CLOSING THE GAP TACKLING HEALTH INEQUALITIES IN ISLINGTON 2010 – 2030
Fish mosaic from Thornhill Bridge Community Gardens, Regents Canal, Caledonian Road, N1
Published June 2010 2
[3]
TACKLING HEALTH INEQUALITIES IN ISLINGTON 2010-2030 CONTENTS FOREWORD EXECUTIVE SUMMARY INTRODUCTION What are health inequalities? What are the determinants of health? Deprivation in Islington Life expectancy & deprivation
SECTION 1 SHORT TERM ACTIONS ON INEQUALITIES
4 5
6
6 7 8 10
PREVENTING EARLY DEATHS (2010–14)
16
The 2010 health inequalities target Cardiovascular disease Cancer Infant mortality Seasonal excess deaths
17 18 21 24 26
SECTION 2 MEDIUM TERM ACTIONS ON INEQUALITIES PROMOTING HEALTHY LIFESTYLES (2010–20)
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The impact of healthy lifestyles on health inequalities Tackling health inequalities Smoking Healthy eating Physical activity Mental health Alcohol Substance misuse Teenage pregnancy Sexual health
29 30 32 36 39 42 45 48 51 54
SECTION 3 LONG TERM ACTIONS ON INEQUALITIES
THE SOCIOECONOMIC DETERMINANTS OF HEALTH (2010–30)
58
The impact of the social determinants on health inequalities The Islington environment Economy & employment Housing Education & lifelong learning Community safety
59 60 62 65 68 71
SECTION 4 CONCLUSION AND RECOMMENDATIONS
74
SECTION 5 APPENDICES
76
Appendix 1 – Life expectancy by ward and slope index of deprivation Appendix 2 – Health Inequalities Strategy - Performance indicators
76 80 3
FOREWORD e are pleased to introduce the first Health Inequalities Strategy for Islington. This strategy has been developed in association with both local and national partners and in response to formal local consultation.
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The first draft of this strategy took a medium term approach to addressing health inequalities, focusing on promoting and developing healthy lifestyle behaviours. In response to consultation feedback and recommendations from the Health Inequalities National Support Team, we have further developed the strategy, bringing together short term actions that address the 2010 national health inequalities target, and medium to longer term actions focusing on lifestyle issues and, importantly, the wider determinants of health. This strategy is not intended to create new areas of work or increase the performance monitoring burden for partners. Rather, this strategy should be seen as an overarching framework that brings together key strategies and plans that are already underway to address health inequalities in Islington, together with the Joint Strategic Needs Assessment (JSNA). This programme of action cannot be delivered by one organisation alone. In Islington we are fortunate to work closely with a range of partners through the Islington Strategic Partnership. Many of our partner organisations are already improving the health of local people every day and we want to ensure that this strategy provides opportunities for us to work in a systematic way, ensuring that the most vulnerable people in Islington are getting the right services and that health inequalities are being addressed at every opportunity. We are committed to ensuring that local people are at the heart of all our work programmes and that everyone in Islington will benefit from this strategy. We will have both universal and targeted actions and ensure robust monitoring, to make sure our programmes are delivering on health improvement. We will achieve this through our many local strategies and policies and primarily through commissioning better services that deliver better outcomes for local people. The aim of this strategy, therefore is to outline our framework for tackling health inequalities. Throughout the sections we have adopted an approach where our services and programmes have the potential to benefit the whole population as well as targeted programmes to reach our most vulnerable communities at the right time.
Rachel Tyndall Chief Executive Officer NHS Islington 4
John Foster Chief Executive Officer Islington Council
EXECUTIVE SUMMARY
[5]
HS Islington and Islington Council have been working in partnership to improve the health and wellbeing of all Islington residents. Islington is a thriving inner city borough with a diverse population. However, there is a gap between the health of Islington residents and the national average. The health of the Islington population is improving, but not as fast as in other areas, and there are considerable variations in health outcomes experienced by people across the borough.
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Islington residents experience poorer physical and mental health that results in early deaths from cancer and circulatory diseases (heart disease and stroke). This is mainly because of deprivation across all Islington wards coupled with unhealthy lifestyle choices and poor access to the right services at the right time.
Deprivation and health inequalities are inextricably linked and deprivation stands out as the main risk factor for early death and poor health in Islington. Islington is the eighth most deprived borough in England and fourth in London. Health inequalities in Islington are stubborn and because of the diffuse nature and spread of deprivation, a comprehensive systematic approach over the short, medium and long term is required. This strategy has been developed to confirm our commitment to reducing inequalities and improving health outcomes for the population as a whole as well as the communities in Islington with the greatest health need. To achieve this, our approach is to prevent early deaths in the short term, promote healthy lifestyles over the medium term, and tackle the socioeconomic determinants in the longer term. We look forward to working with our partners to implement this Health Inequalities Strategy and to improve health outcomes for all our residents.
Regents Canal, Colebrooke Row, N1.
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INTRODUCTION What are health inequalities? ealth inequalities are described as the differences in health status between different groups or communities within the population1. At both community and individual level, poor health is linked to social and economic disadvantage and deprivation. Differences in income, employment, education, housing, social environment and access to services all produce inequalities in health outcome. Living in areas of low income, poor employment and poor infrastructure increases the risk of ill health above and beyond factors on an individual level2.
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Within communities, individuals experience different health outcomes depending on social status (Figure 1). For example, employed routine and manual workers have worse health outcomes than employed white collar workers, with the long-term unemployed likely to experience even worse health outcomes. Different population groups also respond differently to the same public health intervention. Smokers from routine and manual groups who access the Islington Stop Smoking services are less likely to succeed at quitting successfully than smokers from higher socioeconomic groups, despite having the same desire to quit. Socioeconomic inequalities in health typically take the form of a ‘social gradient’, in which those in higher socioeconomic groups have better health and longer life expectancy than the groups below them3.
all cause mortality (per 1000 person yrs.)
Figure 1: Mortality over 25 years according to level in the occupational hierarchy. Whitehall study.
80 70 60 50 40 30 20 10 0
40-64 yrs
65-69 yrs Admin
Prof/Exec
70-89 yrs Clerical
Other
Source: Marmot & Shipley, 1996.
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1.
[online] Available from: www.who.int/hia/about/glos/en/index1.html [accessed 12 September 2009]
2.
Paper on ‘Tackling Health Inequalities’, 2006. [online] Available from: www.eurohealthnet.org Position [accessed 12 November 2009]
3.
[online] Available from:www.who.int/social_determinants/resources/interim_statement/csdh_interim_statement_inequity_ 07.pdf [accessed 10 November 2009]
INTRODUCTION
[7]
What are the determinants of health?
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ealth inequalities are influenced by many factors known as the determinants of health, all of which are interlinked. This is demonstrated in the “rainbow” model of health (Figure 2).
