The Director of Public Health for Hull
A n n u a l R e p o rt 2 0 0 9
...for the want of a
horseshoe nail
2
Acknowledgements
Public Health Website
I would like to express my thanks to
To ensure that all our partners have
NHS Hull and Hull City Council for
the most up to date public health
their support and my appreciation
information and to reduce our
to the many people who have
carbon footprint we have placed the
contributed to this year’s Annual
bulk of our statistical information on
Report, in particular:
our public health website:
www.hullpublichealth.org
The Report Steering Group:
Sarah Jenkins, Public Health Lead
Dr. Andrew Taylor, Assistant Director (Public Health
Sciences)
Robert Sheikh-Iddenden, Epidemiologist/
Statistician
Katie Brookes Personal Assistant to the Director of
Public Health for Hull
Eskimo Soup, Graphic Design
This website includes a wide range of information
which is updated throughout the year, for example:
Previous Director of Public Health for Hull Annual
Reports
Hull Health Atlas
Health and Lifestyle Surveys (including surveys for
BME groups)
Additional assistance from:
Obesity, Exercise and Weight Management
Reports
Peter Brown, Assistant Director (Health
Improvement)
Joint Strategic Needs Assessment
Rachel Iveson, Social Marketing Manager
Kate Birkenhead, Health Improvement Manager
Scott Gustafson, Artist
www.scottgustafson.com
This report is also available on CD and
on the following websites:
www.nhshull.nhs.uk
www.onehull.co.uk
www.heros.org.uk
www.hullcc.gov.uk
www.hullpublichealth.org
Equity Audits
Clinical Policy Documents
Dental Health Documents
Please refer to this website to ensure you are
using the most up to date information.
If you require assistance in accessing any of
the information on the website then please do
not hesitate to contact the Public Health Library
Service:
Telephone: 01482 617970 during office hours
E-mail: [email protected]
If you would like this document in a different
language or format (e.g. large print), please use
the contact below:
Telephone 01482 344812
Email: [email protected]
3
Contents
4
Section 1 - Pages 6 to10
For want of a nail the shoe
was lost
- Introduction
Section 2 - Pages 11 to 17
For want of a shoe the
horse was lost
- Delivery on the ground
Section 3 - Pages 18 to 23
For want of a horse the rider
was lost. For want of a rider the
battle was lost
– Commissioning for change
Section 4 - Pages 24 to 45
For want of a battle the
kingdom was lost
- Health profile for the City of Hull
A CD version of this report is
also attached which includes:
Full copy of this report, with
hyperlinks
Users’ Evaluation
Director of Public Health for Hull
Annual Report 2008
Section 5 - Pages 46 to 52
And all for the want of a
horseshoe nail
- Recommendations and conclusion
Section 6 - Pages 53 to 54
Users’ Evaluation
I strongly recommend that you
investigate the information held
on the public health website:
www.hullpublichealth.org as this
provides access to a constantly
updated resource to ensure all
our research and information is
available to you as soon as it is
published.
If you require assistance in
accessing any of the information
on the website then please do
not hesitate to contact the Public
Health Library Service, telephone
01482 617970 during office hours.
5
For want
of a nail
the shoe
was lost
6
Section 1
Introduction
Firstly can I say welcome to this year’s Director of Public Health Annual Report.
Secondly can I make reference to my report’s title and the imagery I have chosen to
use. The beautiful painting based on the old proverb ‘For Want of a Nail’ has been
reproduced by kind permission of the artist, Scott Gustafson. As I go into my fifth
year as Director of Public Health for Hull, I have been likening the battle we face to
improve health in the City and to increase life expectancy to the words in the old
proverb which can be seen in full below
For want of a nail the shoe was lost.
For want of a shoe the horse was lost.
For want of a horse the rider was lost.
For want of a rider the battle was lost.
For want of a battle the kingdom was lost.
And all for the want of a horseshoe nail.
English Proverb
English Proverb
7
This in no way indicates that our battle to improve health in Hull
is lost. Just the opposite, as you will see from the examples of our
work which are show cased in my report. The reason that this
proverb struck such a chord with me is that it shows that small
actions can have significant consequences. Its origins seem to
be lost within the mists of time and there are several variations
around, quoted as far back as the fifteenth century.
I feel that we have really started to make a difference to people’s
lives in the City and the biggest impact has been at grass
roots level where we have got the detail right, put a series of
interventions in place, up skilled and industrial scaled a local
workforce to have a direct effect on health outcomes. I will take
you through, in the following sections, from making sure we value
and use our ‘nails’ wisely in order to ensure we neither lose the
battle nor the kingdom.
8
Section 1
One of the key commissioning decisions that my team and I took this year was to continue
our investment in getting a trained and competent workforce out there in Hull, and a
workforce that was of sufficient scale to engage with as many of our residents as possible.
As well as all of our health care professionals who immediately spring to mind when we
think about those people who can support health improvement; professionals such as
doctors, nurses, health visitors and the like, here in Hull we can also call on 22 Health
Trainers, (including nine who are specifically trained in spotting the early signs of
cardiovascular disease), 117 Healthwise Champions and over 700 Mental Health First
Aiders. I do hope if you are one of these people and reading this report that you will not
be offended by my reference to you as the ‘nails’ in the proverb. The really important point
here for me is that if we did not have your skills and commitment to work with our local
population we would not be making the inroads we are starting to see in key aspects of our
City’s health profile. We do, however, have a long way to go and making sure that we have
enough ‘nails’ out there is a big part of my team’s plans for the coming year.
An example which always sticks in my mind is the man who, just before a big rugby match
in the City, was checked out by one of our Healthy Hearts team. He had no symptoms
but knew he was a little overweight and was a smoker. The Practitioner, or ‘nail’ if you
will forgive me labouring my analogy, was able to identify him as being at particular risk
of heart problems in the very near future and he was immediately referred to primary
care colleagues who placed him on the appropriate treatment pathway. He is now
back watching rugby with his family. So for want of a nail, both this gentleman’s battle
and kingdom might have been lost if we had not had in place, at grass roots level, the
opportunity for him to receive support. Small actions………. significant consequences.
I want to showcase more of these examples in this year’s report, as well as of course,
detailing what progress we have made to improve health in the population of Hull. This
year we have completed some important health and lifestyle survey work which gives us
a much clearer understanding of, not only what state the population’s health is in, but also
what people’s views and perceptions are about their own health, the health of their families
and friends and what impact their lifestyle choices will have on how long they live and
what quality of life they can expect to have.
Our social marketing research has continued this year and we have learned a lot about
how people feel about their health and the choices they could make which might improve
how they feel both physically and mentally. We have also learned a lot about better ways
of getting across important health information to different groups in the population such
as teenagers, older people, newcomers to the City and indeed the Country and the often
forgotten group, those people in the middle years of their lives. The findings from our
research have helped us to commission interventions with a much tighter focus to reach
specific groups and attract more members of the public into our services.
