Carlisle Health Improvement Plan Health Profile for 2010

Carlisle Health Improvement Plan
Health Profile for 2010
Jennifer Clay
Public Health Intelligence Analyst, NHS Cumbria

Index
Page
Introduction 3
The population of Carlisle 4
Migrants 4
Births 5
Population projections 6
Health inequalities 7
Life expectancy 9
What are the main causes of disease causing
the low level of life expectancy in Carlisle? 11
Infant mortality 11
Mortality and spearheads 12
Premature deaths from circulatory disease 14
Premature deaths from cancer 14
Which type of cancer? 15
Cancer screening 16
What are the behavioural risk factors resulting
in the inequalities gap in life expectancy and infant mortality? 18
Smoking 18
Obesity 21
Obesity and nutrition 23
Obesity and physical activity 23
Mental health 24
Alcohol 25
Chlamydia 27
Teenage pregnancy 28
Breastfeeding 28
Wider determinants of health 30
Work, unemployment and incapacity 30
Fuel poverty 30
Excess winter deaths 31
Child poverty 32
Educational attainment 33
Household income 33
Conclusion 34
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Introduction
The purpose of this profile is to bring together data affecting the health and wellbeing of the
people of Carlisle. It is aimed at colleagues within the NHS, external partners and the third
sector. Firstly, its’ content will aid future commissioning with the intention of improving health
outcomes for the population of Carlisle. Secondly, the report may also be useful for partners
to assist them with their strategic aims around health improvement. Responding to the
Coalition Government’s White Paper: Equity & Excellence: Liberating the NHS (2010) which
suggests a move to locality based GP consortia commissioning arrangements where possible
data are presented at GP practice level. Where this is not feasible data are at local authority
level. National and county comparator information is provided.
Figure 1: Carlisle district and PBC boundary
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Carlisle district council covers an area of some 400 square miles with 69% of the population
living within Carlisle city. Recent changes to the Carlisle Practice Based Commissioning
Consortium (PBC) resulted in Dalston surgery joining with the PBC sub-locality of Solway.
The result of this is that the boundary of Carlisle PBC is no longer co-terminus with the district
council boundary. Due to these changes two of the three lower super output areas that
constitute Dalston ward have been allocated to Solway locality.
The population of Carlisle
Figure 2: Resident populations
Resident population (thousands)
ONS 2009 Exeter 2010
94.3
98.6
104.7
109.3
103.8
107.5
70.9
72.5
69.7
71.5
51.8
53.3
Allerdale Barrow-in-Furness Carlisle Copeland Eden South Lakeland
District council
Figure 2 shows the latest population figures for Carlisle district council indicate a population
of 104,700 (mid year population estimates, Office for National Statistics (ONS). This figure
increases by 4% to 109,300 when the population is taken from the Exeter patient registration
system. The patient registration system tends to record a higher figure than mid year
population estimates. Therefore one would expect the true population to be between the two
figures. Returning to mid year estimates almost one fifth of Carlisle’s residents are aged over
65 years.
Migrants
Table 1: Migrant workers by GP sub localities
Practice sub locality 2006 2007 2008 2009 2010 Total
Brampton & Longtown 23 49 45 39 40 196
Carlisle Medical Group 108 367 255 200 156 1,086
Eden Medical Group 41 95 59 54 26 275
Stanwix Medical Centre 43 90 136 141 102 512
Warwick Rd 67 201 156 109 79 612
Carlisle locality 282 802 651 543 403 2,681
Practice list inflation may well be due to the number of students and migrants living in an
area. Table 1 shows there to be almost 2,700 migrants in Carlisle PBC locality. Of these
43% are from Poland with the remainder arriving from 100 assorted countries. The majority
of migrants, 61%, fall within the age band 20-35 years. One fifth is aged below 20 years of
age.
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Births
Figure 3: Live birth rate trend
Live birth rate per 1,000 population
E&W Cumbria Carlisle
12 . 1 12 . 5 12 . 8 13 . 0 12 . 9
11. 8 12 . 0
10 . 7 11. 1 10 . 9
9.7 9.9 10 . 1 10 . 3 10 . 3
2005 2006 2007 2008 2009
On average each year in Carlisle there are 1,200 live births. Latest figures for 2009 show that
there were 1,229 live births in the district. As shown in figure 3 the live birth rate in Carlisle is
usually above that for Cumbria but below the national average. The current rate of 12 births
per 1,000 population is just below the national average of 13 births per 1,000 population.
Figure 4: Practice birth rate, 1.7.2010
Carlisle PBC: practice birth rate/1,000 population as at 1st July 2010
Carlisle average
13.3
12.4 12.2 12.1 11.8
10.9 10.4 10.0 9.9
7.6
Brunswick
House
Eden
Medical
Group
65 Warwick
Road
Fusehill
Medical
Practice
St Paul's
Medical
Centre
Spencer
Street
Surgery
Esk Valley
Medical
Practice
Stanwix
Medical
Practice
Grosvenor
House
Brampton
Medical
Practice
To have an indication of the birth rate at GP practice level, population figures have been
taken from the Exeter patient registration system. By counting the number of infants aged
below one year, it is possible to calculate a proxy practice birth rate. Using this method the
average birth rate for Carlisle PBC is 11 births per 1,000 registered population (July, 2010).
There is a wide variation in practice birth rates with Brunswick House experiencing the
highest rate of 13.3 births and Brampton the lowest at 7.6 births.
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Population Projections
Figure 5: Population projections (2008 based)
Carlisle projected population
105.1
105.8
106.6
107.3
2008
2009
2010
2011
108.0
108.6
109.2
109.8
110.5
2012
2013
2014
2015
2016
111.1
111.7
112.3
112.9
113.5
114.1
114.7
2017
2018
2019
2020
2021
2022
2023
115.3
115.9
116.5
117.1
117.7
118.2
118.7
119.2
2024
2025
2026
2027
2028
2029
2030
2031
Figure 5 shows the population projection (2008 based) trend for Carlisle. By 2033,
projections suggest a growth of 14% in the overall population size of Carlisle. This is greatest
increase in the Cumbria economy, but below the projected England growth of 18%.