The determinants of health include: 1. Biological determinants such as age, gender, ethnicity. 2. Behavioural determinants such as smoking, alcohol consumption, diet, physical activity, and other lifestyle behaviours. 3. Psychosocial determinants such as stress, isolation, social exclusion and lack of social support. 4. Socioeconomic determinants such as the physical and social environment, including housing quality, the workplace and the wider urban and rural environment, as well as access to and the distribution of income and resources in society. Actions to address the wider socioeconomic determinants of health are highlighted in the recent Strategic Review of Health Inequalities in England Post 2010. Fair Society, Healthy Lives4.
Work environment
So c Ind i
Education
Unemployment
community ne d t an lifestyle f wo l al a ac du t ivi
s rk s or
Gen era l
ral, and env , cultu iron c i m me o Living and working on nt c e al conditions ic o
ns itio nd co
so
Figure 2: “Rainbow” model of health.
Water and sanitation
Health care services Agriculture and food production
Age, sex, and constitutional factors
Housing
Source: Dahlgren and Whitehead, 1991. 4.
Strategic Review of Health Inequalities in England Post 2010 (Marmot review) www.ucl.ac.uk/gheg/marmotreview/
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INTRODUCTION Deprivation in Islington slington is one of 70 Spearhead areas in England5, the eighth most deprived borough in England and the fourth most deprived borough in London6. Two thirds of Islington residents live in the 20% most deprived areas in England (Figure 3). In contrast to many Spearhead areas, wealth and poverty sit alongside one another, with no clear geographical boundaries, and people with very different characteristics living on the same street. Mosaic™ profiling (Map 1) shows that over 70% of Islington’s residents can be described by five dominant Mosaic™ types 7.
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Around 16% are singles and sharers living in converted Victorian houses (type G28), 16% are diverse home-sharers renting small flats in densely populated areas (type N62), 13% are owners in smart purpose built flats in prestige locations, many of which are new builds (type G31), 12% are renters in flats with a cosmopolitan mix (type N62), and 11% are city dwellers owning houses in older neighbourhoods (type G27). Of all Islington wards, Mildmay has the largest percentage of city dwellers owning houses in older neighbourhoods (type G28) (30%), while Tollington has the highest percentage of diverse home-sharers renting small flats in densely populated areas (type N62) (29%). Figure 3: Percentage of residents by Index of Multiple Deprivation (IMD) quintiles, Islington, London and England, 2007. 100
Quintile 1 - least deprived fifth Quintile 2 Quintile 3 Quintile 4 Quintile 5 - most deprived fifth
90
% resdidents
80 70
Residents Quintile Residents Number % 1 0,0 0 2 0,0 0 3 2,7 5,034 4 31,9 58.671 5 65,4 120.225 All 100,0 183.930
60 50 40 30 20 10 0
England
London
Islington
Islington
Source: APHO Islington Health Profile, 2009.
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5.
These are the 70 local authority areas in the bottom fifth of districts nationally for three or more of the following five indicators: Male life expectancy at birth Female life expectancy at birth Cancer mortality rate in under 75s Cardiovascular disease mortality rate in under 75s; and Index of Multiple Deprivation 2004 average score.
6.
The IMD 2007 contains seven domains of deprivation: 1) income deprivation, 2) employment deprivation, 3) health and disability deprivation, 4) education, skills and training deprivation, 5) barriers to housing and services, 6) living environment deprivation, 7) crime
7.
Geodemographic tool which classifies the UK population into 15 lifestyle groups and 69 types based on different characteristics.
INTRODUCTION
[9]
Map 1: Geographical distribution of Mosaic™ types by postcode, Islington 2008.
Source: Experian, Mosaic™, 2008, analysis by NHS Islington Public Health Intelligence.
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INTRODUCTION Life expectancy & deprivation here is a national target to reduce health inequalities by 2010, as measured by infant mortality and life expectancy at birth8. Life expectancy in Islington is lower than the national average. Men in Islington have the lowest life expectancy in London at 75.1 years, and women have the fourth lowest life expectancy, at 81.0 years. Although life expectancy in Islington is increasing, the gap between Islington and the rest of London and England is widening, as life expectancy is increasing elsewhere at a faster rate (Figure 4).
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Figure 4: Life expectancy at birth among men and women in Islington, London and England 88 1995-97 to 2006-08, with Islington plans for 2010-12 to 2014-16. Life expectancy (age, years)
86 84 82 80 78 76 74 72
en - Islington
en - London
en - England
omen - Islington
omen - London
omen - England
pro e ted figures - in line
2014-2016
2013-2015
2012-2014
2011-2013
2010-2012
2009-2011
2008-2010
2007-2009
2006-2008
2005-2007
2004-2006
2003-2005
2002-2004
2001-2003
2000-2002
1999-2001
1998-2000
1997-1999
1996-1998
Years
1995-1997
70
ith urrent plan
Source: ONS, 2009; projections by NHS Islington Public Health Intelligence.
There are differences in life expectancy within Islington, by ward and by deprivation level. Between 2003 and 2007 Clerkenwell had the highest for men at 77.8 years and Tollington had the lowest at 72.6 years, a difference of 5.2 years. For women, St George’s had the highest life expectancy at 82.5 years and Finsbury Park had the lowest at 78.1 years, a difference of 4.4 years9. (Appendix 1 – Table 1). There are further differences in life expectancy depending on deprivation level. This is measured using the slope index of inequalities, which gives the gap in life expectancy in number of years between the best-off and worst-off deciles (tenths of the population). For men in Islington, there was a difference of 6.7 years between the best-off and worst-off in 2004-08, while the equivalent figure was 4.4 years for women (Appendix 1 - Figures A & B, page 79). The main contributors to the gap in life expectancy between Islington and England are circulatory diseases and cancer (Figures 5 & 6), which together account for a large proportion of deaths before 75 years, that are potentially preventable.
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8.
Reduce health inequalities by 10% by 2010 as measured by infant mortality (from a 1997-99 baseline) and life expectancy at birth (from a 1995-97 baseline).
9.
Life Expectancy at Birth by wards in Islington, 2003-2007. NHS Information Centre, 2009. [online] Available from: http://nww. nchod.nhs.uk [accessed 2 November 2009]
INTRODUCTION
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Figure 5: Breakdown of life expectancy gap between Islington and England Spearhead Group by cause of death for men, 2006-08. 100% 90%
Percentage contribution tto the gap
Deaths under 28 days
80% Other
70% External Causes
60%
Infectious and parasitic diseases
50% 40%
All Digestive Diseases
30%
All Respiratory Diseases
20%
All Cancers
10%
All Circulatory Diseases
0%
Islington
England Spearhead Group
Source: Dept of Health, Health Inequalities Intervention Spearhead Tool, LHO, March 2010.
Figure 6: Breakdown of life expectancy gap between Islington and England Spearhead Group by cause of death for women, 2006-08.
100% eaths under 28 da s
Percentage contribution to the gap
90% ther
80% 70%
E ternal auses
60%
Infe tious and parasiti diseases
50% All igestive iseases
40% All Respirator
30%
iseases
All an ers
20% 10%
All ir ulator
iseases
0%
Islington
England Spearhead Group
Source: Dept of Health, Health Inequalities Intervention Spearhead Tool, LHO, March 2010.
