Copeland Health Profile 2010 - Cumbria County Council

Copeland Health Profile 2010
Jennifer Clay
Public Health Intelligence Analyst, NHS Cumbria
Index

Page
Introduction 3
The population of Copeland 4
Births 4
Population projections 5
Health inequalities 6
Life expectancy 9
What are the main causes of disease causing
the low level of life expectancy in Copeland 11
Infant mortality 11
Mortality during 2009 12
Premature deaths from circulatory disease 13
Premature deaths from cancer 14
Which type of cancer 14
Cancer screening 15
What are the behavioural risk factors resulting in the
inequalities gap in life expectancy and infant mortality 17
Smoking 17
Obesity 20
Obesity and nutrition 23
Obesity and physical activity 23
Mental health 23
Alcohol 24
Chlamydia 26
Teenage pregnancy 27
Breastfeeding 27
Wider determinants of health 28
Work, unemployment and incapacity 28
Fuel poverty 29
Excess winter deaths 30
Child poverty 31
Educational attainment 32
Household income 33
Conclusion 33
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Introduction
The purpose of this profile is to bring together data affecting the health and wellbeing of the
people of Copeland. 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 Copeland. 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: Copeland district council and PBC boundary
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Copeland district council covers an area of around 300 square miles. Following the
introduction of Practice Based Commissioning (PBC), practices within the district formed a
local consortium. This consortium does not include the GP practice located in Millom. This
practice opted to join with Furness locality. Therefore the PBC boundary is not co-terminus
with the district council boundary.
The population of Copeland
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 Copeland district council. Figures provided
by the Office for National Statistics (ONS) indicate a population of 69,700 (mid year
population estimates). This figure increases by 3% to 71,500 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 somewhere between the two figures. Returning to mid year estimates
almost one fifth of Copeland’s residents are aged over 65 years. This compares with 16%
nationally.
Births
Figure 2: Live birth rate trend
Live birth rate per 1,000 population
E&W Cumbria Copeland
12 . 1 12 . 5 12 . 8 13 . 0 12 . 9
9.7
10 . 3
10 . 8
9.9 10 . 1 10 . 5 10 . 3 10 . 6 10 . 3 10 . 3
2005 2006 2007 2008 2009
On average each year in Copeland there are around 740 live births. Latest figures for 2009
show that this figure fell to 715 births. As shown in figure 2, the live birth rate in Copeland is
usually above that for Cumbria but below the national average.
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Figure 3: Practice birth rate, 1.7.2010
Copeland PBC: practice birth rate/1,000 population as at 1st July 2010
Copeland average
12.2
10.4 10.4 10.3 9.9 9.6 9.2 9.0 8.9 8.3
Mansion
House
Surgery
Catherine
Street
Surgery
Waterloo
House
Surgery
Distington
Surgery
Queen
Streen
Medical
Practice
Lowther
Medical
Centre
Westcroft
House
Seascale
Health
Centre
Beech
House
Group
Practice,
Flatt Walks
Health
Centre
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, see figure 3. Using this
method the average birth rate for Copeland PBC is 9 births per 1,000 registered population
(July, 2010). There is a wide variation in practice birth rates with Mansion House Surgery
experiencing the highest rate of 12.2 births and Flatt Walks Health Centre the lowest at 8.3
births.
Population Projections
Figure 4: Population projections (2008 based)
Copeland projected population
70.0
70.2
70.4
70.6
70.9
71.1
2008
2009
2010
2011
2012
2013
71.4
71.6
71.9
72.1
72.4
72.7
73.0
2014
2015
2016
2017
2018
2019
2020
73.3
73.5
73.8
74.0
74.2
74.4
74.6
74.7
2021
2022
2023
2024
2025
2026
2027
2028
74.9
75.0
75.2
75.3
75.5
2029
2030
2031
2032
2033
Figure 4 shows the population projection (2008 based) trend for Copeland. By 2033,
projections suggest a growth of 8% in the overall population size of Copeland. Nationally
over the same period the population is projected to grow by 18%.
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Figure 5: Population projections, 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 5 examines those aged over 65 years of age. Projections suggest that this age group
will increase in Copeland from 18% of the total population in 2008 to 30% by 2033. Both
figures are just below the Cumbria average but above those for England.
Health Inequalities
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
experiencing the greatest deprivation, figure 6. 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 Copeland district have been mapped.
