Director of Public Health Annual Report 2018: Healthy places

Buckinghamshire residents are some of the healthiest in the country. Life expectancy has increased by 3.9 years and 3.0 years for men and women respectively between 2001-03 and 2014-16. Life expectancy now stands at 81.9 years for men and 84.9 years for women. However, not all these extra years are lived in good health. Too many of our residents are living with potentially avoidable ill health and disability and not all residents enjoy the same levels of good health. On average men in Buckinghamshire can expect to live in good health until 69.4 years of age and women until they are 70.3 years - a gap between life expectancy and healthy life expectancy of approximately 12.5 years for men and 14.6 years for women.

Certain groups in Buckinghamshire also have poorer health. The fifth of the population living in the most deprived areas of Buckinghamshire have worse health across a wide range of measures than the rest of Buckinghamshire. Men in the most deprived fifth die 5.2 years earlier and women die 4.7 years earlier than those in the least deprived fifth. The contrast is even greater when average life expectancy within each ward is compared. Life expectancy for men living in Gatehouse ward (74.5 years) is nearly 12 years shorter than men living in Cholesbury, The Lee and Bellingdon ward (86.4 years). Life expectancy for women living in Riverside ward (79.4 years) is 16 years shorter than women living in Greater Marlow ward (95.4 years).

Early deaths from conditions that are considered preventable are significantly lower in Buckinghamshire than the national average at 132.5 deaths per 100,000 in 2014-16. However, this still accounts for approximately 670 deaths per year and premature mortality from conditions considered preventable is almost 60% higher for men than for women.

Many of the commonest causes of death, illness and disability in Buckinghamshire are from long term conditions such as heart disease, diabetes, cancer, strokes and dementia. These account for 70% of spending on NHS and social care and affect large numbers of people. However, a significant proportion of these are preventable and are linked to how we live our lives. For example, a poor diet increases the risk of a wide range of conditions including obesity, diabetes, heart disease, stroke, some cancers and dementia. It is estimated in the South East of England poor diet accounts for nearly 70% of disability and early death from heart disease, contributes to nearly half of disability and early death due to diabetes and more than a third of early death and disability caused by stroke. Low levels of physical activity also contribute to rising levels of obesity and increase the risk of many long term conditions and musculoskeletal problems.

Adopting healthy lifestyles reduces the risk of many of these conditions and it has been found that living a healthy life in middle age reduces the likelihood of developing dementia, disability and frailty. The environment and communities in which we live profoundly influence how easy it is to live healthily and the choices we make.

Good mental health is a vital resource for life as well as an important driver of physical health.

It is estimated that one in eight men (12.5%) and nearly one in every five women (19.7%) in Buckinghamshire have a common mental health disorder such as anxiety or depression.

Across the South East, nearly one in seven adults surveyed experienced symptoms of a common mental health disorder in the preceding week.

People with poor mental health also have poorer physical health. Loneliness and social isolation are increasingly recognised as raising the risk of developing depression, anxiety and dementia, heart disease, stroke and early death. National estimates suggest that 1 in 20 people feel lonely often or all the time but the highest reported rate is found in 16-24 year olds.

We do not have local data on loneliness and social isolation for the general population but nearly half of adult social care users in Bucks state that they have as much social contact as they would like (45.1%). This is slightly lower than the proportion across the South East (46.6%) and England (45.4%). The proportion of adult carers in Bucks who have as much social contact as they would like is lower at approximately one in three (30.8%). This is significantly lower than the proportion nationally (35.5%).

Children and young people (under 20 years of age) make up a quarter (25.0%) of the Buckinghamshire population, and 23.7% in England. Although children and young people in Bucks tend to be healthier than the national average there is no room for complacency as UK children’s health outcomes are worse than those in most other wealthy European countries. Low levels of physical activity and unhealthy eating in our children and young people is resulting in overweight and obesity that can lead to poorer physical and mental health.

Only 16% of girls and 23% of boys aged 5-15 years, in the South East of England are reported to achieve the recommended levels of physical activity. Levels of overweight and obesity among children in reception year and year six are 18% and 27% respectively. This is equivalent to nearly 1100 children in reception year and nearly 1400 children in year 6 who are overweight or obese. Approximately 1% (0.98%) of reception year and 1.4% children in year 6 are underweight.

There are also rising concerns around children’s and young people’s mental health and wellbeing. Recent national estimates suggest that one in ten children has a clinically diagnosable mental health disorder. In Buckinghamshire, the estimate is slightly lower at 7.9% (or slightly more than one in 13 children aged 5-16 years). In 2016/17, there were 329 hospital admissions for self-harm per 100,000 children and young people aged 10-24 years. This is significantly lower than the rate nationally (405 per 100,000).

Children and young people are particularly vulnerable to threats to health from before they are born and as they grow up. Adverse environments can result in low birth weight and poorer development and poorer physical and mental health. Children are particularly vulnerable to poor housing conditions, air and noise pollution, extreme temperatures and lack of safe spaces to play and be active. The communities and surroundings in which they live influence whether they will adopt healthy or harmful behaviours and these behaviours will then tend to stay with them throughout life.