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INTRODUCTION Death rates from cardiovascular disease, cancer, smoking-related diseases and mental health are all higher in Islington than the rest of the country. This is reflected in the high rates of illness and disease. The health of Islington residents is improving, but not as fast as we would like it to and it is not improving equally for all our residents. This strategy therefore sets out our key priorities and work programmes to tackle health inequalities, identified through the Joint Strategic Needs Assessment (JSNA) and NHS Islington’s Commissioning Strategy Plan.
Source: Ian Christie
The fundamental and deep-rooted causes of health inequalities mean they can only be addressed by working in partnership. This requires joined up working, shared vision and effective collaboration across all partners to tackle the root causes, especially poverty and deprivation.
Caledonian Road, N1
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INTRODUCTION
[13]
This strategy is divided into three sections. • Section one examines actions that contribute to the 2010 target as highlighted by the National Support Team. • Section two considers the major lifestyle behaviours that contribute to poor health and early deaths in Islington. • Section three examines the socioeconomic factors that have the greatest impact on poor health and health inequalities over the long term, as identified in Islington’s JSNA (2009/10) and in the recent Strategic Review of Health Inequalities in England post 201010.
Source: Ian Christie
Appendix two highlights the work programmes with performance indicators, to monitor progress on inequalities. This framework identifies the actions across all partners to improve health in the borough and will be monitored by the Islington Strategic Partnership, through the Local Area Agreement (LAA) process and sub groups.
St Mary’s Church, Upper Street, N1 10.
Strategic Review of Health inequalities in England post 2010. www.ucl.ac.uk/gheg/marmotreview/Documents
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INTRODUCTION
The NHS Islington vision In 2014 local people are healthier and live longer, living independently and participating in society. Local people know their voice is heard in how health services are provided. • There are more services delivered closer to people’s home • The quality is higher and the standards more consistent • Fewer practices provide a wide range of services • Targeted and tailored services are provided to particular groups in the population and those with specific needs • Hospitals only do what they do best
Source: NHS Islington Photo Library
• All local people have easy access to services and make choices about their care
Bingfield Primary Care Centre, Bingfield St, N1
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INTRODUCTION
[15]
Islington Sustainable Community Strategy vision for Islington 2020 is to: “Create a stronger, more sustainable community in which everyone has access to excellent services and is able to fulfil their potential.“ To achieve this vision for Islington, the strategy focuses on three key objectives: • Reducing poverty • Improving access for all
Source: NHS Islington Photo Library
• Realising everyone’s potential
Old Street, EC1
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SECTION 1
SHORT TERM ACTION ON INEQUALITIES PREVENTING EARLY DEATHS (2010-14)
THE 2010 HEALTH INEQUALITIES TARGET CARDIOVASCULAR DISEASE CANCER INFANT MORTALITY SEASONAL EXCESS DEATHS
16
SECTION 1
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The 2010 health inequalities target ackling health inequalities is a national priority. The overall national target on health inequalities was set in the Government’s 2001 Public Service Agreement11 (PSA) to:
T •
Reduce health inequalities by 10% by 2010 as measured by infant mortality (from a 1997-99 baseline) and life expectancy at birth (from a 1995-97 baseline)
Underlying this overall target, there are specific targets to reduce the difference in infant mortality between social classes and reduce the gap in life expectancy for men and women between the most deprived areas and the rest of the country: •
Starting with local authorities, by 2010 to reduce by at least 10 per cent the gap in life expectancy at birth between the fifth of areas with the worst health and deprivation indicators (the Spearhead Group) and the population as a whole
•
Starting with children under one year, by 2010 to reduce by at least 10 per cent the gap in mortality between the routine and manual group and the population as a whole
A recent Department of Health review on the progress of Spearhead local authorities 2010 target, shows that Islington is currently “off track” to meet the 2010 target. In May 2009 the Health Inequalities National Support Team visited Islington and made a series of recommendations on how to focus efforts to increase life expectancy in the short term. They identified four areas: 1. Cardiovascular Disease (CVD) – including secondary prevention of CVD and stroke 2. Cancers – early intervention, prevention, case finding and scaling up the tobacco control programme 3. Infant Mortality – in particular implementing national inequalities guidance on infant mortality 4. Seasonal Excess Deaths (SED) – focusing mainly on excess winter deaths Section one identifies action to prevent early deaths from CVD, Cancer, Infant Mortality and SED.
11.
Health Inequalities: Progress and Next Steps (2008). www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_085312.pdf
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CARDIOVASCULAR DISEASE
The NHS Hea lth Check pro gramme offe of routine he rs a range alth tests to p eople aged b and 74, who etween 40 do not have a diagnosis o disease. f vascular The checks in clude tests lik e, blood press weight measu ure, rement and b loods to check diabetes and for raised cholest erol. In Islington th e age range is 35 to 74 be of the divers cause e population a nd high leve deprivation. l of 18
[19]
CVD ardiovascular disease (CVD) is the major killer in Islington, accounting for 35% of all deaths in 2006-08 and 29% of deaths under the age of 75. Deaths from CVD are one of the biggest contributors to the inequalities gap in life expectancy between Islington and England (Figures 5 & 6, page 11). Although the death rate from CVD in Islington is decreasing, rates in London and England have been decreasing at a faster rate, leading to a widening of the gap (Figure 7).
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Figure 7: Age-standardised premature cardiovascular disease mortality in Islington, London & England, 1995-97 to 2006-08, with Islington plans for 2011-13 to 2014-16.
orttalit
250
ge stan ndardised pre ature e popula ation per
200
150
100
50
Islington
ondon
England
pro ected figures in line
14 2016
13 2015
12 2014
11 2013
2010 12
2009 11
2008 10
2007 09
2006 08
2005 07
2004 06
2003 05
2002 04
2001 03
2000 02
1999 01
1998 00
1997 99
1996 98
1995 97
0
ith current plan
Source: National Centre for Health Outcomes Development (NCHOD), 2009 (projections by NHS Islington, 2010).
In keeping with the rest of the country, more men in Islington die early from CVD than women. There are also inequalities among different ethnic groups, with South Asian and Irish groups more at risk of coronary heart disease and Black African and Caribbean groups more likely to die from stroke12. Local recording of CVD diagnosis in Islington suggests that prevalence is lower than would be expected for coronary heart disease, stroke, blood pressure and diabetes. This means that there are a large number of undiagnosed people in Islington, not receiving appropriate treatment and care. However, when compared with other areas, Islington’s population profile (age, gender, and ethnicity) and low levels of recorded CVD prevalence do not fully explain higher CVD in Islington.
12.
Public health annual report 2007, Reducing early deaths from Cardiovascular disease in Islington. P14.
