Public Health Wales
North Wales Health Profile
Family, Friends & Community
Key Messages:
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The impact of social networks such as friends and family, and the
wider community are important determinants of health and
wellbeing
Social support can have direct effects on health or can act as a
buffer by moderating the impact of acute and chronic stressors.
The physical environment, in particular transport and planning,
play an important part in developing supportive environments
within communities where people feel free to walk, cycle, use
local facilities and talk with each other.
It has been recognised that the design of buildings and groups of
building, their layout and the way in which buildings relate to one
another may help to encourage or discourage neighbourliness
and hence may have effects on health.
There are 295,600 households in the Betsi Cadwaladr University
Health Board (BCU HB) region. Married or same-sex civil
partnership households are the largest group in BCU HB,
followed closely by one person households.
There are 44,000 single person households in the area served by
BCU HB.
Unpaid carers, that is, family, friends and neighbours provide
around 70% of care in the community.
The percentage of the population of BCU HB providing unpaid
care varies from 12.4% in Denbighshire to 10.2% in Gwynedd.
Adequate shelter is a fundamental pre-requisite for health;
therefore homelessness is a fundamental threat to health. Poor
housing has been linked to increased levels of limiting long term
illness, respiratory and infectious diseases, injuries, psychological
problems and perceived poor general health and even increased
mortality.
Around 1,170 households in BCU HB are accepted as homeless;
Wrexham has the highest number of homeless households.
The inability to adequately heat a house can have major health
consequences. The percentage of households with no central
heating in the BCU HB area ranges from 1.6% in Flintshire to
7.6% in Gwynedd (this is also the lowest provision in Wales).
Car ownership can have significant advantages to an individual
and household. Wrexham has the highest proportion of
households in BCU HB with no car or van, 22.2%
In general, North Wales has a superlative physical environment.
Significant parts of the region are designated as either
Snowdonia National Park, Area of Outstanding Natural Beauty,
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North Wales Health Profile
Heritage Coast, Site of Special Scientific Interest, Conservation
Area, World Heritage Site or has other intrinsic landscape or
environmental value, with many areas carrying dual designation.
This can provide an important setting for health-promoting
leisure opportunities.
Crime is associated with social disorganisation, low social capital,
relative deprivation and health inequalities. Conwy has the
highest rate of criminal damage incidents per 1,000 day time
population (14 per 1,000 daytime population in BCU HB);
Flintshire has the lowest rate (10 per 1,000 daytime population);
there is also variation on an MSOA and locality level. However,
on an all-Wales basis, BCU HB counties report relatively lower
rates of criminal damage incidents than counties in the south
e.g. Blaenau Gwent.
The impact of social networks such as friends and family, and the wider
community are important determinants of health and wellbeing 1. Social
support is defined as ‘resources provided by other persons’. Belonging to
a social network has a strong protective effect on health. Thus, people
who receive less social and emotional support from others are more likely
to experience a lower degree of well-being, more depression, higher rates
of pregnancy complications and disability from chronic diseases.
Evidence has shown that those individuals with the fewest social
connections (lack of participation in organisations, few friends and not
being married) also have the highest mortality rate. Social support can
have direct effects on health or can act as a buffer by moderating the
impact of acute and chronic stressors. Social integration also has a
positive effect on the whole community. There is increasing evidence that
those communities with high levels of social cohesion (high levels of
participation in communal and public affairs and high levels of
membership of community groups) have better health than those
communities with low levels. For example, social cohesion is related to
community coronary heart disease rates. Social capital can be broadly
defined as the resources within a community that create family and social
organisation. These include civic engagement, trust, social relationships,
formal and informal social networks and reciprocity.
The physical environment, in particular transport and planning, play an
important part in developing supportive environments within communities
where people feel free to walk, cycle, use local facilities and talk with each
other. It has been recognised that the design of buildings and groups of
building, their layout and the way in which buildings relate to one another
may help to encourage or discourage neighbourliness and hence may
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have effects on health. ‘Semi-private’ space is important in allowing
people to make informal social contacts in a non-threatening communal
setting.
This section describes data on a number of aspects which are important in
developing and strengthening communities, and supporting self-reliance
and independence.