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Figure 6: Index of multiple deprivation 2007
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Figure 7: Most deprived areas of Copeland
Figure 7 shows those areas of Copeland experiencing the worst deprivation (quintile one).
Data for 2004 and 2007 have been compared to show if any area has improved. The areas
that were in quintile one during 2004 have remained there. Parts of Cleator Moor North,
Cleator Moor North and Newtown have joined them. The most deprived areas of Copeland
are listed in table 1. Currently around one quarter of Copeland’s population are living within
the most deprived communities in England.
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Table 1: IMD, 2007 most deprived areas of Copeland
LSOA code LSOA description Estimated
population
England rank
(1-32,482)
Cumbria
rank (1-322)
National
quintile
E01019301 Sandwith Part 1 1,597 293 2 1
E01019295 Mirehouse Part 2 1,577 1,270 10 1
E01019280 Harbour Part 1 1,525 2,658 23 1
E01019267 Cleator Moor South Part 2 1,347 3,150 27 1
E01019269 Distington Part 2 1,545 3,306 28 1
E01019277 Frizington Part 1 1,330 3,554 30 1
E01019263 Cleator Moor North Part 1 1,248 5,062 42 1
E01019272 Egremont North Part 2 1,501 5,067 43 1
E01019271 Egremont North Part 1 1,162 5,738 50 1
E01019294 Mirehouse Part 1 1,522 5,852 51 1
E01019265 Cleator Moor North Part 3 1,346 6,147 56 1
E01019299 Newtown Part 2 1,981 6,485 60 1
Most deprived 17,681
Life expectancy
Figure 8: 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) Copeland (M) Eng (F) Copeland (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 8, over the past fifteen years there has been a steady improvement in life
expectancy for men and women living in Copeland. The latest figure for female life
expectancy is of concern. This shows a decrease over the previous years’ steady
improvement. Life expectancy for both males and females continues to be below the national
average.
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Figure 9: 2006-08, life expectancy at birth and at age 65 years, males and females
Life expectancy at birth, 2006-2008
Copeland Cumbria England
Life expectancy at age 65 years, 2006-2008
Copeland Cumbria England
77.2
77.8
77.9
79.8
81.4
82.0
17.4
17.6
17.7
19.1
20.2
20.4
Males
Females
Males
Females
Figure 9 shows the average life expectancy for a man living in Copeland is 77.2 years. This
compares with 77.8 years for Cumbria and 77.9 years for England. Life expectancy for
women in Copeland is 79.8 years. This is below the Cumbria and National averages of 81.4
82 years respectively.
Once a man in Copeland has reached his 65 th year of life he can expect to live for a further
17.4 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 Copeland they can expect to live for a
further 19.1 years. This is just above the Cumbria average of 20.2 years and just below the
national average of 20.4 years.
Figure 10: Ward life expectancy at birth, 1999 to 2003, persons
Life expectancy at birth by electoral wards in Copeland (years)
75 yrs
82.5 81.2 81.0 80.8 80.7 80.4 79.6 79.1 79.0 79.0 78.9 78.3 77.7 77.5 77.2 76.6 76.4 76.3 76.1 76.0 75.8 75.2 74.2 73.2 73.1
Beckermet
St Bees
Haverigg
Gosforth
Seascale
Bransty
Cleator Moor North
Millom Without
Arlecdon
Bootle
Hillcrest
Egremont North
Ennerdale
Holborn Hill
Ward
Consdideration should be given to the location of medical & care establishements
Hensingham
Distington
Egremont South
Frizington
Cleator Moor South
Newtown
Kells
Sandwith
Moresby
Mirehouse
Harbour
Wider variations in life expectancy can be found when looking at data at sub-district level, see
figure 10. Someone living in the ward of Beckermet has an average life expectancy of 82.5
years. Whereas their opposite number living in Harbour ward has a life expectancy of 73.1
years. In other words they die 9.4 years earlier! People living in the wards of Moresby,
Mirehouse and Harbour 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 Copeland
Figure 11: Life expectancy gap and cause of death (The Association of Public Health Observatories)
Most of the difference between life expectancy in Copeland and the average for England as a
whole is related to three main groups of diseases and conditions: circulatory diseases, cancer
and respiratory diseases. Figure 11 shows the proportion of the gap in life expectancy that is
attributed to these causes. It appears that external causes, particularly amongst men in
Copeland, also accounts for a considerable gap in life expectancy.