9
Section 1
Section 4 of my report will show you how the health profile for the City is starting to
change. There is also much more information on the Public Health Website www.
hullpublichealth.org. When we establish new ways of supporting individuals to improve
their health, it sometimes takes a few years before we start to see real health gain and in
some parts of the City and in some groups of the population, we are starting to see those
positive changes. Individuals are starting to win their own personal health battles, with
support, but predominantly through their own actions and it is by working with more and
more of these folk that we will see Hull becoming known as a healthy, vibrant, forward
thinking City, working closely with partners and using a range of methods to show
residents how important health is to personal and City-wide economic stability.
I hope you find this report helpful in terms of providing a picture of how health and
lifestyles are changing here in Hull, but more importantly I hope you will use this
information when you are planning services or when thinking about how you can
contribute to health improvement in the City. I will be following through the theme of
the proverb in each section and so I would remind you that we can only make great health
gains in the City and win the battle for improved health if we have every nail in place. That
means continuing to expand a competent public health workforce with a range of skills
and from a range of backgrounds and organisations. Through them will we achieve the
critical mass of contacts with individuals that we need to move forward the City’s health.
The battle is certainly not lost. As you can see from our success stories, many people are
thoroughly enjoying making sure that we have horses with shoes on galore!
Dr. Wendy Richardson
Director of Public Health for Hull
NHS Hull and Hull City Council
The Maltings, Silvester Square
Silvester Street, Hull, HU1 3HA
10
For want
of a shoe
the horse
was lost
Section 2
Delivery on the
ground
In this section I will showcase some of the excellent
work that is underway to improve the health of our local
communities. Many people in Hull do not regularly
access support from health care professionals: the
services I am commissioning aim to ensure that we do
not miss any opportunities to engage with people about
their health. We need to make every contact count.
Raising health aspirations in individuals quickly results
in significant changes across the whole community.
These communities really are the ‘shoes on the horse’
and they can change the health profile of the City.
12
Section 2
Fit Fans Participants
Fit Fans
Fit Fans, run in conjunction with Hull City Football Club and Super League team Hull KR,
is aimed at men aged 40 to 65 years of age who need to lose weight and take up a healthier
lifestyle. Twelve week programmes are held at both Craven Park and the KC stadium
giving fans the chance to take part in the same training programme as their local sporting
heroes.
The sessions consist of advice on health and nutrition and include a physical activity
component with the local teams’ trainers. Around 350 men have completed the programme
to date and have made significant changes to their lifestyle leading to a combined weight
loss of over 2000lbs.
The Fit Fans programme is proving popular with men in the City and the demand for
the service has led to a pilot programme for women which became over subscribed very
quickly.
13
Section 2
Healthy Hearts Assessment
Healthy Hearts
The Hull Healthy Hearts service is one of many initiatives helping to tackle Hull’s heartdisease mortality rates and reduce the incidence of cardiovascular disease. A mobile booth
is used to carry out testing in community and business venues and allows easy access for
people who wouldn’t normally engage with preventative services. A number of lifestyle
questions are asked as part of the testing and this has highlighted particularly higher levels
of alcohol consumption within the local population.
A 41 year old man from the City was recently screened. He has always drunk alcohol
socially, mainly at weekends. However in the last year his alcohol intake has increased
to having a drink on a daily basis due to family and work pressures. His assessment
concluded that his alcohol intake far exceeded the maximum number of daily (2-3 units)
and weekly (21 units) levels of alcohol recommended for males. The client was completely
unaware of his drinking levels until accessing the Healthy Hearts services which
highlighted the real risk of his drinking behaviour. The service advised him about safe
drinking levels and provided information about access to local alcohol services.
The healthy hearts team has participated in a number of pre-match health events at the KC
stadium over the past twelve months and identified high risk clients; for instance 4 men
who were screened were advised to seek medical attention urgently based on their results.
14
Section 2
Smoking Cessation
The Goodwin Community Health
Wardens are commissioned to deliver
smoking cessation services across the City
and are starting to see higher numbers of
people accessing the service.
A 43 year old woman from East Hull, who
is in quite good health, apart from her
Smoking Cessation advice
smoking, describes herself as a light to
moderate smoker who has been smoking for 20 years. She decided to access the service after
seeing a poster advertising the community health wardens service at work.
She was finding it difficult to quit due to working among other smokers and not being able
to find the time to access the stop smoking service. She said that having ongoing support at
work from the community health warden kept her on track. She has now also convinced her
daughter and two of her colleagues to access the service and they too have quit smoking.
Healthwise Hull
Healthwise Hull aims to build capacity within the City’s
priority communities by supporting people to be more
active, eat more healthily and to improve their emotional
well-being. The project aims to empower people to
become engaged in local planning decisions affecting
their health. We are continuing our commitment and
support to initiatives like this and as a result we are
seeing some real improvements to people’s health and
their quality of life.
Patrick Nolan, Healthwise Champion
One particular story that highlights this is that of an ex
serviceman who wanted to make personal lifestyle changes for himself and his family. He
completed Community Health Champion training which enabled him to pass on positive
health messages in the community. He has made significant lifestyle changes and supported
many people in his community to stop or cut down smoking, lose weight, and increase their
levels of physical activity. Patrick is now embarking on fulfilling a career as a health trainer.
15
Section 2
Engaging People
with Diabetes
It is estimated that there are around
3,700 people in the City with
undiagnosed type II Diabetes and
the current trend is that numbers are
increasing. It is also well evidenced
that some of those who are already
diagnosed do not access education and
support to help them manage their
condition.
In June 2009 two specific pieces of
activity were undertaken. Underpinned
by social marketing techniques the
diabetes education package was remodelled to encourage those with
the condition to take more control in
managing the disease and a substantial
public awareness campaign. By carrying
out consumer insight work the PCT
was able to learn more about the target
audience and the motivational factors
Diabetes awareness week
that would improve access. Following
this piece of work there has been a
significant increase in those attending education sessions and subsequently an increase
in access to public health interventions e.g. smoking cessation, and weight management
services.
During Diabetes Awareness Week a number of events were held across the City engaging
with 684 members of the public to raise awareness and ‘case-find’ those who are potentially
at high risk of diabetes to come forward for testing and diagnosis.
The outcome of this campaign resulted in making individuals aware that whilst they may
not have diabetes their current lifestyle behaviours are putting them at an increased risk of
developing the disease or other health-related conditions and as a result are taking steps to
reduce their risk.
16
Section 2
From reading this section I hope you will agree that we are
using innovative ways of working with our local partners
in the city to opportunistically engage our population to
participate in health services which traditionally they may
not have accessed.
