joint strategic needs assessment foundation profile - JSNA

Interative Hull Atlas: www.hullpublichealth.org/Pages/hull_atlas.htm More information: www.jsnaonline.org and www.hullpublichealth.org
not necessarily „cure‟ a patient of diabetes. There are similar issues associated
with increasing exercise levels, improving 5-A-DAY and diet, etc.
There is also an issue of influencing factors in relation to public health versus
clinical changes. Public health initiatives as mentioned above generally influence
life expectancy and AAACMR in the long-term. Clinical initiatives tend to be more
short-term, e.g. statins, improvements in surgical procedures, etc. However, the
problem is that if there is a focus on clinical initiatives without the underlying
improvements in public health, any short-term clinical effects would be swamped
in the long-term without public health improvements.
There are also a number of issues more specific to Hull, and some of these points will
apply to other geographical areas.
AAACMR and life expectancy calculations do not take into account deprivation
and „case mix‟ of the population. In more deprived areas such as Hull, as
mentioned previously, there is a higher prevalence of behavioural risk factors
such as smoking, lack of exercise and poor diet (see section 8 on page 233) and
more general risk factors such as poor housing, education, stress, etc. People in
Hull also tend to have lower health expectations and fewer GPs per population so
there are more likely to be delays in diagnosis and treatment which will influence
survival. There will also be a higher percentage of patients with co-morbidities
(e.g. diabetes, CHD, etc) which will influence mortality.
The infant mortality rate can have a relatively large impact on life expectancy, but
less so on the AAACMR. However, Hull is relatively unique compared to other
similarly-deprived areas in that the infant mortality rate in Hull is similar to the rate
for England and this has been the case for a number of years (see section 7.8.3
on page 209). Therefore, it is not as simple as reducing the infant mortality rate
in Hull as it is already relatively low.
There also tends to be differences between first and late adopters in relation to
models of change between people living in the most deprived and the least
deprived areas. People living in more affluent areas tend to be „first adopters‟
and be among the first to initiate positive health changes. People living in more
deprived areas find it more difficult to change due to increased pressures on life,
e.g. poor housing, debt, stress, unemployment, etc. There may also be more
barriers in relation to access to health improvement services such as financial
barriers, transport issues, access to local cheap good quality fresh fruit and
vegetables, etc. It is generally more difficult to encourage „late adopters‟ into
public health services like smoking cessation.
Another problem relatively unique to Hull is its tight geographical boundaries.
Most cities such as Hull are relatively deprived, but most other local authority and
PCT boundaries for that city cover some more affluent areas. Hull has very few
affluent areas, and it is estimated that around 2,500 of people in Hull move to the
„leafy suburbs‟ in East Riding of Yorkshire just outside Hull‟s boundary. The
people that tend to move will generally move because of children and better
schools, better quality and choice of housing, etc. The more aspirational and
Joint Strategic Needs Assessment Foundation Profile – Hull Health Profile: Release 3. March 2011. 226