'Health suffers in poor areas' - report

THE link between deprivation and poor health in East Anglia has been highlighted in an alarming new report.

The latest “Health Atlas” – comparing the likes of death rates and the prevalence of certain diseases in the Norfolk, Suffolk and Cambridgeshire Strategic Health Authority area – reveals significant disparities.

And now, in the wake of the report, tackling the pockets of deprivation and coping with the booming population in the three counties has become a top priority of the authority.

Based on data from the Primary Care Trusts (PCTs) and local authorities, the Health Atlas 2004 gives a snapshot of health problems in particular areas.

It reveals the population in the three counties is growing at twice the national rate, with an increase in both older people and young adults.

While the region is relatively wealthy compared to the rest of England, there are areas that are deprived, particularly Peterborough, Great Yarmouth and Fenland, and this is adversely impacting on residents' well-being.

And the map shows that the health inequalities in the region are increasing over time. There is now a wider gap between the highest and lowest life expectancies, which the report says is caused by a faster improvement in more affluent areas.

The 113-page document also shows obesity is increasing in the region and smoking levels have stayed steady, despite the SHA concentrating on smoking cessation services and the dangers of the pastime being advertised on cigarettes.

However, health is also improving - fewer people are dying from cancers and heart disease and overall the three counties do compare favourably with similar European regions.

On a local level, Great Yarmouth PCT, which has a higher deprivation index and greater unemployment than the national averages, had above average infant mortality, smoking prevalence and deaths due to prostate cancer and circulatory disease.

Low birth weight and the number of men killed in accidents, also compared unfavourably with the average for England.

East Cambridgeshire and Fenland PCT also had a number of categories worse than the average for England, including the number of deaths due to prostate cancer and accidents, as well as the number of women dying from bronchitis and emphysema.

In comparison, the other PCTs in Suffolk fared either well or average in most categories.

However, more women lose their lives to breast cancer in Central Suffolk PCT compared to anywhere else in the county, with 85.4 dying per 100,000 between 2001 and 2002. This compares to the average for the SHA at 62 and England at 66.3.

Ipswich PCT had a high number of smokers, with an estimated 30% of the population smoking, compared to a 27% national and SHA average. The Health Atlas concluded that a “radical step change” was needed across the three counties to achieve the smoking target of 21% by 2010.

In Suffolk Coastal and Waveney PCTs the number of men dying from prostate cancer was worst than the average for England, although they had figures that were below average (Suffolk Coastal) and average (Waveney) for all cancer deaths. Suffolk Coastal also had a higher than average number of women killed in accidents with 12.2 deaths per 100,000 compared to 10.1 in England.

On average, more men died in accidents in Suffolk West PCT than in England. The death rate from accidents was 29.1 per 100,000 in males, compared to a national figure of 21.7. The health atlas concluded that accident death rates were a “cause for concern”.

Dr Tony Jewell, clinical director and director of public health at the SHA, said factors such as income, educational attainment and employment have an impact on people's health, causing the results in deprived areas.

He said: “In a way the atlas helps inform us at the SHA about the health needs of different areas of the health authority.

“We performance manage the PCTs. When we do our reviews with the PCTs we would expect, for example Great Yarmouth, to have a programme to tackle some of these problems and the directors of public health to do an analysis of local needs.”

He added: “Things we have noted in particular are that population is growing across Norfolk, Suffolk and Cambridgeshire at a much higher rate than nationally. In some parts of the country it is declining but here it is growing, especially in the older age group.

“The second factor is the inequalities. This is shown in the increasing inequalities in male and female life expectancies. The PCTs need to work to try and combat the inequalities with other authorities.

“There has been a reduction in deaths due to heart disease and cancer so people's health is improving there.

“Smoking levels are fairly flat and there has been a rise in obesity so we need to work with the public to change their lifestyles so they do more exercise and eat less fatty foods.”

Dr Brian Keeble, lead public health director for the three east Suffolk PCT's - Central Suffolk, Ipswich and Suffolk Coastal - said the health atlas was a "useful report".

He added: "If you look at a longer time span there's some particular parts of east Suffolk where levels of breast cancer and prostate cancer are significantly higher than other parts of Suffolk.

"There's an association between both and greater levels of affluence, which is quite interesting because normally with cancer poorer areas get more of them.

"We are publishing figures this summer - in the annual public health report - which will show what has been happening over a 15-year period, so it's much more in depth."

He continued: "The Bronchitis and Emphysema deaths (in Ipswich) doesn't surprise me. Ipswich is a poorer community and there's higher levels of lung cancer.

"You'd expect the smoking figures (in Ipswich) as well because it's a poorer community with lots of working class people.

"Overall, the health atlas is a useful snapshot. It's sometimes helpful in pointing to areas to look at further. We'd planned to look at cancer anyway, but had we not and then seen this it would have been interesting.

"I think these figures are very useful to people who aren't working in public health, but it's our bread and butter to know these sort of things.

"On the whole, the people in east Suffolk have health that's as good as anywhere in East Anglia."

Amanda Cousins, director of planning and performance at Great Yarmouth PCT, said the organisation had produced their own, more detailed health atlas.

She added: "We've done a local needs assessment which allows us to target our efforts in areas of higher needs.

"In terms of the targets, yes we've got the highest rate of many things but we've got a range of initiatives in place to try and tackle these problems."

Mrs Cousins said that among others, the PCT had schemes running such as exercise programs, a smoking cessation service, healthy schools initiative, a falls strategy for the elderly and surestart schemes for mothers and babies.

She added: "Most of these scores will be reflected in other areas of the region where deprivation is a factor, like Norwich and Thetford.

"We've got a lot of activities in place to tackle the issues we face."