We are continuing to use the tools of social marketing
to learn more about our population and further develop
existing and new services, and raise awareness of healthy
lifestyles.
This section demonstrates that we are ‘case-finding’
individuals who in some cases are at serious risk of illhealth. We are starting to steadily see some real results
in terms of people making step by step changes to their
lifestyles and ultimately their health status.
Not only are these changes happening at an individual level,
we are starting to see a cascade effect in that members of the
local community are passing on healthy lifestyle information
to their friends and family to encourage them to make
lifestyle changes.
I feel we have put in place and will continue to build upon
a range of services that are not only unique but more
importantly acceptable and accessible to our communities.
17
For want of a
horse the rider
was lost.
For
want of
a rider
the
battle
was lost.
Section 3
Commissioning
for change
Our social marketing research has made a considerable difference
to the sorts of services we commission. Whilst we have always
commissioned evidence based services, our social marketing
findings have enabled us to augment our service delivery, targeting
and focussing services towards specific groups and communities.
Our future service development is always informed by the
performance management information we review about each
service. Is the service meeting targets? Is the service delivering the
planned health outcomes? These two key elements represent the
horse and rider, the vital steer of our public health commissioning
cycle. We will only research and invest in services which raise
health aspirations in the City.
19
Section 3
NHS Hull has put in place a robust governance structure in which each goal, including
Healthy Lifestyles, is performance managed on a monthly basis to ensure all agreed actions
are on track and working towards agreed outcome, intermediate and process measures.
NHS Hull, like all Primary Care Trusts, is required to demonstrate improvement of
commissioning processes reflecting the following 11 nationally defined competencies:
•Leadership
•Partnership working
•Public and patient engagement
•Clinical engagement
•Health knowledge
•Prioritising investment reflecting need
•Market development
•Quality and outcomes
•Procurement
•Contracting
•Efficiency and effectiveness of spend
20
Section 3
The challenge for my team and I is to demonstrate and evidence that NHS Hull is
continuously improving its approach to commissioning in order to respond to local health
needs whilst at the same time operating efficiently and obtaining best value.
NHS Hull has adopted the Darzi Review ‘Staying Healthy Model’ focussing upon key risk
behaviours which account for/contribute to preventable conditions such as cardiovascular
disease, Cancer, etc. Underpinning this approach NHS Hull has developed its Medium
Term Strategic Plan (2008-13) with a number of priority areas for action including:
•Coronary Heart Disease
•Stroke
•Cancer
•Chronic Obstructive Pulmonary Disease
•Diabetes
•Mental Health
•Children & Young People
•Primary Care
•Healthy Lifestyles
21
Section 3
Each priority area represents a ‘goal’ with defined commissioning plans, investment
schedules and key performance indicators, which are all part of an annual delivery plan.
Public Health is a key contributor to all of the goal areas within the Medium Term Strategic
Plan in order to support the delivery of targets. The Healthy Lifestyles Delivery Plan for
which myself and my team are responsible for implementing has resulted in a significant
level of investment for the City leading to not only new and innovative services but new
and innovative approaches to the commissioning and delivery of lifestyle interventions.
In my last report I presented a snapshot of some of the exciting developments that were
being put in place across the City. I am keen to share with you how our plans have come to
further fruition through new services and development of existing ones. In Section 2 I have
showcased in more detail what some of the services have achieved over the last 12 months
which demonstrates not only have we commissioned the right service model, we are seeing
some great results in terms of reaching our communities and engaging them in lifestyle
choices they perhaps weren’t aware of.
Social Marketing
Social marketing is described as ‘the systematic’ application of marketing, alongside other
concepts and techniques, to achieve specific behavioural goals, to improve health and
reduce health inequalities.
We are continuing to use the techniques of social marketing which have underpinned
our commissioning arrangements by providing crucial insight into our local population,
identifying key factors that will motivate people to engage in our services and make healthy
changes to their lifestyle. The results from our social marketing work have been born-out in
our commissioning of new services and health awareness campaigns.
Smoking Cessation
In an effort to motivate and assist every smoker in the City who wants to quit smoking we
have made some good progress this year. We have both increased the target number of
‘quits’ we commission and also expanded the range of services delivering stop smoking
support. The Goodwin Development Trust have piloted a community based approach and
we have also increased the number of pharmacies offering stop smoking support. This is in
addition to the main Stop Smoking Service which has been re-designed by the team to meet
clients requirements.
22
Section 3
To support this we have invested in a number of marketing campaigns to raise awareness
and drive people into services. These have focussed on a number of key messages including
‘Free Nicotine Replacement Therapy’, numbers of people quitting each year and conversely
the number of people in the City who die each year due to smoking related illness.
Weight Management
Launched in February 2009 the Single Point of Access (SPoA) for adult weight management
brings together weight loss programmes under one contact point. The aim is to reduce any
confusion regarding weight management services and simplify access to services. After
consultation with a highly qualified professional to discuss individual issues clients are
then usually referred to an appropriate weight management service that will increase their
chances of losing excess weight and subsequently maintaining that weight loss.
NHS Hull has recognised the potential success of working in partnership with local
professional sports clubs to draw local people to health services. We are now working with
the two professional rugby league teams, Hull FC and Hull Kingston Rovers to develop
new health centres at the clubs. Members of the public will be able to access a range of
public health interventions at locations where members of the public have an affiliation and
are happy to attend.
We have also recently commisioned new weight management services to support black
and minority ethnic groups and a healthy workplace programme to support employees to
maintain a healthy lifestyle through increased physical activity and healthy eating.
Alcohol
Services for adults and children and young people have recently been commissioned
to offer prevention and low level support to residents of the City who may be at risk of
developing health problems because they drink more than the recommended units of
alcohol.
The services will raise awareness of safe drinking levels and offer identification and brief
advice through screening and structured interventions in a range of settings including
primary care, accident and emergency and in local communities.
23
For want
of a
battle the
kingdom
was
lost.
Section 4
Health Profile for
the City of Hull.
This section of my report describes some of the health outcomes
which I feel are most important and is an important one in any
Director of Public Health Annual Report. In addition, my team has
developed a resource for all those who are interested in health in
Hull. The information is used by many agencies in their planning
as it brings together a picture of the widespread health challenges
the City is facing. Readers can then link how we are rising to those
challenges through the interventions we deliver on the ground. As
we gather more and more intelligence, working closely with the
Yorkshire and Humber Public Health Observatory, we can better
shape both NHS and Local Government commissioning plans. All
of the battles are not yet won but the following information will
show that we are making some headway with individual battles
against disease that are killing people early and making people ill
and unable to live a full life.
25
Section 4
Our website at www.hullpublichealth.org contains a wealth of further information. All of
the reports from our surveys over the last few years are available, including the 2008-09
Children and Young People’s Health and Lifestyle Survey. The Hull Health Atlas has been
updated to include the most recently available data. This allows users to know what health
outcomes are experienced by people down to electoral ward level. A series of two-page
summary factsheets for each ward in Hull are also available to download.