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CARDIOVASCULAR DISEASE Lifestyle factors (smoking, unhealthy diet, differences in physical activity levels between routine and manual and non routine groups), linked with deprivation, explain most of the differences in CVD mortality between Islington compared with other areas, with deprivation standing out as the greatest risk factor13. Medium term actions to improve lifestyle behaviours such as reducing smoking, healthy eating and physical activity will have an impact on the cardiovascular health of the local population. In the short term, and in addition to lifestyle modifications, improving primary prevention, improved case finding and early diagnosis of CVD will also help reduce inequalities in CVD mortality. The NHS Health Check Programme is a national programme that assesses individuals’ risk of heart disease, stroke, diabetes and kidney disease and gives support and advice to reduce or manage that risk. By doing so it will improve primary prevention, case finding and early diagnosis. In the short term, general practices in Islington are targeting those thought to be at greatest risk of CVD. NHS Health Check in the community will focus on people who do not attend their GP frequently, as well as those who are not registered with a GP. The Health Inequalities National Support Team identified a number of other measures to reduce CVD inequalities in the borough, including improving practice records of patients who have established CVD or who are at high risk of CVD. This is being tackled through an enhanced service provided by general practices which includes monitoring and control of hypertension and cholesterol.
Key risk factors for CVD •
Undiagnosed CVD across the population
•
Lifestyle factors such as smoking, unhealthy diet, physical activity
•
High blood pressure and cholesterol
•
Deprivation
Short term priorities for action •
Prevention and population risk factor reduction (cholesterol, smoking and blood pressure)
•
Systematic management and monitoring of CVD disease and risk registers
•
Promote systems of medicines utilisation review for patients with CVD, and link with acute CVD management and CVD care pathways
•
Improvements in lifestyle behaviours, particularly smoking cessation and obesity management
•
Promote programmes to reduce Islington’s overall deprivation status
13. Public health annual report 2007, Reducing early deaths from Cardiovascular disease in Islington.
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[21]
Source: istockphoto.com
CANCER
A digital che st with a large X-ray of a male smoker tumour in th e right lung. The white are a represents th in the right lung e tumour. 21
CANCER
I
slington has the third highest death rate from cancer in London, and premature deaths from cancer are significantly higher in Islington than London and England (Figure 8).
The main lifestyle risk factors for cancer are: •
smoking and tobacco use,
•
poor diet and lack of physical activity,
•
alcohol, and
•
exposure to ultraviolet radiation (for example, sunbeds).
Figure 8: Age-standardised premature cancer mortality in Islington, London and England, 1995-97 to 2006-08, with Islington plans for 2011-13 to 2014-16.
ge stand dardised p pre ature cancer c per popula ation
ortalit o
250
200
150
100
50
Islington
ondon
England
pro ected figures in line
2014 16
2013 15
2012 14
2011 13
2010 12
2009 11
2008 10
2007 09
2006 08
2005 07
2004 06
2003 05
2002 04
2001 03
2000 02
1999 01
1998 00
1997 99
1996 98
1995 97
0
ith current plan
Source: National Centre for Health Outcomes Development (NCHOD), 2009 (projections by NHS Islington, 2010).
Ethnicity data for cancer mortality are not available, as death records only provide data on place of birth. However, local records show that people born in the Republic of Ireland have significantly higher death rates from cancer compared to people born in the UK and all other groups. There is no significant difference in cancer mortality by Islington wards.
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CANCER
[23]
The most common cancers in Islington are those of the lung, breast and bowel. Compared to all other London boroughs, Islington has significantly higher presentations of new cases and deaths from lung cancer, which is likely to be a consequence of the high smoking prevalence and widespread deprivation. Uptake of national cancer screening programmes in Islington (breast, cervical and bowel) are all lower than the national averages. To address premature deaths from cancer, NHS Islington is prioritising health promotion programmes, using social marketing techniques to improve awareness and increase participation in cancer screening. This aims to improve the quality of cancer screening services through improved commissioning, access, appropriateness and acceptability of services and by incentivising GPs to increase screening uptake locally. Improvements in outcome measures, audit methods and data collection is also being prioritised.
Key risk factors for cancer •
Unhealthy lifestyle behaviours, particularly smoking and poor diet
•
Late detection and presentation of cancer
Short term priorities for action •
Reducing smoking prevalence is the single most important contributor towards reducing inequalities from cancer mortality
•
For all cancers, promoting early detection through case finding and national screening programmes is a priority
•
Sustained population health promotion and prevention programmes promoting healthy lifestyles behaviours with targeted communities
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Source: istockphoto.com
INFANT MORTALITY
Between 200 6 and 2008 th ere were 39 deaths of infa nts under on e year in Islington.
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INFANT MORTALITY
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[25]
ational Infant Mortality Target: Starting with children under one year, by 2010 to reduce the gap in mortality by at least 10% between routine and manual groups and the population as a whole.
Infant mortality refers to the death of a baby before his or her first birthday, excluding stillbirths. Between 2006 and 2008 there were 39 deaths of infants under one year old in Islington, a rate of five per 1,000 live births (similar to London and England). Although the infant mortality rate is similar to London, there are inequalities between social classes and ethnic groups. There are no detailed ethnicity data on infant mortality in Islington, and although Hospital Episode Statistics record mothers’ ethnic origin, coverage is not always complete. Groups who are at risk of poverty and socioeconomic disadvantage (Pakistani, Bangladeshi, Black Caribbean and Black African families) are high-risk groups for infant mortality. Analysis by the London Health Observatory did not identify infant mortality as a major contributor to lower life expectancy in Islington compared with the rest of the country; however, there are significant risk factors for infant mortality locally, including high levels of exposure to second hand smoke in the home, low immunisation coverage and deprivation. Although the infant mortality rate is decreasing, the local deprivation profile and the widespread nature of deprivation in Islington mean that it should remain a priority.
Key risk factors for infant mortality •
Risk factors associated with infant mortality relate primarily to living in deprivation, in particular, child poverty, overcrowding, teenage conceptions, late booking for antenatal care and maternity services and unhealthy lifestyle behaviours, particularly smoking and obesity
Short term priorities for action •
Promote joined-up delivery of services to high-risk groups in line with national guidance, prioritising early booking and post natal support for routine and manual groups and teenage parents (including immunisation and breast feeding)
•
Deliver coordinated programmes of work with local partners to reduce Islington’s overall deprivation status
•
Sustained population health promotion and prevention programmes promoting healthy lifestyles behaviours with targeted groups, particularly on stopping smoking and maternal obesity
25
Source: Ian Christie
SEASONAL EXCESS DEATHS
“The high ce ilings make it very cold in th so I used to st e winter ay in my bed ro om. Since the panels were fitted I can re radiator ad, watch TV friends in the or see my morning. Em ily’s helping fuller life.“ me to live a Islington resi dent Marion Gorman (righ about the En t), talking ergy Doctor service provid Emily Jewell ed by (left). 26
[27]
SED easonal excess deaths (SED) are deaths that are greater than the annual average. The term is usually used to describe winter deaths. These deaths are called Excess Winter Deaths (EWD). However, seasonal deaths also occur in very hot weather conditions, such as heat waves.
