Adults

This section of the JSNA looks at the needs of adults in Stockton-on-Tees.  Separate sections of the JSNA describe the needs of young adults in transition between services for children/ young people and adults, and the needs of older people (those aged 50 and over).  Inevitably, there is some overlap between the needs of these groups and those of adults in general. This section cover issues principally affecting adults aged 18-65, plus those issues which are common to all adults in Stockton-on-Tees, including young adults and/or older people.  It brings together the major issues facing this population age group from the JSNA topics in the Vulnerable groups, Wider determinants, Behaviour and lifestyle and Illness and death themes.

 

Last updated: 2016-01-27 11:34:02
[+] Expand all

1. What are the key issues?

Securing sustainable improvements in the future health and wellbeing of adults who live in Stockton-on-Tees will need to go beyond simply targeting interventions at adults in the most deprived geographical areas.  A more sophisticated, personalised approach that seeks to identify individuals and groups with the greatest potential to improve their health and wellbeing, wherever they live, may provide the most sustainable and equitable way to secure improvements in health and wellbeing for Stockton-on-Tees as a whole.

The key issues for commissioners in developing this approach include:

  • There is a range of wider determinants of health and environmental factors (both geographical and non-geographical) which contribute to poor health and wellbeing for adults in Stockton-on-Tees.
  • Relatively low proportions of adults currently making lifestyle choices which will contribute to improving their personal health and wellbeing
  • The system of care and support in place for adults should be improved to increased equity and overall improvements in the health and well-being of the population.


The priorities for this more personalised approach should be on a small number of issues which:

  • Have an impact on the lives of large numbers of adults in Stockton;
  • Act as indicators of other potential risks to health and wellbeing which can be tackled through additional interventions;
  • Are already recognised as important by adults in the borough.

Obesity and the impact of the economic downturn on household incomes are two such issues and are the problems around which the recommendations in this section are centred.

 

Last updated: 23/05/14

2. What commissioning priorities are recommended?

2012/01
Tackle environmental factors
by:
a) Making universal services responsive and accessible
Ensure that services provided for all Stockton residents (libraries, leisure facilities, environmental services, etc.) are responsive to the needs of users and potential users, and are accessible to all, including those in vulnerable groups.
b) Managing the impact of economic downturn on individuals
Continue to invest in work to recognise and tackle sources of social exclusion - not just focusing on adults in deprived areas, but looking to identify other groups and ‘communities of need’ at risk of exclusion, especially those for whom economic downturn has an adverse impact on household incomes (adults dependent on benefits, the newly unemployed, etc.).
c) Building community resilience
Ensure that the most deprived areas of Stockton are supported to build social capital, but also work to build the resilience of all areas to the potential impact of economic downturn on worklessness, incomes, lifestyles and future aspirations.

2012/02
Support adults to make healthy choices
by:
a) Targeting promotion of healthy lifestyles

  • Identify those at risk of future health problems.
  • Target work to promote healthy lifestyles towards those people where the greatest potential health gain can be made.
  • Target adults aged over 50 years to support healthy lifestyles for the future, aimed at reducing the incidence of health problems in older adults.
  • Provide targeted support for parents to encourage healthy lifestyles for themselves and their children.

b) Encouraging adults to access health and wellbeing services early

  • Continue to promote early identification of potential health and wellbeing issues, including:
    • Encouraging self-care and responsibility;
    • Ensuring local advice and support is available and accessible (for example, pharmacy advice, debt advice, benefits checks, home equipment for those with disabilities, annual health checks in primary care for people with learning disabilities), to reduce subsequent need for more intensive support;
    • Developing services to support early diagnosis, targeted at groups where early access has traditionally been low including, for example, men, some ethnic minority groups and young people.
  • Ensure that people who access services early are supported to minimise their subsequent need for services, helping to reduce unplanned demand.

2012/03
Develop the care and support system
by:
a) Reducing unplanned care and support needs

  • Use the information gathered from people accessing services early to take a proactive approach to continuing needs, thus reducing unplanned demand.
  • Develop services to prevent or minimise the impact of crises and reduce the incidence of emergencies requiring more intensive support, including:
    • Support for newly unemployed people on healthy lifestyles and accessing community services;
    • Advice to prevent unsafe working and accidents;
    • Low-level mental health support targeted at people at risk of self-harm;
    • Co-ordinated care packages to support adults with complex needs.

b) Increasing equity in the care and support system

  • Remove any barriers to accessing care and support services on the basis of factors other than need.
  • Encourage and support adults in vulnerable groups to access mainstream services, and encourage and support providers of mainstream services to welcome people from vulnerable groups.

c) Increasing the level of personalised care and support

  • Ensure that adults with disabilities and/or complex needs are supported to exercise choice in planning care and support.


