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Carlisle Health Improvement Plan Health Profile for 2010

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<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

<strong>Health</strong> <strong>Profile</strong> <strong>for</strong> <strong>2010</strong><br />

Jennifer Clay<br />

Public <strong>Health</strong> Intelligence Analyst, NHS Cumbria


Index<br />

Page<br />

Introduction 3<br />

The population of <strong>Carlisle</strong> 4<br />

Migrants 4<br />

Births 5<br />

Population projections 6<br />

<strong>Health</strong> inequalities 7<br />

Life expectancy 9<br />

What are the main causes of disease causing<br />

the low level of life expectancy in <strong>Carlisle</strong>? 11<br />

Infant mortality 11<br />

Mortality and spearheads 12<br />

Premature deaths from circulatory disease 14<br />

Premature deaths from cancer 14<br />

Which type of cancer? 15<br />

Cancer screening 16<br />

What are the behavioural risk factors resulting<br />

in the inequalities gap in life expectancy and infant mortality? 18<br />

Smoking 18<br />

Obesity 21<br />

Obesity and nutrition 23<br />

Obesity and physical activity 23<br />

Mental health 24<br />

Alcohol 25<br />

Chlamydia 27<br />

Teenage pregnancy 28<br />

Breastfeeding 28<br />

Wider determinants of health 30<br />

Work, unemployment and incapacity 30<br />

Fuel poverty 30<br />

Excess winter deaths 31<br />

Child poverty 32<br />

Educational attainment 33<br />

Household income 33<br />

Conclusion 34<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

2


Introduction<br />

The purpose of this profile is to bring together data affecting the health and wellbeing of the<br />

people of <strong>Carlisle</strong>. It is aimed at colleagues within the NHS, external partners and the third<br />

sector. Firstly, its’ content will aid future commissioning with the intention of improving health<br />

outcomes <strong>for</strong> the population of <strong>Carlisle</strong>. Secondly, the report may also be useful <strong>for</strong> partners<br />

to assist them with their strategic aims around health improvement. Responding to the<br />

Coalition Government’s White Paper: Equity & Excellence: Liberating the NHS (<strong>2010</strong>) which<br />

suggests a move to locality based GP consortia commissioning arrangements where possible<br />

data are presented at GP practice level. Where this is not feasible data are at local authority<br />

level. National and county comparator in<strong>for</strong>mation is provided.<br />

Figure 1: <strong>Carlisle</strong> district and PBC boundary<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

3


<strong>Carlisle</strong> district council covers an area of some 400 square miles with 69% of the population<br />

living within <strong>Carlisle</strong> city. Recent changes to the <strong>Carlisle</strong> Practice Based Commissioning<br />

Consortium (PBC) resulted in Dalston surgery joining with the PBC sub-locality of Solway.<br />

The result of this is that the boundary of <strong>Carlisle</strong> PBC is no longer co-terminus with the district<br />

council boundary. Due to these changes two of the three lower super output areas that<br />

constitute Dalston ward have been allocated to Solway locality.<br />

The population of <strong>Carlisle</strong><br />

Figure 2: Resident populations<br />

Resident population (thousands)<br />

ONS 2009 Exeter <strong>2010</strong><br />

94.3<br />

98.6<br />

104.7<br />

109.3<br />

103.8<br />

107.5<br />

70.9<br />

72.5<br />

69.7<br />

71.5<br />

51.8<br />

53.3<br />

Allerdale Barrow-in-Furness <strong>Carlisle</strong> Copeland Eden South Lakeland<br />

District council<br />

Figure 2 shows the latest population figures <strong>for</strong> <strong>Carlisle</strong> district council indicate a population<br />

of 104,700 (mid year population estimates, Office <strong>for</strong> National Statistics (ONS). This figure<br />

increases by 4% to 109,300 when the population is taken from the Exeter patient registration<br />

system. The patient registration system tends to record a higher figure than mid year<br />

population estimates. There<strong>for</strong>e one would expect the true population to be between the two<br />

figures. Returning to mid year estimates almost one fifth of <strong>Carlisle</strong>’s residents are aged over<br />

65 years.<br />

Migrants<br />

Table 1: Migrant workers by GP sub localities<br />

Practice sub locality 2006 2007 2008 2009 <strong>2010</strong> Total<br />

Brampton & Longtown 23 49 45 39 40 196<br />

<strong>Carlisle</strong> Medical Group 108 367 255 200 156 1,086<br />

Eden Medical Group 41 95 59 54 26 275<br />

Stanwix Medical Centre 43 90 136 141 102 512<br />

Warwick Rd 67 201 156 109 79 612<br />

<strong>Carlisle</strong> locality 282 802 651 543 403 2,681<br />

Practice list inflation may well be due to the number of students and migrants living in an<br />

area. Table 1 shows there to be almost 2,700 migrants in <strong>Carlisle</strong> PBC locality. Of these<br />

43% are from Poland with the remainder arriving from 100 assorted countries. The majority<br />

of migrants, 61%, fall within the age band 20-35 years. One fifth is aged below 20 years of<br />

age.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

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Births<br />

Figure 3: Live birth rate trend<br />

Live birth rate per 1,000 population<br />

E&W Cumbria <strong>Carlisle</strong><br />

12 . 1 12 . 5 12 . 8 13 . 0 12 . 9<br />

11. 8 12 . 0<br />

10 . 7 11. 1 10 . 9<br />

9.7 9.9 10 . 1 10 . 3 10 . 3<br />

2005 2006 2007 2008 2009<br />

On average each year in <strong>Carlisle</strong> there are 1,200 live births. Latest figures <strong>for</strong> 2009 show that<br />

there were 1,229 live births in the district. As shown in figure 3 the live birth rate in <strong>Carlisle</strong> is<br />

usually above that <strong>for</strong> Cumbria but below the national average. The current rate of 12 births<br />

per 1,000 population is just below the national average of 13 births per 1,000 population.<br />

Figure 4: Practice birth rate, 1.7.<strong>2010</strong><br />

<strong>Carlisle</strong> PBC: practice birth rate/1,000 population as at 1st July <strong>2010</strong><br />

<strong>Carlisle</strong> average<br />

13.3<br />

12.4 12.2 12.1 11.8<br />

10.9 10.4 10.0 9.9<br />

7.6<br />

Brunswick<br />

House<br />

Eden<br />

Medical<br />

Group<br />

65 Warwick<br />

Road<br />

Fusehill<br />

Medical<br />

Practice<br />

St Paul's<br />

Medical<br />

Centre<br />

Spencer<br />

Street<br />

Surgery<br />

Esk Valley<br />

Medical<br />

Practice<br />

Stanwix<br />

Medical<br />

Practice<br />

Grosvenor<br />

House<br />

Brampton<br />

Medical<br />

Practice<br />

To have an indication of the birth rate at GP practice level, population figures have been<br />

taken from the Exeter patient registration system. By counting the number of infants aged<br />

below one year, it is possible to calculate a proxy practice birth rate. Using this method the<br />

average birth rate <strong>for</strong> <strong>Carlisle</strong> PBC is 11 births per 1,000 registered population (July, <strong>2010</strong>).<br />

There is a wide variation in practice birth rates with Brunswick House experiencing the<br />

highest rate of 13.3 births and Brampton the lowest at 7.6 births.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

5


Population Projections<br />

Figure 5: Population projections (2008 based)<br />

<strong>Carlisle</strong> projected population<br />

105.1<br />

105.8<br />

106.6<br />

107.3<br />

2008<br />

2009<br />

<strong>2010</strong><br />

2011<br />

108.0<br />

108.6<br />

109.2<br />

109.8<br />

110.5<br />

2012<br />

2013<br />

2014<br />

2015<br />

2016<br />

111.1<br />

111.7<br />

112.3<br />

112.9<br />

113.5<br />

114.1<br />

114.7<br />

2017<br />

2018<br />

2019<br />

2020<br />

2021<br />

2022<br />

2023<br />

115.3<br />

115.9<br />

116.5<br />

117.1<br />

117.7<br />

118.2<br />

118.7<br />

119.2<br />

2024<br />

2025<br />

2026<br />

2027<br />

2028<br />

2029<br />

2030<br />

2031<br />

Figure 5 shows the population projection (2008 based) trend <strong>for</strong> <strong>Carlisle</strong>. By 2033,<br />

projections suggest a growth of 14% in the overall population size of <strong>Carlisle</strong>. This is greatest<br />

increase in the Cumbria economy, but below the projected England growth of 18%.<br />