1.
Household Composition
There are 295,600 households in the BCU HB region; Table 1 shows the
numbers by main household type. This shows that married or same-sex
civil partnership households are the largest group in BCU HB, followed
closely by one person households.
Table 1: Household composition in Betsi Cadwaladr University Health
Board, 2011
Married or
same-sex civil
partnership
couple
One person
Cohabiting
couple
Lone parent
All other
Betsi Cadwaladr UHB
92,741
97,386
28,929
30,665
16,975
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
9,888
18,548
17,297
12,714
17,477
16,817
9,907
15,439
15,508
13,130
23,606
19,796
2,783
5,131
4,598
3,942
6,409
6,066
3,009
4,889
4,975
4,392
6,980
6,420
1,754
3,515
2,847
2,121
3,483
3,255
Source: Office for National Statistics, C ensus 2011
Further Information
 Welsh Assembly Government Local Area Summary Statistics:
Housing
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People living alone
Tables 2 and 3 show the large number of one person households in BCU
HB and Wales; there are about 44,000 of these in area served by BCU
HB.
Table 2: Percentage of one person households, Wales and Betsi
Cadwaladr University Health Board unitary authorities, 2011
Percentage
One person
household:
Aged 65 and
over
One person
household:
Other
Wales
13.7
17.1
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
15.7
16.6
17.1
15.2
12.9
12.9
16.6
18.8
16.7
16.2
14.5
16.6
Source: Office for National Statistics, C ensus 2011
Table 3: Number of one person households, Wales, Betsi
Cadwaladr University Health Board and unitary authorities, 2011
Numbers
One person
household:
Aged 65 and
over
Total
households
Wales
Betsi Cadwaladr UHB
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
One person
household:
Other
1,302,676
178,334
222,434
295,600
30,594
52,473
51,177
40,546
63,781
57,029
43,932
4,802
8,701
8,748
6,147
8,200
7,334
48,809
5,086
9,847
8,549
6,567
9,277
9,483
Source: Office for National Statistics, C ensus 2011
Further Information
 Welsh Assembly Government Local Area Summary Statistics:
Older people supported in the community
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2. Carers
Unpaid carers, that is, family, friends and neighbours provide around 70%
of care in the community. Societal changes such as increases in single
person households, lone parent families and mobility among family
members are likely to reduce the availability of informal care. A decline in
informal carers is likely to increase the demand for statutory health and
social care services 2.
Further Information
 Welsh Assembly Government, Welsh Health Survey 2008: Health
of Carers
Table 4 shows that the percentage of the population of BCU HB providing
unpaid care varies from 12.4% in Denbighshire to 10.2% in Gwynedd.
Table 5 and Figure 1 show how the number of hours varies across this
group by unitary authority in BCU HB and Wales.
Table 4: Percentage of Betsi Cadwaladr UHB population providing
unpaid care, 2011
Percentage
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
11.5
10.2
11.8
12.4
11.6
11.2
Source: Office for National Statistics, C ensus 2011
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Table 5: Provision of unpaid care by duration category, Betsi
Cadwaladr UHB unitary authorities, 2011
Percentage
1-19 hours
20-49 hours
6.7
6.0
6.8
6.9
7.0
6.6
1.7
1.4
1.6
1.9
1.6
1.7
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
50+ hours
3.1
2.9
3.5
3.6
2.9
3.0
Source: Office for National Statistics, C ensus 2011
Figure 1: Provision of unpaid care by duration category and
unitary authority in Wales, 2011
1-19 hours
20-49 hours
50 hours or more
Cardiff
Gwynedd
Wrexham
Ceredigion
Newport
Isle of Anglesey
Flintshire
Conwy
Powys
The Vale of Glamorgan
Denbighshire
Pembrokeshire
Blaenau Gwent
Monmouthshire
Merthyr Tydfil
Rhondda Cynon Taf
Swansea
Caerphilly
Bridgend
Carmarthenshire
Torfaen
Neath Port Talbot
0
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Table 6 gives predictions for unpaid care provision for BCU HB up to 2030
by age group. This shows a decline in the number of carers aged 16-24
and 24-64 in this period, contrasting with an increase in the number of
carers aged 65 years and over. This reflects the aging of the population.