The Joint Strategic Needs Assessment, the result of collaboration with the Council, brings
together statistics from the Council and NHS Hull so that planners can jointly work on
improving health for the people of Hull. This is available on the Hull public health website
or at www.jsnaonline.org.
In this section of my report I will examine how the health gap between Hull and the rest of
England has been changing. My hope would be that improvements in health in the people
of Hull were happening at a greater rate than in England, so that the gap between Hull
residents and those of other areas of the country would be getting narrower.
Of course, one of the main reasons why people in Hull have worse health is that they are
still smoking more than in other areas. I reported last year that an estimated 65,000 people
in Hull aged 18 years and over were smokers (based on the results of Hull’s 2007 Health
and Lifestyle Survey which found 32% of adults in Hull smoked). Over the past 12 months
my team has carried out a further health and lifestyle survey, this time among school
children in Hull’s secondary schools. Based on the results from this survey we estimate that
around 1 in 9 secondary school children in Hull aged between 11 and 16 years smoke.
Other common risk factors for many diseases include poor diet, lack of exercise, obesity and
excessive alcohol consumption. Information on these risk factors were collected in Hull’s
2008-09 Children and Young People’s Health and Lifestyle survey. A summary of key
lifestyle risk factors in both adults and children in Hull appears later in this section.
26
Section 4
Male life expectancy
Male life expectancy at birth has been steadily improving over the last few years, although
the annual improvements have been small over the past 2 years. Life expectancy in
England as a whole has been improving at a faster rate than in Hull, such that in 2006-2008
men in England lived 2.9 years longer on average than men in Hull. I am very concerned
that the gap between Hull and the rest of England is continuing to widen. The gap is
unlikely to be reduced unless we see improvements in lifestyle factors such as smoking
rates and diet, which have a big impact on life expectancy.
Figure 1: Trends in male life expectancy at birth
80
Male life expectancy at birth (years)
79
78
77
76
75
74
73
72
71
70
1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08
Years
England
Hull
27
Section 4
Female life expectancy
Life expectancy at birth increased substantially in women in Hull in the late 1990s. It then
remained steady for several years before decreasing for two years. There have since been
three years of improvement in life expectancy for women in Hull, with 2006-2008 seeing the
largest increase for some years (0.4 years, or almost 5 months). This was twice the increase
seen in England as a whole, and for the first time in five years the gap between Hull and the
rest of England has decreased. We still have a long way to go before Hull women catch up
with those in the rest of England, who now live 2.5 years longer on average than women in
Hull. We need to work hard at maintaining or increasing this rate of improvement in Hull
women so that the gap with the rest of England can be reduced.
To have a real chance of reducing these gaps we need to tackle the same lifestyle factors
that affect men, that is the high smoking rate, the levels of obesity and the poor diet that
Hull people have when compared with the rest of England.
Figure 2: Trends in female life expectancy at birth
85
Female life expectancy at birth (years)
84
83
82
81
80
79
78
77
76
75
74
1991-93 1992-94 1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08
Years
England
28
Hull
Section 4
Circulatory disease
Circulatory diseases (heart problems, such as coronary heart disease or strokes) caused
more than one quarter of early deaths in Hull in 2005-07 (where early death is defined as a
death before 75 years of age). Figure 3 shows that the rate of early deaths has been steadily
decreasing in Hull, as it has in other parts of England. The decreases in Hull during this
time period have been slightly larger than the England average, so the gap between Hull
and England has decreased by 22% since 1993-1995.
While this is good news, we still have a long way to go to catch up with the rest of England.
The rate of early circulatory disease deaths in Hull is still 36% higher than the England
average. In order to see substantial reductions in the gap between Hull and England, large
changes in personal lifestyle and improvements in medical care are needed.
Figure 3: Trends in circulatory disease death rates for under 75s per 100,000
population (directly standardised rate – standardised to European Standard
population)
Circulatory disease mortality rate for those aged under
75 years (per 100,000 persons)
200
180
160
140
120
100
80
60
40
20
0
1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07
Years
England
Hull
29
Section 4
Coronary heart disease (CHD)
More than half of all circulatory disease deaths are due to CHD, with around 60% of early
deaths from circulatory diseases caused by CHD. Early CHD deaths account for around 1
in 6 of all early deaths in Hull. Table 1 shows the CHD death rates by age.
Among men aged 35-64 years, the death rate in Hull in 2005-2007 was 32% higher than
the England average. Among men aged 65-74 years the rate was 26% higher in Hull. This
represents a large increase in the gap between Hull and England since last year, due to the
rate in men in Hull increasing by 8% while in England it decreased by 8%.
Among men aged 75 years and older the rate in Hull was 12% higher than the England
average, a doubling of the gap between Hull and England, due to a decrease of 6% in
England but little change in Hull.
For the gap with England to narrow as I would hope, we need the death rate in Hull to fall
faster than that in England which at the moment it is not doing.
Among women aged 35-64 years, the death rate in Hull was 70% higher than the England
average, which is similar to last year.
Among women aged 65-74 years, where most of the early CHD deaths in women occur,
the rate in Hull decreased by 15% from last year, while in England the rate decreased by
10%, leading to a reduction in the gap between Hull and England. However, with a rate
78% higher than in England, women in Hull aged 65-74 are still 75% more likely to die from
CHD than women of a similar age in the rest of England. In women aged 75 years and over,
the gap between Hull and England increased slightly: as the 3% decrease in the rate in Hull
was smaller than the 5% decrease seen in England.
While it is encouraging to see the rate of CHD deaths decrease in women aged 65-74 years,
this group are still of particular concern to me. Although more men than women do die
from CHD, in Hull the death rate in women aged 65-74 is 44% lower than in men, while in
England it is 60% lower than in men. This reinforces the fact that although CHD is often
perceived as affecting mainly men, a large number of women in Hull also have a very high
risk of dying from CHD. Women as well as men need to address their risk factors for CHD,
and consider modifying their lifestyles if we are to see these death rates fall substantially.
30
Section 4
Table 1: CHD age-specific death rates per 100,000 persons 2005-2007
CHD death rates per 100,000 persons by age (years)
Males
Females
35-64
65-74
75+
35-64
65-74
75+
England
82.8
491
1,673
20.0
194
1,157
Hull
109
621
1,877
34.1
346
1,315
Stroke
Around 1 in 6 early deaths in men (from circulatory diseases) are due to stroke, while
among women stroke deaths account for more than 1 in 4 early circulatory disease deaths.
Stroke accounts for more than 5% of all early deaths occurring in Hull. The death rates
from stroke are shown in Table 2.