119.6<br />

120.1<br />

2032<br />

2033<br />

Figure 6: Population projections: population aged 65 plus (2008 based)<br />

% Population projection aged 65 years and over<br />

2008 2033<br />

31% 32%<br />

20% 20%<br />

27% 26%<br />

18% 18% 18%<br />

30%<br />

21%<br />

35%<br />

23%<br />

37%<br />

16%<br />

23%<br />

Cumbria Allerdale Barrow-in-<br />

Furness<br />

<strong>Carlisle</strong> Copeland Eden South<br />

Lakeland<br />

England<br />

Figure 6 examines those aged over 65 years of age. Projections suggest that this age group<br />

will increase in <strong>Carlisle</strong> from 18% of the total population in 2008 to 26% by 2033. Both figures<br />

are above the Cumbria average but below those <strong>for</strong> England.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

6


<strong>Health</strong> Inequalities<br />

Figure 7: Index of multiple deprivation 2007<br />

In order to tackle health inequalities it is necessary to focus activities on those most in need.<br />

Using the English Indices of Deprivation 2007 which measured seven domains and combined<br />

these to produce the Index of Multiple Deprivation it is possible to identify those areas<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

7


experiencing the greatest deprivation, figure 7. The geographical area the Index is based on<br />

is the lower super output area (LSOA). A LSOA nests within an existing ward. A more<br />

populous ward may contain several LSOAs, a sparsely populated ward only one. There<strong>for</strong>e<br />

pockets of deprivation can be detected at sub-ward level.<br />

All LSOAs in England were given a score and ranked. The rank of one indicates the area with<br />

the worst deprivation in the country. Rankings were divided into quintiles (fifths) where<br />

quintile one represents the most deprived and quintile five the least deprived. Taking the<br />

quintile and using a traffic light system where red indicates the worst and dark green the best,<br />

data <strong>for</strong> <strong>Carlisle</strong> district have been mapped.<br />

Figure 8: Most deprived areas of <strong>Carlisle</strong><br />

Figure 8 shows those areas of <strong>Carlisle</strong> experiencing the worst deprivation (quintile one).<br />

Data <strong>for</strong> 2004 and 2007 have been compared. Over the two periods only part of Castle ward<br />

has moved out of quintile one. Between 2004 and 2007 parts of Botcherby, Morton and St<br />

Aidans have slipped into quintile one. The most deprived areas of <strong>Carlisle</strong> are shown in the<br />

table 2.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

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Table 2: IMD 2007, most deprived areas of <strong>Carlisle</strong><br />

Estimated England rank Cumbria Rank National<br />

LSOA code LSOA description<br />

population (1-32,482) (1-322) Quintile<br />

E01019193 Belle Vue Part 2 1,274 1283 11 1<br />

E01019245 Upperby Part 1 1,474 1364 12 1<br />

E01019197 Botcherby Part 2 1,824 1373 13 1<br />

E01019199 Botcherby Part 4 1,008 2663 24 1<br />

E01019248 Upperby Part 4 1,126 3007 26 1<br />

E01019231 Morton Part 2 1,434 3448 29 1<br />

E01019222 Harraby Part 3 1,425 4934 41 1<br />

E01019234 St Aidans Part 1 1,375 5183 44 1<br />

E01019198 Botcherby Part 3 1,384 5464 46 1<br />

E01019246 Upperby Part 2 1,313 5536 47 1<br />

E01019236 St Aidans Part 3 1,367 5641 49 1<br />

E01019230 Morton Part 1 1,596 5974 52 1<br />

E01019194 Belle Vue Part 3 1,411 6054 53 1<br />

E01019207 Castle Part 4 1,396 6068 54 1<br />

E01019221 Harraby Part 2 1,491 6102 55 1<br />

E01019206 Castle Part 3 1,400 6476 59 1<br />

Most deprived 22,298<br />

Currently around one fifth of <strong>Carlisle</strong>’s population are living within the most deprived<br />

communities in England.<br />

Life expectancy<br />

Figure 9: Life expectancy trend, males and females<br />

Life Expectancy at birth<br />

Years<br />

83.0<br />

82.0<br />

81.0<br />

80.0<br />

79.0<br />

78.0<br />

77.0<br />

76.0<br />

75.0<br />

74.0<br />

73.0<br />

72.0<br />

1991-<br />

1993<br />

1992-<br />

1994<br />

1993-<br />

1995<br />

1994-<br />

1996<br />

1995-<br />

1997<br />

Eng (M) <strong>Carlisle</strong> (M) Eng (F) <strong>Carlisle</strong> (F)<br />

1996-<br />

1998<br />

1997-<br />

1999<br />

1998-<br />

2000<br />

1999-<br />

2001<br />

2000-<br />

2002<br />

2001-<br />

2003<br />

2002-<br />

2004<br />

2003-<br />

2005<br />

2004-<br />

2006<br />

2005-<br />

2007<br />

2006-<br />

2008<br />

The most basic way of measuring the health of a community is to look at when and how<br />

people die. Life expectancy shows the average age a child born today in an area could<br />

expect to live assuming that people are dying at the same rate and ages that we find today. It<br />

is affected by the number of people dying and the age at which they die.<br />

As shown in figure 9, over the past fifteen years there has been a steady improvement in life<br />

expectancy <strong>for</strong> men and women living in <strong>Carlisle</strong>. However life expectancy <strong>for</strong> both males<br />

and females continues to be below the national average.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

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Figure 10: 2006-08, life expectancy at birth and at age 65 years, males and females<br />

Life exp ectancy at birth, 2006-2008<br />

<strong>Carlisle</strong> Cumbria England<br />

Life expectancy at ag e 65 years, 2006-2008<br />

<strong>Carlisle</strong> Cumbria England<br />

81. 4<br />

81.4<br />

82.0<br />

20.3 20.2<br />

20. 4<br />

77.1<br />

77. 8<br />

77.9<br />

17.2<br />

17.6<br />

17.7<br />

Males<br />

Females<br />

Males<br />

Females<br />

Latest figures in figure 10, show average life expectancy <strong>for</strong> men in <strong>Carlisle</strong> is 77.1 years.<br />

This compares with 77.8 years <strong>for</strong> Cumbria and 77.9 years <strong>for</strong> England. Life expectancy <strong>for</strong><br />

women in <strong>Carlisle</strong> matches that of Cumbria at 81.4 years but is below the national average of<br />

82 years.<br />

Once a man in <strong>Carlisle</strong> has reached his 65 th ye ar of life he can expect to live <strong>for</strong> a further 17.2<br />

years . Again this is below the county and national averages of 17.6 years and 17.7 years<br />

respectively. For women aged 65 living in <strong>Carlisle</strong> they can expect to live <strong>for</strong> a further 20.3<br />

years. This is just above the Cumbria average of 20.2 years and just below the national<br />

average of 20.4 years.<br />

Figure 11: Ward life expectancy at birth, 1999 to 2003, persons<br />

Life expectancy at birth by electoral wards in <strong>Carlisle</strong> (years)<br />

1999 to 2003<br />

75 yrs<br />

83.2 81.7 81.2 81.2 80.8 79.7 79.4 79.1 79.1 78.6 77.7 77.7 77.1 76.6 76.5 76.3 76.3 76.1 75.3 74.7 74.4 73.5<br />

Hayton<br />

Stanwix Urban<br />

Burgh<br />

Wetheral<br />

Great Corby and Geltsdale<br />

Lyne<br />

Stanwix Rural<br />

Belah<br />

Irthing<br />

Yewdale<br />

Brampton<br />

St Aidans<br />

Ward<br />

Dalston<br />

Harraby<br />

Denton Holme<br />

Currock<br />

Longtown & Rockcliffe<br />

Morton<br />

Upperby<br />

Castle<br />

Botcherby<br />

Belle Vue<br />

Consdideration should be given to the location of medical & care establishements<br />

Wider variations in life expectancy can be found when looking at data at sub-district level, see<br />

figure 11 . Someone living in the ward of Hayton has an average life expectancy of 83.2<br />

years. Whereas their opposite number living in Belle Vue ward has a life expectancy of 73.5<br />

years. In other words they die 9.7 years earlier! People living in the wards of Belle Vue,<br />

