Illness and Death

Radiotherapy

Premature deaths in Middlesbrough

Life expectancy in Middlesbrough continues to improve.  However, latest reports show that the gaps in life expectancy between the deprived and affluent areas within Middlesbrough, and between Middlesbrough and England are widening. The Slope Index of Inequality (an estimate of the range in life expectancy at birth from most to least deprived) shows changing inequalities in Middlesbrough. The gap in life expectancy has widened for males from 14.8 years in 2006-10 to 16.4 years in 2009-11.  For females, the gap has also widened from 11.3 years in 2006-2010, to 12.3 in 2009-2011

The major causes of illness and premature deaths (deaths before age 75 years) in Middlesbrough are circulatory diseases, cancer, respiratory disease and digestive diseases (including liver disease). Charts 1 and 2 below illustrate the contribution of these conditions to the gap in life expectancy between Middlesbrough and England and for the also gap between deprived and affluent areas within Middlesbrough.

Middlesbrough and England premature mortality gap scarf chart 2009-11

Middlesbrough inequality gap causes of premature mortality scarf chart

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

Premature mortality differences, Middlesbrough, North East and England, various dates

 

Long-term conditions, cancer and mental health in Middlesbrough

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.

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

Outcomes for babies, children and young people remain poor. Infant mortality rates continue to improve but remain higher than the England average (although the difference is not statistically significant). Emergency admissions are higher than the England average for respiratory illness, dental health, injuries, under 18 alcohol-related and under 18 self-harm and these mirror the patterns of deprivation across the town.

There is an over reliance on urgent care for addressing health issues within Middlesbrough. This is characterised by higher than regional average levels of attendance at accidents and emergency, emergency admissions and less planned care with a geographical (ward level) distribution that mirrors deprivation.

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

  • a prevalence of depression that is higher than England.
  • a higher rate of emergency admissions for self- harm compared to England.
  • a higher rate of in-year bed days for mental health is higher than national average.
  • higher numbers of children and young people with significant mental health and psychiatric conditions.
  • higher prevalence of suicide and self-harm compared to 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 Middlesbrough.

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, fuel poverty, raising literacy and educational attainment
Summary authors

Heidi Douglas
Specialty Registrar Public Health
Middlesbrough Borough Council

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