 

Last updated: 23/05/14

3. Who is at risk and why?

Age
The prevalence of long-term illness increases with age.  Over half of people aged over 65 years in Stockton-on-Tees currently suffer from at least one long-term illness. They are also the main users of health and social care services.  In the working age population, long-term illness and service use are likely to be more common at older ages.

Gender
Men are less likely to access health or healthy lifestyle services or perform self-examination. Their life expectancy is generally shorter compared with women.

Women are significantly less physically fit than men, and fitness decreases significantly with age. The decline is steepest for men, although more males are physically fit in every age group.

Socioeconomic status
There is a strong link between levels of deprivation and health outcomes. Adults who live in the most deprived areas are more likely to die early, to experience in ill-health such as coronary heart disease and to have unhealthy lifestyles including higher rates of smoking, obesity and binge drinking.

The prevailing economic climate means pressure on household incomes is likely to be experienced throughout the population, with associated risks to physical and mental health and wellbeing.  While average incomes may remain higher in less deprived areas, the impact of changes in adults’ income relative to their past experience, or relative to those of neighbours in the immediate area, may carry its own risk in terms of its impact on the wellbeing of individuals and their families.

Ethnicity
Adults from the black and minority ethnic communities are less likely to access services due to cultural and language barriers and more likely to experience health inequalities. They face more barriers to job seeking.

Disability
Adults with learning disabilities have an increased risk of premature death compared to the general population and often experience barriers in accessing services, which will impact on their health and wellbeing.

Adults with physical disabilities are more prone to mental health problems due to the problems they face as a result of their disability and the barriers caused by society.

Offenders
Adults in contact with the criminal justice system are more likely to be socially excluded and experience high levels of health inequalities. They are more likely to suffer from mental health problems and learning disabilities, and to have problems with drugs and/or alcohol. The link between offending, reoffending and wider factors, including health, is widely recognised.

Identification of people at risk
The current increased focus on prevention, early intervention and personalisation means that identifying people at risk of future ill health will become central to the ability of commissioners to develop a system that will support local people to make healthy choices and take responsibility for their own health and wellbeing. Data on lifestyles is in its infancy, but early modelling work suggests that the areas with the lowest levels of deprivation do not always exhibit the highest prevalence of healthy lifestyle choices. These choices will in turn have an impact on the level of future risks in the population to health and wellbeing.

In considering a more individualised approach to identifying which adults may be at risk, two groups are highlighted:

  • Those at risk of experiencing a crisis event in the short-term which will have an impact on their need for care and support.
  • Those at risk of developing health problems in the longer-term due to their lifestyle, existing health status and/or demographic status.

 

Short-term crises
Adults with existing poor health or leading unhealthy lifestyles are more likely to experience a health crisis requiring intervention, treatment or support. In some cases their families are also at increased risk of a crisis event. For example:

  • Smoking, obesity or binge drinking increase the risk of heart attack.
  • Adults with diabetes have an increased risk of stroke.
  • Adults who misuse alcohol are proportionately more likely to become perpetrators of domestic abuse than the general adult population.
  • Adults with dementia have an increased risk of unscheduled admission to hospital.
     

Some of these adults are known to services before the onset of the crisis, but a substantial proportion of people at short-term risk of a health crisis are not. Identifying those at short-term risk will always present problems to services, but the development of a culture which supports self-care, early access to diagnosis and tests, and a non-stigmatised approach to seeking help will in turn support the identification of short-term risk.