S
There were 71 excess winter deaths (mostly from respiratory diseases) in Islington in 2005-07, similar to London and England. Data on summer deaths are not routinely reported at local level. Excess winter deaths are most common in the over 65 age group and in vulnerable groups such as those at risk of poverty (in particular fuel poverty) and socioeconomic disadvantage, social isolation and people with pre-existing long-term conditions, such as CVD and/or respiratory disease (including influenza) and/or restricted mobility. Addressing SED requires action from a range of services, from accessing housing and fuel benefits, through to flu vaccinations for at-risk groups. Currently there is no systematic mechanism in Islington to address seasonal excess deaths. However the Islington Affordable Warmth Group has prioritised this as an area for development.
Key risk factors for Seasonal Excess Deaths •
Being over 65 years
•
Living with a long term condition (CVD, respiratory disease, diabetes and disability)
•
Living with and experiencing deprivation particularly in relation to housing tenure and fuel poverty
•
Social isolation
Short term priorities for action •
Systematically analyse SEDs to include winter and summer deaths
•
Develop a SED Strategy, to encompass actions related to affordable warmth
•
Identify Islington’s at-risk vulnerable groups through systematic caseloads
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SECTION 2
MEDIUM TERM ACTION ON INEQUALITIES PROMOTING HEALTHY LIFESTYLES (2010–2020)
THE IMPACT OF HEALTHY LIFESTYLES ON HEALTH INEQUALITIES TACKLING HEALTH INEQUALITIES SMOKING HEALTHY EATING PHYSICAL ACTIVITY MENTAL HEALTH ALCOHOL SUBSTANCE MISUSE TEENAGE PREGNANCY SEXUAL HEALTH
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SECTION 2
[29]
The impact of healthy lifestyles on health inequalities he lifestyle choices we make have a major impact on our health and wellbeing. Deprivation and poverty have a direct correlation with unhealthy lifestyle behaviours. The major lifestyle factors that contribute to early deaths in Islington are smoking, healthy eating, physical activity, mental health, alcohol and substance misuse, teenage pregnancy and sexual health.
T
This section examines the major lifestyle factors that contribute to health inequalities in Islington. Each lifestyle area is supported by a local strategy, the majority of which have been developed in partnership by a number of lead agencies in Islington. All the lifestyle programmes have targeted and universal actions, with an outline of the work programme (Figure 9 overleaf).
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roActive Islington ro oting hysical Activity 2006 2012
argeted actions specifically addressing those in the cri inal ustice syste E groups people ith learning difficulties children and young people carers and older people as ell as increasing or place and volunteering opportunities for people ith ental health pro le s
hysical Ativity
ni ersal actions including continuing to ta e for ard the ro oting ental ealth and ell eing trategy strengthening social capital raising a areness of ental health pro le s pro oting A i proving access to psychological therapies and strengthening local partnerships and lin s to other relevant or strea s
ood A trategy for Islington
argeted actions ai ed at increasing opportunities for and access to physical activity particularly a ongst children and young people older people those in routine and anual groups and those ith physical sensory and ental health disa ilities
ealthy Eating
ni ersal actions including refreshing the roActive trategy developing activity friendly environ ents pro oting the use of green space and active travel and onitoring the local o esity care path ays
or ing o ards a o efree Islington y 2020
argeted actions to prevent and anage o esity across age groups target food pre ises i prove reastfeeding rates and onitor the i pact of free school eals
o ing
ni ersal actions including i ple entation of the ood trategy or to ards ICE a y riendly tatus use of national social ar eting initiatives and enhancing oral health pro otion
argeted actions particularly ai ed at children and young people as ell as their parents and carers actions targeting E groups those in routine and anual groups and those undergoing surgery
ni ersal actions including i ple entation of the o efree trategy increasing the use of top o ing services action on sales of illegal cigarettes and regular health e uity audits
TACKLING HEALTH INEQUALITIES
Figure 9 ac ling health ine ualities b pro oting health li est les
ental ealth
RA Strateg E AC ction IO Plan A
trategy for ro oting ental ealth and ell eing in Islington 2008 13
LEAD PARTNERS NHSI and other local NHS, LBI, CEA, Metropolitan Police, London Fire Brigade, Aquaterra Leisure, Islington Community and Voluntary Sector, IBUG, Islington MIND, HMP Pentonville and Holloway, Safer Islington Partnership, DAAT, The Annex, Children’s Board, Healthy Schools team, Children’s Services, Teenage Pregnancy Coordinator
Teenage Pregnancy Strategy
argeted actions ainly focusing on children and young people in a variety of settings
Substance Misuse Strategy eenage regnancy
ni ersal actions including i ple entation of the exual ealth and I trategy i proved lin ages for ental health service users pro otion of local a ortion services and pro otion of contraceptive choice
Strateg
argeted actions to identify young people at ris of eco ing teenage parents and those ho are already teenage parents hese include training professionals or ing ith high ris young people outreach services access and RE for vulnera le groups dedicated services and support for teenagers and i proved collection use of data
u stance isuse
ni ersal actions to reduce teenage conceptions including universal sex and relationship education RE across the Children s ervices or force increased access to high uality RE i proved access availa ility and choice of contraception and health services responsive to the needs of young people
ith
Alcohol
argeted actions including drugs education and prevention in schools and youth settings and training for those or ing children and young people
ini i
ensi le Drin ing trategy due pring 2010
ni ersal actions including a su stance isuse needs assess ent and e uity audit and i ple entation of har sation easures as identified through the u stance isuse trategy
argeted actions ai ed specifically at children and young people especially o en and girls older people pregnant o en and pro le venues and hotspots
ni ersal actions around delivering the ensi le Drin ing trategy li iting the access and availa ility of alcohol or ing ith licensees delivering an alcohol education ca paign pro ot ing har reduction screening and rief interventions
[31]
Figure 9 (cont’d) ac ling health ine ualities b pro oting health li est les
exual ealth
ction Plan
Islington s exual ealth I trategic lan 2009 2014
31
Source: Ian Christie
SMOKING
“This is my th ird or fourth serious attem and the key pt to quit is - plan ahea d. I know no quality of life w that my will be so mu ch better in a to 15 years.” bout 10 Alan Fry, 58, ex-smoker Stop Smokin g Service use r 32
SMOKING
[33]
moking is the main contributor to the gap in inequalities in health between the disadvantaged and better off. Smoking-related illnesses (heart disease, stroke, cancers and respiratory diseases) are the main preventable cause of early death in Islington.
S
Approximately 28% of Islington adults smoke (about 44,000 Islington residents aged 16 years and over), compared to the London and England averages of 23.5% and 23.3%. Most smokers start in childhood and develop a lifelong smoking habit. The main risk factors that influence the uptake and continuation of smoking relate to social deprivation. Issues like homelessness, unemployment, low income, routine and manual employment, lone parenthood are associated with high rates of smoking and very low rates of quitting. Smoking rates are higher among some BME groups, such as Asian men (Bangladeshi and Pakistani), Turkish, Somali and Irish men and Irish women. Smoking rates are particularly high among people with mental illness and this is likely to be one of the reasons why the severely mentally ill die younger from CVD and cancer. Up to 80% of prisoners in UK correctional facilities smoke. This is important for Islington as there are two prisons located in the borough.