Infant mortality
Figure 12: Infant mortality trend
Infant death rate per 1,000 live births
E&W Cumbria Copeland
8.0
5.0 4.4
5.0 4.7 4.8 4.4 4.8 4.9
3.9 4.1
4.7
1.4
3.5
1.4
2005 2006 2007 2008 2008
Infant mortality is a good indicator of the overall health of a society. On average each year in
Copeland three 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 Copeland was 1.4 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). The number of deaths has fallen from five
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during 2008 to one death. Infant mortality is mainly as a result of: immaturity, low birth
weight, sudden unexpected death in infancy, congenital malformations and infection.
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 during 2009
Figure 13: Mortality in Copeland, 2009
Copeland mortality, 2009 by age group
Percentage
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
0-74 years 75+ years
194
263
457
142
107 249
Male Female Persons
During 2009 in Copeland there were 706 deaths, see figure 13. This is a 5% reduction on
the previous years’ figure of 746 deaths. Just over a third of all deaths in 2009 were to people
aged below 75 years of age. In terms of gender, just over two fifths of all male deaths were
premature. For women, over one quarter of all deaths is classed as premature. Premature
mortality during 2009 fell by 16% when compared with the previous year (295 deaths). There
was an 18% reduction in the number early deaths in females during the year. Male deaths
declined by 14%.
Figure 14: All age mortality: cause of death in Copeland, 2009
Copeland mortality, all ages, 2009
Circulatory, 30% Circulatory, 34%
Cancer, 30% Cancer, 25%
Respiratory , 13%
Respiratory , 16%
Digestive, 7%
Digestive, 4%
Other , 19% Other , 22%
Male
Female
Figure 14 shows the main causes of death in Copeland during 2009. Almost three quarters
of all deaths can be attributed to three disease groups: circulatory diseases, malignant
cancers and respiratory diseases.
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Figure 15: Premature mortality: cause of death in Copeland, 2009
Copeland premature mortality, 2009
Cancer, 34%
Cancer, 44%
Circulatory, 32%
Circulatory, 21%
Respiratory , 13% Respiratory , 12%
Digestive, 4% Digestive, 6%
Other , 18% Other , 18%
Male
Female
Figure 15 shows premature mortality by main cause of death. For this age group cancer is
the primary cause of death, accounting for almost two out of five deaths. Proportionately
more women than men will die from cancer in this age group.
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 Copeland premature mortality for this disease
group are above the county and national level for males and females.
Figure 16: Premature mortality from circulatory disease by gender
DSR
Premature Mortality: All circulatory disease, males
(directly standardised rates)
210.0
190.0
170.0
150.0
130.0
110.0
90.0
England Cumbria Copeland
2001 2002 2003 2004 2005 2006 2007 2008
DSR
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
Premature Mortality: All circulatory disease, females
(directly standardised rates)
England Cumbria Copeland
2001 2002 2003 2004 2005 2006 2007 2008
Figure 16 shows the trend in premature mortality from circulatory diseases. Until 2008 there
was a general downward trend in mortality for both sexes. During the year the male mortality
rate increased to 127 deaths per 100,000 men (53 deaths); placing it above the county and
national rate of around 100 males deaths per 100,000. Recent figures for 2009 show that the
number of deaths has fallen by 15% to 45 deaths. During 2008 female mortality rates
increased to 62 deaths per 100,000 women (28 deaths). This is above county and national
rates of 49 female deaths per 100,000 and 44 female deaths per 100,000 respectively.
Figures for 2009 show that the number of deaths reduced by 21% to 22 female deaths.
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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 17: Premature mortality from cancer by gender
Premature Mortality: All cancers, males
(directly standardised rates)
Premature Mortality: All cancers, females
(directly standardised rates)
England Cumbria Copeland
England Cumbria Copeland
DSR
190.0
170.0
150.0
130.0
110.0
90.0
2001 2002 2003 2004 2005 2006 2007 2008
DSR
140.0
130.0
120.0
110.0
100.0
90.0
80.0
70.0
60.0
2001 2002 2003 2004 2005 2006 2007 2008
Figure 17 shows premature mortality rates from cancer. Male mortality of 124 deaths per
100,000 (56 deaths) men is in line with the national average and below the county rate of 164
deaths per 100,000. Recently released figures for 2009 reveal that the number of male
deaths has decreased by 14% to 48 deaths. During recent years female mortality from
cancer has show a steady increase. The current rate of 131 deaths per 100,000 females (57
deaths) is above the county and national rate of 100 deaths for every 100,000 females.