Botcherby and Castle can expect to die “prematurely” as all three wards have an average live<br />

expectancy of below 75 years of age. A cautionary note must be sounded when looking at<br />

data at a lower level. The location of medical and care establishments should be taken into<br />

consideration when looking at sub-district data. The number of residents within these<br />

establishments will impact on an areas life expectancy.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

10


What are the main diseases causing the low level of life expectancy in <strong>Carlisle</strong>?<br />

Figure 12: Life expectancy and cause of death, 2006-08<br />

The Association of Public <strong>Health</strong> Observatories provides in<strong>for</strong>mation on the differences in life<br />

expectancy <strong>for</strong> a local area compared with the average <strong>for</strong> England, see figure 12. For men<br />

in <strong>Carlisle</strong> three causes of death: circulatory disease, cancer and external causes, account <strong>for</strong><br />

three quarters of the gap in life expectancy when compared with the national average. For<br />

women, replace external causes with digestive diseases. These three diseases are<br />

responsible <strong>for</strong> 80% of the life expectancy gap <strong>for</strong> women living in <strong>Carlisle</strong>.<br />

Infant mortality<br />

Figure 13: Infant mortality trend<br />

Infant death rate per 1,000 population<br />

E&W Cumbria <strong>Carlisle</strong><br />

7.2<br />

5.0 4.4<br />

5.0 4.7<br />

4.8 4.4 4.5 4.8 4.9<br />

4.1 4.7<br />

2.6<br />

3.5<br />

2.4<br />

2005 2006 2007 2008 2009<br />

Infant mortality is a good indicator of the overall health of a society. On average each year in<br />

<strong>Carlisle</strong> five infants die be<strong>for</strong>e reaching their first birthday. As shown in figure 13 infant<br />

mortality rates are at an all time low. In 2009 the mortality rate in <strong>Carlisle</strong> was 2.4 deaths <strong>for</strong><br />

every 1,000 live births. This is well below the national average of 4.7 deaths per 1,000 live<br />

births and that of Cumbria (3.5 deaths per 1,000). During 2009 in <strong>Carlisle</strong>, three babies died<br />

in the first year of life, this compares with eight deaths in 2005. Infant mortality is mainly as a<br />

result of: immaturity, low birth weight, sudden unexpected death in infancy, congenital<br />

mal<strong>for</strong>mations and infection.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

11


The emphasis on reducing smoking during pregnancy, teenage pregnancy obesity, improved<br />

parental nutrition and an increase in breast feeding contribute to reducing the number of<br />

deaths in the first year of life.<br />

Mortality and Spearheads<br />

To tackle health inequalities the Government selected those districts of England with the<br />

greatest inequalities and designated them as “spearhead” areas. <strong>Carlisle</strong> district council falls<br />

within the classification of spearhead.<br />

Figure 14: All causes, all ages mortality trend by gender<br />

DSR<br />

900<br />

850<br />

800<br />

750<br />

700<br />

650<br />

Mortality: all causes, all ages, males<br />

(directly standardised rates)<br />

England Cumbria <strong>Carlisle</strong><br />

2001 2002 2003 2004 2005 2006 2007 2008<br />

DSR<br />

650<br />

600<br />

550<br />

500<br />

450<br />

Mortality: all causes, all ages, females<br />

(directly standardised rates)<br />

England Cumbria <strong>Carlisle</strong><br />

2001 2002 2003 2004 2005 2006 2007 2008<br />

Although showing a downwards trend, figure 14 shows the all age, all cause mortality rates<br />

<strong>for</strong> males and females to be above the county and national averages. The current directly<br />

standardised rate <strong>for</strong> men in <strong>Carlisle</strong> is 760 deaths <strong>for</strong> every 100,000 men. This compares<br />

with 693 deaths per 100,000 men in Cumbria and a national rate of 680 deaths per 100,000<br />

men. Looking to the female population of <strong>Carlisle</strong> the current rate of female mortality is 530<br />

deaths <strong>for</strong> every 100,000 women. This is above county and national rates of 513 deaths per<br />

100,000 and 487 deaths per 1900,000 respectively.<br />

Figure 15: All causes, under 75 years mortality trend by gender<br />

DSR<br />

470<br />

420<br />

370<br />

320<br />

Premature Mortality: all causes, males<br />

(directly standardised rates)<br />

England Cumbria <strong>Carlisle</strong><br />

2001 2002 2003 2004 2005 2006 2007 2008<br />

DSR<br />

320<br />

300<br />

280<br />

260<br />

240<br />

220<br />

Premature Mortality: all causes, females<br />

(directly standardised rates)<br />

England Cumbria <strong>Carlisle</strong><br />

2001 2002 2003 2004 2005 2006 2007 2008<br />

Moving to premature mortality, that is deaths below the age of 75 years. As shown in figure<br />

15, mortality rates in <strong>Carlisle</strong> <strong>for</strong> both sexes remain above county and national levels. Over<br />

the last few years premature mortality followed a general downward trend. However<br />

2008<br />

saw a change locally with morality rates increasing in both men and women. Men in <strong>Carlisle</strong><br />

experience a premature mortality rate of 407 deaths per 100,000 men. This is above the<br />

county rate of 363 deaths per 100,000 men and national rate of 357 deaths per 100,000.<br />

Female premature mortality in <strong>Carlisle</strong> is currently 272 deaths <strong>for</strong> every 100,000 women.<br />

This compares with a rate of 255 deaths <strong>for</strong> every 100,000 women in Cumbria and a national<br />

rate of 227 deaths <strong>for</strong> every 100,000 women. Data recently released to the PCT <strong>for</strong> 2009<br />

indicate a reduction in the number of premature deaths <strong>for</strong> both genders.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

12


Figure 16: Mortality in <strong>Carlisle</strong>, 2009<br />

ge<br />

ta<br />

Percen<br />

100%<br />

90%<br />

80%<br />

70%<br />

60%<br />

50%<br />

40%<br />

30%<br />

20%<br />

10%<br />

0%<br />

<strong>Carlisle</strong> mortality, 2009 by age gr oup<br />

0-74 years 75+ years<br />

336<br />

429<br />

226<br />

150<br />

Male<br />

Female<br />

765<br />

376<br />

Persons<br />

During 2009 in <strong>Carlisle</strong> there were 1,141 deaths, see figure 16. This is a slight reduction of<br />

2% on the previous years’ figure of 1,159 deaths. A third of all deaths in 2009 were in people<br />

aged below 75 years of age. In terms of gender, two fifths of all male deaths were premature.<br />

For women, just over one quarter of all deaths was be<strong>for</strong>e the age of 75 years. Premature<br />

mortality during 2009 fell by 9% when compared with the previous year (411 deaths). There<br />

was a 15% reduction in the number of early deaths in females during the year. Male deaths<br />

declined by 4%.<br />

Figure 16: All age mortality: causes of death in <strong>Carlisle</strong>, 2009<br />

<strong>Carlisle</strong> mortality, all ages, 2009<br />

Circulatory, 36% Circulatory, 37%<br />

Cancer, 32%<br />

Cancer, 27%<br />

Respiratory , 12%<br />

Respiratory , 12%<br />

Digestive, 4%<br />

Digestive, 6%<br />

Other , 15% Other , 17%<br />

Male<br />

Female<br />

Figure 16 shows the main cause of death in <strong>Carlisle</strong> during 2009. Four out of five deaths can<br />

be attributed to three disease groups: circulatory diseases, malignant cancers and respiratory<br />

diseases. For both sexes, death from circulatory diseases tops the table as the main cause<br />

of death. Numbers are fairly evenly split between men and women.<br />

Figure 17: Premature mortality: causes of death in <strong>Carlisle</strong>, 2009<br />

<strong>Carlisle</strong> premature mortality, 2009<br />

Cancer, 36%<br />

Cancer, 45%<br />

Circulatory, 32% Circulatory, 19%<br />

Respiratory , 8%<br />

Respiratory , 11%<br />

Digestive, 6% Digestive, 7%<br />

Other , 17% Other , 17%<br />

Male<br />

Female<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

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13


Figure 17 shows premature mortality by main cause of death. For this age group cancer is<br />

the primary cause of death, accounting <strong>for</strong> two out of five deaths. Proportionately more<br />

women than men will die from cancer in this age group. Almost half of all female deaths are<br />

attributable to some <strong>for</strong>m of cancer.<br />

Premature deaths from circulatory disease<br />

The main behavioural risk factors that contribute to high levels of circulatory disease are:<br />

smoking, diet and levels of physical activity. In <strong>Carlisle</strong> premature mortality <strong>for</strong> this disease<br />

group are above the county and national level <strong>for</strong> males and females.<br />