Death rates in men have decreased in Hull since last year. In men aged 35-64 years the
rate decreased by less than the England average, so the gap between Hull and England
increased slightly to 13%.
However, among men aged 65-74 years the death rate decreased by 17% and in men aged 75
years and older the death rate decreased by 11%. In each case the decrease was more than
double the decrease for England. Despite these large falls, men aged 65-74 years in Hull
were still more than one third more likely to die from stroke than in the rest of England,
while men age 75 years and over were 5% more likely to do so.
Among women the picture was more mixed. The gap between Hull and England did
decrease by almost half in women aged 35-64 years, although the Hull death rate was still
40% higher than the England average.
In women aged 65-74 years although the stroke death rate did decrease by 3%, this was
less than half the decrease seen in England, leading to the gap between Hull and England
rising to 81%. In other words, women aged 65-74 years in Hull have almost twice the risk
of dying from stroke than women of that age in the rest of England.
31
Section 4
However the stroke death rate in women aged 75 years and older also decreased more
slowly in Hull than the England average, leading to a small widening in the gap for this
age group, although rates were similar, women in Hull aged 75 years and older are just 3%
more likely to die of stroke than in the rest of England.
As well as the early deaths from stroke, the fact that only one third of strokes result in
death means that a large number of people in Hull are left with the burden of disability that
stroke often imposes on stroke survivors and their families, as well as the impact on quality
of life which often worsens substantially after a stroke.
Table 2: Stroke age-specific death rates per 100,000 persons for 2005-2007
Stroke death rates per 100,000 persons by age (years)
Males
Females
35-64
65-74
75+
35-64
65-74
75+
England
16.5
135
856
12.9
103
1,014
Hull
18.6
186
898
18.1
186
1,049
Cancer
Cancer is responsible for more than one in three of all early deaths in Hull. Figure 4 shows
that for most years since 1993-95 the death rate from cancer in the under 75s had been
falling faster in Hull than in the rest of England. The rate in Hull decreased in 10 of the past
12 years, with decreases greater than the England average in 7 of these years. In my report
last year I reported that the small increase in the gap between Hull and England might be
a ‘statistical blip’; with a decrease in the death rate this year greater than for England this
does indeed appear to have been the case. Of course, despite the very welcome decreases
in the gap between Hull and England, there is still a long way to go before the rates of early
death due to cancer in Hull approach the national rates, with people aged less than 75 years
in Hull still one quarter more likely to die from cancer than in the rest of England.
32
Section 4
Figure 4: Trends in cancer death rates for under 75s per 100,000 population
(directly standardised rate – standardised to European Standard)
Cancer mortality rate for those aged under 75 years
(per 100,000 persons)
200
180
160
140
120
100
80
60
40
20
0
1993-95 1994-96 1995-97 1996-98 1997-99 1998-00 1999-01 2000-02 2001-03 2002-04 2003-05 2004-06 2005-07
Years
England
Hull
If we discount men aged 15-34 years, where an increase of 1 death has a disproportionate
impact on rates due to the small numbers of deaths in this age group, the largest gap in
early deaths from cancer between Hull and the England average was in people aged 65-74
years. Rates in men in Hull were 33% higher than the England average, although the gap
between Hull and England decreased for this age group, as the rate in Hull decreased more
rapidly than the England average. Among men aged 35-64 years and in men aged 75 years
and over the death rates in Hull also decreased more rapidly than the rest of England, with
consequent decreases in the gap between Hull and England. However, men in Hull aged
35-64 years and 75 years and over were still 10% and 25% respectively more likely to die
from cancer than men in the rest of England.
Among women aged 35-64 years and 75 years and over rates in Hull increased by 8%
and 6% respectively while in England they were unchanged in women aged 35-64 years
and increased by less than 1 % in women aged 75 years and over. Consequently the gaps
between Hull and England increased in both theses age groups, such that Hull women aged
35-64 years were 24% more likely to die from cancer than in the rest of England and those
aged 75 years and over were 20% more likely to do so.
33
Section 4
Cancer death rates in women aged 65-74 years did decrease in Hull faster than in England,
reducing the gap between Hull and England. Women in Hull aged 65-74 years were still
24% more likely to die from cancer than their counterparts in the rest of England.
Table 3: Cancer age-specific death rates per 100,000 persons for 2005-2007
Cancer death rates per 100,000 persons by age (years)
Males
Females
15-34
35-64
65-74
75+
15-34
35-64
65-74
75+
England
6.9
146
917
2,166
6.8
139
628
1,338
Hull
9.7
161
1,216
2,703
5.2
172
779
1,612
Lung cancer
Lung cancer is the most avoidable cancer, with more than 80% of deaths from lung cancer
attributable to smoking. In Hull one in nine early deaths are caused by lung cancer. This
represents almost 33% of all early deaths from cancer, which is much higher than for
the rest of England (23%). Death rates from lung cancer in Hull were far higher than for
England for each age, with the largest difference in those aged 65-74 years. Among Hull
residents aged 65-74 years men were 80% more likely to die from lung cancer than in the
rest of England and women were 78% more likely to do so.
Despite this, there have been some reductions in the gap with England among women aged
35-64 and 65-74 years, as rates in England increased slightly while falling slightly in Hull.
Among women aged 75 years and older the rate in Hull increased by 10%, twice as fast as
in England, meaning the risk of dying in Hull from lung cancer aged 75 years and over was
two thirds higher than in the rest of England.
Among men there were few changes in death rates from lung cancer with the exception
of those aged 35-64, where the rate decreased by almost one fifth, while little changed for
England, (although this age group only accounts for one fifth of lung cancer deaths).
34
Section 4
Lung cancer remains the largest avoidable cause of death in Hull. We must do everything
possible to prevent people from starting to smoke, to help people to stop smoking and to
remain non-smokers once they have stopped smoking.
Table 4: Lung cancer age-specific death rates per 100,000 persons for 2005-2007
Lung cancer death rates per 100,000 persons by age (years)
Males
Females
35-64
65-74
75+
35-64
65-74
75+
England
36.1
246
480
25.3
146
237
Hull
51.6
442
827
47.2
260
393
Prevalence of risk factors
The prevalence of modifiable behavioural risk factors which often result in disease may be
estimated from health and lifestyle surveys conducted on my behalf by my Public Health
Science team at NHS Hull. Last year I reported on the 2007 adult health and lifestyle
survey, while this year I concentrate on the winter 2008-09 health and lifestyle survey of
children and young people, conducted in all but one of Hull’s 14 secondary schools.