Investing in child health reaps impressive economic rewards with each pound spent returning more than £10 to society over a lifetime. Poor health in childhood leads to reduced workforce participation and productivity and lower national wealth.

In 2016, the population of Bucks had a similar age profile to that in England except there was a smaller proportion aged 20-34 years in Bucks (16.2%) than in England (20.1%), and a larger proportion aged 40- 59 years in Bucks (28.6%) than in England (26.5%).

For older people, Bucks and England have similar age profiles, with 18.3% (Bucks) and 17.9% (England) of the population aged at least 65 years, and 2.5% (Bucks) and 2.4% (England) for those aged at least 85 years.

Buckinghamshire is expecting to see significant growth over the coming years. Based on projections for births, deaths and migration as well as an estimated 45,000 new homes being built between 2015 and 2039, the population of Buckinghamshire is estimated to increase by 100,000 people between 2015 and 2039.

This will mean that the population of Buckinghamshire will reach approximately 635,000 by 2039. The age profile in Buckinghamshire is also set to change over the next 20-25 years. The number of children aged 0-4 years and 5-9 years is estimated to increase by 1368 (4%) and 1165 (3%) respectively between 2016 and 2039. Over the same time period, the number of people aged 65 years and over is estimated to increase by nearly 60,000 people (60%). The largest percentage increase will be seen among the over 85 year old age group, increasing from 13,578 to 33,700 (a 148% increase between 2016 and 2039). The working age population (aged 16-65 years) is estimated to remain relatively stable, increasing by less than 16,000 (6%) between 2016 and 2039.

Although some health related behaviours have improved (e.g. levels of smoking over the last decade), others behaviours have not. The UK has the highest prevalence of obesity in Western Europe and obesity levels have increased from 15% in 1993 to 27% in 2015, the fastest rise in any developed nation. More than 7 in 10 millennials (those born between early 80s and mid 90s) are set to be overweight or obese by the age of 35-44 on current trends and are on track to be the most obese generation since records began with consequent adverse impacts on their health and their risk of developing a range of long term conditions. This compares to 5 in 10 baby boomers (born 1945-55).

The rise in the older population will increase the numbers of people living with long term conditions and disability unless we age more healthily. The number of cases of dementia is expected to increase significantly across the county, doubling by 2050. However the good news is that living a healthy life in middle age (not smoking, a healthy diet, being physically active, maintaining a healthy weight and not drinking alcohol above recommended limits) can lead to healthier ageing reducing the risk of disability, dementia and frailty. We need to ensure that the environments in which we live make healthy choices the easy choices.

Other factors that can adversely impact on our health could include weakening of social ties in our communities, increased pollution levels and increases in extreme weather.

In 2016, the population of Bucks had a similar age profile to that in England except there was a smaller proportion aged 20-34 years in Bucks (16.2%) than in England (20.1%), and a larger proportion aged 40- 59 years in Bucks (28.6%) than in England (26.5%).

For older people, Bucks and England have similar age profiles, with 18.3% (Bucks) and 17.9% (England) of the population aged at least 65 years, and 2.5% (Bucks) and 2.4% (England) for those aged at least 85 years.

Buckinghamshire is expecting to see significant growth over the coming years. Based on projections for births, deaths and migration as well as an estimated 45,000 new homes being built between 2015 and 2039, the population of Buckinghamshire is estimated to increase by 100,000 people between 2015 and 2039. This will mean that the population of Buckinghamshire will reach approximately 635,000 by 2039.

The age profile in Buckinghamshire is also set to change over the next 20-25 years. The number of children aged 0-4 years and 5-9 years is estimated to increase by 1368 (4%) and 1165 (3%) respectively between 2016 and 2039. Over the same time period, the number of people aged 65 years and over is estimated to increase by nearly 60,000 people (60%). The largest percentage increase will be seen among the over 85 year old age group, increasing from 13,578 to 33,700 (a 148% increase between 2016 and 2039). The working age population (aged 16-65 years) is estimated to remain relatively stable, increasing by less than 16,000 (6%) between 2016 and 2039.

We know that the places and communities in which people grow up, learn, live, work, play and age can influence child development, educational attainment, mental and physical health and how well people age. It also influences the friendliness of neighbourhoods and how included people feel, crime and fear of crime and economic productivity.

This in turn influences demand on health and social care services and other public sector services. This report focuses on the health and wellbeing benefits of living in a good place.

The World Health Organisation defines a ‘Healthy City’ as one that supports health, recreation and wellbeing, safety, social interaction, easy mobility, a sense of pride and cultural identity and is accessible to the needs of all citizens. The same aspiration could be applied to towns and villages throughout Buckinghamshire.

This report highlights key areas impacting on health and wellbeing:

• Community life
• Housing, land use and inclusive design
• Healthy travel
• Air and noise pollution
• Natural environment and green spaces
• Access to healthy food