Figure 18: Premature mortality from circulatory disease by gender<br />

DSR<br />

Premature Mortality: All circulatory disease, males<br />

(directly standardised rates)<br />

190.0<br />

170.0<br />

150.0<br />

130.0<br />

110.0<br />

90.0<br />

England Cumbria <strong>Carlisle</strong><br />

2001 2002 2003 2004 2005 2006 2007 2008<br />

DSR<br />

Premature Mortality: All circulatory disease, females<br />

(directly standardised rates)<br />

England Cumbria <strong>Carlisle</strong><br />

80.0<br />

70.0<br />

60.0<br />

50.0<br />

40.0<br />

30.0<br />

2001 2002 2003 2004 2005 2006 2007 2008<br />

As shown in figure 18, in <strong>Carlisle</strong> the current male mortality rate from circulatory disease is<br />

103 deaths per 100,000 men slightly above that of England and Cumbria. The rate of 50<br />

deaths out of 100,000 females in <strong>Carlisle</strong> compares favourably with that of Cumbria but is<br />

above the national rate of 44 female deaths. Looking at the broader picture, since 2001<br />

mortality from circulatory disease has decreased by 36% <strong>for</strong> both sexes. Latest figures <strong>for</strong><br />

2009 reveal that the number of male deaths has increased by a fifth over the previous year to<br />

73 deaths and decreased by over a fifth in females to 28 deaths.<br />

Premature deaths from cancer<br />

The risk of developing cancer depends on many factors: including age, lifestyle and genetic<br />

make-up. It is estimated that up to half of all cancers could be avoided if people made<br />

changes to their lifestyles such as stopping smoking, moderate alcohol intake, maintaining a<br />

healthy bodyweight and avoiding excessive sun exposure. Early detection and increased<br />

awareness of screening interventions such as colorectal, breast and cervical screening<br />

provide an opportunity to reduce premature mortality rates.<br />

Figure 19: Premature mortality from cancer by gender<br />

Premature Mortality: All cancers, males<br />

(directly standardised rates)<br />

England Cumbria <strong>Carlisle</strong><br />

Premature Mortality: All cancers, females<br />

(directly standardised rates)<br />

England Cumbria <strong>Carlisle</strong><br />

190.0<br />

140.0<br />

DSR<br />

170.0<br />

150.0<br />

130.0<br />

110.0<br />

DSR<br />

120.0<br />

100.0<br />

80.0<br />

90.0<br />

2001 2002 2003 2004 2005 2006 2007 2008<br />

60.0<br />

2001 2002 2003 2004 2005 2006 2007 2008<br />

In <strong>Carlisle</strong>, as shown in figure 19, the current male mortality rate from cancer is 128 deaths<br />

per 100,000 men, slightly above that <strong>for</strong> England but below the county rate of 164 deaths per<br />

100,000. The female mortality rate of 108 deaths out of 100,000 women is above the national<br />

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14


and county rates of just over 100 deaths per 100,000 women. Looking at the broader picture<br />

since 2001 mortality from cancer has decreased by 13% <strong>for</strong> men and 8% <strong>for</strong> women. Latest<br />

figures <strong>for</strong> 2009 reveal that the numbers of deaths in men have decreased by 17% over the<br />

previous year to 82 deaths. For women, compared with the previous year there has been a<br />

slight increase of 5% in the number of female deaths, with a total of 68 deaths during 2009.<br />

Which type of cancer?<br />

Standardised mortality ratios (SMRs) are used to measure the ratio of deaths in a standard<br />

population, in this case England, with a study population. The standard population is<br />

measured as 100 and the study population is compared with this. Anything above 100 is<br />

worse than average and anything below is better. A statistical test is applied to the SMR to<br />

identify if it is significantly better or worse than would be expected. In this instance this<br />

significance is represented by “faces”. A sad face (red) represents worse than expected and<br />

a happy face (green) better than expected when compared to the national average.<br />

Table 3: Cancer trend by site and gender<br />

Males Deaths SMR with statistical significance<br />

Site ICD No. 02-04 03-05 04-06 2002-04 2003-05 2004-06<br />

All cancers C00-C97 240 221 242 102 96 106<br />

MN Oesophagus C15 16 15 20 103 96 128<br />

MN Stomach C16 12 6 6 117 61 65<br />

MN Colon/Rectum C18-C20 26 29 28 105 118 117<br />

MN Pancreas C25 8 8 7 71 70 60<br />

MN Trachea, Bronchus, Lung C33-C34 69 69 76 113 116 129 <br />

Mal Melanoma Skin C43 .. 5 7 .. 133 179<br />

Mesothelioma C45 5 7 7 88 123 121<br />

MN Prostate C61 18 19 22 104 112 132<br />

MN Kidney ex Renal Pelvis C64 10 6 5 146 86 69<br />

MN Bladder C67 .. .. .. .. .. .. ☺<br />

MN Brain C71 14 7 8 160 79 95<br />

Non-Hodgkin's Lymphoma C82-C85 11 6 6 132 76 80<br />

Leukaemia C91-C95 7 7 10 98 97 139<br />

Females<br />

All cancers C00-C97 192 223 234 96 112 118 <br />

MN Oesophagus C15 10 15 14 181 277 257 <br />

MN Stomach C16 11 10 8 243 227 193<br />

MN Colon/Rectum C18-C20 8 12 12 50 ☺ 85 96<br />

MN Pancreas C25 10 12 18 111 128 186 <br />

MN Trachea, Bronchus, Lung C33-C34 48 55 52 125 142 130<br />

Mal Melanoma Skin C43 .. .. 5 .. .. 180<br />

Mesothelioma C45 .. .. .. .. .. ..<br />

MN Female Breast C50 28 27 35 72 69 90<br />

MN Cervix Uteri C53 .. .. 7 .. .. 191<br />

MN Uterus C54 .. .. 5 .. .. 149<br />

MN Ovary C56 15 21 19 95 136 126<br />

MN Kidney ex Renal Pelvis C64 .. .. .. .. .. ..<br />

MN Bladder C67 .. .. .. .. .. ..<br />

MN Brain C71 7 6 6 120 104 107<br />

Non-Hodgkin's Lymphoma C82-C85 .. .. 6 .. .. 111<br />

Leukaemia C91-C95 .. .. .. .. .. ..<br />

.. Data suppressed (less than five deaths)<br />

Lung cancer in men and women is significantly higher than would be expected. For women<br />

overall, all cancers, oesophageal cancer and stomach cancer are areas of concern.<br />

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Cancer screening<br />

Currently there are three national screening programmes operating within the district. These<br />

are: cervical – screening women aged 25 to 64 years, breast – screening women aged 53 to<br />

64 years and bowel screening. Originally bowel screening was offered to men and women<br />

aged 60 to 69 years. This has recently been extended to include the age group 70 to 75<br />

years. Latest coverage figures are shown in table 4.<br />

Table 4: Screening coverage<br />

2009/10 2009 2009/10<br />

Area Breast Bowel Cervical<br />

<strong>Carlisle</strong> 82% 59% 81%<br />

Cumbria 82% 60% 82%<br />

England *77% 52% 79%<br />

*2008/09 coverage<br />

Generally <strong>Carlisle</strong> locality per<strong>for</strong>ms w ell when compared with screening averag es locally and<br />

nationally.<br />

Figure 20: Screening coverage by GP practice<br />

Coverage<br />

90%<br />

85%<br />

80%<br />

75%<br />

70%<br />

65%<br />

60%<br />

55%<br />

50%<br />

45%<br />

40%<br />

Brampton<br />

Medical Pract ice<br />

Warwick Road Surgery<br />

St Paul's Medical Centre<br />

Brunswick House Medical Group<br />

<strong>Carlisle</strong> PBC: Screening covverage<br />

Spencer Street Surgery<br />

Fusehill<br />

Medical Practice<br />

Eden Medical Group<br />

Breast Bowel Cervical<br />

Stanwix Medical Practice<br />

Longto wn Medical Centre<br />

Practice<br />

Grovenor House Surgery<br />

Grosvenor House Surgery<br />

Grosvenor House Surgery<br />

Esk Valley Medical Group<br />

Grosvenor House Surgery<br />

Figure 20 examines screening coverage by GP practi ce. There is a varied picture across the<br />

locality with cervical screening coverage ranging from 69 % to 89% of the target population.<br />