2008-09 Health and Lifestyle Survey of Children
and Young People
During the winter of 2008-09 a health and lifestyle survey was conducted by the Public
Health Science team in 13 of Hull’s 14 secondary schools, as well as three pupil referral
units. Almost 3,000 pupils in years 7 to 11, that is pupils aged 11 to 16 years old,
participated. Questions were asked about general health, as well as on known risk factors
for disease in later life such as smoking. Pupils were also asked about their attitudes to
their schools, their experiences of being bullied, about their mental health and about some
of the activities they take part in. Some of the key results from the survey are outlined
below, while the full results may be viewed or downloaded from www.hullpublichealth.
org:
35
Section 4
• Percentages smoking in years 7 to 10 had decreased since 2002
• More girls smoked than boys (twice as many in year 11)
• By year 11, adult smoking patterns were established among girls, with
one third smoking
• More than half of pupils lived in homes where at least one other person
was a smoker (69% in most deprived areas, 36% in least deprived
areas)
• 40% of pupils had been drunk at least once, while in year 11 36% of
boys and 39% of girls got drunk at least once a month
• 13% of boys and 10% of girls in year 11 reported exceeding the weekly
recommended maximum guideline amounts of alcohol for adults (men:
21 units; women: 14 units)
• One fifth of pupils that drank alcohol bought alcohol from shops, pubs
or clubs
• More than one third of pupils were given alcohol by their parents or
carers
• While few pupils in years 7 and 8 had used or tried drugs, in year 11
22% of girls and 18% of boys had used or tried drugs
• The most commonly used drug by pupils was cannabis (13% of girls
and almost 7% of boys in years 9-11)
• 61% of boys and 59% of girls reported they ate a healthy diet
• Percentages eating 5-A-DAY fruit and vegetables decreased by 30% in
boys and 40% in girls between years 7 and 11
• 48% of boys and 34% of girls engaged in at least 1 hour of physical
activity per day on average
36
Section 4
• 14% of boys and 16% of girls reported that they had been bullied at
school in the last month, with the percentages reporting they had ever
been bullied at school three times higher
• Around three-quarters of pupils were happy all of the time or most of
the time, while 7% of boys and 11% of girls were sad all of the time or
most of the time
• Awareness of sexually transmitted infections had increased since 2002
in pupils in years 9 to 11
As the prevalence of risk factors in young people differ substantially with age, the
following three tables present the prevalence of smoking, excessive alcohol consumption
and the percentage getting insufficient exercise, each by age and gender, together with the
most recent national comparisons in the case of smoking.
Table 5: The prevalence of smoking in young people by age, Hull 2008-09 and
England 2008
Smoking
behaviour and
gender
Smoking behaviour by age and gender (%)
Age (years)
11 yrs
12 yrs
13 yrs
14 yrs
15 yrs
16yrs
1.1
1.1
5.8
6.2
13.1
15.2
2
3
6
12
17
-
11.4
13.5
25.2
29.3
43.2
42.4
13
17
28
38
52
-
3.6
2.7
9.2
19.7
26.6
35.2
1
3
7
18
25
-
15.5
20.1
36.7
54.0
60.7
71.4
8
13
32
44
58
-
Males
Smoked in Hull
last week
England
Ever
Hull
smoked
England
Females
Smoked in Hull
last week
England
Ever
Hull
smoked
England
37
Section 4
Table 6: The prevalence of excessive alcohol consumption (based on alcohol
consumed in the seven days prior to completing a survey questionnaire) among
young people by school year, Hull 2008-09
School year
Year 7
Year 8
Year 9
Year 10
Year 11
Years 7-11
Drank more than weekly recommended adult guideline
amount (>21 units males, >14 units females) in past
week (%)
Males
Females
All
0.4
0.7
0.5
1.2
1.5
1.4
1.3
3.5
2.4
5.2
8.2
6.7
13.4
10.2
11.5
3.7
4.7
4.2
Table 7: The prevalence of insufficient physical activity (defined as less than one
hour per day on average) taken by young people by school year, Hull 2008-09
School year
Year 7
Year 8
Year 9
Year 10
Year 11
Years 7-11
38
Percentage of pupils taking part in less than 1 hour of
sports and physical activities per day on average
Males
Females
All
50.8
72.2
61.0
51.5
61.0
56.3
50.4
67.1
58.4
53.4
69.9
61.3
55.2
58.9
57.3
52.1
66.0
59.1
Section 4
Estimated numbers of young people in Hull with
specified lifestyle behaviour
As the survey was broadly representative of Hull’s population of young people aged 11-16
years, the results can be generalised and applied to Hull’s population of 11 to 16 year olds
and we can estimate the numbers of people engaged in these and other lifestyle behaviours
and lifestyle aspirations. These results are displayed in the following tables.
• Table 8 shows some of the behavioural risk factors that are known to
impact on health in later life.
• We estimate that almost 5,000 young people drank alcohol the week
before completing our survey, including more than 700 who drank more
alcohol than the recommended maximum amount for adults, that is
more than 21 units for men (about 10.5 pints of ordinary strength beer)
and more than 14 units for women (about 7 pints of ordinary strength
beer). More than 1,100 get drunk at least once a week with the same
number again getting drunk once or twice a month.
• Almost 1,800 young people aged 11-16 years smoked in the last week,
while more than 1,200 said they might start smoking in the future. • 1,300 had tried illegal drugs. • More than 3,500 said they did not eat a healthy diet, while a further
3,000 did not know either what a healthy diet was or whether they had
one.
•Almost 10,000 young people did not take part in enough physical
activities.
39
Section 4
Table 8: Estimated numbers of young people in Hull by specified lifestyle
behaviours, estimated by applying the results of the 2008-09 health and lifestyle
survey of children and young people to Hull’s October 2008 population aged 11-16
years
Lifestyle behaviour
Males
(n=8,445)
Females
(n=7,888)
Total
(n=16,333)
Ever had a whole alcoholic drink
5,392
5,186
10,578
Drank alcohol in last week
2,458
2,290
4,748
More than adult recommend weekly units
349
368
717
Get drunk at least once a week
596
555
1,151
Get drunk 1-2 times a month
502
674
1,176
Smoked in last week
577
1,190
1,767
Don’t smoke now but may in future
551
720
1,271
Healthy diet - no
1,884
1,685
3,569
Healthy diet - don’t know
1,459
1,604
3,063
Average 1 hr per day of physical activity
4,419
5,185
9,604
862
747
1,309
Tried illegal drugs
40
Estimated total resident population
(October 2008) aged 11-16 years with
specified lifestyle behaviour
Section 4
The results from the survey were not all doom and gloom, with substantial proportions of
pupils reporting that they would like to make various changes to their lifestyles. Estimates
of the numbers of young people reporting that they would like to make changes to their
lifestyles have been produced, again by applying the results from the survey to Hull’s
population aged 11-16 years as at October 2008. These estimates are shown in Table 9. For
each aspiration, more girls than boys wanted to make changes. Overall, more than 8,500
young people wanted to lose weight and almost 11,000 wanted to eat a healthier diet.