Assessing the level of crisis events relating to economic factors is not straightforward, but research suggests a relationship between the onset of worklessness or economic hardship and health issues (Health Development Agency, 2005; Levecque et al, 2011; Solantaus et al, 2004):

  • There is a positive association between mortality and unemployment for all age groups, with suicide increasing within a year of job loss
  • During the anticipation and termination phase of factory closure, illness and health service use increase, the rate of hospital admissions doubles and conditions such as cardiovascular disease and higher blood pressure increase.
  • There is evidence to suggest a strong association between unemployment and depression. The link is stronger for younger adults, women, more highly qualified people, and people living alone. Upon re-employment, there appears to be a reversal of these effects.
  • Unemployment is considered to be a significant cause of psychological distress in itself.
  • There is an estimated 20% excess risk of death for both men actively seeking work and their wives, with the possibility that this may be higher still in areas of higher unemployment.
  • A reduction in family income increases the risk of children in the family developing mental health problems.
     


Long-term health risks
The links between lifestyle, health status and on-going health needs are complex.  Supporting adults to make and sustain healthy lifestyle choices for their long-term benefit is a key role of the health system.  The transition of responsibility for Public Health from NHS to local authorities provides an opportunity to refresh and relaunch work on supporting healthy lifestyles and to build on Stockton’s strong record of working in partnership to deliver support across the system.

Obesity provides an example of one factor with an impact on long-term health, and with complex links to other factors. For example:

  • 29% of obese men and 36% of obese women have a limiting long-term illness (compared to 16% and 17% of those with a healthy weight) (DH, 2008).
  • Obese adults are at increased risk of some cancers, cardiovascular disease and diabetes.
  • People in a range of vulnerable groups (for example, those with learning disabilities, minority ethnic groups, and those in areas with the highest levels of deprivation) are proportionately more likely to be obese.
  • There is a link between adult obesity and child obesity. The link is in two directions: children of obese parents are more likely to be obese themselves, and obese children are more likely to become obese adults in the future.  Maternal obesity presents additional health risks to the mother and child

 

Links between economically deprived communities and levels of long-term illness are well established, but there is additional evidence of links between individual economic hardship/ worklessness and the risk of developing long-term health conditions.  The impact of worklessness on physical and mental health does not appear to be related to the duration of the period of worklessness, and re-employment appears to reverse some of the effects of worklessness on psychological and psychiatric morbidity.  However, worklessness is one of a range of factors (such as eligibility for benefits) which does have an impact on household incomes and the incidence of poverty, and these are correlated with poor health and wellbeing. (HDA, 2005).  There is a positive association between mortality and unemployment for all age groups, with suicide increasing within a year of job loss, and cardiovascular mortality accelerating after two or three years and continuing for the next 10-15 years.

The incidence of long-term illness increases with age.  Reducing the incidence of long-term ill health or increasing the age of onset, through prevention or early intervention strategies, will reduce the overall ‘burden of ill health’ in Stockton-on-Tees and the effects of long-term ill health on wellbeing, service use, and the level of complexity.

 

Last updated: 23/05/14

4. What is the level of need in the population?

In 2010 there were 155,200 adults (aged over 16) in Stockton-on-Tees. Of these, 29,800 (19%) were aged over 65 (ONS, 2011).  This means that there are around 125,000 people of working age in Stockton-on-Tees, some 65% of the population.

Needs in the adult population range from the universal (environmental health, access to primary care) to the highly specific (support for complex health conditions or for relatively small groups such as ex-service personnel).

The 2010 Stockton-on-Tees Health Profile showed 21.8% of adults have a healthy diet compared to the England average of 28.7%. Only 12.3% of adults achieved the recommended levels of physical activity, with over 135,000 adults in Stockton-on-Tees not participate in levels of physical activity that benefit their health. There is a need to increase healthy lifestyles. Evidence suggests that unhealthy lifestyles are independently associated with all-cause mortality, type 2 diabetes and some types of cancer.

In Stockton-on-Tees the estimated prevalence of diabetes is 7.0%, but only 5.0% of the population has been diagnosed with diabetes.  It is likely that over 3,000 people with diabetes remain undiagnosed.

Stockton-on-Tees has higher proportions of individuals drinking at increased risk levels when compared to the region and nationally. Analysis from the alcohol needs assessment has highlighted the following trends: 20-29 year age group are most likely to present in arrest referral; 35-39 year age group are most represented with ambulance data; 40-49 year age group are most likely to access treatment services; and the 40-49 year group were also most commonly observed within secondary care. It was also identified that the most common age group for those receiving a detoxification from alcohol in HMP Holme House was the 31-40 year olds.