Figures for 2009 show that the number of female deaths decreased by 18% to 47 deaths.
Which type of cancer
Table 2 shows standardised mortality ratios (SMRs). These are used to measure the ratio of
deaths in a standard population, in this case England, with a study population (Copeland).
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.
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Table 2: Cancer trend by site and gender, under 75 years
Males Deaths SMR with statistical significance
Site ICD No. 02-04 03-05 04-06 02-04 03-05 04-06
All cancers C00-C97 154 178 182 93 108 110
MN Oesophagus C15 7 10 12 64 89 106
MN Stomach C16 6 10 7 84 144 106
MN Colon/Rectum C18-C20 22 22 21 127 126 121
MN Pancreas C25 7 6 7 89 73 83
MN Trachea,Bronchus,Lung C33-C34 40 45 46 93 106 108
Mal Melanoma Skin C43 .. 5 6 .. 186 213
Mesothelioma C45 .. .. 5 .. .. 119
MN Prostate C61 11 13 17 92 108 142
MN Kidney ex Renal Pelvis C64 7 .. .. 144 .. ..
MN Bladder C67 .. .. .. .. .. ..
MN Brain C71 6 7 6 97 111 93
Non-Hodgkin's Lymphoma C82-C85 .. 5 6 .. 89 110
Leukaemia C91-C95 5 7 7 100 137 136
Females
All cancers C00-C97 138 130 135 104 98 102
MN Oesophagus C15 .. .. .. .. .. ..
MN Stomach C16 4 5 7 133 170 254
MN Colon/Rectum C18-C20 9 11 11 85 117 132
MN Pancreas C25 9 8 .. 150 128 ..
MN Trachea, Bronchus, Lung C33-C34 29 23 27 113 89 101
Mal Melanoma Skin C43 .. .. .. .. .. ..
Mesothelioma C45 .. .. .. .. .. ..
MN Female Breast C50 30 24 22 115 91 84
MN Cervix Uteri C53 .. .. .. .. .. ..
MN Uterus C54 .. .. .. .. .. ..
MN Ovary C56 8 12 13 76 116 129
MN Kidney ex Renal Pelvis C64 .. .. .. .. .. ..
MN Bladder C67 .. .. .. .. .. ..
MN Brain C71 5 6 6 127 155 155
Non-Hodgkin's Lymphoma C82-C85 .. .. .. .. .. ..
Leukaemia C91-C95 .. .. .. .. .. ..
.. Data suppressed (less than five deaths)
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 3.
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Table 3: Screening coverage
2009/10 2009 2009/10
Area Breast Bowel Cervical
Copeland 83% 59% 82%
Cumbria 82% 60% 82%
England *77% 52% 79%
*2008/09 coverage
Generally Copeland performs well when compared with screening averages locally and
nationally.
Figure 18: Screening coverage by GP practice
90%
85%
Copeland PBC: Screening covverage
Breast Bowel Cervical
80%
75%
Coverage
70%
65%
60%
55%
50%
45%
40%
Hinnings
Road
Surgery
Seascale
Health
Centre
Catherine
Street
Surgery
Lowther
Medical
Centre
Flatt Walks
Health
Centre
Beech
House Group
Practice
Queen
Street
Medical
Practice
Trinity House
Surgery
Westcroft
House
Mansion
House
Surgery
Practice
Figure 18 examines screening coverage by GP practice. There is a varied picture across the
locality with cervical screening coverage ranging from 76% to 85% of the target population.
Moving to breast screening, coverage ranges from 78% to 87%. Finally bowel screening
coverage varies from 54% to 62% of the target population.
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What are the main behavioural risk factors resulting in the inequalities gap in life
expectancy and infant mortality
Figure 19: 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 20: Estimated smoking prevalence
Figure 20 takes data from the Joint Strategic Needs Assessment, 2009 report. This shows
that smoking prevalence within Copeland is well above the Cumbria average.
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Figure 21: Smoking status by GP practice, June 2010
Smoking status by practice: current smoker
20%
17% 17% 17% 16% 15% 14% 14% 14% 14%
Lowther
Medical
Centre
Flatt Walks
Health
Centre
Church
Street
Surgery
Beech
House
Group
Practice
Westcroft
House
Drs Timney
& Westhead
Catherine
Street
Surgery
Distington
Seascale
Health
Centre
Ironside &
Ironside
It is difficult to quantify the number of people who smoke. Figure 21 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 20% of the register to 14%. Using this methodology almost 7,000
current smokers had visited their GP.