Looking at breast screening, coverage acro ss <strong>Carlisle</strong> ranges from 76% to 90% of target.<br />

Finally bowel screening coverage varies from 51% to 63% o f the targe t populati on.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

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Figure 21: Progress of spearhead local authorities<br />

With reference to <strong>Carlisle</strong>’s “spearhead” status figures produced by the Department of <strong>Health</strong>,<br />

indicate that <strong>Carlisle</strong> is one of twelve spearhead local authorities that are on track to narrow<br />

the gap in life expectancy. Figure 21 shows the progress spearhead local authorities have<br />

made in narrowing their local life expectancy gap.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

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What are the main behavioural risk factors resulting in the inequalities gap in life<br />

expectancy and infant mortality?<br />

Figure 22: Behavioural risk factors<br />

There are six main behavioural risk factors that contribute to poor health and health<br />

inequalities: diet, physical exercise, smoking alcohol consumption, teenage pregnancy and<br />

breast feeding. Their impact on health is illustrated in figure 22. These risk factors will be<br />

discussed in the following sections.<br />

Smoking<br />

Smoking is the biggest preventable single cause of preventable illness and death in the UK.<br />

About 90% of lung cancer deaths and 17% of coronary heart disease are attributable to<br />

smoking (ASH, 2007). Smoking during pregnancy is estimated to increase infant mortality by<br />

about 40% (DoH 2007).<br />

Figure 23: Estimated smoking prevalence<br />

Figure 23 takes data from the Joint Strategic Needs Assessment, 2009 report. This shows<br />

that smoking prevalence within <strong>Carlisle</strong> is well above the Cumbria average.<br />

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Figure 24: Smoking status by GP practice, June <strong>2010</strong><br />

Smoking status by practice: current smoker<br />

25%<br />

21%<br />

19% 18%<br />

18% 17% 17% 16% 16% 15% 13% 12% 12%<br />

Warwick Road<br />

Brunswick House<br />

Eden Medical<br />

Dr Ward<br />

Drs Adam & Wigmore<br />

St Paul's<br />

Burn Street<br />

Spencer Street<br />

Dr Frost<br />

Dr Ashton<br />

London Road<br />

Stanwix Medical<br />

Brampton Medical<br />

It is difficult to quantify the number of people who smoke. Figure 24 takes data from GP<br />

practice registers. This shows the number of patients aged 16 and over, whose smoking<br />

status has been recorded in the last 15 months with latest status recorded as current smoker.<br />

Smokers ranged from 25% of the register to as low as 12%. Using this methodology over<br />

11,000 current smokers had visited their GP.<br />

Data collected by the Cumbria Stop Smoking Service shows that during the last financial<br />

year, 1,743 residents of <strong>Carlisle</strong> approached the service <strong>for</strong> help with quitting smoking. Of<br />

these over one half successfully quit smoking; just over one third were unsuccessful.<br />

Another source of smoking data is the local tobacco control profiles produced by the<br />

A ssociation of Public <strong>Health</strong> Observatories. Results <strong>for</strong> <strong>Carlisle</strong> are shown in figures 25 and<br />

26.<br />

Figure 25: Local tobacco control profile, part 1<br />

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Figure 25: Local tobacco control profile, part 2<br />

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Obesity<br />

Obesity is when a person is carrying too much body fat <strong>for</strong> their height and sex. A person is<br />

considered obese if they have a body mass index (BMI) of 30 or greater. In 2008 nearly a<br />

quarter of all adults (16 plus) in England were obese. Just under one third of women, 32%,<br />

were overweight (a BMI of 25-30), and 42% of men were overweight (NHS Choices <strong>2010</strong>).<br />

The number of overweight and obese people is likely to increase. The Foresight (2007)<br />

report, a scientific report used to guide Government policy, has predicted that by 2025, nearly<br />

half of men and over one third of women will be obese. Obesity can cause a number of<br />

health problem, such as type 2 diabetes and heart disease. Being overweight or obese can<br />

also shorten life expectancy,<br />

Figure 26: Patients with Body Mass Index >=30, (January 2009 to March <strong>2010</strong>)<br />

Patients over 16 with BMI of >=30<br />

15.0%<br />

14.0%<br />

11.2% 10.9%<br />

9.8% 9.6% 9.6% 9.1%<br />

7.7%<br />

5.7%<br />

Brunswick<br />

House<br />

Spencer<br />

Street<br />

Brampton<br />

Medical<br />

St Paul's<br />

Medical<br />

Stanwix<br />

Medical<br />

Eden<br />

Medical<br />

Fusehill<br />

Medical<br />

Warwick<br />

Road<br />

Grosvenor<br />

House<br />

Esk Valley<br />

Data taken from the GP QOF (Quality and Outcomes Framework) registers shows a varied<br />

picture across <strong>Carlisle</strong> regarding obesity. Of those patients measured, as many as 15% and<br />

as few as 6% were recorded as obese when viewed at practice level. Looking at <strong>Carlisle</strong> as a<br />

whole this converts to an average of 11%. This is slightly above the county average of<br />

10.5%,<br />

Data taken from the NHS Cumbria Obesity Atlas <strong>2010</strong> examines QOF data in more detail <strong>for</strong><br />

the period 2006/09. This is shown in table 5 . Here data are shown at ward level with a<br />

district and county comparison. The table shows firstly: of those patients who have been<br />

weighed the proportion classified as obese. Secondly of the obese group of patients the<br />

proportion of that group who are also suffering from a long term condition. It must be<br />

remembered that not all of a practices population have been measured. On average 26% of<br />

patients in <strong>Carlisle</strong> had their BMI recorded during the period.<br />

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Table 5: Patients recorded with a BMI >=30 and a long term health condition, ward (percentage)<br />

Obese with:<br />

Ward Total Obese Asthma Diabetes COPD CHD Hypertension<br />

Belah 28.8 18.3 17.3 2.7 11.7 48.6<br />

Belle Vue 29.5 14.9 19.3 3.5 11.6 40.6<br />

Botcherby 30.9 18.1 12.9 4.3 14.2 38.6<br />

Brampton 27.3 19.4 14.8 3.8 13.8 42.4<br />

Burgh 25.4 11.3 10.7 2.5 13.2 38.4<br />

Castle 25.0 17.5 16.1 3.9 15.8 37.5<br />

Currock 31.1 18.6 15.3 4.5 9.3 37.5<br />

Dalston 26.9 15.7 14.8 2.4 11.6 41.3<br />

Denton Holme 27.0 18.6 14.3 4.2 15.4 38.2<br />

Great Corby and Geltsdale 20.9 17.9 16.8 3.3 13.0 46.7<br />

Harraby 29.2 17.2 14.3 4.0 13.3 43.5<br />

Hayton 22.3 20.3 17.9 5.3 14.0 45.4<br />

Irthing 25.6 16.7 16.3 3.4 12.3 41.4<br />

Longtown & Rockcliffe 31.9 18.5 23.0 2.3 14.4 41.5<br />

Lyne 26.6 24.5 15.2 5.3 12.6 41.7<br />

Morton 26.9 19.8 21.3 4.4 16.3 51.0<br />

St Aidans 24.8 15.6 13.2 2.2 9.4 35.7<br />

Stanwix Rural 25.7 18.0 14.5 1.3 10.2 45.4<br />

Stanwix Urban 23.7 15.8 13.3 2.0 12.0 46.8<br />

Upperby 31.8 21.7 19.7 5.2 13.8 36.7<br />

Wetheral 22.7 16.4 12.9 2.4 12.4 39.6<br />

Yewdale 28.9 17.4 14.1 3.1 12.3 41.2<br />

<strong>Carlisle</strong> 27.2 17.8 15.8 3.4 12.8 41.8<br />

Cumbria PCT 28.0 18.1 17.5 2.8 12.3 39.8<br />

In addition to in<strong>for</strong>mation from QOF the National Child Measurement Programme (NCMP)<br />

also provides data around young people. Reception year and year 6 pupils are measured. In<br />

