilience forums
• four strategic clinical networks
• one local education and training board
• one academic health science network
• public health teams in universities
Changes in Southampton’s population over time….
Southampton Population 1851
Changes in Southampton’s population over time….
Southampton Population 2011
Changes in Southampton’s population over time….ethnicity
• 77.7% of residents recorded as white British (compared to 88.7% in 2001)
• ‘Other white’ population (which includes migrants from Europe) has increased
in last 10 years by over 200% (from 5,519 to 17,461)
• Largest % increase in ‘other Asian’ population (833 people in 2001 to 5,281 in
2011)
Improvements over the past decade…
• Compared with 10 years ago, men are 19% and women are
3% more likely to live to the age of 75 (the probability of
survival to age 75 in 1997-99 was 56% for males and 74% for
females, in 2007-09 the figures were 67% and 77%
respectively)
• Compared with 10 years ago, male life expectancy is four
years longer and women’s life expectancy is two years longer
• Death rates have fallen by 22% (342 fewer deaths each year
in the city)
• Deaths from heart disease have fallen by 49% (202 per year
fewer)
• Deaths from stroke are 38% lower
• Cancer death rate has fallen by 9%
• Smoking prevalence is estimated to have fallen from 32% to
22% over the past decade
• Since 2003/04 smoking in pregnancy has reduced from 25.1%
to 19.5% whilst breastfeeding rates have increased from
69.6% to 74.5%
• Every day now an average of 15 eligible women are screened
for breast cancer, 25 for cervical cancer and a further 23
eligible adults screened for bowel cancer
• Educational attainment has improved – in 2005 34.6% of
Southampton pupils gained 5 or more GCSEs at grades A*-C
(including English and Maths), and by 2013 this had increased
to 58.9%
Challenges
• Men from the most deprived areas of Southampton have a life
expectancy eight years less than men from the least deprived areas
• In Southampton there is one teenage conception every two days
• Every day a Southampton resident dies from a cause related to smoking
• Every day in Southampton an average of three people are newly
diagnosed with cancer
• Gross annual pay for full-time workers in Southampton was just over
£23,000 on average in 2010, compared with a national average of over
£26,000
• Every 13 hours there is a net gain of one additional person to
Southampton GPs’ diabetic risk registers
• Only 31.7% of adults access NHS dentistry with extra provision being
under-used.
Southampton
Children living in poverty
Numbers of children living in poverty in Wessex local
authorities: 2011
Hampshire
Southampton
Portsmouth
Dorset
Bournemouth
Isle of Wight
Poole
0
5000
10000
15000
20000
Source: Public Health Outcomes Framework www.phoutcomes.info
25000
30000
35000
Teenage conception rates across Wessex LAs
SHIP Population Change by Age: 2011-2021
Percentage change in population aged 0-14 years from 2011
baseline
60
Southampton
40
Hampshire
20
IOW
% change
% change
60
Percentage change in population aged 65-74 years from 2011
baseline
Portsmouth
0
2016
40
Hampshire
20
IOW
2021
2016
60
Hampshire
IOW
0
% change
% change
Percentage change in population aged 75-84 years from 2011
baseline
Southampton
20
Portsmouth
-20
2016
2016
2021
Percentage change in population aged 85+ years from 2011
baseline
60
Hampshire
20
IOW
Portsmouth
% change
% change
40
2021
Portsmouth
Source: ONS i nteri m 2011-ba s ed Sub-Na tiona l Popul a tion Projections
Southampton
2016
IOW
0
Percentage change in population aged 45-64 years from 2011
baseline
Source: ONS i nteri m 2011-ba s ed Sub-Na tiona l Popul a tion Projections
Hampshire
20
2021
0
Southampton
40
-20
Source: ONS i nteri m 2011-ba s ed Sub-Na tiona l Popul a tion Projections
60
2021
Source: ONS i nteri m 2011-ba s ed Sub-Na tiona l Popul a tion Projections
Percentage change in population aged 15-44 years from 2011
baseline
40
Portsmouth
0
Source: ONS i nteri m 2011-ba s ed Sub-Na tiona l Popul a tion Projections
60
Southampton
Southampton
40
Hampshire
20
IOW
Portsmouth
0
2016
2021
Source: ONS i nteri m 2011-ba s ed Sub-Na tiona l Popul a tion Projections
Trend in the proportion of Southampton children classified
as obese by age group
Proportion of Southampton children considered to be obese:
2001/02-2003/04 to 2010/11-2012/13 (3 years pooled)
22.00
Year R
20.00
Year 6
Expected by 1990 standard
18.00
17.6
17.5
18.6
18.9
19.6
19.7
14.00
12.00
10.3
9.7
9.8
9.7
9.3
9.3
9.8
9.9
9.7
9.4
03/04-05/06
04/05-06/07
05/06-07/08
06/07-08/09
07/08-09/10
08/09-10/11
09/10-11/12
10/11-12/13
8.00
02/03-04/05
10.00
01/02-03/04
% Obese
16.00
6.00
4.00
2.00
0.00
Data notes: 2001/02 to 2005/06 data is taken from the Southampton Child Health Information System (CHIS) whilst data after 2005/06 is taken from
the validated NCMP national dataset. The most recent year's data has also been taken from CHIS as validated data has yet to be published. Data
from 2006/07 onwards is based on data collected by Southampton schools and so should match nationally published datasets, whilst data prior to this
is based on children resident in Southampton.