119.6
120.1
2032
2033
Figure 6: Population projections: population aged 65 plus (2008 based)
% Population projection aged 65 years and over
2008 2033
31% 32%
20% 20%
27% 26%
18% 18% 18%
30%
21%
35%
23%
37%
16%
23%
Cumbria Allerdale Barrow-in-
Furness
Carlisle Copeland Eden South
Lakeland
England
Figure 6 examines those aged over 65 years of age. Projections suggest that this age group
will increase in Carlisle from 18% of the total population in 2008 to 26% by 2033. Both figures
are above the Cumbria average but below those for England.
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Health Inequalities
Figure 7: Index of multiple deprivation 2007
In order to tackle health inequalities it is necessary to focus activities on those most in need.
Using the English Indices of Deprivation 2007 which measured seven domains and combined
these to produce the Index of Multiple Deprivation it is possible to identify those areas
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experiencing the greatest deprivation, figure 7. The geographical area the Index is based on
is the lower super output area (LSOA). A LSOA nests within an existing ward. A more
populous ward may contain several LSOAs, a sparsely populated ward only one. Therefore
pockets of deprivation can be detected at sub-ward level.
All LSOAs in England were given a score and ranked. The rank of one indicates the area with
the worst deprivation in the country. Rankings were divided into quintiles (fifths) where
quintile one represents the most deprived and quintile five the least deprived. Taking the
quintile and using a traffic light system where red indicates the worst and dark green the best,
data for Carlisle district have been mapped.
Figure 8: Most deprived areas of Carlisle
Figure 8 shows those areas of Carlisle experiencing the worst deprivation (quintile one).
Data for 2004 and 2007 have been compared. Over the two periods only part of Castle ward
has moved out of quintile one. Between 2004 and 2007 parts of Botcherby, Morton and St
Aidans have slipped into quintile one. The most deprived areas of Carlisle are shown in the
table 2.
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Table 2: IMD 2007, most deprived areas of Carlisle
Estimated England rank Cumbria Rank National
LSOA code LSOA description
population (1-32,482) (1-322) Quintile
E01019193 Belle Vue Part 2 1,274 1283 11 1
E01019245 Upperby Part 1 1,474 1364 12 1
E01019197 Botcherby Part 2 1,824 1373 13 1
E01019199 Botcherby Part 4 1,008 2663 24 1
E01019248 Upperby Part 4 1,126 3007 26 1
E01019231 Morton Part 2 1,434 3448 29 1
E01019222 Harraby Part 3 1,425 4934 41 1
E01019234 St Aidans Part 1 1,375 5183 44 1
E01019198 Botcherby Part 3 1,384 5464 46 1
E01019246 Upperby Part 2 1,313 5536 47 1
E01019236 St Aidans Part 3 1,367 5641 49 1
E01019230 Morton Part 1 1,596 5974 52 1
E01019194 Belle Vue Part 3 1,411 6054 53 1
E01019207 Castle Part 4 1,396 6068 54 1
E01019221 Harraby Part 2 1,491 6102 55 1
E01019206 Castle Part 3 1,400 6476 59 1
Most deprived 22,298
Currently around one fifth of Carlisle’s population are living within the most deprived
communities in England.
Life expectancy
Figure 9: Life expectancy trend, males and females
Life Expectancy at birth
Years
83.0
82.0
81.0
80.0
79.0
78.0
77.0
76.0
75.0
74.0
73.0
72.0
1991-
1993
1992-
1994
1993-
1995
1994-
1996
1995-
1997
Eng (M) Carlisle (M) Eng (F) Carlisle (F)
1996-
1998
1997-
1999
1998-
2000
1999-
2001
2000-
2002
2001-
2003
2002-
2004
2003-
2005
2004-
2006
2005-
2007
2006-
2008
The most basic way of measuring the health of a community is to look at when and how
people die. Life expectancy shows the average age a child born today in an area could
expect to live assuming that people are dying at the same rate and ages that we find today. It
is affected by the number of people dying and the age at which they die.
As shown in figure 9, over the past fifteen years there has been a steady improvement in life
expectancy for men and women living in Carlisle. However life expectancy for both males
and females continues to be below the national average.
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Figure 10: 2006-08, life expectancy at birth and at age 65 years, males and females
Life exp ectancy at birth, 2006-2008
Carlisle Cumbria England
Life expectancy at ag e 65 years, 2006-2008
Carlisle Cumbria England
81. 4
81.4
82.0
20.3 20.2
20. 4
77.1
77. 8
77.9
17.2
17.6
17.7
Males
Females
Males
Females
Latest figures in figure 10, show average life expectancy for men in Carlisle is 77.1 years.
This compares with 77.8 years for Cumbria and 77.9 years for England. Life expectancy for
women in Carlisle matches that of Cumbria at 81.4 years but is below the national average of
82 years.
Once a man in Carlisle has reached his 65 th ye ar of life he can expect to live for a further 17.2
years . Again this is below the county and national averages of 17.6 years and 17.7 years
respectively. For women aged 65 living in Carlisle they can expect to live for a further 20.3
years. This is just above the Cumbria average of 20.2 years and just below the national
average of 20.4 years.
Figure 11: Ward life expectancy at birth, 1999 to 2003, persons
Life expectancy at birth by electoral wards in Carlisle (years)
1999 to 2003
75 yrs
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
Hayton
Stanwix Urban
Burgh
Wetheral
Great Corby and Geltsdale
Lyne
Stanwix Rural
Belah
Irthing
Yewdale
Brampton
St Aidans
Ward
Dalston
Harraby
Denton Holme
Currock
Longtown & Rockcliffe
Morton
Upperby
Castle
Botcherby
Belle Vue
Consdideration should be given to the location of medical & care establishements
Wider variations in life expectancy can be found when looking at data at sub-district level, see
figure 11 . Someone living in the ward of Hayton has an average life expectancy of 83.2
years. Whereas their opposite number living in Belle Vue ward has a life expectancy of 73.5
years. In other words they die 9.7 years earlier! People living in the wards of Belle Vue,
Botcherby and Castle can expect to die “prematurely” as all three wards have an average live
expectancy of below 75 years of age. A cautionary note must be sounded when looking at
data at a lower level. The location of medical and care establishments should be taken into
consideration when looking at sub-district data. The number of residents within these
establishments will impact on an areas life expectancy.
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What are the main diseases causing the low level of life expectancy in Carlisle?
Figure 12: Life expectancy and cause of death, 2006-08
The Association of Public Health Observatories provides information on the differences in life
expectancy for a local area compared with the average for England, see figure 12. For men
in Carlisle three causes of death: circulatory disease, cancer and external causes, account for
three quarters of the gap in life expectancy when compared with the national average. For
women, replace external causes with digestive diseases. These three diseases are
responsible for 80% of the life expectancy gap for women living in Carlisle.
