Illness and Death

Radiotherapy

Premature deaths in Redcar & Cleveland

Life expectancy in Redcar & Cleveland continues to improve.  However, latest reports show that the gaps in life expectancy between the deprived and affluent areas within Redcar & Cleveland, and between Redcar & Cleveland 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 Redcar & Cleveland. The gap in life expectancy has widened for males from 13.1 years in 2006-10 to 19.3 years in 2009-11.  For females, the gap has also widened from 8.4 years in 2006-2010, to 12.3 in 2009-2011

The major causes of illness and premature deaths (deaths before age 75 years) in Redcar & Cleveland 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 Redcar & Cleveland and England and for the also gap between deprived and affluent areas within Redcar & Cleveland.

Life expectancy gap between R&C and England, 2009-11

Life expectancy gap between affluent and deprived areas of R&C, 2009-11

To reduce premature mortality in Redcar & Cleveland, 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 Redcar & Cleveland and the regional and national averages.

Premature mortality differences, R&C, North East and England, various dates

Long-term conditions, cancer and mental health in Redcar & Cleveland

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 and respiratory disease. Premature deaths from cancer in Redcar & Cleveland remain significantly higher than the England average and are the largest contributor to local health inequalities in Redcar & Cleveland. Breast, lung, colorectal and prostate cancer account for over half of all cancer cases and deaths. Lung cancer incidence and mortality in Redcar & Cleveland is statistically significantly higher than the national average for males and females.

Many outcomes for babies, children and young people remain poor. Infant mortality rates continue to improve and have been lower than the national average in recent years (although the difference is not statistically significant). Hospital admissions for injuries in those aged under 18 are higher than North East and England averages.

There are higher levels of mental illness, 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.

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 Redcar & Cleveland.

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 improving 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 Author

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service
leon.green@tees.nhs.uk