Data collected by the Cumbria Stop Smoking Service sows that during the financial year
2009/10, 1,167 residents of Copeland approached the service for help with quitting smoking.
Of these just over two thirds successful quit smoking. Just over one fifth were unsuccessful.
Another source of smoking data is the local tobacco control profiles produced by the
Association of Public Health Observatories. Results for Copeland are shown in figures 21
and 22.
Figure 21: Local tobacco control profile, part 1
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Figure 22: Local tobacco control profile, part 1
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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 23: Patients with Body Mass Index >=30, (January 2009 to March 2010)
Patients over 16 with BMI of >=30
16.3% 16.1% 15.7% 15.0% 14.9%
12.9% 12.8%
10.9% 10.7%
7.4%
Hinnings
Road
Surgery
Lowther
Medical
Centre
Catherine
Street
Surgery
Mansion
House
Surgery
Westcroft
House
Queen
Street
Medical
Practice
Seascale
Health
Centre
Flatt Walks
Health
Centre
Beech
House
Group
Practice
Trinity
House
Surgery
Data taken from the GP QOF (Quality and Outcomes Framework) registers shows a varied
picture across Copeland regarding obesity, see figure 23. Of those patients measured as
many as 16% and as few as 7% were recorded as obese when viewed at practice level.
Looking at Copeland as a whole this converts to an average obesity rate of 13%. This is
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 4. 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 40% of
patients in Copeland had their BMI recorded during the period.
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Table 4: Patients recorded with a BMI >=30 and a long term health condition, ward (percentage)
Obese with:
Ward Total Obese Asthma Diabetes COPD CHD Hypertension
Arlecdon 31.7 18.9 20.0 3.4 13.7 38.3
Beckermet 32.6 18.5 18.8 1.2 15.8 49.3
Bootle 30.5 20.1 16.0 5.7 10.3 50.0
Bransty 29.2 15.9 17.7 2.6 10.5 32.8
Cleator Moor North 37.8 15.5 23.4 1.3 13.9 43.1
Cleator Moor South 36.2 21.5 23.8 4.5 12.5 44.7
Distington 35.2 16.6 17.6 3.7 10.4 33.6
Egremont North 36.7 20.0 22.4 4.7 15.3 39.2
Egremont South 31.9 21.5 21.1 3.5 17.4 54.9
Ennerdale 28.2 15.3 20.0 3.5 15.3 34.1
Frizington 36.0 20.4 20.8 2.8 13.5 33.6
Gosforth 26.6 19.3 22.4 3.1 11.8 44.7
Harbour 30.0 17.4 19.4 4.5 12.3 39.3
Haverigg 37.7 17.9 51.2 0.0 20.2 44.0
Hensingham 34.1 20.0 19.8 3.1 11.4 41.9
Hillcrest 25.5 15.6 10.7 1.8 11.6 37.9
Holborn Hill 30.1 18.5 45.2 0.0 12.9 40.3
Kells 32.4 15.6 15.6 2.8 8.9 39.6
Millom Without 27.2 12.3 23.6 5.7 12.3 34.9
Mirehouse 32.9 18.8 20.6 5.4 14.7 32.7
Moresby 34.1 16.7 17.3 3.0 7.1 37.5
Newtown 36.8 24.0 41.2 1.4 18.1 38.0
St Bees 23.5 20.3 15.8 3.0 10.5 43.6
Sandwith 34.2 23.8 21.0 5.0 11.6 30.4
Seascale 28.0 15.1 15.1 1.4 7.4 43.7
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.
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Figure 24: Reception year obesity prevalence by district council
NCMP: Reception obesity prevalence 08/09 - 09/10
2008/09 2009/10
14%
10% 10%
9%
10%
6%
8%
12%
8%
10%
12%
11%
8%
8%
7%
8%
England Cumbria Allerdale Barrow-in-
Furness
Carlisle Copeland Eden South
Lakeland
Figure 24 shows reception year data for 2009/10. In Copeland 1% of children were recorded
as obese. This is a slight reduction over the previous year’s figure of 12%. Current obesity
rates are just above county and national averages.