Cumbria during 2009/10 of those eligible: 89% of reception year pupils were measured and<br />

86% of pupils in year 6.<br />

Figure 27: Reception year obesity prevalence by district council<br />

NCMP: Reception obesity prevalence 08/09 - 09/10<br />

2008/09 2009/10<br />

14. 2%<br />

9.6% 9.8% 9.6%<br />

9.2%<br />

6.4%<br />

8.0%<br />

12. 5%<br />

8.2%<br />

9.6%<br />

11. 9%<br />

10. 9%<br />

8.0%<br />

7.6%<br />

8.5%<br />

7.3%<br />

England Cumbria Allerdale Barrow-in-<br />

Furness<br />

<strong>Carlisle</strong> Copeland Eden South<br />

Lakeland<br />

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Figure 27 shows reception year data <strong>for</strong> 2009/10. Almost 10% of children were recorded as<br />

obese in <strong>Carlisle</strong>. This is an increase on the previous year’s figure of just over 8%. Current<br />

obesity rates are similar to county and national rates.<br />

Figure 28: Year 6 obesity prevalence b y district council<br />

NCMP: Year 6 obesity prevalence 08/09 - 09/10<br />

2008/09 2009/10<br />

19 . 7 %<br />

18 . 7 % 18 . 8 %<br />

18 . 3 %<br />

20.7%<br />

20.0%<br />

21.2% 21.0%<br />

19 . 2 %<br />

18 . 7 %<br />

19 . 6 % 19 . 6 %<br />

19 . 2 % 19 . 3 %<br />

16 . 8 %<br />

15 . 8 %<br />

England Cumbria Allerdale Barrow-in-<br />

Furness<br />

<strong>Carlisle</strong> Copeland Eden South<br />

Lakeland<br />

Figure 28 shows the results <strong>for</strong> yea r 6. Almost<br />

19% of pupils in <strong>Carlisle</strong> are recorded as<br />

being obese. This is in line with national and county averages.<br />

Obesity and nutrition<br />

The Government recommends an intake of at least five portions of fruit or vegetables per<br />

person per day to help reduce the risk of some cancers, heart disease and many other<br />

chronic conditions.<br />

Figure 29: Fruit and vegetable consumption<br />

Figure 29 takes data from the <strong>Health</strong> Survey England. This shows that an estimated 26% of<br />

the population of <strong>Carlisle</strong> reported eating five or more pieces of fruit and vegetables per day.<br />

This is slightly worse than the Cumbria average of 28%.<br />

Obesity and Physical activity<br />

Adults who are physically active have a 20-30% reduced risk of premature death (DoH 2004).<br />

Physical activity has an effect on cardiovascular risk, it reduces the risk of some cancers such<br />

as colorectal cancer, and it reduces the incidence of falls and osteoporosis in the elderly, and<br />

has been shown to reduce depression, stress and anxiety (DoH 2004).<br />

The National Indicator, N18 measures the percentage of the adult population (age 16 years<br />

and over) in a local area who participate in sport and active recreation, at moderate intensity,<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

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23


<strong>for</strong> at least 30 minutes on at least 12 days out of the last 4 weeks (equivalent to 30 minutes<br />

on 3 or more days a week). Figures taken from Sport England show that just over 20% of the<br />

adult population of <strong>Carlisle</strong> participate in some <strong>for</strong>m of physical activity. This is below the<br />

Cumbria average of 22%.<br />

Mental <strong>Health</strong><br />

Mental well-being is as important as physical health if people are to live their lives to the full.<br />

Mental ill-health is common with one in four people experiencing a mental health problem at<br />

some point in their life. Ten percent of children have a mental health problem.<br />

Table 6: Selected mental health indicators<br />

Indicator<br />

Number<br />

Estimated number of people with a common mental disorder 9,900<br />

Estimated number of people age over 65 with dementia 1,300<br />

Estimated number of adults (16+) who have engaged in deliberate self ham in 2,920-3,200<br />

their lifetime<br />

Admissions to hospital <strong>for</strong> self harm 250<br />

Attendances at A&E departments in a year <strong>for</strong> self harm 520<br />

Average number of suicides each year 13<br />

T he recent Mental <strong>Health</strong> Joint Strategic Needs Assessment: Adults report (NHS Cumbria<br />

<strong>2010</strong>) provides valuable in<strong>for</strong>mation on the mental health of the local community. Data taken<br />

from this report are shown in table 6. This shows a selection of mental health problems<br />

experienced by the residents of <strong>Carlisle</strong>.<br />

Figure 30: Trend <strong>for</strong> suicide and injury undetermined, persons<br />

20.0<br />

18.0<br />

16.0<br />

14.0<br />

12.0<br />

10.0<br />

8.0<br />

6.0<br />

4.0<br />

Suicide & injury undetermined, DSR<br />

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008<br />

6.06<br />

England Cumbria <strong>Carlisle</strong> DC<br />

Looking at a more specific area of mental health, namely suicides; figure 30 shows the trend<br />

in <strong>Carlisle</strong>. This compares the local directly standardised rate (DSR) with the county and<br />

national rate. On the whole the suicide rate <strong>for</strong> <strong>Carlisle</strong> tends to be above the national and<br />

county level. However 2008 saw a dramatic drop in the rate to 6 deaths per 100,000<br />

population (6 deaths). Latest figures <strong>for</strong> 2009 show that the numbers of suicides has<br />

increased to 13 deaths.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

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Figure 31: Suicide and injury undetermined, 2006-08<br />

DSR:suicides & injury undetermined 2006-08<br />

15.5 11.3 10.9 9.9 8.2 6.6 5.3 7.8<br />

Copeland <strong>Carlisle</strong> Allerdale Cumbria South<br />

Lakeland<br />

Eden<br />

Barrow-in-<br />

Furness<br />

England<br />

To smooth out the peaks and troughs in annual statistics figure 31 compares the three year<br />

average f or suicides. With a rate of 11.3 suicides <strong>for</strong> every 100,000 people , <strong>Carlisle</strong> is above<br />

the county and national average.<br />

Alcohol<br />

High levels of alcohol consumption will increase the risk of several cancers (liver, oral,<br />

pharynx and oesophagus), liver cirrhosis and circulatory disease. Alcohol consumption also<br />

has an impact on accidents, violent incidents and mental health disorders.<br />

Figure 32 takes data from the Local Alcohol <strong>Profile</strong>s <strong>for</strong> England <strong>2010</strong> and show that <strong>Carlisle</strong><br />

is significantly worse than average <strong>for</strong> the following:<br />

• Alcohol specific hospital admissions - under 18 years<br />

• Alcohol specific hospital admissions - males<br />

• Hospital admissions <strong>for</strong> alcohol related harm<br />

• Alcohol-attributable violent crime<br />

• Claimants on incapacity benefit – working age<br />

• Mortality from land transport accidents<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

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Figure 32: Local alcohol profile, <strong>Carlisle</strong><br />

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Figure 33: Hospital admissions <strong>for</strong> wholly attributable alcohol related conditions<br />

Rate/1,000<br />

7.0<br />

6.0<br />

5.0<br />

4.0<br />

3.0<br />

2.0<br />

1.0<br />

0.0<br />

65 Warwick Road<br />

Brunswick House Medical<br />

Patients admitted to hospital with a wholly attributable alcohol related<br />

condition<br />

Grosvenor House (Frost)<br />

St Paul's Medical<br />

Eden Medical Group<br />

Fusehill Medical Practice<br />

Grosvenor House (Adam)<br />

Grosvenor House (Ashton)<br />

Grosvenor House (Ward)<br />

Spencer Street Surgery<br />

Stanwix Medical Practice<br />

Brampton Medical<br />

Cumbria<br />

Esk Valley Medical<br />

Alcohol related health problems can be divided into tow groups: those conditions that are<br />

wholly attributable to alcohol and those that are partially attributable to alcohol. Figure 33<br />

takes data from the report: NHS Cumbria: Hospital admissions <strong>for</strong> alcohol specific conditions,<br />

2009. Concentrating on wholly attributable conditions the chart shows hospital admission rate<br />

<strong>for</strong> patients registered with GPs in <strong>Carlisle</strong>. The chart clearly shows those practices above<br />

the Cumbria average rate of 2.6 patients per 1,000 practice population aged over ten years.<br />