Table 6: People aged 16 and over predicted to provide unpaid care, by
age and hours of care provided, Betsi Cadwaladr University Health
Board, projected to 2030
Betsi Cadwaladr University Health Board
Figures may not sum due to rounding
People aged 16-24 predicted to provide <19 hours of care per week
People aged 16-24 predicted to provide 20-49 hours of care per week
People aged 16-24 predicted to provide >50 hours of care per week
Total population aged 16-24 predicted to provide unpaid care
2012
8,100
2,209
2,946
13,255
2015
7,896
2,154
2,871
12,921
2020
7,269
1,983
2,643
11,895
2025
7,189
1,961
2,614
11,764
2030
7,531
2,054
2,739
12,324
People aged 25-64 predicted to provide <19 hours of care per week
People aged 25-64 predicted to provide 20-49 hours of care per week
People aged 25-64 predicted to provide >50 hours of care per week
Total population aged 25-64 predicted to provide unpaid care
38,079
10,385
13,847
62,310
37,864
10,327
13,769
61,960
38,057
10,379
13,839
62,276
37,860
10,325
13,767
61,952
36,695
10,008
13,344
60,046
People aged 65 and over predicted to provide <19 hours of care per week
People aged 65 and over predicted to provide 20-49 hours of care per week
People aged 65 and over predicted to provide >50 hours of care per week
Total population aged 65 and over predicted to provide unpaid care
16,022
4,370
5,826
26,218
17,334
4,727
6,303
28,364
18,899
5,154
6,872
30,926
20,447
5,577
7,435
33,459
22,346
6,094
8,126
36,566
Source: Welsh Health Survey via Daffodil Cymru website
Table produced by Public Health Wales Observatory
3.Transport
The key road transport links in North Wales are the A55 Expressway
(which also acts as the North Wales section of Euro Route 22), the A5,
A483, A487 and A470. The A55 Expressway (which has four road tunnels)
experiences the highest volume of traffic, which increases significantly
during the summer months owing to the flow of tourists into the region.
Car ownership can have significant advantages to an individual and
household. Owning a car can improve access to services such as
healthcare, employment and leisure activities.
Table 7 shows that Wrexham has the highest proportion of households in
North Wales with no car or van, 22.2%, which is similar to the average
for Wales, 22.9%.
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Table 7: Percentage of households with no cars or vans in household,
Wales and Betsi Cadwaladr University Health Board unitary authorities,
2011
Percentage
Wales
22.9
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
18.0
21.4
21.7
21.0
17.0
22.2
Source: ONS C ensus 2011
Further information
 Welsh Assembly Government Local Area Summary Statistics:
Transport
4
Physical Environment
4.1 Internal Environment
An association between poor housing and ill health was made in Victorian
times when slums and poor sanitation were linked to sickness; slum
clearance and better sanitation improved health and reduced the death
rates from infectious diseases such as cholera and typhoid. Today, the
association between poor quality housing and poor health, both physical
and mental, is still made. Adequate shelter is a fundamental pre-requisite
for health; therefore homelessness is a fundamental threat to health. Poor
housing has been linked to increased levels of limiting long term illness,
respiratory and infectious diseases, injuries, psychological problems and
perceived poor general health and even increased mortality. Groups most
at risk from the health effects of poor housing include mothers and
children, those already chronically ill and older people. The highest risks
to health in housing are attached to cold, damp and mouldy conditions;
the strongest links appear to be between reported illness in children and
dampness and mould. Poor housing also brings a risk of fire and
accidents. Overcrowded accommodation increases the risk of infectious
disease and also impacts on mental health through factors such as high
noise levels and lack of privacy. In general worse housing conditions are
found in private rented accommodation, older owner occupied houses,
and houses in multiple occupation (HMOs). A lack of adequate, affordable
housing can aggravate other problems associated with low income.
Homeless people tend to have higher rates of physical and mental illness
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and rates of alcohol and drug dependence and poorer access to health
care than those with homes.
There were around 1,170 households accepted as homeless in BCU HB
during 2011/12. Wrexham has the highest number of households
accepted as homeless, 465 (Table 8).