To reduce smoking prevalence in Islington we will prioritise a number of UNIVERSAL (across the whole population) and TARGETED (specific groups within Islington) actions across the borough through our Smokefree Strategy (2010-20). Through implementation of the borough-wide Smokefree Strategy, universal actions across the whole population will focus on preventing young people from starting to smoke, keeping Islington free of counterfeit cigarettes and making sure that every smoker has an opportunity to access the Islington stop smoking services as soon as possible and at a location that is convenient for them. The Smokefree Strategy has a series of targeted actions for those groups most at risk of starting to smoke and those less likely to quit without extra support. For example, young people who may have other health and social care needs, people from communities where smoking is common place (Somali and Turkish, including action on shisha smoking for women) and groups who may find it more difficult to quit smoking, like lone parents, routine and manual groups, heavy dependant smokers with mental health problems and smokers with existing long term conditions such as CVD and respiratory diseases.
33
Source: Ian Christie
SMOKING
“Of all my w ork in Nags H ead, I’m part proud of the icularly partnership w ork that rem the counterf oved all eit tobacco se llers from the the height o area. At f the problem there were 7 sellers on the 0 or 80 street. For th e last two ye have been no ars there ne - and we intend to kee way.” p it that Joyce Pollaya , Nag’s Head Town Centre Photo taken Manager. on Holloway Road, N7 34
SMOKING
[35]
The key risk factors related to smoking prevalence •
Deprivation and socioeconomic disadvantage
•
Poor mental health
•
Prisoners, as there is high smoking prevalence among prisoners
•
BME communities where smoking prevalence is high
•
Smokers with established smoking-related diseases (CVD and respiratory disease)
Medium term priorities for action •
Implement a coordinated borough-wide tobacco control programme
•
Develop the advocacy role of the Smokefree Alliance, particularly around areas of high local concern, e.g. second hand smoke, illicit and counterfeit tobacco
•
Develop and implement joint communications activities ensuring consistent messaging and planned and coordinated activity across all strategic partners
•
Develop an industrial-scale approach to Stop Smoking Services, by linking with a range of programmes aimed at reducing Islington’s overall deprivation status. E.g. lifestyle health promotion programmes, education and workplace programmes
•
Appropriate scaled-up and targeted stop smoking support using stop smoking pathways within acute and primary care linked to CVD and respiratory disease registers
35
Source: Ian Christie
HEALTHY EATING
“Mushrooms and tomatoe s are our top local custom buy. Our ers love our fr u it and veg be get it fresh fr cause we om the mark et every morn it’s good qua ing – so lity, it’s tasty and we stick produce. Like to seasonal our Chilean w hite seedless Delicious!” grapes. Ozgur Uyan, Market stall holder. Nags Market. Photo Head taken on Sev en Sisters Ro ad, N7 36
HEALTHY EATING
[37]
poor diet, high in saturated fat and low in fruit and vegetables is associated with obesity in younger children, and obesity, chronic illness (cardiovascular disease, colorectal cancer and diabetes) and early deaths in adults. Low levels of fruit and vegetable consumption (< five portions per day) is a key indicator for a poor diet. Approximately 42,100 Islington residents (27%) consume five portions of fruit and vegetables per day, which is broadly similar to the England average.
A
In 2007/08 one quarter of Islington Year 6 children (11 years of age) were obese with a further 15% overweight. Prevalence of obesity in this group is significantly higher than the England average. 10.6% of children in Reception year (5 years of age) were obese and 12.5% overweight. This is broadly similar to the England average. Low-income communities and those living in areas of deprivation have high rates of obesity. People with mental health problems and learning disabilities are also more at risk of obesity, exacerbated by a sedentary lifestyle and a restricted range of opportunities to exercise or eat healthily. Diabetes prevalence is particularly high among Bangladeshi and Black Caribbean ethnicities. Islington GP practice data shows a higher prevalence of obesity among female patients compared to males among those aged 55-74 and among Black African or Black Caribbean groups.
To promote healthy eating in Islington, there are a number of UNIVERSAL (across the whole population) and TARGETED (specific groups within Islington) multi-agency actions identified in the Islington Food Strategy. Universal actions include prioritising healthy eating in maternal health and early years for children and young people. This includes promoting breast feeding as normal and integrating oral health and healthy food choices throughout the life course. We will continue to promote Change4Life14 across all front line staff. Our targeted work will focus on preventing obesity and developing obesity care pathways. We will use social marketing techniques to gather more insight into food choices and dietary habits within the diverse communities in Islington. We will also evaluate the impact of the Islington “Free school meals programme” to ensure that children in most need gain the most benefit.
14. [online] Available from: www.nhs.uk/change4life/Pages/default.aspx [accessed 12 November 2009]
37
HEALTHY EATING
Key risk factors for early deaths associated with poor diets •
Deprivation and associated unhealthy lifestyle behaviours such as diets high in saturated fat and low in fruit and vegetables
•
Communities at high risk of obesity, including people with mental health and learning disabilities and established chronic diseases such as CVD and diabetes
•
BME groups with high diabetes prevalence, such as Bangladeshi and Black Caribbean ethnicities
•
Limited access to a variety of affordable healthy food choices due to geographical location and/or limited cooking skills to make healthy food choices
Medium term priorities for action
38
•
Continue to implement the Islington Food Strategy and action plan
•
Sustain population health promotion and prevention programmes promoting healthy lifestyles particularly around weight management, and building life skills to enable health food choices
•
Obesity prevention and weight management initiatives targeting high-risk children and adults
•
Support the local population to make healthy food choices through ensuring a sustainable food culture in Islington by supporting local enterprise to provide a range of seasonal foods choices
[39]
Source: Ian Christie
PHYSICAL ACTIVITY
“We train ad ults and child ren on how to on the roads. ride safely The training is for all leve beginners to ls, from more experie nced cyclists. great way to Cycling is a get around th e borough an the same tim d get fit at e.” William Poun tney, Islingto n Council Cycl ing Officer. 39
PHYSICAL ACTIVITY egular physical activity is associated with a reduced risk of coronary heart disease, diabetes, obesity, osteoporosis, colon cancer as well as improved mental health. For adults the recommended level is:
R
“a minimum of 30 minutes a day of at least moderate intensity physical activity on five or more days of the week”15. Overall physical activity levels among adults in Islington are estimated at 24%, broadly similar to London and England averages. However, there are marked inequalities in activity rates between groups. Levels for Islington men and women from routine and manual groups are very low at 9.8%, with non-white (particularly Asian communities) at 20.0%. Fewer people who are overweight and/or obese achieve recommended levels of physical activity. There is a sharp decline in physical activity among older age groups particularly after 65 years. People with mental health problems and/or learning disabilities are less likely to achieve recommended physical activity levels because of a restricted range of opportunities to exercise. All of the above groups are high-risk groups for premature deaths from CVD and cancer. Routine and manual groups are particularly at risk of CVD due to low levels of physical activity as well as other unhealthy lifestyle behaviours like smoking and poor diet.