More than 10,000 wanted to take more exercise or play more sport, while a similar number
wished to be more active generally.
Table 9: Estimated numbers of young people in Hull with aspirations to change
lifestyle behaviours, estimated by applying the results of the 2008-09 health and
lifestyle survey of children and young people to Hull’s October 2008 population
aged 11-16 years
Lifestyle aspirations
Estimated total resident population
(October 2008) aged 11-16 years with
specified lifestyle aspiration
Males
(n=8,445)
Females
(n=7,888)
Total
(n=16,333)
Would like to lose weight
3,329
5,202
8,531
Would like to eat a healthier diet
4,897
5,950
10,846
4,696
5,569
10,265
4,725
5,884
10,609
Would like to take more exercise/play
more sports
Would like to be more active
41
Section 4
Prevalence of risk factors in adults
In last year’s report I presented some of the findings from the 2007 adult health and lifestyle
survey commissioned on my behalf by the Public Health Science team at NHS Hull. This
year I am going to present just the prevalence of the key modifiable behavioural risk factors,
together with an estimate of the number of adults in Hull that exhibit these risk factors, by
applying the prevalence to the October 2008 population of adults (18+ years) in Hull.
Percentages with the specified lifestyle behaviour are shown in Table 10, while the
estimated numbers of adults in Hull with these behaviours are shown in Table 11. It is
estimated that 65,000 adults in Hull are smokers, with almost one third of these smoking
at least 20 cigarettes per day. More than 83,000 adults in Hull are overweight, and almost
43,000 are obese, that is more than 126,000 adults in Hull are overweight or obese. More
than 151,000 adults in Hull do not get enough physical activity, including more than 17,000
who never exercise and more than 48,000 that only ever take light exercise. More than
31,000 adults in Hull drink more than the recommended maximum amounts for adults
(21 units men, 14 units women), 45,000 binge drink at least once a week, with more than
22,000 adults both binge drinking at least once a week and drinking above weekly guideline
maximum amounts.
42
Section 4
Table 10: Prevalence of specified lifestyle behaviours among adults in Hull,
estimated from the results of the 2007 health and lifestyle survey of adults applied
to Hull’s October 2008 population aged 18 years or over
Lifestyle behaviour
Prevalence (%) with specified lifestyle
behaviour
Men
Women
Persons
Smoker
33.6
29.9
31.7
Smoke 20+ cigarettes per day
11.0
9.6
10.1
Overweight (BMI 25-29.9)
48.6
32.7
40.6
Obese (BMI 30+)
18.4
23.2
20.8
Eats a healthy diet - no
9.3
5.8
7.5
Eats a healthy diet - don’t know
30.1
20.7
25.3
5-A-DAY (<5)
78.9
75.2
77.0
Never exercises
9.5
7.4
8.4
Light exercise only
20.3
26.8
23.6
41.5
41.9
41.7
21.9
8.0
15.2
Binge drinking at least once per week
29.3
13.9
21.9
Excessive and binge drinking
15.9
5.5
10.9
Excessive and/or binge drinking
35.3
16.4
26.2
Moderate/vigorous exercise <5 times per
week (excluding light/never)
Excessive weekly alcohol consumption
(>21 units M, >14F)
43
Section 4
Table 11: Estimated numbers of adults (18+) in Hull with specified lifestyle
behaviours, estimated by applying the results of the 2007 health and lifestyle
survey of adults to Hull’s October 2008 population aged 18 years or over
Lifestyle behaviour
Estimated total adult (18+) resident population
(October 2008) with specified lifestyle
behaviour
Men
Women
Persons
(n=103,760) (n=101,570) (n=205,330)
Smoker
34,863
30,369
65,090
Smoke 20+ cigarettes per day
11,414
9,751
20,738
Overweight (BMI 25-29.9)
50,427
33,213
83,364
Obese (BMI 30+)
19,092
23,564
42,709
Eats a healthy diet - no
21,582
15,236
36,549
Eats a healthy diet - don’t know
9,650
5,891
15,400
5-A-DAY (<5)
81,867
76,381
158,104
Never exercises
9,857
7,516
17,248
Light exercise only
21,063
27,221
48,458
43,060
42,558
85,623
22,723
8,126
31,210
30,402
14,118
44,967
Excessive and binge drinking
16,498
5,586
22,381
Excessive and/or binge drinking
36,627
16,657
53,796
Moderate/vigorous exercise <5
times per week (excluding light/
never)
Excessive weekly alcohol
consumption (>21 units M, >14F)
Binge drinking at least once per
week
44
Section 4
Future prevalence surveys
In future years, it is anticipated that a survey to estimate the prevalence of risk factors will
be done more regularly, with the first prevalence survey conducted in 2009, the results of
which I will include in my next annual report.
45
Conclusion,
Progress and
Recommendations
– And all for
the want of a
horseshoe nail
Section 5
Progress on 2008
Recommendations
Recommendation 1
We need to champion the ‘Healthy Ambitions, Staying Healthy’ recommendations within
the NHS and with partners, to develop plans based on need and commission services which
address the three key lifestyle risk factors of alcohol, obesity and tobacco.
• Newly commissioned services addressing weight management issues
have achieved high profile and significant success in identifying and
supporting middle aged men and women through weight loss and
exercise programmes.
• Embarked on a broader approach to commissioning services for wider
tobacco control which, whilst still including investment in smoking
cessation, also encompassed illegal sales and smuggling.
• Commissioned services to provide identification and brief advice
and built capacity within the existing workforce which is identifying
hazardous and harmful drinkers and providing support.
47
Section 5
Recommendation 2
We need to ensure that public health and health improvement is embedded into NHS Hull’s
World Class Commissioning plans for all clinical development areas as well as leading on the
healthy lifestyle strand of the medium term strategic plan, giving strong and clear leadership
to achieving the goal of increasing life expectancy.
• Public health science and health improvement is intrinsic in all priority
areas in NHS Hull’s World Class Commissioning plans, ensuring
that understanding need, evidence and modelling is at the heart of
investment decision making and that the prime outcome for all plans is
improving health and the quality of health provision for the citizens of
Hull.
• The medium term strategic plan includes healthy lifestyles as a goal
area which also includes a social marketing programme designed to
support the preventative element of all PCT priority areas to achieve
their goals. Recommendation 3
We need to ensure that the financial commitment that NHS Hull has made to improving
health in the city is followed through by delivering on the investment plan developed for
this year. We also need tight performance management of provider contracts and continuous
development of World Class Commissioning competencies and particularly with reference to
managing knowledge and assessing needs.
• Tight performance management of provider contracts has continued
with increased learning around working with a range of providers to
deliver on targets.