The DAAT Needs Assessment 2010/2011 identified that the majority of those in the drug treatment services were aged between 20 and 44 years old. Consideration should therefore be given to the likely health needs of an aging drug using population, such as increased prevalence’s of circulatory and vascular conditions and long-term poor nutrition.


Life expectancy and deprivation
In general, the health and wellbeing of adults in Stockton-on-Tees is poorer than that of adults in England as a whole.  Stockton-on-Tees performs poorly compared to the England average against many, but not all, of the key indicators of health and wellbeing.  For example:

  • Life expectancy for a man living in Stockton-on-Tees is 1.4 years lower than the England average (76.9 years v 78.3 years).
  • Life expectancy for a woman living in Stockton-on-Tees is 1.1 years lower than the England average (81.2 years v 82.3 years).
  • 27.2% of the population of Stockton-on-Tees lives in the 20% most deprived areas of England, compared to 19.9% of the total England population and 32.7% of the North East regional population.
  • All-cause mortality in 2006-2010 for adults aged under 75 was 18.3% higher in Stockton-on-Tees than the England average.
  • Over half of people aged over 65 years in Stockton-on-Tees have at least one limiting long-term illness.

(sources: Stockton-on-Tees Health Profile (DH, 2011), POPPI (2012))

Health status and lifestyle choices

  • The rate of early death from cancer is 17% higher in Stockton-on-Tees than the England average (131.0 v 112.1 deaths per 100,000 population)
  • The rate of early death from heart disease and stroke is 11% higher in Stockton-on-Tees than the England average (78.2 v 70.5 deaths per 100,000 population)
  • Assuming average England prevalence applies in Stockton-on-Tees, over 19,000 adults aged 18-64 have one or more common mental health disorder.  Mental health needs in Stockton-on-Tees are higher than the national average and the promotion and development of good mental health is essential to the human, social and economic development of the borough.
  • 27.7% of adults in Stockton-on-Tees are obese compared to 24.2% in England as a whole.

 

Economic issues

 

Last updated: 23/05/14

5. What services are currently provided?

Universal services – available to all

  • NHS healthcare
  • Health promotion (smoking cessation, health advice etc.)
  • Leisure services (sport, arts, libraries etc.)
  • Adult education
  • Benefits advice and some universal benefits (for example, child benefit)
  • Environmental services (roads, green spaces, waste disposal, street cleaning etc.)

Targeted – available to individuals or communities meeting specific criteria

  • Employment support/ jobseekers’ services
  • Benefits (tax credits etc)
  • Support for families (Sure Start centres, after school clubs, etc)
  • NHS healthcare
  • Community development
  • Economic development
  • Supporting diversity (translation, targeted health intervention etc)

Specialist ongoing support

  • Personalised packages of health and/or social care for people with complex needs, living at home or in a care home

  

Last updated: 23/05/14

6. What is the projected level of need?

Overall, the adult population of Stockton is not projected to increase significantly in the next 5 years, with the only marked change being a decline in the 18-24 age group.

The number of older people with diagnosed depression or dementia currently stands at 5,500 and will be over 6,000 in the next three years.

Obesity prevalence is forecast to rise with consequent increases in the incidence of disease attributable to obesity.

The impact of changes in the overall UK economy in the next few years due to the economic downturn and planned changes to benefits is likely to be intensified in Stockton-on-Tees, with consequent risks to the health and wellbeing of a significant proportion of the adult population.

While detailed projections are not available, current trend data suggest that economy-related crisis events are at a higher level in Stockton-on-Tees (as well as in the country) now compared with previous periods.

The chart below shows the rate of individual insolvencies in Stockton-on-Tees from 2000 to 2009. The rate has increased from 7.6 per 10,000 adults in 2000 to 32.1 per 10,000 adults in 2009 and now exceeds the England and Wales average for the first time (source: Insolvency Service).

Rate of insolvencies, Stockton

New claims of income related benefits for less than 6 months, i.e. those starting to receive benefits within the past 6 months, have also increased over time.

 

Last updated: 23/05/14

7. What needs might be unmet?

Future needs of adults affected by economic hardship, including those outside existing communities identified as deprived include:

  • Supporting the physical and mental wellbeing of people newly affected by economic hardship.
  • Ensuring that universal services are sensitive to the needs of people affected by economic hardship.
  • Working on environmental factors to build resilience of groups and communities most at risk from the economic downturn.
  • A range of good quality affordable housing.
  • Need for sufficiently paid employment, opportunities for education & training and opportunities for volunteering.