Chlamydia<br />

Chlamydia is a sexually transmitted infection (STI) caused by the bacterium chlamydia<br />

trachomatis. In the UK, the numbers of diagnoses of the infection have been steadily<br />

increasing each year since the mid 1990’s, and it has now become the most commonly<br />

diagnosed STI. Chlamydia is called the “silent” disease because most people who get it do<br />

not experience any noticeable symptoms.<br />

Table 7: Chlamydia screening<br />

Chlamydia 2009/10 Cumbria England<br />

Chlamydia tests reported to the National Chlamydia Screening Programme<br />

8,944<br />

(NCSP)<br />

Laboratory reports of chlamydia tests not reported directly to NCSP 2682<br />

Total test 11,626<br />

Resulting positive tests 739<br />

% young people testing positive 6.4% 6.0%<br />

Target population aged 15 -24 years 58,100<br />

% population tested 20.0% 22.1%<br />

Young people under 25 are more likely to be infected. A national screening programme has<br />

been established to test this age group. Not all tests are reported through the national<br />

screening programme. Tests generated in GP surgeries are processed directly by the<br />

laboratories and not reported to the local screening programme. A national target to test 25%<br />

of the population by the end of 2009/10 was set. Due to the nature of how the data are<br />

collected it is not possible to produce an accurate picture of local coverage. However<br />

Cumbria achieved coverage of 20% compared with 22% <strong>for</strong> England; both below target, see<br />

table 7.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

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Teenage pregnancy<br />

Teenage pregnancy is thought to have various effects on the health and socio-economic<br />

position of both mother and baby. Teenage mothers tend to end up being poorer, having<br />

lower educational attainment and worse mental health as compared to other women from<br />

similar backgrounds (<strong>Health</strong> Development Agency 2004).<br />

Figure 34: Trend in teenage pregnancy (below 18 years of age)<br />

55.0<br />

Teenage pregnancy rate/1,000 women (15-17 yrs)<br />

England Cumbria <strong>Carlisle</strong><br />

50.0<br />

45.0<br />

40.0<br />

35.0<br />

1998-00 2001-03 2004-06 2005-07 2006-08<br />

Teenage pregnancy rates in <strong>Carlisle</strong> continue to be above the county and national rates, as<br />

shown in figure 34. Currently in <strong>Carlisle</strong> there are 51 conceptions <strong>for</strong> every 1,000 women<br />

aged 15 to 17 years. Not all women chose to continue with the pregnancy as 54% terminated<br />

the pregnancy. This is above the county and national rate of 50%.<br />

Breastfeeding<br />

Evidence suggests that breastfeeding <strong>for</strong> at least the first six months of a baby’s life provides<br />

significant benefits <strong>for</strong> both the mother and baby. These benefits include: reducing the risk of<br />

developing diabetes in childhood, fewer respiratory tract infections, middle-ear infections and<br />

gastroenteritis. Babies are also less likely to develop allergies, such as asthma and eczema<br />

if they have bee breast fed.<br />

Figure 35: Breast feeding initiation rates<br />

Breast feeding initiation rates<br />

(Source: Vital Signs DoH)<br />

Cumb<br />

England<br />

ria<br />

72.7% 73.1% 72.6% 72.7% 73.<br />

4%<br />

69.7% 69.2%<br />

65.5%<br />

69.0%<br />

66.9%<br />

2009/10 Q1 2009/10 Q2 2009/10 Q3 2009/10 Q4 <strong>2010</strong>/11 Q1<br />

Breast feeding initiation rates in Cumbria continue to be below the national average, see<br />

figure 35. Currently in Cumbria 67% of new babies are breast fed. Once the baby has gone<br />

home breast feeding status is recorded at 6-8 weeks of age. By this stage breast feeding<br />

rates in Cumbria have fallen to 31% compared to 48 nationally.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

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Figure 36: Prevalence of breast feeding at 6-8 weeks, locality<br />

Prevelance breast feeding 6-8 weeks<br />

as at quarter 2, <strong>2010</strong>/11<br />

47%<br />

29%<br />

32%<br />

29%<br />

28%<br />

18%<br />

20%<br />

Allerdale<br />

Barrow in<br />

Furness<br />

<strong>Carlisle</strong> Copeland Eden South<br />

Lakes<br />

Cumbria<br />

Breast feeding prevalence data at 6 to 8 weeks are shown in figures 36 and 37 . Latest<br />

figures (quarter 2, <strong>2010</strong>/11) prevalence of 32% in <strong>Carlisle</strong>. This is above the Cumbria<br />

average of 28%. Figure 37 breaks this figure down by GP practice. A wide variation is<br />

shown at this level, ranging from 21% to 28% of mothers still breast feeding their babies at<br />

six to eight weeks.<br />

Figure 37: Prevalence of breast feeding at 6-8 weeks, GP practice<br />

Prevalence breast feeding 6-8 weeks<br />

as at quarter 2, <strong>2010</strong>/11<br />

48%<br />

21%<br />

24%<br />

29% 29%<br />

30% 30%<br />

33%<br />

38%<br />

40%<br />

Brunswick House Surgery<br />

Warwick Road Surgery<br />

St Paul's Practice<br />

Esk Valley Medical Group<br />

Grosvenor House<br />

Eden Medical Group<br />

Spencer Street Surgery<br />

Fusehill Medical Practice<br />

Stanwix Medical Practice<br />

Brampton Medical Practice<br />

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29


Wider determinants of health<br />

It is important to remember that behavioural factors are not the only influences on health.<br />

Social and economic circumstances affect how people behave and consequently their health.<br />

Work, unemployment and incapacity<br />

Being in good employment is protective of health. Conversely, unemployment contributes to<br />

poor health. Getting people back into employment is crucial <strong>for</strong> reducing health inequalities.<br />

However, jobs need to be sustainable and offer a minimum level of quality that not only<br />

includes a decent living wage but also the opportunities <strong>for</strong> in-work development.<br />

Figures <strong>for</strong> 2009/10 showed that in <strong>Carlisle</strong> 81.6% of the population (16 to 64 years) were<br />

economically active. This is above the national average <strong>for</strong> Great Britain of 76.5%. The<br />

unemployment rate was 6.1% in <strong>Carlisle</strong> compared with 7.9% nationally.<br />

During 2009 in <strong>Carlisle</strong>, full-time gross weekly pay was £414. This is below regional and<br />

national rates of £460 and £491 respectively.<br />

Table 8: Benefit claimants<br />

Working age key benefit claimants (February <strong>2010</strong>)<br />

<strong>Carlisle</strong><br />

GB<br />

Number<br />

Total claimants 9,830 14.5% 15.1%<br />

Job seekers 2,050 3.0% 3.9%<br />

ESA & incapacity benefits 4,970 7.4% 6.7%<br />

Lone parents 950 1.4% 1.8%<br />

Carers 730 1.1% 1.1%<br />

Others on income related benefits 270 0.4% 0.5%<br />

Disabled 690 1.0% 1.0%<br />

Bereaved 160 0.2% 0.2%<br />

Source: nomisweb.co.uk<br />

In terms of benefit claimants, <strong>Carlisle</strong> compares favourably with the national average <strong>for</strong> a<br />

range of benefits, see table 8. In total 14.5% of the working age population in <strong>Carlisle</strong> claim<br />

benefits, this is just below the national rate of 15.1%. The employment and support<br />

allowance (ESA) has replaced incapacity benefit and income support. In <strong>Carlisle</strong> 7.4% of the<br />

working age population claim this allowance, this is above the national average of 6.7%.<br />

Fuel Poverty<br />

The number of extra deaths occurring in winter varies depending on temperature, the level of<br />

disease in the population and other factors. These deaths may be partially attributed to the<br />

fact that many people cannot af<strong>for</strong>d to adequately heat their homes (National Energy Action,<br />

2009). A household is said to be in fuel poverty if it needs to spend more than 10% of its<br />

income on fuel to maintain a satisfactory heating regime (usually 21 degrees <strong>for</strong> the main<br />

living area and 18 degrees <strong>for</strong> other occupied rooms). Fuel poverty is caused by the<br />

interaction of a number of factors, but three specifically stand out. These are: energy<br />

efficiency status of the property, cost of energy and household income.<br />

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Figure 38: Fuel poverty<br />