A weighty problem
• Children who were overweight at Year R tend
to still be so at Year 6
• 20% of children who are a healthy weight at
Year R have become overweight or obese by
Year 6
Change in BMI classification between Year R and Year 6
in the same children
• Challenge 1
– Nanny or nudge?
Fit for life
• Being active
• Eating well
• A healthy weight
LIFELAB
SOUTHAMPTON
Hospital-based classroom
Hands-on practical activities
+ pre and post school-based lessons
31
• Challenge 2
– Universal v targeted
A tale of two cities?
A vibrant city…..
….with Challenges
3
Challenges
Priority areas v the rest
• Life expectancy is lower – 3.4 years for men, 2.7 years for
women
• Overall mortality rate is 28% higher
• Premature (under 75) deaths are 58% higher
• The death rate from circulatory disease in people under
75 is 56% higher
• Severe mental illness is more common
• Teenage pregnancy rates are higher
• Low birth-weight is 32% more frequent
• Smoking in pregnancy is over twice as common
• Breast feeding is less common – 21% v 39%
Is the gap reducing?
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Life expectancy
Overall mortality rates
Premature (under 75) deaths
Under 75 deaths from circulatory disease
Severe mental illness
Teenage pregnancy rates
Low birth-weight
Smoking in pregnancy
Breast feeding
Dental health – 5 year-olds
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Inequalities – gap between most and least
deprived quintile
Inequalities –
gap between
most and least
deprived
quintile
Most Deprived areas
improving?
Measure
Life Expectancy for males
Life Expectancy for females
Mortality – all cause, all age
Premature mortality (under 75) –
all cause
Circulatory disease mortality – all
ages
Circulatory disease mortality –
under 75s
Cancer mortality – all ages
Cancer mortality – under 75s
COPD mortality – all ages
Change between
2006-08 and 2009-11
Increase of 1.0 years
Increase of 0.2 years
Decreased 3.9%
Decreased 0.9%
Smoking in pregnancy (recorded
at booking)
Breastfeeding at initial feed
81.1% higher
69.8% higher
Decreased 41.3%
226.8% higher
184.9% higher
Increased 2.7%
Increased 10.1%
Increased 12.0%
61.2% higher
71.9% higher
298.9% higher
94.1% higher
119.2% higher
203.9% higher
Change between
2008-09 and 2011-12
Decrease by 2.9
percentage points
Increase by 3.0
percentage points
Most Deprived areas
improving?
Measure
Low weight births
Difference between most deprived
and least deprived areas
2006-08
2009-11
6.5 years
6.4 years
1.1 years
2.6 years
40.6% higher
53.25% higher
101.6% higher
131.6% higher
Decreased 28.2%
Most Deprived areas
improving?
Measure
Gap narrowing?
Change between
2006-08 and 2009-11
Increase 2.1%
Gap narrowing?
Difference between most deprived
and least deprived areas
2008-09
2011-12
243.8% higher
185.0% higher
27.1% lower
21.5% lower
Gap narrowing?
Difference between most deprived
and least deprived areas
2006-08
2009-11
57.7% higher
25.3% higher
• Challenge 3
– Pragmatism v perfectionism
• Improving the public’s health – a resource for
local authorities. D Buck and S Gregory. Kings
Fund. December 2013
Return on investment (ROI)
• For every £1 spent on sexual health services to prevent
teenage pregnancy, there is a net saving of £11
• Every new teenage mothers costs £100,000 over the next 5
years, including £15K per year in housing-related costs
• Family Nurse Partnerships have generated savings of more
than five time the programme costs
• Targeted parenting programmes to prevent conduct
disorders pay back £8 over six years for every £1 invested
(savings to NHS, education and criminal justice system)
• Good social and emotional health outcomes through
investment in good education provide returns of up to £7 for
every £1 invested
• For every £1 spent on alcohol treatment £4 is saved in other
public sector costs
• Employee wellness programmes return £2 - £10 for every £1
spent
• Improving air quality – the overall benefit-cost return can be
over £600 for every £100 spent (eg Kensington and Chelsea)
• Investment in falls prevention and bone health saves £5 for
every £2 spent, through saving lives and maintaining
independence
• For £1 spent on smoking cessation and tobacco control
measures, £5 are saved over a five year period
• For £1 spent on measures to reduce obesity, there is a net
saving of £2 over five years
• Challenge 4
– Deficit model v asset-based approach
• Eg loneliness / social isolation
Better Care
(draft)
It’s no longer a question about whether you use social media, but how well you do it.
• Challenge 5
– The tyranny of the present v playing the long
game
A forward look
Our world in 2025
(Courtesy Geoff Glover)
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World population reaches 8.1 billion
Over 60% live in Asia
97% of population growth in the developing world
5 billion people live in cities
3 billion people lack water access
EU accounts for only 6.5% of world population
30% of EU population over 65
Asia becomes first producer and exporter globally
34% of worlds wealth - developing countries( 20% in 2005)
India and China 20% of worlds R and D(10% in 2010)
Global middle-class reaches 1 billion- 90% in developing countries
"Brain drain" becomes "brains circulation"!
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Nanny v nudge
Universal v targeted
Pragmatism v perfectionism
Deficit model v asset-based approach
The tyranny of the present v playing the long game
• Welcome to our world of public health – science and
art!
www.publichealth.southampton.gov.uk
andrew.mortimore@southampton.gov.uk