Table 8: Households accepted as homeless, Betsi Cadwaladr
University Health Board and unitary authorities, 2011/12
Numbers
Betsi Cadwaladr University HB
Isle of Anglesey
Gwynedd
Conwy
Denbigshire
Flintshire
Wrexham
1,170
70
230
250
80
75
465
Source: Welsh Government
The inability to adequately heat a house can have major health
consequences. The cold itself can exacerbate many respiratory and
circulatory problems, especially in the elderly, and is likely to contribute
to excess winter deaths. Inadequate heating causes dampness and
condensation within a house. Dust mites and fungal spores proliferate in
such conditions, which then exacerbate respiratory problems such as
asthma, wheezing and other lung inflammations.
Table 9 shows the percentage of households with no central heating in the
BCU HB area ranges from 1.6% in Flintshire to 7.6% in Gwynedd.
Anglesey also has a particularly high percentage, 5.3%. Figure 2 shows
the variation across Wales; Gwynedd, as well as having the lowest
provision of central heating in BCU HB, also has the lowest provision in
Wales.
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Table 9: Number and proportion of households with no central
heating, Wales, Betsi Cadwaladr University Health Board and
unitary authorities, 2011
Total
number of
households
Wales
No central
heating
(number)
No central
heating
(%)
1,302,676
29,534
2.3
295,600
30,594
52,473
51,177
40,546
63,781
57,029
10,865
1,627
3,971
1,858
1,237
1,049
1,123
3.7
5.3
7.6
3.6
3.1
1.6
2.0
Betsi Cadwaladr University HB
Isle of Anglesey
Gwynedd
Conwy
Denbighshire
Flintshire
Wrexham
Source: ONS / C ensus 2011
Figure 2:
Percentageo f households with no central heating, Wales and unitary
authorities, 2011
Source: Office for National Statistics, Census 2011
7.6
5.9
5.3
4.0
3.6
3.6
3.1
2.3
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Monmouthshire
Torfaen
Blaenau Gwent
0.8 0.8 1.0
Caerphilly
Rhondda Cynon Taf
Cardiff
1.6
1.1
Merthyr Tydfil
1.3
0.9
The Vale of Glamorgan
1.1
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1.3
Newport
1.7
Bridgend
Carmarthenshire
Pembrokeshire
Ceredigion
Powys
1.4
Wrexham
Flintshire
Denbighshire
Conwy
Gwynedd
Isle of Anglesey
Wales
1.6
Neath Port Talbot
2.0
Swansea
2.3
Public Health Wales
North Wales Health Profile
4.2 External Environment
In general, BCU HB has a superlative physical environment. Significant
parts of the region are designated as either Snowdonia National Park,
Area of Outstanding Natural Beauty, Heritage Coast, Site of Special
Scientific Interest, Conservation Area, World Heritage Site or has other
intrinsic landscape or environmental value, with many areas carrying dual
designation. This can provide an important setting for health-promoting
leisure opportunities.
Table 10 shows CADW historical sites in BCU HB compared to Wales.
Table 11 gives areas of environmental importance and Table 11 illustrates
the significant length of coastline (and heritage coastline) enjoyed by BCU
HB residents and visitors.
Table 10: CADW sites, North East & North West Wales & Wales,
2010
North East
Wales
North West
Wales
Wales
Numbers of CADW sites:
Listed buildings
Scheduled ancient monuments
Conservation areas
Parks and gardens
Historic landscapes
World heritage sites
5,603
553
112
89
9
1
7,012
790
87
63
18
4
29,906
4,113
506
370
57
5
CADW sites per 10,000 population*
Listed buildings
Scheduled ancient monuments
Conservation areas
Parks and gardens
Historic landscapes
World heritage sites
114.1
11.3
2.3
1.8
0.2
0.0
234.6
26.4
2.9
2.1
0.6
0.1
99.7
13.7
1.7
1.2
0.2
0.0
Source: Welsh Assembly Government geographic information system, Small Area Population Estimates (ONS)
*Figures are based on 2009 population data.