Figure 36 illustrates data supplied by the Centre <strong>for</strong> Sustainable Energy<br />

(fuelpovertyindicator.co.uk) at lower super output area level. This shows a varied picture<br />

across the county. The areas shown in the darker shade of red are those households<br />

experiencing the highest rates of fuel poverty.<br />

Excess winter death<br />

There are higher levels of mortality in the winter than in the summer. Excess deaths are<br />

measured by the “excess winter mortality index”. The excess winter mortality (EWM) index is<br />

calculated as excess winter deaths divided by the average non-winter deaths, expressed as a<br />

percentage.<br />

Figure 39: Excess winter deaths<br />

Excess winter deaths (%)<br />

(2009/10 data are provisional)<br />

<strong>Carlisle</strong> Cumbria E&W<br />

16 14 16 18 17 15 22 14 16 19 19 24 6 11 17<br />

2005/06 2006/07 2007/08 2008/09 2009/10<br />

The elderly are more vulnerable than others during the winter. Policies such as “winter fuel<br />

payment” and influenza vaccinations are particularly focussed on older people. Although<br />

EWM is associated with low temperatures, conditions directly relating to cold, such as<br />

hypothermia, are not the main cause of excess winter mortality. The majority of additional<br />

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winter deaths are caused by cerebrovascular diseases, ischaemic heart disease and<br />

respiratory diseases (ONS <strong>2010</strong>). As shown in figure 39 the EWM index peaked in <strong>Carlisle</strong><br />

at 22% during the winter of 2007/08. This has now decreased to 6% <strong>for</strong> 2009/10 (provisional<br />

figures).<br />

Child Poverty<br />

The goal to end child poverty by 2020 was set out in the Child Poverty Act. Children are said<br />

to be living in relative income poverty of their household’s income is less than 60% of the<br />

median national income. Using this measure, there are currently 2.8million children living in<br />

poverty in this country. Children and young people living in poverty face a greater risk of poor<br />

health, more accidents, exposure to crime and failing to reach their full potential.<br />

Table 9: Child poverty<br />

% of Children in "Poverty"<br />

Under 16<br />

All Children<br />

England 21.6% 20.9%<br />

Cumbria 15.7% 15.1%<br />

<strong>Carlisle</strong> 16.7% 16.0%<br />

Belah 9.9% 9.6%<br />

Belle Vue 25.4% 24.8%<br />

Botcherby 33.8% 32.5%<br />

Brampton 14.2% 12.9%<br />

Burgh 6.3% 6.5%<br />

Castle 31.3% 28.7%<br />

Currock 23.8% 23.4%<br />

Dalston 6.4% 6.1%<br />

Denton Holme 23.3% 22.3%<br />

Great Corby and Geltsdale 3.4% 3.8%<br />

Harraby 17.0% 16.0%<br />

Hayton 7.8% 7.0%<br />

Irthing 7.1% 7.3%<br />

Longtown & Rockcliffe 9.5% 9.3%<br />

Lyne 9.3% 9.3%<br />

Morton 15.5% 15.0%<br />

St Aidans 21.8% 21.1%<br />

Stanwix Rural 4.2% 4.2%<br />

Stanwix Urban 4.3% 4.2%<br />

Upperby 30.3% 29.7%<br />

Wetheral 2.8% 3.1%<br />

Yewdale 8.7% 9.0%<br />

Source:http://www.hmrc.gov.uk/stats/personal-tax-credits/child_poverty.htm<br />

Data supplied by HM Revenues & Customs shows that around 16% of child in <strong>Carlisle</strong> are<br />

living in poverty, see table 9. This is slightly above the Cumbria average of 15% but below<br />

the national average of 21%. However when this data is broken down to ward level parts of<br />

the district exceed the national rate. The ward of Botcherby has a third of its children<br />

growing up in poverty: compare this with Wetheral ward where only 3% of children are living<br />

in poverty.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

32


Tackling child poverty will lead to reductions in levels of obesity and higher levels of<br />

educational attainment.<br />

Educational attainment<br />

As a result of child poverty, a child’s education suffers. This makes it difficult <strong>for</strong> them to get<br />

the qualifications they need they need to move on to sustainable, well-paid jobs. This limits<br />

their potential to earn the money needed to support their own families in later life, and so a<br />

cycle of poverty is created.<br />

Figure 40: Educational attainment, 2009/10<br />

Educational attainment, 2009/10<br />

England Cumbria <strong>Carlisle</strong><br />

84%<br />

86% 84% 81% 83%<br />

83%<br />

89%<br />

91%<br />

90% 88% 91% 90%<br />

72% 74%<br />

69%<br />

50% 52%<br />

50%<br />

KS1 Reading KS1 Writing KS1 Maths KS2 English & KS2 Science 5 A*-C GCSE' s<br />

maths<br />

Data provided by the County Council <strong>for</strong> 2009/10, figure 40 , shows <strong>Carlisle</strong> compares<br />

favourably with national averages. In all but KS2 English and maths, exams results equal of<br />

exceed those of the national rates. However when compared to county levels, <strong>Carlisle</strong><br />

results are just below those <strong>for</strong> all stages in Cumbria.<br />

Looking to the working population of <strong>Carlisle</strong>, 11.3% (7,300) have no qualifications, this<br />

compares with 12.3% nationally, (NOMIS).<br />

Household Income<br />

Figure 41: Mean household income by district<br />

Mean household income <strong>2010</strong><br />

Source: Cumbria County Council, CACI paycheck data<br />

National average = £35,299<br />

33,338 32,063 31,810 31,696 31,410 30,818 28,013<br />

South<br />

Lakeland<br />

Eden Copeland <strong>Carlisle</strong> Cumbria Allerdale Barrow in<br />

Furness<br />

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Figure 41 shows the gross mean household income <strong>for</strong> Cumbria and its six constituent<br />

district councils. All are below the national average income of £35,299. Overall the average<br />

income within <strong>Carlisle</strong> district (£31,696) is just above the county average but below that of<br />

South Lakeland, Eden and Copeland.<br />

Figure 42: Mean household income by district<br />

<strong>Carlisle</strong> wards: mean household income <strong>2010</strong><br />

Source: Cumbria County Council, CACI paycheck data<br />

<strong>Carlisle</strong> average = £31,696<br />

44,302<br />

42,938<br />

40,648<br />

40,176<br />

40,161<br />

39,934<br />

39,135<br />

37,970<br />

37,229<br />

34,488<br />

34,018<br />

33,205<br />

30,598<br />

30,149<br />

29,294<br />

28,161<br />

27,431<br />

26,834<br />

26,434<br />

25,168<br />

23,991<br />

22,609<br />

Wetheral<br />

Stanwix Rural<br />

Great Corby & Geltsdale<br />

Hayton<br />

Burgh<br />

Denton Holme<br />

Dalston<br />

Stanwix Urban<br />

Irthing<br />

Belah<br />

Yewdale<br />

Lyne<br />

Belle Vue<br />

Harraby<br />

Brampton<br />

Longtown & Rockcliffe<br />

St Aidans<br />

Castle<br />

Currock<br />

Botcherby<br />

Morton<br />

Upperby<br />

Figure 42 views the data at ward level shows the wide disparity in household income. Just<br />

over half (12) of <strong>Carlisle</strong>’s wards have an average income that exceeds the district average.<br />

Incomes within the ward of Wetheral are almost double those of Upperby.<br />

Conclusion<br />

This document provides an assessment of the current health of the population of <strong>Carlisle</strong>. It’s<br />

content provides commissioners and partner agencies with an opportunity to address the<br />

health inequalities within the locality.<br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

34


Contact details:<br />

Name: Jennifer Clay<br />

Title: Public <strong>Health</strong> Intelligence Analyst<br />

Address: NHS Cumbria, 4 Wavell Drive, Rosehill, <strong>Carlisle</strong>, Cumbria CA1 2SE<br />

Tel: 01228 603988<br />

Email: jennifer.clay@cumbriapct.nchs.uk<br />

Web:<br />

www.cumbria.nhs.uk<br />

www.cumbriaobservatory.org.uk<br />

October <strong>2010</strong><br />

<strong>Carlisle</strong> <strong>Health</strong> <strong>Improvement</strong> <strong>Plan</strong><br />

J. Clay<br />

35

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