Figure 25: Year 6 obesity prevalence by district council
NCMP: Year 6 obesity prevalence 08/09 - 09/10
2008/09 2009/10
20%
18%
19% 19%
21%
20%
21% 21%
19%
19%
20% 20%
19% 19%
17%
16%
England Cumbria Allerdale Barrow-in-
Furness
Carlisle Copeland Eden South
Lakeland
Figure 25 shows the results for year 6 students. In Copeland 20% of pupils are recorded as
being obese. This is slightly above national and county averages.
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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 26: Fruit and vegetable consumption
Figure 26 takes data from the Health Survey England. This shows that an estimated 26% of
the population of Copeland 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,
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 Copeland 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 5: Selected mental health indicators
Indicator
Number
Estimated number of people with a common mental disorder 7,300
Estimated number of people age over 65 with dementia 800
Estimated number of adults (16+) who have engaged in deliberate self harm in their 1,970-2,840
lifetime
Admissions to hospital for self harm 150
Attendances at A&E departments in a year 440
Average number of suicides each year 11
The 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 5. This shows a selection of mental health problems
experienced by the residents of Copeland.
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Figure 27: 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
12.55
England Cumbria Copeland
Looking at a more specific area of mental health, namely suicides; figure 27 shows the trend
in Copeland. This compares the local directly standardised rate (DSR) with the county and
national averages. On the whole the suicide rate for Copeland tends to be above the national
and county level.
Figure 28: 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 28 compares the three year
average for suicides. With a rate of 15.5 suicides for every 100,000 people, Copeland is well
above the county and national averages.
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 29 takes data from the Local Alcohol Profiles for England 2010 and show that
Copeland 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 29: Local alcohol profile, Copeland
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Figure 30: Hospital admissions for wholly attributable alcohol related conditions, patients
Patients admitted to hospital with a wholly attributable alcohol related
condition
Cumbria
Rate/1,000
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
Trinity House Surgery
Catherine Street Surgery
Flatt Walks Health Centre
Lowther Medical Centre
Beech House Group Pr...
Westcroft House
Mansion House Surgery
Queen Street Medical ...
Distington Surgery
Seascale Health Centre
Alcohol related health problems can be divided into two groups: those conditions that are
wholly attributable to alcohol and those that are partially attributable to alcohol. Figure 30
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 Copeland. 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 6: 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 6.
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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 31: Trend in teenage pregnancy (below 18 years of age)
55.0
50.0
45.0
40.0
35.0
30.0
Teenage pregnancy rate/1,000 women (15-17 yrs)
England Cumbria Copeland
1998-00 2001-03 2004-06 2005-07 2006-08
As shown in figure 31 teenage pregnancy rates in Copeland are above county and national
levels. Currently in Copeland there are 47 conceptions for every 1,000 girls aged 15 to 17
years. 43% of these young women chose to have their pregnancy terminated. This is below
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 32: Breast feeding initiation rates
Breast feeding initiation rates
(Source: Vital Signs DoH)
England
Cumbria
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 32. 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 33: 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 33 and 34. Latest
figures (quarter 2, 2010/11) show prevalence of 29% in Copeland. This is just above the
Cumbria average of 28%. Figure 34 breaks this figure down by GP practice. A wide
variation is shown at this level, ranging from 13% to 46% of mothers still breast feeding their
babies at six to eight weeks.
Figure 34: Prevalence of breast feeding at 6-8 weeks, GP practice
Prevalence breast feeding 6-8 weeks
as at quarter 2, 2010/11
20%
23% 23%
26%
28%
33%
36%
41%
46%
13%
Distington Surgery
Trinity House Surgery
Mansion House Surgery
Catherine Street Surgery
Beech House Group Practice
Lowther Medical Centre
Flatt Walks Health Centre
Queet Streen Medical Practice
Westcroft House
Seascale Health Centre
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.
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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 (July 09/June10) showed that in Copeland 73.8% of the populations (16
to 64 years) were economically active. This is below the national averaged for Great Britain
of 76.4%. The unemployment rate was 6.8% in Copeland compared with 7.7% nationally.
During 2010 in Copeland, full-time gross weekly pay was £622.
national rates of £471 and £502 respectively.