Infant mortality
Figure 13: Infant mortality trend
Infant death rate per 1,000 population
E&W Cumbria Carlisle
7.2
5.0 4.4
5.0 4.7
4.8 4.4 4.5 4.8 4.9
4.1 4.7
2.6
3.5
2.4
2005 2006 2007 2008 2009
Infant mortality is a good indicator of the overall health of a society. On average each year in
Carlisle five infants die before reaching their first birthday. As shown in figure 13 infant
mortality rates are at an all time low. In 2009 the mortality rate in Carlisle was 2.4 deaths for
every 1,000 live births. This is well below the national average of 4.7 deaths per 1,000 live
births and that of Cumbria (3.5 deaths per 1,000). During 2009 in Carlisle, three babies died
in the first year of life, this compares with eight deaths in 2005. Infant mortality is mainly as a
result of: immaturity, low birth weight, sudden unexpected death in infancy, congenital
malformations and infection.
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The emphasis on reducing smoking during pregnancy, teenage pregnancy obesity, improved
parental nutrition and an increase in breast feeding contribute to reducing the number of
deaths in the first year of life.
Mortality and Spearheads
To tackle health inequalities the Government selected those districts of England with the
greatest inequalities and designated them as “spearhead” areas. Carlisle district council falls
within the classification of spearhead.
Figure 14: All causes, all ages mortality trend by gender
DSR
900
850
800
750
700
650
Mortality: all causes, all ages, males
(directly standardised rates)
England Cumbria Carlisle
2001 2002 2003 2004 2005 2006 2007 2008
DSR
650
600
550
500
450
Mortality: all causes, all ages, females
(directly standardised rates)
England Cumbria Carlisle
2001 2002 2003 2004 2005 2006 2007 2008
Although showing a downwards trend, figure 14 shows the all age, all cause mortality rates
for males and females to be above the county and national averages. The current directly
standardised rate for men in Carlisle is 760 deaths for every 100,000 men. This compares
with 693 deaths per 100,000 men in Cumbria and a national rate of 680 deaths per 100,000
men. Looking to the female population of Carlisle the current rate of female mortality is 530
deaths for every 100,000 women. This is above county and national rates of 513 deaths per
100,000 and 487 deaths per 1900,000 respectively.
Figure 15: All causes, under 75 years mortality trend by gender
DSR
470
420
370
320
Premature Mortality: all causes, males
(directly standardised rates)
England Cumbria Carlisle
2001 2002 2003 2004 2005 2006 2007 2008
DSR
320
300
280
260
240
220
Premature Mortality: all causes, females
(directly standardised rates)
England Cumbria Carlisle
2001 2002 2003 2004 2005 2006 2007 2008
Moving to premature mortality, that is deaths below the age of 75 years. As shown in figure
15, mortality rates in Carlisle for both sexes remain above county and national levels. Over
the last few years premature mortality followed a general downward trend. However
2008
saw a change locally with morality rates increasing in both men and women. Men in Carlisle
experience a premature mortality rate of 407 deaths per 100,000 men. This is above the
county rate of 363 deaths per 100,000 men and national rate of 357 deaths per 100,000.
Female premature mortality in Carlisle is currently 272 deaths for every 100,000 women.
This compares with a rate of 255 deaths for every 100,000 women in Cumbria and a national
rate of 227 deaths for every 100,000 women. Data recently released to the PCT for 2009
indicate a reduction in the number of premature deaths for both genders.
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Figure 16: Mortality in Carlisle, 2009
ge
ta
Percen
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Carlisle mortality, 2009 by age gr oup
0-74 years 75+ years
336
429
226
150
Male
Female
765
376
Persons
During 2009 in Carlisle there were 1,141 deaths, see figure 16. This is a slight reduction of
2% on the previous years’ figure of 1,159 deaths. A third of all deaths in 2009 were in people
aged below 75 years of age. In terms of gender, two fifths of all male deaths were premature.
For women, just over one quarter of all deaths was before the age of 75 years. Premature
mortality during 2009 fell by 9% when compared with the previous year (411 deaths). There
was a 15% reduction in the number of early deaths in females during the year. Male deaths
declined by 4%.
Figure 16: All age mortality: causes of death in Carlisle, 2009
Carlisle mortality, all ages, 2009
Circulatory, 36% Circulatory, 37%
Cancer, 32%
Cancer, 27%
Respiratory , 12%
Respiratory , 12%
Digestive, 4%
Digestive, 6%
Other , 15% Other , 17%
Male
Female
Figure 16 shows the main cause of death in Carlisle during 2009. Four out of five deaths can
be attributed to three disease groups: circulatory diseases, malignant cancers and respiratory
diseases. For both sexes, death from circulatory diseases tops the table as the main cause
of death. Numbers are fairly evenly split between men and women.
Figure 17: Premature mortality: causes of death in Carlisle, 2009
Carlisle premature mortality, 2009
Cancer, 36%
Cancer, 45%
Circulatory, 32% Circulatory, 19%
Respiratory , 8%
Respiratory , 11%
Digestive, 6% Digestive, 7%
Other , 17% Other , 17%
Male
Female
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Figure 17 shows premature mortality by main cause of death. For this age group cancer is
the primary cause of death, accounting for two out of five deaths. Proportionately more
women than men will die from cancer in this age group. Almost half of all female deaths are
attributable to some form of cancer.
Premature deaths from circulatory disease
The main behavioural risk factors that contribute to high levels of circulatory disease are:
smoking, diet and levels of physical activity. In Carlisle premature mortality for this disease
group are above the county and national level for males and females.
Figure 18: Premature mortality from circulatory disease by gender
DSR
Premature Mortality: All circulatory disease, males
(directly standardised rates)
190.0
170.0
150.0
130.0
110.0
90.0
England Cumbria Carlisle
2001 2002 2003 2004 2005 2006 2007 2008
DSR
Premature Mortality: All circulatory disease, females
(directly standardised rates)
England Cumbria Carlisle
80.0
70.0
60.0
50.0
40.0
30.0
2001 2002 2003 2004 2005 2006 2007 2008
As shown in figure 18, in Carlisle the current male mortality rate from circulatory disease is
103 deaths per 100,000 men slightly above that of England and Cumbria. The rate of 50
deaths out of 100,000 females in Carlisle compares favourably with that of Cumbria but is
above the national rate of 44 female deaths. Looking at the broader picture, since 2001
mortality from circulatory disease has decreased by 36% for both sexes. Latest figures for
2009 reveal that the number of male deaths has increased by a fifth over the previous year to
73 deaths and decreased by over a fifth in females to 28 deaths.