To promote physical activity in Islington, there are a number of UNIVERSAL (across the whole population) and TARGETED (specific groups within Islington) multi-agency actions that will be implemented through the ProActive Physical Activity Strategy. Universal actions include promoting everyday activities as well as sport-related activities, particularly in the lead up to the London 2012 Olympic and Paralympic Games. We will promote activity-friendly and safe environments through appropriate use of green space and linked with our planning applications and commitment to affordable housing. Active travel will be promoted across all agencies. Targeted actions will focus on those in most need and those most likely to benefit from easy access to physical activity opportunities. Groups with physical, sensory and mental health disabilities, older people, obese and overweight groups, individuals with long-term conditions and routine and manual groups are our priority groups for extra support to become more physically active.
15. Department of Health, (2004). At least five a week: Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer.
40
PHYSICAL ACTIVITY
[41]
Key risk factors for early deaths associated with low levels of physical activity •
Socioeconomic deprivation, unhealthy lifestyle behaviours and low levels of physical activity in routine and manual groups.
•
People with mental health problems and/or learning disabilities, and established chronic illness, particularly those with diabetes and cardiovascular diseases
•
Older adults (over 65 years)
•
People with limited access to safe physical activity opportunities and environments (e.g. access to green space or local physical activity programmes)
Medium term priorities for action •
Promote a supportive review and refresh the Islington ProActive physical activity action plan to increase everyday activities (walking/cycling), as well as sport-related activities across the whole population
•
Promote a supportive built environment to encourage physical activity through Section106 planning applications and appropriate use of green spaces to facilitate active lifestyles in a safe environment
•
Implement social marketing programmes to improve the understanding of barriers to and potential motivating factors for physical activity within highrisk sedentary groups, especially routine and manual groups.
41
Source: Ian Christie
MENTAL HEALTH
“The Mental Health First A id training co people to un urse helps derstand how to address m health issues ental in everyday li fe.” Anne Thoma s (right), Islin gton MIND, Manor Garde ns, N7 42
MENTAL HEALTH
[43]
ental ill health is very common in Islington with approximately 28,900 Islington residents (or about 31,000 of the GP-registered population) experiencing depression and anxiety during any week. Depression and anxiety are more common in women, while men are more vulnerable to psychotic disorders and suicide.
M
In Islington the high-risk communities are the Black Caribbean, Black African and Irish communities. Other risk groups are those experiencing socioeconomic disadvantage such as single parents, older people linked to social isolation, the unemployed, carers, prisoners and youth offenders. Mental health problems are linked to less healthy lifestyle behaviours and poorer physical health. People with mental health problems are therefore more likely to have poorer diets, take less exercise, smoke more heavily, and have drug and alcohol misuse problems, which increases their risk of CVD and cancers. There is an inequality in death rates from CVD amongst people with mental health problems. The CVD report (2007) showed that 43% of people with mental ill health had established CVD and were not on appropriate risk registers. This is in part due to “diagnostic overshadowing”, where the mental health illness is prioritised over general physical health.
To promote positive mental health in Islington, there are a number of UNIVERSAL (across the whole population) and TARGETED (specific groups within Islington) multi-agency actions that we have committed to, currently being implemented through our Mental Health Promotion Strategy. Across the whole population, actions to address stigma and discrimination raise awareness about mental health problems and support services, and suicide prevention will remain our population priority. Our targeted actions will prioritise those groups in Islington in most need of support. This involves providing mental health support for individuals who find themselves in the criminal justice system, BME groups where prevalence of mental health problems are high, such as Irish, Black African and Black Caribbean communities, as well as carers, people with learning difficulties and older people and families living with dementia.
43
MENTAL HEALTH
Key risk factors for early deaths associated with mental health •
Family history of mental ill health
•
Black Caribbean, Black African and Irish communities
•
Lesbian, gay, bisexual and transgender groups
•
Economic downturn/recession creating social and financial instability e.g. increased unemployment
•
Social isolation and poor community networks
•
A culture of stigma and discrimination
•
Inadequate CVD risk assessment and incomplete CVD risk register data for people with mental ill health who have established, untreated CVD
Medium term priorities for action
44
•
Implementation of the Islington Mental Health Promotion Strategy
•
Early identification of CVD (through completing of risk register data) in clients with mental ill health
•
Sustain health promotion and prevention programmes promoting healthy lifestyle behaviour for patients with mental ill heath, particularly around physical activity, stopping smoking and healthy eating to reduce early deaths from CVD and cancer
•
Improve understanding of the barriers to accessing mental health services for patients, carers and families through social marketing programmes
•
Addressing stigma and discrimination through Improving Access to Psychological Therapies and Mental Health First Aid training programmes
[45]
Source: Ian Christie
ALCOHOL
Upper Street, N1 (above) Angel tube station (below)
Every week fr om Wednesd ay evening through to S unday, thousa nds of people visit Islington to socialise a t the pubs, b restaurants a ars, nd clubs. 45
ALCOHOL lcohol misuse is becoming an increasing problem in Islington. Heavy alcohol consumption is associated with poor mental and physical health outcomes such as depression, anxiety and suicide, cancer, cardiovascular disease, accidents and trauma. Local alcohol profiles (2009) show that men in Islington have a shortened life expectancy (12.3 months) from alcohol-related illness, which is worse than London and England averages. For women life expectancy from alcohol-related ill health is shortened by 3.9 months. Islington also has higher hospital admissions for alcohol-related harm compared to London and England. In 2009, 21% of Islington adults were estimated to engage in hazardous drinking, similar to London (19%) and England (20%). Prevalence of binge drinking was 15%, similar to London and England averages16.
A
Islington has the sixth highest rate of alcohol-related crime among the London boroughs and the 12th highest in the country. In 2009, 330 people in Islington were on Incapacity Benefits due to alcohol dependence. This is significantly higher than other parts of the country. Islington was the fourth most densely saturated borough in London for alcohol licences in 2007/8. There are a number of vulnerable groups which are at higher risk of problematic alcohol use. These include children and young people, women, older people, and men in manual classes and professional women.
To promote sensible drinking in Islington, there are a number of UNIVERSAL (across the whole population) and TARGETED (specific groups within Islington) multi-agency actions prioritised across partners. Actions will be delivered in the forthcoming Islington Alcohol Strategy, due in May 2010. As alcohol plays a significant role in our society and economy, universal actions across the whole population need to focus on promoting safe, sensible and sociable alcohol consumption. This requires working with the trade on responsible retailing linked to safer communities and a reduction in alcoholrelated crime. Our universal actions will use a social marketing approach to increase awareness about the harms of alcohol and promote early access to services through a borough-wide alcohol brief interventions programme. Our targeted actions will focus on groups where alcohol causes most harm, in particular alcohol-related violence, problem hot spots, young people at risk of hazardous and harmful drinking and older people. Actions will also focus on improving treatment services for chronic dependant drinkers.
