Illness and Death

Radiotherapy

Premature deaths in Hartlepool

Life expectancy in Hartlepool continues to improve.  The gaps in life expectancy between the deprived and affluent areas within Hartlepool, and between Hartlepool and England are narrowing. The Slope Index of Inequality (an estimate of the range in life expectancy at birth from most to least deprived) shows changing inequalities in Hartlepool. The gap in life expectancy has fluctuated for males from 11.8 years in 2002-04 to 11.3 years in 2010-12.  For females, the gap has narrowed from 10.3 years in 2002-2004, to 7.1 years in 2010-2012.

The major causes of illness and premature deaths (deaths before age 75 years) in Hartlepool are circulatory diseases, cancer, respiratory disease and digestive diseases (including liver disease). The charts below illustrate the contribution of these conditions to the gap in life expectancy between Hartlepool and England and for the gap between deprived and affluent areas within Hartlepool.

Breakdown of life expectancy gap between Hartlepool and England for males and females

Breakdown of life expectancy gap between affluent and deprived areas in Hartlepool for males and females

To reduce premature mortality in Hartlepool, the focus should be on the major causes of premature deaths.  The chart below shows the number of deaths (in people under the age of 75 years) that need to be prevented to close the gap between Hartlepool and the regional and national averages.

Estimated number of premaure deaths that need to be prevented in Hartlepool

 

Long-term conditions, cancer and mental health in Hartlepool

There are increasing numbers of people with more than one long-term condition receiving support from the NHS, social care and voluntary and community services. However, their care is not always co-ordinated, resulting in variation in their outcomes and quality of life.

Deaths from cardiovascular disease, cancer and respiratory diseases in people under 75 have continued to fall, but the same pattern has not been observed for liver disease. Premature deaths from cancer and circulatory disease in Hartlepool remain significantly higher than the England average and are the largest contributors to local health inequalities in Hartlepool. Breast, lung, colorectal and prostate cancer account for over half of all cancer cases and deaths. Lung cancer incidence and mortality in Hartlepool is statistically significantly higher than the regional average for males and females.

Outcomes for babies, children and young people remain poor. The infant mortality rate fluctuates but remains statistically similar to England. Emergency admissions for children are higher than England for alcohol-related harm, substance misuse, self-harm and injuries.

There is an over reliance on urgent care for addressing health issues within Hartlepool. This is characterised by higher than average levels of attendance at accidents and emergency, and emergency admissions.

There are higher levels of mental health, behavioural and psychiatric morbidity characterised by:

  • a higher rate of emergency admissions for self-harm compared to England.
  • a higher rate of in-year bed days for mental health than national average.
  • higher prevalence of self-harm compared to England.

However:

  • Suicide mortality is similar to England.
  • The rate of depression in adults is significantly lower than England.
  • Admissions for mental health are significantly lower than England.

The local prevalence of dementia is similar to England.  However, consideration needs to be given to projections of future need and service configuration.

There are considerable gaps between the number of people known to health services compared to the expected numbers with diseases such as circulatory diseases (heart disease, stroke, high blood pressure), respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma) and diabetes.  This suggests that there is a high number of people with undiagnosed disease – ‘the missing thousands’.

There are variations in diagnosis, treatment, quality of care and outcomes in primary care for patients with long-terms conditions (asthma, COPD, circulatory diseases and diabetes).

There is lower uptake of preventative, screening and early detection services for cancers and long-term conditions (NHS Health Check, Abdominal Aortic Aneurysm (AAA), diabetes, lung health) in deprived and disadvantaged communities in Hartlepool.


Recommendations 

The recommendations below summarise the topic recommendations for the illness and death theme.  They are similar to those identified in the Marmot review: Fair Society, Healthy Lives, the former National Support Team recommendations for tackling Health Inequalities and latest national policy and professional guidance.

Short-term actions (1-2 years)

  • Ensure that people with existing disease are managed effectively. Reduce variation in clinical management of long-term conditions, cancer, mental health and dementia to ensure equitable access, across all social groups, to effective care, which minimises progression, enhances recovery and promotes independence.
  • Ensure that people at high risk are identified and managed at the earliest opportunity. Increase uptake of preventative and early intervention programmes with more targeted approaches for deprived and vulnerable groups (such as people with learning disability, mental health).
  • Increase early identification of long-term conditions, cancer, mental health and dementia by raising community awareness and promoting health seeking behaviours (targeted at high risk groups and those ‘seldom seen, seldom heard’ and socially isolated or excluded).

Medium-term actions (3-5 years)

  • Make all care "planned care". reduce reliance on urgent care, emergency admissions and delayed/late stage presentations for cancer, circulatory diseases, diabetes and other long-term conditions, including mental health and dementia.
  • Prevent illness by addressing lifestyle risk factors. Design community-based interventions that tackle obesity, smoking and alcohol misuse with a clear focus on improve mental wellbeing. 

Long-term actions (over 5 years)

  • Address the social causes of poor health and premature deaths. Continue to address the ‘causes of the causes’ of illness and premature deaths such as unemployment, poor quality housing and fuel poverty. Raise literacy and numeracy rates and educational attainment.

 

Summary Authors

Carole Johnson
Head of Health Improvement
Hartlepool Borough Council

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service