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Table 11: Areas of environmental importance, North East & North
West Wales & Wales, 2010
North East
Wales
Total land area (thousand hectares)
Residents per hectare **
Area (thousand hectares) occupied by:
Sites of Special Scientific Interest
Special Areas of Conservation
Special Protection Areas
National nature reserves
Sites of international importance as a wetland site (Ramsar sites)
National Parks
Historic landscapes
Areas of Outstanding Natural Beauty
Royal Society for the Protection of Birds reserves
Wildlife Trust reserves
Open country
Registered common land
Public forests
Other statutory access land
Country Parks
Local nature reserves
Length (km) of:
Public rights of way
National trails
North West
Wales
Wales*
290.7
1.69
437.9
0.68
2,072.2
1.45
42.6
31.9
16.5
2.9
1.8
42.8
46.8
15.9
0.6
0.4
29.0
14.3
11.1
6.0
1.6
0.4
78.9
61.9
25.8
6.2
1.2
212.2
130.2
31.6
1.6
0.3
92.2
15.1
23.7
17.2
0.6
0.4
258.7
684.4
332.3
25.3
49.4
406.0
394.4
105.3
14.4
5.3
165.1
114.1
99.3
72.0
3.9
4.9
4,842
75
6,406
0
33,198
730
Source: Countryside Council for Wales and Welsh Assembly Government geographic information systems
*For some designations, the Wales data also include off-shore areas.
**These figures are based on 2009 population data.
Table 12: Coastlines in North East & North West Wales & Wales,
2010
North
East
Wales
Total length of coastline (km)
Length of heritage coastline (km)
Percentage of coastline which is classed as heritage coastline
216.0
7.6
3.5%
North
West
Wales
850.5
216.3
25.4%
Wales
2,611.7
841.4
32.2%
Source: C ountryside C ouncil for Wales and Welsh Assembly Government geographic information systems
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5. Community Safety
Crime is associated with social disorganisation, low social capital, relative
deprivation and health inequalities. The same social and environmental
factors that predict geographic variation in crime rates may also be
relevant to explaining community variations in health and well-being. In
many ways, these inequalities mirror those found in health, suggesting
that crime is likely to be a contributory factor in the substantial health
inequalities that exist in Wales. Intentional injury from violence is much
less of a health problem than unintentional ‘accidental’ injuries. However,
violence disproportionately affects certain groups in society, including
young people and those who are more deprived. The British Crime Survey
shows that these unequal risks extend to other types of crime, such as
burglary and vehicle-related theft.
The causes of crime are largely the same socio-economic factors that
determine health and well-being. A safe environment, free of crime,
contributes significantly to people’s sense of well-being. If the social
environment becomes unsafe, mental health status is jeopardised; fear of
crime is associated with increased anxiety and higher blood pressure, and
is significantly associated with poor self- rated health.
Violent crime against the person is clearly an important health
determinant, but so too is crime against property. Poor design of built
environments creates opportunities for crime and decreases residents’
willingness to use local space. Deprived neighbourhoods with empty
properties, unmaintained housing, graffiti and visible signs of criminal
activity are strongly related to the fear of crime.
Figures 3 and 4 show that Conwy has the highest rate of criminal damage
incidents per 1,000 day time population (14 per 1,000 daytime population
in BCU HB); Flintshire has the lowest rate (10 per 1,000 daytime
population). Data at MSOA level highlight variations in crime rates.
Wrexham MSOA 010 (Cartrefle, Queensway, Wynnstay) has the highest
rate (38.1 per 1,000 daytime population) and Denbighshire MSOA 013
(Llanarmon-yn-Ial/Llandegla,
Llanbedr
Dyffryn
Clwyd/Llangynhafal,
Llandyrnog) has the lowest rate (2.9 per 1,000 daytime population).
Figure 4 also includes locality boundaries.
However, Figure 5 shows that on an all-Wales basis, BCU HB counties
report relatively lower rates of criminal damage incidents than counties in
the south e.g. Blaenau Gwent.