Premature deaths from cancer
The risk of developing cancer depends on many factors: including age, lifestyle and genetic
make-up. It is estimated that up to half of all cancers could be avoided if people made
changes to their lifestyles such as stopping smoking, moderate alcohol intake, maintaining a
healthy bodyweight and avoiding excessive sun exposure. Early detection and increased
awareness of screening interventions such as colorectal, breast and cervical screening
provide an opportunity to reduce premature mortality rates.
Figure 19: Premature mortality from cancer by gender
Premature Mortality: All cancers, males
(directly standardised rates)
England Cumbria Carlisle
Premature Mortality: All cancers, females
(directly standardised rates)
England Cumbria Carlisle
190.0
140.0
DSR
170.0
150.0
130.0
110.0
DSR
120.0
100.0
80.0
90.0
2001 2002 2003 2004 2005 2006 2007 2008
60.0
2001 2002 2003 2004 2005 2006 2007 2008
In Carlisle, as shown in figure 19, the current male mortality rate from cancer is 128 deaths
per 100,000 men, slightly above that for England but below the county rate of 164 deaths per
100,000. The female mortality rate of 108 deaths out of 100,000 women is above the national
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and county rates of just over 100 deaths per 100,000 women. Looking at the broader picture
since 2001 mortality from cancer has decreased by 13% for men and 8% for women. Latest
figures for 2009 reveal that the numbers of deaths in men have decreased by 17% over the
previous year to 82 deaths. For women, compared with the previous year there has been a
slight increase of 5% in the number of female deaths, with a total of 68 deaths during 2009.
Which type of cancer?
Standardised mortality ratios (SMRs) are used to measure the ratio of deaths in a standard
population, in this case England, with a study population. The standard population is
measured as 100 and the study population is compared with this. Anything above 100 is
worse than average and anything below is better. A statistical test is applied to the SMR to
identify if it is significantly better or worse than would be expected. In this instance this
significance is represented by “faces”. A sad face (red) represents worse than expected and
a happy face (green) better than expected when compared to the national average.
Table 3: Cancer trend by site and gender
Males Deaths SMR with statistical significance
Site ICD No. 02-04 03-05 04-06 2002-04 2003-05 2004-06
All cancers C00-C97 240 221 242 102 96 106
MN Oesophagus C15 16 15 20 103 96 128
MN Stomach C16 12 6 6 117 61 65
MN Colon/Rectum C18-C20 26 29 28 105 118 117
MN Pancreas C25 8 8 7 71 70 60
MN Trachea, Bronchus, Lung C33-C34 69 69 76 113 116 129
Mal Melanoma Skin C43 .. 5 7 .. 133 179
Mesothelioma C45 5 7 7 88 123 121
MN Prostate C61 18 19 22 104 112 132
MN Kidney ex Renal Pelvis C64 10 6 5 146 86 69
MN Bladder C67 .. .. .. .. .. .. ☺
MN Brain C71 14 7 8 160 79 95
Non-Hodgkin's Lymphoma C82-C85 11 6 6 132 76 80
Leukaemia C91-C95 7 7 10 98 97 139
Females
All cancers C00-C97 192 223 234 96 112 118
MN Oesophagus C15 10 15 14 181 277 257
MN Stomach C16 11 10 8 243 227 193
MN Colon/Rectum C18-C20 8 12 12 50 ☺ 85 96
MN Pancreas C25 10 12 18 111 128 186
MN Trachea, Bronchus, Lung C33-C34 48 55 52 125 142 130
Mal Melanoma Skin C43 .. .. 5 .. .. 180
Mesothelioma C45 .. .. .. .. .. ..
MN Female Breast C50 28 27 35 72 69 90
MN Cervix Uteri C53 .. .. 7 .. .. 191
MN Uterus C54 .. .. 5 .. .. 149
MN Ovary C56 15 21 19 95 136 126
MN Kidney ex Renal Pelvis C64 .. .. .. .. .. ..
MN Bladder C67 .. .. .. .. .. ..
MN Brain C71 7 6 6 120 104 107
Non-Hodgkin's Lymphoma C82-C85 .. .. 6 .. .. 111
Leukaemia C91-C95 .. .. .. .. .. ..
.. Data suppressed (less than five deaths)
Lung cancer in men and women is significantly higher than would be expected. For women
overall, all cancers, oesophageal cancer and stomach cancer are areas of concern.
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Cancer screening
Currently there are three national screening programmes operating within the district. These
are: cervical – screening women aged 25 to 64 years, breast – screening women aged 53 to
64 years and bowel screening. Originally bowel screening was offered to men and women
aged 60 to 69 years. This has recently been extended to include the age group 70 to 75
years. Latest coverage figures are shown in table 4.
Table 4: Screening coverage
2009/10 2009 2009/10
Area Breast Bowel Cervical
Carlisle 82% 59% 81%
Cumbria 82% 60% 82%
England *77% 52% 79%
*2008/09 coverage
Generally Carlisle locality performs w ell when compared with screening averag es locally and
nationally.
Figure 20: Screening coverage by GP practice
Coverage
90%
85%
80%
75%
70%
65%
60%
55%
50%
45%
40%
Brampton
Medical Pract ice
Warwick Road Surgery
St Paul's Medical Centre
Brunswick House Medical Group
Carlisle PBC: Screening covverage
Spencer Street Surgery
Fusehill
Medical Practice
Eden Medical Group
Breast Bowel Cervical
Stanwix Medical Practice
Longto wn Medical Centre
Practice
Grovenor House Surgery
Grosvenor House Surgery
Grosvenor House Surgery
Esk Valley Medical Group
Grosvenor House Surgery
Figure 20 examines screening coverage by GP practi ce. There is a varied picture across the
locality with cervical screening coverage ranging from 69 % to 89% of the target population.
Looking at breast screening, coverage acro ss Carlisle ranges from 76% to 90% of target.
Finally bowel screening coverage varies from 51% to 63% o f the targe t populati on.