There is a need to support more adults in Stockton-on-Tees to make healthy lifestyle choices with an impact on their long-term health and wellbeing through:

  • Preventative advice and support for people at risk.
  • Sustained co-ordination of services to share information and facilitate connections between lifestyle choices and adults’ health and wellbeing (for example, by linking work on binge drinking, food poverty, income deprivation, etc. to assess the impact on obesity).
  • Targeted weight management services.
  • Capacity building with frontline staff to make every contact count.
  • Need to maximise approaches to utilise the social capital within communities to improve health and wellbeing and reduce health inequalities.

 

Last updated: 23/05/14

8. What evidence is there for effective intervention?

Institute of Health Equity (2010). Fair Society, Healthy Lives (the Marmot report)
An independent review to propose the most effective evidence-based strategies for reducing health inequalities in England.

NICE (2005). Worklessness and health - what do we know about the causal relationship? Evidence review.
Review of evidence of the causal relationship between worklessness and health

National Obesity Observatory (2010). Tackling Adult Obesity Through Lifestyle Change Interventions: A briefing paper for commissioners.
A brief guide to current best available evidence on the effective treatment of obesity through lifestyle change interventions for adults who are overweight or obese

Department of Health (2011). Mental health promotion and mental illness prevention: The economic case.
Findings of a project on the economic case for mental health promotion and prevention, based on a detailed analysis of costs and benefits for fifteen different interventions.

 

Last updated: 23/05/14

9. What do people say?

In the Stockton-on-Tees Adult Viewpoint survey conducted in January 2012, ‘healthy lifestyles’ was identified as the most important strategic action to improve the health and wellbeing of both adults and children.

Being overweight, and the need to lose weight / improve one’s diet, were both identified as ‘top 5’ issues by adults: young people identified the need to improve their diet.

The impact of the credit crunch was identified as an area of concern by adults, although the impact of this on their health and wellbeing had yet to be felt (or recognised).

Adults were aware of risks connecting obesity to some other health issues such as the incidence of diabetes and heart disease, but not others (for example, cancer), and made links between lifestyle choices, such as alcohol consumption and obesity.

 

Last updated: 23/05/14

10. What additional needs assessment is required?

Linkages between obesity and other lifestyle risk factors.

Current and projected future need for support due to economic hardship and/or worklessness in Stockton-on-Tees.

 

Last updated: 23/05/14

Key contact

Topic lead

Name: Liz Hanley

Job Title: Adult Services Lead

e-mail: liz.hanley@stockton.gov.uk

phone:

Topic author

Name: Lucy O'Leary

Job Title:

e-mail: lucyoleary@btinternet.com

References

Local strategies and plans

Stockton-on-Tees Borough Council (2012). Stockton-on-Tees Joint Health and Wellbeing Strategy 2012-2018
Stockton-on-Tees Borough Council (2012). Stockton-on-Tees Sustainable Community Strategy 2012-2021.
Stockton-on-Tees Borough Council (2012). Stockton-on-Tees Council Plan 2012-2015.
Stockton-on-Tees Borough Council (2009). The Vision for Adults: A Strategy for Adult Health & Care Services in Stockton-on-Tees 2009-2014.

National strategies and plans

Department of Health (2011) Mental health promotion and mental illness prevention: The economic case.
Institute of Health Equity (2010) Fair Society, Healthy Lives (the Marmot report).
NICE (2005) Worklessness and health - what do we know about the causal relationship? Evidence review.

Other references

Health Development Agency (2005). Worklessness and health - what do we know about the causal relationship? Evidence review.
Levecqu, K; Van Rossem, R; De Boyser, K et al (2011). Economic hardship and depression across the life course: the impact of welfare state regimes. Journal of Health and Social Behavior 52 (2) 262-276.
National Obesity Observatory (2010) Tackling Adult Obesity Through Lifestyle Change Interventions: A briefing paper for commissioners.
Solantaus, T; Leinonen, J; Punam Ki, R-L (2004).  Children's mental health in times of economic recession: replication and extension of the Family Economic Stress Model in Finland. Developmental Psychology, 40 (3) 412-429/