This is above regional and
Table 7: Benefit claimants
Working age key benefit claimants (May 2010)
Copeland GB
Number % %
Total claimants 7370 16.5 14.7
Job seekers 1390 3.1 3.5
ESA & incapacity benefits 3820 8.5 6.7
Lone parents 680 1.5 1.7
Carers 710 1.6 1.1
Others on income related benefits 200 0.4 0.5
Disabled 480 1.1 1.0
Bereaved 100 0.2 0.2
Source: nomisweb.co.uk
Table 7 shows benefit claimants living in Copeland. In terms of overall claimants; 16.5% of
the working age population of Copeland are in receipt of some form of benefit. This is above
the national average of 14.7%. The employment and support allowance (ESA) has replaced
incapacity benefit and income support. In Copeland 8.5% 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 35: Fuel poverty
Figure 35 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 36: Excess winter deaths
Excess winter deaths (%)
(2009/10 data are provisional)
Copeland Cumbria E&W
15 14 16 44 17 15 9 14 16 21 19 24 15 11 17
2005/06 2006/07 2007/08 2008/09 2009/10
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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
winter deaths are caused by cerebrovascular diseases, ischaemic heart disease and
respiratory diseases (ONS 2010). As shown in figure 36 the EWM index peaked in Copeland
at 44% during the winter of 2006/07. This has now decreased to 15% 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 8: Child poverty
% of Children in "Poverty"
Under 16 All children
England 21.6% 20.9%
Cumbria 15.7% 15.1%
Copeland 19.0% 18.3%
Arlecdon 7.1% 6.1%
Beckermet 14.7% 14.9%
Bootle 9.5% 8.3%
Bransty 6.8% 7.0%
Cleator Moor North 24.9% 23.5%
Cleator Moor South 28.8% 28.0%
Distington 25.4% 23.8%
Egremont North 21.7% 21.2%
Egremont South 12.8% 12.6%
Ennerdale 5.6% 6.5%
Frizington 24.3% 22.0%
Gosforth 7.2% 7.3%
Harbour 13.2% 13.3%
Haverigg 11.3% 11.3%
Hensingham 19.6% 19.4%
Hillcrest 1.3% 1.5%
Holborn Hill 23.6% 22.3%
Kells 14.3% 14.5%
Millom Without 9.0% 8.2%
Mirehouse 35.6% 34.1%
Moresby 15.3% 15.0%
Newtown 22.2% 21.7%
St Bees 5.5% 4.8%
Sandwith 46.3% 44.3%
Seascale 6.2% 5.6%
Source: http://www.hmrc.gov.uk/stats/personal-tax-credits/child_poverty.htm
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Data supplied by HM Revenues & Customs shows that around 18% of children in Copeland
are living in poverty, see table 8. This is 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 Sandwith has 44%of its children growing up in
poverty: compare this with Hillcrest ward where only 1.5% of children are living in poverty.
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 37: Educational attainment, 2009/10
Educational attainment, 2009/10
England Cumbria Copeland
84%
86% 85%
81% 83%
81%
89%
91%
90%
72%
74%
73%
88%
91%
89%
69%
69%
66%
KS1 Reading KS1 Writing KS1 Maths KS2 English &
maths
KS2 Science
5 A*-C GCSE's
Educational data provided by the County Council for 2009/10, is shown in figure 37. Results
for Copeland are generally just below the Cumbria average and above those for England.
Looking to the working population of Copeland, 13.3% (6,000) have no qualifications, this
compares with 12.3% nationally, (NOMIS).
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Household Income
Figure 38: 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
Figure 38 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 Copeland district (£31,810) is just above the county average but below that of
South Lakeland, Eden.
Figure 39: Mean household income by ward
Copeland wards: mean household income 2010
Source: Cumbria County Council, CACI paycheck data
Copeland average = £31,810
46,914
41,770
41,139
40,505
38,573
St Bees
Hillcrest
Beckermet
Bransty
Arlecdon
38,329
38,106
37,539
36,659
35,846
Seascale
Moresby
Gosforth
Ennerdale
Millom Without
32,521
31,908
31,636
30,691
Frizington
Bootle
Kells
Egremont North
30,662
30,318
29,812
29,696
28,367
Cleator Moor North
Egremont South
Harbour
Haverigg
Hensingham
27,225
26,101
24,808
24,367
23,786
23,190
Distington
Holborn Hill
Newtown
Mirehouse
Cleator Moor South
Sandwith
Figure 39 views the data at ward level. This shows the wide disparity in household income.
Just less than half (12) of Copeland’s wards have an average income that exceeds the district
average. Incomes within the ward of St Bee’s are almost double those of Sandwith.
Conclusion
This document provides an assessment of the current health of the population of Copeland.
Its 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
March 2011
Copeland Health Profile 34
J Clay