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Figure 21: Progress of spearhead local authorities
With reference to Carlisle’s “spearhead” status figures produced by the Department of Health,
indicate that Carlisle is one of twelve spearhead local authorities that are on track to narrow
the gap in life expectancy. Figure 21 shows the progress spearhead local authorities have
made in narrowing their local life expectancy gap.
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What are the main behavioural risk factors resulting in the inequalities gap in life
expectancy and infant mortality?
Figure 22: Behavioural risk factors
There are six main behavioural risk factors that contribute to poor health and health
inequalities: diet, physical exercise, smoking alcohol consumption, teenage pregnancy and
breast feeding. Their impact on health is illustrated in figure 22. These risk factors will be
discussed in the following sections.
Smoking
Smoking is the biggest preventable single cause of preventable illness and death in the UK.
About 90% of lung cancer deaths and 17% of coronary heart disease are attributable to
smoking (ASH, 2007). Smoking during pregnancy is estimated to increase infant mortality by
about 40% (DoH 2007).
Figure 23: Estimated smoking prevalence
Figure 23 takes data from the Joint Strategic Needs Assessment, 2009 report. This shows
that smoking prevalence within Carlisle is well above the Cumbria average.
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Figure 24: Smoking status by GP practice, June 2010
Smoking status by practice: current smoker
25%
21%
19% 18%
18% 17% 17% 16% 16% 15% 13% 12% 12%
Warwick Road
Brunswick House
Eden Medical
Dr Ward
Drs Adam & Wigmore
St Paul's
Burn Street
Spencer Street
Dr Frost
Dr Ashton
London Road
Stanwix Medical
Brampton Medical
It is difficult to quantify the number of people who smoke. Figure 24 takes data from GP
practice registers. This shows the number of patients aged 16 and over, whose smoking
status has been recorded in the last 15 months with latest status recorded as current smoker.
Smokers ranged from 25% of the register to as low as 12%. Using this methodology over
11,000 current smokers had visited their GP.
Data collected by the Cumbria Stop Smoking Service shows that during the last financial
year, 1,743 residents of Carlisle approached the service for help with quitting smoking. Of
these over one half successfully quit smoking; just over one third were unsuccessful.
Another source of smoking data is the local tobacco control profiles produced by the
A ssociation of Public Health Observatories. Results for Carlisle are shown in figures 25 and
26.
Figure 25: Local tobacco control profile, part 1
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Figure 25: Local tobacco control profile, part 2
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Obesity
Obesity is when a person is carrying too much body fat for their height and sex. A person is
considered obese if they have a body mass index (BMI) of 30 or greater. In 2008 nearly a
quarter of all adults (16 plus) in England were obese. Just under one third of women, 32%,
were overweight (a BMI of 25-30), and 42% of men were overweight (NHS Choices 2010).
The number of overweight and obese people is likely to increase. The Foresight (2007)
report, a scientific report used to guide Government policy, has predicted that by 2025, nearly
half of men and over one third of women will be obese. Obesity can cause a number of
health problem, such as type 2 diabetes and heart disease. Being overweight or obese can
also shorten life expectancy,
Figure 26: Patients with Body Mass Index >=30, (January 2009 to March 2010)
Patients over 16 with BMI of >=30
15.0%
14.0%
11.2% 10.9%
9.8% 9.6% 9.6% 9.1%
7.7%
5.7%
Brunswick
House
Spencer
Street
Brampton
Medical
St Paul's
Medical
Stanwix
Medical
Eden
Medical
Fusehill
Medical
Warwick
Road
Grosvenor
House
Esk Valley
Data taken from the GP QOF (Quality and Outcomes Framework) registers shows a varied
picture across Carlisle regarding obesity. Of those patients measured, as many as 15% and
as few as 6% were recorded as obese when viewed at practice level. Looking at Carlisle as a
whole this converts to an average of 11%. This is slightly above the county average of
10.5%,
Data taken from the NHS Cumbria Obesity Atlas 2010 examines QOF data in more detail for
the period 2006/09. This is shown in table 5 . Here data are shown at ward level with a
district and county comparison. The table shows firstly: of those patients who have been
weighed the proportion classified as obese. Secondly of the obese group of patients the
proportion of that group who are also suffering from a long term condition. It must be
remembered that not all of a practices population have been measured. On average 26% of
patients in Carlisle had their BMI recorded during the period.
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Table 5: Patients recorded with a BMI >=30 and a long term health condition, ward (percentage)
Obese with:
Ward Total Obese Asthma Diabetes COPD CHD Hypertension
Belah 28.8 18.3 17.3 2.7 11.7 48.6
Belle Vue 29.5 14.9 19.3 3.5 11.6 40.6
Botcherby 30.9 18.1 12.9 4.3 14.2 38.6
Brampton 27.3 19.4 14.8 3.8 13.8 42.4
Burgh 25.4 11.3 10.7 2.5 13.2 38.4
Castle 25.0 17.5 16.1 3.9 15.8 37.5
Currock 31.1 18.6 15.3 4.5 9.3 37.5
Dalston 26.9 15.7 14.8 2.4 11.6 41.3
Denton Holme 27.0 18.6 14.3 4.2 15.4 38.2
Great Corby and Geltsdale 20.9 17.9 16.8 3.3 13.0 46.7
Harraby 29.2 17.2 14.3 4.0 13.3 43.5
Hayton 22.3 20.3 17.9 5.3 14.0 45.4
Irthing 25.6 16.7 16.3 3.4 12.3 41.4
Longtown & Rockcliffe 31.9 18.5 23.0 2.3 14.4 41.5
Lyne 26.6 24.5 15.2 5.3 12.6 41.7
Morton 26.9 19.8 21.3 4.4 16.3 51.0
St Aidans 24.8 15.6 13.2 2.2 9.4 35.7
Stanwix Rural 25.7 18.0 14.5 1.3 10.2 45.4
Stanwix Urban 23.7 15.8 13.3 2.0 12.0 46.8
Upperby 31.8 21.7 19.7 5.2 13.8 36.7
Wetheral 22.7 16.4 12.9 2.4 12.4 39.6
Yewdale 28.9 17.4 14.1 3.1 12.3 41.2
Carlisle 27.2 17.8 15.8 3.4 12.8 41.8
Cumbria PCT 28.0 18.1 17.5 2.8 12.3 39.8
In addition to information from QOF the National Child Measurement Programme (NCMP)
also provides data around young people. Reception year and year 6 pupils are measured. In
Cumbria during 2009/10 of those eligible: 89% of reception year pupils were measured and
86% of pupils in year 6.