• Board level consideration of the health needs of the population through
the Joint Strategic Needs Assessment and other health survey and
audit information has ensured that health improvement in the city has
continued through both investment in the prevention of ill health as
well as investing in improving service delivery and quality.
48
Section 5
Recommendation 4
We need to work with all partners through the Local Strategic Partnership (LSP), and
specifically through the LSP’s Health and Wellbeing Strategic Delivery Partnership, to
deliver our targets for both Local Area Agreements 1 and 2. Ensure that all partners are
signed up to delivery of the Sustainable Community Strategy and are prepared for the
Comprehensive Area Assessment process where we can demonstrate that with the effective
use of skills and knowledge from a range of partners we can deliver bigger, better, quicker.
• Full review of the work of the Health and Well-being Strategic
Delivery Partnership (which reports into the LSP Executive Board)
being undertaken as part of the Comprehensive Area Assessment
process. • Good progress made to date on key target areas and full participation
in the development of a consistent performance management system
across all areas of the LSP.
49
Section 5
Recommendations
2009 Report
Every year as Directors of Public Health prepare their respective Annual Reports, they are
charged with the duty of making personal recommendations that they would like to see
come to fruition during the course of the coming year. As I have explained in previous
Annual Reports that I have written, I have always tried to make recommendations that are
over and above the normal run of the mill target areas that we have to meet as part of our
performance management arrangements with the Department of Health. I have often set
recommendations about ways of working with partners as well as recommendations for
reducing health inequalities through investment plans and delivering innovative services.
This year I have found it difficult to move away from the four strategic recommendations
that I made last year. Whilst we have made some progress with these recommendations
as demonstrated by my comments in the previous section, I do not feel we have seen the
sea of change in health outcomes for the citizens of Hull. With this in mind I propose to let
my recommendations stand for the coming year and to add a fifth recommendation which
covers some major changes in the way I want to deliver services and engage with people in
the coming year.
I do hope you will support my approach and work with me and my team to deliver on the
recommendations below and review progress in 2010.
Recommendation 1
We need to champion the ‘Healthy Ambitions, Staying Healthy’ recommendations within
the NHS and with partners, to develop plans based on need and commission services which
address the three key lifestyle risk factors of alcohol, obesity and tobacco.
50
Section 5
Recommendation 2
We need to ensure that public health and health improvement is embedded into NHS Hull’s
World Class Commissioning plans for all clinical development areas as well as leading on
the healthy lifestyle strand of the medium term strategy, giving strong and clear leadership
to achieving the goal of increasing life expectancy.
Recommendation 3
We need to ensure that the financial commitment that NHS Hull has made to improving
health in the city is followed through by delivering on the investment plan developed
for this year, with tight performance management of provider contracts and continuous
development of World Class Commissioning competencies and particularly with reference
to managing knowledge and assessing needs.
Recommendation 4
We need to use all partners through the Local Strategic Partnership (LSP), and specifically
through the LSP’s Health and Wellbeing Strategic Delivery Partnership, to deliver our
targets for Local Area Agreement 2. Ensure that all partners are signed up to delivery of the
Sustainable Community Strategy and are prepared for the Comprehensive Area Assessment
process where we can demonstrate that with the effective use of skills and knowledge from
a range of partners we can deliver bigger, better, quicker.
Recommendation 5
In the coming year my team and I will bring to completion a series of developments
which will result in a real ‘shop front’ approach to engaging with the population of Hull
to support them with health assessments and lifestyle change. This will include the
opening of ‘Health Central’ in the St Stephen’s Shopping Centre, the continued running
of the ‘Single Point of Access’ shop as well as potential partnerships with Hull FC and
Hull KR resulting in NHS public health staff operating from these sports clubs. We will
also be closely supporting the range of NHS estates developments across the city and
are developing healthy lifestyle facilities at NHS Hull’s new ‘Story Street Development’
as well as other locations across the city. Through these facilities I want to see a genuine
engagement from the people of Hull in taking control of their own health and really making
a difference to themselves and their families and their health outcomes.
51
Section 5
And all for the want
of a horseshoe nail
For the first time since I became Director of Public Health I have been able to report that
not only is female life expectancy increasing in the City, but also that we have actually seen
a reduction in the gap in life expectancy between Hull and the rest of England. This is the
first time that there has been such a decrease for five years. This is tremendous news.
I have also been able to share with you in this year’s report that we are starting to see a
steady increase in male life expectancy, but we are not catching up with the rest of England,
in fact the gap is widening. Whilst this is good news in part, we must still work hard on the
catch up.
In previous years I have also compared these statistics to the Hambleton and Richmond
area and this year I decided against this. Looking at the figures I have presented I hope
you will agree that even though we are aware of the inequalities gap in comparison to
such areas, I want for the coming years to maintain an inward focus to improving health
in Hull based on maximising the effects of our workforce in the City who can influence the
population to make healthy lifestyle choices.
We evaluate the performance and outcomes of all of the services we commission and one
of the things this shows us is that by having such a range of services and people with
different skills who can interact with members of the public, then we can really start to
make a difference to health in Hull. It also shows us that those people who we are trying
to support really value the work of the health professionals they encounter and contact.
We need to make sure we make every one of those contacts, from all partner organisations,
count in terms of health improvement. We will continue to recruit from members of our
communities to seek out more of our local population who may not yet be aware that they
are at risk. Finding such individuals and intervening at the most basic level can make such
a significant difference. Small actions……………significant consequences.
This brings me back to the proverb which has captured my attention this year. If we ensure
we have the right level of skill base on the ground, we can work with individuals and
groups to narrow the gap in health outcomes for men and women in the City. We can win
the battles and the Kingdom if the horses, shoes and nails are in place.
Dr. Wendy Richardson
Director of Public Health for Hull
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Section 6
Users’ Evaluation
This report is my independent, professional statement about the health of local
communities based on epidemiological evidence and objective interpretation. It is aimed at
mainly local service providers and other interested parties. I hope that it will prove to be a
useful resource for local inter-agency action.
Please will you take a few minutes to answer the following questions. Your views are
valued and will contribute to the planning for my report in 2010.
1. Did you find this report informative and interesting?
2. How will you be able to use the information contained in this report to benefit
people in Hull?
3. What was the most significant, memorable or useful information you have learned
from this report?
4. The report is available in both printed and CD format. Did you find this format
easy to use? If not, how could we improve it in the future?
5. Have you explored the information available on the public health website
www.hullpublichealth.org? If so, how useful was this?
6. I would welcome any further comments you would like to make about this report.
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Please return by post to:
Dr. Wendy Richardson
Director of Public Health for Hull
NHS Hull
The Maltings
Silvester Square
Silvester Street
Hull
HU1 3HA
Or via email to:
Sarah Jenkins
Public Health Lead
NHS Hull
[email protected]
The CD contains a word version of
the User’s Evaluation that can be
completed and emailed.
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