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Figure 3: Community safety: criminal damage incidents per 1000 day
time population, Betsi Cadwaladr University Health Board locality areas,
April 2008-March 2010
© Crown Copyright Licence Number 100022432
Produced by Public Health Wales Observatory;
adapted by Claire Jones, March 2013
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Figure 4: Community safety: criminal damage incidents per 1,000 day
time population, April 2008-March 2010
Gwynedd
Isle of Anglesey
0.00
MSOA
Local Authority
5.00
Wales (13.4)
10.00
25.30
0.00
005
002
MSOA
Conwy
007
009
001
011
005
002
004
013
008
010
012
006
003
015
014
14.8
14.0
20.00
25.00
13.3
13.2
13.2
12.2
12.0
11.5
8.9
8.5
7.8
7.6
7.0
20.00
Gwynedd 25.00
= 13.1
6.0
5.5
Criminal damage incidence rate
14.8
14.4
13.9
13.4
12.2
10.3
10.1
9.6
9.4
9.0
8.9
7.1
6.9
6.9
6.8
6.8
5.9
4.6
Flintshire = 10
3.1
Criminal damage incidence rate
Author: Jones C, Atenstaedt R
et al
Version: Ob
004
011
006
007
002
016
005
009
001
003
008
014
010
015
012
013
30.5
22.3
20.4
14.3
10.3
10.0
9.4
8.8
8.5
8.0
8.0
7.6
7.4
4.7
Denbighshire = 11.9
4.5
2.9
Criminal damage incidence rate
Wrexham
18.7
MSOA
MSOA
25.3
25.1
Denbighshire
25.7
20.4
19.5
16.6
16.5
16.3
14.5
13.2
12.0
11.1
10.0
9.5
7.2
Conwy = 14
6.1
4.1
Criminal damage incidence rate
Flintshire
004
007
003
008
002
009
011
005
017
015
001
013
016
012
020
010
014
018
019
006
MSOA
25.0
10.8
10.0
9.6
9.6
8.9
8.5
Isle of Anglesey = 11.5
7.6
10.00
7.2 5.00
Criminal damage incidence rate
MSOA
003
007
006
001
008
004
009
005
002
14.00
13.30
003
13.20
13.20
007
12.20
006
748
11.50
001
8.90
8.50
008
7.80
7.60
004
7.00
6.00
009
5.50
MSOA
msoa
25.10 of Anglesey
Isle
14.80
001
006
002
009
15.00
008
003
007
016
010
012
011
005
013
004
017
15.00
015
014
Date: March 2013
Page 15 of 16
010
015
012
005
009
017
006
011
004
013
003
014
008
016
019
007
018
002
001
38.1
23.5
22.4
20.1
18.7
16.2
14.9
14.4
14.1
13.8
12.7
12.5
10.9
10.5
7.9
7.0
5.3
Wrexham = 13.4
4.1
3.3
Criminal damage incidence rate
Status: Working Draft
Intended Audience: BCU HB
and partners
Public Health Wales
North Wales Health Profile
Figure 5:
The rate of incidents of criminal damage per 1,000 day time population
by local authority, April 2008 - March 2010
15.9
15.3
14.6
Newport
Torfaen
Blaenau Gwent
Caerphilly
Merthyr Tydfil
Rhondda Cynon Taf
Cardiff
The Vale of Glam organ
Monm outhshire
9.3
13.1
Bridgend
Areas ordered geographically from north west to south east
5.
12.4
13.5
Neath Port Talbot
Swansea
Carm arthenshire
Pem brokeshire
7.3
Ceredigion
8.1
Powys
Wrexham
8.3
10.9
12.7
13.4
10.0
Flintshire
11.9
Denbighshire
14.0
Conwy
13.1
Gwynedd
Isle of Anglesey
11.5
Wales = 13.4
16.0
17.5
21.5
22.3
Produced by Public Health Wales Observatory, using data from Welsh Police Forces & ONS (MYE)
References
1. Dahlgren G. & Whitehead M. 1991. Policies and Strategies to Promote
Social Equality in Health. Stockholm, Institute of Further Studies.
2. Welsh Assembly Government 2007. Carers Strategy for Wales Action
Plan 2007. [Accessed 19.02.13]
Author: Jones C, Atenstaedt R
et al
Version: Ob
Date: March 2013
Page 16 of 16
Status: Working Draft
Intended Audience: BCU HB
and partners