Figure 27: Reception year obesity prevalence by district council
NCMP: Reception obesity prevalence 08/09 - 09/10
2008/09 2009/10
14. 2%
9.6% 9.8% 9.6%
9.2%
6.4%
8.0%
12. 5%
8.2%
9.6%
11. 9%
10. 9%
8.0%
7.6%
8.5%
7.3%
England Cumbria Allerdale Barrow-in-
Furness
Carlisle Copeland Eden South
Lakeland
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Figure 27 shows reception year data for 2009/10. Almost 10% of children were recorded as
obese in Carlisle. This is an increase on the previous year’s figure of just over 8%. Current
obesity rates are similar to county and national rates.
Figure 28: Year 6 obesity prevalence b y district council
NCMP: Year 6 obesity prevalence 08/09 - 09/10
2008/09 2009/10
19 . 7 %
18 . 7 % 18 . 8 %
18 . 3 %
20.7%
20.0%
21.2% 21.0%
19 . 2 %
18 . 7 %
19 . 6 % 19 . 6 %
19 . 2 % 19 . 3 %
16 . 8 %
15 . 8 %
England Cumbria Allerdale Barrow-in-
Furness
Carlisle Copeland Eden South
Lakeland
Figure 28 shows the results for yea r 6. Almost
19% of pupils in Carlisle are recorded as
being obese. This is in line with national and county averages.
Obesity and nutrition
The Government recommends an intake of at least five portions of fruit or vegetables per
person per day to help reduce the risk of some cancers, heart disease and many other
chronic conditions.
Figure 29: Fruit and vegetable consumption
Figure 29 takes data from the Health Survey England. This shows that an estimated 26% of
the population of Carlisle reported eating five or more pieces of fruit and vegetables per day.
This is slightly worse than the Cumbria average of 28%.
Obesity and Physical activity
Adults who are physically active have a 20-30% reduced risk of premature death (DoH 2004).
Physical activity has an effect on cardiovascular risk, it reduces the risk of some cancers such
as colorectal cancer, and it reduces the incidence of falls and osteoporosis in the elderly, and
has been shown to reduce depression, stress and anxiety (DoH 2004).
The National Indicator, N18 measures the percentage of the adult population (age 16 years
and over) in a local area who participate in sport and active recreation, at moderate intensity,
Carlisle Health Improvement Plan
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for at least 30 minutes on at least 12 days out of the last 4 weeks (equivalent to 30 minutes
on 3 or more days a week). Figures taken from Sport England show that just over 20% of the
adult population of Carlisle participate in some form of physical activity. This is below the
Cumbria average of 22%.
Mental Health
Mental well-being is as important as physical health if people are to live their lives to the full.
Mental ill-health is common with one in four people experiencing a mental health problem at
some point in their life. Ten percent of children have a mental health problem.
Table 6: Selected mental health indicators
Indicator
Number
Estimated number of people with a common mental disorder 9,900
Estimated number of people age over 65 with dementia 1,300
Estimated number of adults (16+) who have engaged in deliberate self ham in 2,920-3,200
their lifetime
Admissions to hospital for self harm 250
Attendances at A&E departments in a year for self harm 520
Average number of suicides each year 13
T he recent Mental Health Joint Strategic Needs Assessment: Adults report (NHS Cumbria
2010) provides valuable information on the mental health of the local community. Data taken
from this report are shown in table 6. This shows a selection of mental health problems
experienced by the residents of Carlisle.
Figure 30: Trend for suicide and injury undetermined, persons
20.0
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
Suicide & injury undetermined, DSR
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
6.06
England Cumbria Carlisle DC
Looking at a more specific area of mental health, namely suicides; figure 30 shows the trend
in Carlisle. This compares the local directly standardised rate (DSR) with the county and
national rate. On the whole the suicide rate for Carlisle tends to be above the national and
county level. However 2008 saw a dramatic drop in the rate to 6 deaths per 100,000
population (6 deaths). Latest figures for 2009 show that the numbers of suicides has
increased to 13 deaths.
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Figure 31: Suicide and injury undetermined, 2006-08
DSR:suicides & injury undetermined 2006-08
15.5 11.3 10.9 9.9 8.2 6.6 5.3 7.8
Copeland Carlisle Allerdale Cumbria South
Lakeland
Eden
Barrow-in-
Furness
England
To smooth out the peaks and troughs in annual statistics figure 31 compares the three year
average f or suicides. With a rate of 11.3 suicides for every 100,000 people , Carlisle is above
the county and national average.
Alcohol
High levels of alcohol consumption will increase the risk of several cancers (liver, oral,
pharynx and oesophagus), liver cirrhosis and circulatory disease. Alcohol consumption also
has an impact on accidents, violent incidents and mental health disorders.
Figure 32 takes data from the Local Alcohol Profiles for England 2010 and show that Carlisle
is significantly worse than average for the following:
• Alcohol specific hospital admissions - under 18 years
• Alcohol specific hospital admissions - males
• Hospital admissions for alcohol related harm
• Alcohol-attributable violent crime
• Claimants on incapacity benefit – working age
• Mortality from land transport accidents
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Figure 32: Local alcohol profile, Carlisle
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Figure 33: Hospital admissions for wholly attributable alcohol related conditions
Rate/1,000
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
65 Warwick Road
Brunswick House Medical
Patients admitted to hospital with a wholly attributable alcohol related
condition
Grosvenor House (Frost)
St Paul's Medical
Eden Medical Group
Fusehill Medical Practice
Grosvenor House (Adam)
Grosvenor House (Ashton)
Grosvenor House (Ward)
Spencer Street Surgery
Stanwix Medical Practice
Brampton Medical
Cumbria
Esk Valley Medical
Alcohol related health problems can be divided into tow groups: those conditions that are
wholly attributable to alcohol and those that are partially attributable to alcohol. Figure 33
takes data from the report: NHS Cumbria: Hospital admissions for alcohol specific conditions,
2009. Concentrating on wholly attributable conditions the chart shows hospital admission rate
for patients registered with GPs in Carlisle. The chart clearly shows those practices above
the Cumbria average rate of 2.6 patients per 1,000 practice population aged over ten years.
Chlamydia
Chlamydia is a sexually transmitted infection (STI) caused by the bacterium chlamydia
trachomatis. In the UK, the numbers of diagnoses of the infection have been steadily
increasing each year since the mid 1990’s, and it has now become the most commonly
diagnosed STI. Chlamydia is called the “silent” disease because most people who get it do
not experience any noticeable symptoms.
