Dr Stephen Monaghan
Public Health Director, Cardiff LHB
Consultant in Public Health Medicine, NPHS
Why Cardiff?
A Tale of Two Cities
A Tale of Two Cities
• Whilst Cardiff is a thriving, affluent city,
• It is really a tale of (at least) two cities
– in terms of health outcomes and deprivation indices,
– the reality is that there are still over 50,000 people living in
the top decile of of disadvantage according to the Welsh Index
of Multiple Deprivation.
– More people in the top decile of deprivation than than
• in RCT or
• in Merthyr Tydfil and Blaenau Gwent combined
• 10 year life expectancy difference between the Lisvane
and Butetown 2 LSOAs
• “southern arc” – south of the railway line – “wrong side
of the tracks”
Demography
and population sub-groups
Current Population
• 2006 Population Estimates give
Cardiff a population of:
– 317,523 as derived from the ONS or
– 352,954 as derived from NHSAR
Cardiff Population Age
Structure in 2006
[317,500 persons - ONS data]
Population Trends
• The average annual increase in Cardiff’s
population was 2,400 persons (20012005)
– natural population growth
– net migration
• Migration accounted for 43.7% of the
total estimated population change.
Ethnic Minority
Populations
• 25,735 persons (2001 Census)
• Cardiff has the highest population proportion of
ethnic minority in Wales
• Half of the ethnic minority population in Wales
live in Cardiff
• Often live in the poorest inner city areas
• Many rank amongst the most impoverished of the
city’s inhabitants
Ethnic Minority
Populations
Asylum Seeker
Population
Student Population
• 25,000 students (and rising) in Cardiff
• Population is concentrated in specific areas:
– Cathays, Plasnewydd, Penylan (Central Locality)
– Gabalfa (North Locality)
Determinants of Health
Welsh Index of Multiple
Deprivation by LSOAs (2001)
Lifestyle
• <29% of Wales’ residents reported meeting the
physical activity guidelines (30 mins moderate
exercise 5 days / week)
– Cardiff had a lower proportion of adults who met the
guidelines than the Welsh average
• 64.1% of Welsh adults are overweight or obese.
The proportion in Cardiff is slightly lower than
this Welsh average
Welsh Health Survey 2003/5)
Lifestyle
• 27.1% of Welsh adults reported being smokers
with the proportion in Cardiff just above this
Welsh average
• Almost 40% of Cardiff (and Wales’) adults report
their average weekly alcohol consumption is
above recommended limits
• Cardiff residents report higher rates of binge
drinking than the Welsh average
Welsh Health Survey 2003/5)
Lifestyle
• Sexually transmitted infection rates
continue to increase
– Cardiff has the highest prevalence of HIV in
Wales
Health Outcomes
EASMRs for All Cause
Mortality by MSOA (2002-2004)
EASMRs for all circulatory
diseases (persons, all ages) by
MSOA (2000-2004)
EASMRs for respiratory
disease (persons, all ages)
by MSOA (2000-2004)
Female Morbidity from All
Malignancies (excl NMSC) WASR
Per 100,000 Population
Female Mortality from All
Malignancies (excl NMSC)
WASR per 100,000 Population
Key Points
A Tale of Two Cities
A Tale of Two Cities
• Whilst Cardiff is a thriving, affluent city,
• It is really a tale of (at least) two cities
– in terms of health outcomes and deprivation indices,
– the reality is that there are still over 50,000 people living in
the top decile of disadvantage according to the Welsh Index of
Multiple Deprivation.
– More people in the top decile of deprivation than
• in RCT or
• in Merthyr Tydfil and Blaenau Gwent combined
• 10 year life expectancy difference between the Lisvane
and Butetown 2 LSOAs
• “southern arc” – south of the railway line – “wrong side
of the tracks”
Most modern health problems
and diseases are:
Problems of maladaptation
between human biology and the
modern environment
If we truly want to tackle our
modern health problems:
• we have to consider changing the environment
− Economic, social, physical
• not just treating human biology consequences
• not just educating/informing people re: choices
WHO Healthy Cities
• This is what led us to Healthy Cities
– A world-wide movement of city-based public health
initiatives
• “In one sense the Healthy Cities Project was a new
initiative, in another it was the Health of Towns
Association of Exeter 1844 reborn…the challenge to
us is to pick up where Chadwick’s thinking left off
100 years ago” (John Ashton 1992)
Phase V themes
(2009 – 2013)
• Caring and supportive environments
• Healthy Living
• Healthy urban environment and design
(Healthy Urban Planning)
Overarching theme
• Health and health equity in all local
policies
Cardiff: WHO Healthy
City
• Obesity proposed as an initial unifying
theme – incorporating healthy urban planning as a major
element (alongside physical activity, food, work
place health and weight management)
Obesity – initial
exemplar / unifier
• Partners have agreed to use the issue of obesity
as an exemplar and unifier, as a framework for
the Cardiff Healthy City Programme.
• The causes of obesity and overweight are
complex, resulting in the need to implement a
range of approaches and complimentary
strategies to address individual, social, and
environmental determinants.
Obesity
•
•
•
•
Trends
Health consequences
Mortality
Financial costs
• Issues are well known and will not be
covered here
Obesity: What is the
explanation?
What in particular has changed in
recent years to potentially
explain the rise?
Can a city make you fat?
How can a city change its
environment to help prevent its
people not to be obese?
Foresight Report 2007
Foresight Report 2007
Causes of obesity
• Causes of obesity are complex and the
Foresight Report summarises:
–
–
–
–
–
–
–
–
Technology
The built environment
Opportunities for physical activity
Food and drink availability
The price of food and drink
Food marketing
Purchasing capacity and impact on eating patterns
Impact of working practices
Obesity:
An Initial Exemplar and Unifier
• Obesity:
– leaves people with chronic health problems like
diabetes, cancer, osteoarthritis,
– as well as increasing mortality from heart disease
and strokes.
• Our answer can't be to just treat people in the
NHS and send them home again,
• Rather to design our city, educate people and
provide opportunities that stop people
developing these problems in the first place.
Obesity:
An Initial Exemplar and Unifier
• Reducing obesity levels is a major challenge
and involves far more than consideration of
what we eat and whether we go to the gym.
• We need to consider:
–
–
–
–
healthy urban planning,
the food environment,
transport,
housing regeneration
• Introducing changes that may not be easy for
us, but are critical to our long term health.
Work so far / future
action
• Much work already focuses on tackling obesity
in Cardiff
• To ensure co-ordination and synergy, a draft
Cardiff-wide Healthy Weight Strategy and
Action Plan has been developed.
• WHO European Healthy Cities Network will
– support and strengthen the delivery of this multiagency strategy,
– build on current work,
– identify gaps in activity
– and address the broader issues.
Work so far / future
action
• The momentum from WHO Healthy City should
enable Cardiff to drive forward the public
health agenda with regards to
– lifestyle choices,
– the impact of the built and natural environment on
health
– and the provision of supportive services.
• Although the initial focus will be on obesity, the
action will impact right across the determinants
of health.
• Community involvement and engagement will
be key.
Next Steps
• Today is both a celebratory event and a
planning workshop
– to discuss the way forward and to develop plans for
implementing the Healthy Cities Programme
• Health is everybody’s business
• The workshops will be your opportunity to:
– highlight issues,
– voice your ideas and the contributions you can make
to this important work.