Table 7: Chlamydia screening
Chlamydia 2009/10 Cumbria England
Chlamydia tests reported to the National Chlamydia Screening Programme
8,944
(NCSP)
Laboratory reports of chlamydia tests not reported directly to NCSP 2682
Total test 11,626
Resulting positive tests 739
% young people testing positive 6.4% 6.0%
Target population aged 15 -24 years 58,100
% population tested 20.0% 22.1%
Young people under 25 are more likely to be infected. A national screening programme has
been established to test this age group. Not all tests are reported through the national
screening programme. Tests generated in GP surgeries are processed directly by the
laboratories and not reported to the local screening programme. A national target to test 25%
of the population by the end of 2009/10 was set. Due to the nature of how the data are
collected it is not possible to produce an accurate picture of local coverage. However
Cumbria achieved coverage of 20% compared with 22% for England; both below target, see
table 7.
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Teenage pregnancy
Teenage pregnancy is thought to have various effects on the health and socio-economic
position of both mother and baby. Teenage mothers tend to end up being poorer, having
lower educational attainment and worse mental health as compared to other women from
similar backgrounds (Health Development Agency 2004).
Figure 34: Trend in teenage pregnancy (below 18 years of age)
55.0
Teenage pregnancy rate/1,000 women (15-17 yrs)
England Cumbria Carlisle
50.0
45.0
40.0
35.0
1998-00 2001-03 2004-06 2005-07 2006-08
Teenage pregnancy rates in Carlisle continue to be above the county and national rates, as
shown in figure 34. Currently in Carlisle there are 51 conceptions for every 1,000 women
aged 15 to 17 years. Not all women chose to continue with the pregnancy as 54% terminated
the pregnancy. This is above the county and national rate of 50%.
Breastfeeding
Evidence suggests that breastfeeding for at least the first six months of a baby’s life provides
significant benefits for both the mother and baby. These benefits include: reducing the risk of
developing diabetes in childhood, fewer respiratory tract infections, middle-ear infections and
gastroenteritis. Babies are also less likely to develop allergies, such as asthma and eczema
if they have bee breast fed.
Figure 35: Breast feeding initiation rates
Breast feeding initiation rates
(Source: Vital Signs DoH)
Cumb
England
ria
72.7% 73.1% 72.6% 72.7% 73.
4%
69.7% 69.2%
65.5%
69.0%
66.9%
2009/10 Q1 2009/10 Q2 2009/10 Q3 2009/10 Q4 2010/11 Q1
Breast feeding initiation rates in Cumbria continue to be below the national average, see
figure 35. Currently in Cumbria 67% of new babies are breast fed. Once the baby has gone
home breast feeding status is recorded at 6-8 weeks of age. By this stage breast feeding
rates in Cumbria have fallen to 31% compared to 48 nationally.
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Figure 36: Prevalence of breast feeding at 6-8 weeks, locality
Prevelance breast feeding 6-8 weeks
as at quarter 2, 2010/11
47%
29%
32%
29%
28%
18%
20%
Allerdale
Barrow in
Furness
Carlisle Copeland Eden South
Lakes
Cumbria
Breast feeding prevalence data at 6 to 8 weeks are shown in figures 36 and 37 . Latest
figures (quarter 2, 2010/11) prevalence of 32% in Carlisle. This is above the Cumbria
average of 28%. Figure 37 breaks this figure down by GP practice. A wide variation is
shown at this level, ranging from 21% to 28% of mothers still breast feeding their babies at
six to eight weeks.
Figure 37: Prevalence of breast feeding at 6-8 weeks, GP practice
Prevalence breast feeding 6-8 weeks
as at quarter 2, 2010/11
48%
21%
24%
29% 29%
30% 30%
33%
38%
40%
Brunswick House Surgery
Warwick Road Surgery
St Paul's Practice
Esk Valley Medical Group
Grosvenor House
Eden Medical Group
Spencer Street Surgery
Fusehill Medical Practice
Stanwix Medical Practice
Brampton Medical Practice
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Wider determinants of health
It is important to remember that behavioural factors are not the only influences on health.
Social and economic circumstances affect how people behave and consequently their health.
Work, unemployment and incapacity
Being in good employment is protective of health. Conversely, unemployment contributes to
poor health. Getting people back into employment is crucial for reducing health inequalities.
However, jobs need to be sustainable and offer a minimum level of quality that not only
includes a decent living wage but also the opportunities for in-work development.
Figures for 2009/10 showed that in Carlisle 81.6% of the population (16 to 64 years) were
economically active. This is above the national average for Great Britain of 76.5%. The
unemployment rate was 6.1% in Carlisle compared with 7.9% nationally.
During 2009 in Carlisle, full-time gross weekly pay was £414. This is below regional and
national rates of £460 and £491 respectively.
Table 8: Benefit claimants
Working age key benefit claimants (February 2010)
Carlisle
GB
Number
Total claimants 9,830 14.5% 15.1%
Job seekers 2,050 3.0% 3.9%
ESA & incapacity benefits 4,970 7.4% 6.7%
Lone parents 950 1.4% 1.8%
Carers 730 1.1% 1.1%
Others on income related benefits 270 0.4% 0.5%
Disabled 690 1.0% 1.0%
Bereaved 160 0.2% 0.2%
Source: nomisweb.co.uk
In terms of benefit claimants, Carlisle compares favourably with the national average for a
range of benefits, see table 8. In total 14.5% of the working age population in Carlisle claim
benefits, this is just below the national rate of 15.1%. The employment and support
allowance (ESA) has replaced incapacity benefit and income support. In Carlisle 7.4% of the
working age population claim this allowance, this is above the national average of 6.7%.
Fuel Poverty
The number of extra deaths occurring in winter varies depending on temperature, the level of
disease in the population and other factors. These deaths may be partially attributed to the
fact that many people cannot afford to adequately heat their homes (National Energy Action,
2009). A household is said to be in fuel poverty if it needs to spend more than 10% of its
income on fuel to maintain a satisfactory heating regime (usually 21 degrees for the main
living area and 18 degrees for other occupied rooms). Fuel poverty is caused by the
interaction of a number of factors, but three specifically stand out. These are: energy
efficiency status of the property, cost of energy and household income.
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Figure 38: Fuel poverty
Figure 36 illustrates data supplied by the Centre for Sustainable Energy
(fuelpovertyindicator.co.uk) at lower super output area level. This shows a varied picture
across the county. The areas shown in the darker shade of red are those households
experiencing the highest rates of fuel poverty.
Excess winter death
There are higher levels of mortality in the winter than in the summer. Excess deaths are
measured by the “excess winter mortality index”. The excess winter mortality (EWM) index is
calculated as excess winter deaths divided by the average non-winter deaths, expressed as a
percentage.
Figure 39: Excess winter deaths
Excess winter deaths (%)
(2009/10 data are provisional)
Carlisle Cumbria E&W
16 14 16 18 17 15 22 14 16 19 19 24 6 11 17
2005/06 2006/07 2007/08 2008/09 2009/10
The elderly are more vulnerable than others during the winter. Policies such as “winter fuel
payment” and influenza vaccinations are particularly focussed on older people. Although
EWM is associated with low temperatures, conditions directly relating to cold, such as
hypothermia, are not the main cause of excess winter mortality. The majority of additional
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winter deaths are caused by cerebrovascular diseases, ischaemic heart disease and
respiratory diseases (ONS 2010). As shown in figure 39 the EWM index peaked in Carlisle
at 22% during the winter of 2007/08. This has now decreased to 6% for 2009/10 (provisional
figures).
Child Poverty
The goal to end child poverty by 2020 was set out in the Child Poverty Act. Children are said
to be living in relative income poverty of their household’s income is less than 60% of the
median national income. Using this measure, there are currently 2.8million children living in
poverty in this country. Children and young people living in poverty face a greater risk of poor
health, more accidents, exposure to crime and failing to reach their full potential.
Table 9: Child poverty
% of Children in "Poverty"
Under 16
All Children
England 21.6% 20.9%
Cumbria 15.7% 15.1%
Carlisle 16.7% 16.0%
Belah 9.9% 9.6%
Belle Vue 25.4% 24.8%
Botcherby 33.8% 32.5%
Brampton 14.2% 12.9%
Burgh 6.3% 6.5%
Castle 31.3% 28.7%
Currock 23.8% 23.4%
Dalston 6.4% 6.1%
Denton Holme 23.3% 22.3%
Great Corby and Geltsdale 3.4% 3.8%
Harraby 17.0% 16.0%
Hayton 7.8% 7.0%
Irthing 7.1% 7.3%
Longtown & Rockcliffe 9.5% 9.3%
Lyne 9.3% 9.3%
Morton 15.5% 15.0%
St Aidans 21.8% 21.1%
Stanwix Rural 4.2% 4.2%
Stanwix Urban 4.3% 4.2%
Upperby 30.3% 29.7%
Wetheral 2.8% 3.1%
Yewdale 8.7% 9.0%
Source:http://www.hmrc.gov.uk/stats/personal-tax-credits/child_poverty.htm
Data supplied by HM Revenues & Customs shows that around 16% of child in Carlisle are
living in poverty, see table 9. This is slightly above the Cumbria average of 15% but below
the national average of 21%. However when this data is broken down to ward level parts of
the district exceed the national rate. The ward of Botcherby has a third of its children
growing up in poverty: compare this with Wetheral ward where only 3% of children are living
in poverty.
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Tackling child poverty will lead to reductions in levels of obesity and higher levels of
educational attainment.
Educational attainment
As a result of child poverty, a child’s education suffers. This makes it difficult for them to get
the qualifications they need they need to move on to sustainable, well-paid jobs. This limits
their potential to earn the money needed to support their own families in later life, and so a
cycle of poverty is created.
Figure 40: Educational attainment, 2009/10
Educational attainment, 2009/10
England Cumbria Carlisle
84%
86% 84% 81% 83%
83%
89%
91%
90% 88% 91% 90%
72% 74%
69%
50% 52%
50%
KS1 Reading KS1 Writing KS1 Maths KS2 English & KS2 Science 5 A*-C GCSE' s
maths
Data provided by the County Council for 2009/10, figure 40 , shows Carlisle compares
favourably with national averages. In all but KS2 English and maths, exams results equal of
exceed those of the national rates. However when compared to county levels, Carlisle
results are just below those for all stages in Cumbria.
Looking to the working population of Carlisle, 11.3% (7,300) have no qualifications, this
compares with 12.3% nationally, (NOMIS).
Household Income
Figure 41: Mean household income by district
Mean household income 2010
Source: Cumbria County Council, CACI paycheck data
National average = £35,299
33,338 32,063 31,810 31,696 31,410 30,818 28,013
South
Lakeland
Eden Copeland Carlisle Cumbria Allerdale Barrow in
Furness
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Figure 41 shows the gross mean household income for Cumbria and its six constituent
district councils. All are below the national average income of £35,299. Overall the average
income within Carlisle district (£31,696) is just above the county average but below that of
South Lakeland, Eden and Copeland.
Figure 42: Mean household income by district
Carlisle wards: mean household income 2010
Source: Cumbria County Council, CACI paycheck data
Carlisle average = £31,696
44,302
42,938
40,648
40,176
40,161
39,934
39,135
37,970
37,229
34,488
34,018
33,205
30,598
30,149
29,294
28,161
27,431
26,834
26,434
25,168
23,991
22,609
Wetheral
Stanwix Rural
Great Corby & Geltsdale
Hayton
Burgh
Denton Holme
Dalston
Stanwix Urban
Irthing
Belah
Yewdale
Lyne
Belle Vue
Harraby
Brampton
Longtown & Rockcliffe
St Aidans
Castle
Currock
Botcherby
Morton
Upperby
Figure 42 views the data at ward level shows the wide disparity in household income. Just
over half (12) of Carlisle’s wards have an average income that exceeds the district average.
Incomes within the ward of Wetheral are almost double those of Upperby.
Conclusion
This document provides an assessment of the current health of the population of Carlisle. It’s
content provides commissioners and partner agencies with an opportunity to address the
health inequalities within the locality.
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Contact details:
Name: Jennifer Clay
Title: Public Health Intelligence Analyst
Address: NHS Cumbria, 4 Wavell Drive, Rosehill, Carlisle, Cumbria CA1 2SE
Tel: 01228 603988
Email: jennifer.clay@cumbriapct.nchs.uk
Web:
www.cumbria.nhs.uk
www.cumbriaobservatory.org.uk
October 2010
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