16. Local Alcohol Profiles for England (2009). [online] Available from: www.nwph.net/alcohol/lape/LAProfile.aspx?reg=h#foot [accessed 10 January 2010]
46
ALCOHOL
[47]
Key risk factors for alcohol misuse •
Living in deprivation and social disadvantage and isolation
•
Routine and manual groups
•
Young people are particularly associated with binge and harmful drinking
•
A vibrant night-time economy with easy access to alcohol
Medium term priorities for action •
Develop and implement the Islington Alcohol Harm Reduction Strategy
•
Improve coverage of alcohol treatment services, alcohol screening and brief interventions for hazardous and harmful drinking in key settings (primary care, acute trust and criminal justice)
•
Promote sensible drinking and implement appropriate interventions using a social marketing approach across all partner agencies to explore the differing needs of various target audiences
•
Explore use of the Sustainable Communities Act to restrict alcohol licences in Islington, especially for specific geographical locations where alcoholrelated crime is high
•
Improve local data links between A&E and police intelligence to build a local picture on alcohol-related harm in the borough
47
Islington’s Yo ung People D rug & Alcoho offer inform l Service ation, advice , a ssessment, on support and e-to-one treatment to young people families affe and their cted by or w orried about alcohol issue d ru g and s. 48
Source: Ian Christie
SUBSTANCE MISUSE
SUBSTANCE MISUSE
[49]
ubstance misuse is strongly associated with poverty and deprivation. Rates of substance misuse are particularly high in London compared with other regions. A range of problems are linked to substance misuse including death, poor physical and mental health including depression, anxiety, personality disorders and psychotic disorders, crime and poor family and social functioning.
S
Home Office estimates suggest that Islington has a high prevalence of problem drug users aged 15-64 years (2006/07). The Islington estimate was nearly twice the rate for London and represented 3,575 problem drug users. Amongst Spearhead PCTs in London, Islington had the fourth highest rate of problematic drug use17. The most vulnerable groups for substance misuse in Islington are the homeless, prisoners and disadvantaged young people. Levels of drug misuse are particularly high among the prison population.
To prevent substance misuse in Islington, there are a number of UNIVERSAL (across the whole population) and TARGETED (specific groups within Islington) multi-agency action points identified in the Islington Substance Misuse Strategy. Universal actions to tackle substance misuse in Islington will focus on ensuring that the correct services are available based on local need. The introduction of new data collection systems and service reorganisation will facilitate more efficient and equitable local service provision across the whole population. Our targeted actions are linked towards prevention and education for at-risk groups, particularly children and young people. This will be delivered through appropriate training for all those who work with children and young people to identify problematic behavior earlier, with the provision of appropriate information, advice and support.
17. Hay, G., Gannon, M., MacDougall, J., Millar, T., Eastwood, C. and McKeganey, N (2008) National and regional estimates of the prevalence of opiate use and/ or crack cocaine use 2006/07: a summary of key findings. Home Office Research Report 9. London: Home Office. [online] Available from: www.nta.nhs.uk/areas/facts_and_figures/prevalence_data/docs/0607/ London_Prevalence_data_0607doc.pdf [accessed 14 October 2009]
49
SUBSTANCE MISUSE
Key risk factors associated with substance misuse •
Living in deprivation and social disadvantage
•
Involvement in the criminal justice system (prisoners)
•
Inappropriate drug treatment service provision, resulting in poor access, uptake and retention, particularly for younger people
Medium term priorities for action
50
•
Implement the Islington Substance Misuse Strategy and action plan
•
Embed the new drug treatment system following the service review, ensuring smooth working and pathways through the system, including key worker arrangements.
•
Monitor and deliver the new drug treatment system
•
Increase awareness of substance misuse services for young people in Islington particularly amongst BME and lesbian, gay, bisexual and transgender communities
•
Ensure all Islington children and young people receive drugs prevention advice and education, through a variety of settings such as schools, youth services etc
[51]
The highest u nder 18 teen age pregnan rates in Isling cy ton were in F insbury Park, Tollington, M ildmay and B unhill wards.
Source: istockphoto.com
TEENAGE PREGNANCY
51
TEENAGE PREGNANCY ike all other inequalities teenage pregnancy and teenage parenthood is strongly associated with socioeconomic deprivation. Most common risk factors are low educational attainment (early school leavers), risk-taking behaviours like alcohol, drug misuse, early onset of sexual activity, being a teenage mother, living in care and being the daughter of a teenage mother.
L
Analysis of ethnicity of at-risk groups is not straightforward, however local analysis shows that young women from White and Black communities are at higher risk of teenage pregnancy, while Asian communities are at lower risk. Information on fathers is more limited, but suggests that young Black males are at greater risk. The teenage (less than16 and 18 years) conception rate in Islington is higher than London and England, although overall rates have been reducing. The highest under 18 conception rates were in Finsbury Park and Tollington wards in the North and Mildmay and Bunhill in the South.
To reduce teenage conceptions in Islington, there are a number of UNIVERSAL (across the whole population) and TARGETED (specific groups within Islington) multi-agency action points identified in the local Teenage Pregnancy Action plan 2009-2011. Population actions to reduce teenage pregnancy in Islington focus on ensuring all young people receive good quality sex and relationship education at a relevant age plus improving access to and availability of a range of contraception choices, including condoms and Emergency Hormonal Contraception (EHC) across a range of settings both NHS and non-NHS, that are appropriate for young people. Our targeted actions focus on ensuring that young people identified as being at most risk of teenage pregnancy are provided with appropriate tailored support though education programmes, individual support, easy access to contraception and post-termination follow up. Further targeted actions support teenage parents to access a range of support services, from health care through to housing needs and to continue in education or training.
52
TEENAGE PREGNANCY
[53]
Key risk factors associated with teenage conceptions • Low education attainment and leaving school with no qualifications is associated with a significantly increased risk of teenage pregnancy for both boys and girls over and above the impact of deprivation •
Living and experiencing socioeconomic deprivation
•
Risk-taking behaviours among young people
•
Living in care, being the daughter of a teenage parent and being a teenage parent already
•
Children born to teenage parents are at greater risk of infant mortality
Medium term priorities for action • Continue to implement and update the local Teenage Pregnancy Strategy and action plan • Specifically target and improve educational and life aspirations for at-risk young people by promoting easy access to suitable education, training, life skills and employment opportunities • Increase availability and access to contraception and contraceptive services in a range of settings (e.g. youth centres, GUM practices, schools, Pupil Referral Units (PRU), community pharmacies), with signposting to specialist services where appropriate • Link up all programmes to reduce Islington’s overall deprivation status with teenage pregnancy action plans especially the Islington Child Poverty pilot
53
Good quality sex and relati onship educa to promoting tion is key sexual health behaviour in Islington. The Pulse, se rvices for you ng people on Road offers co Holloway nfidential se xual health cl Monday to S inics aturday. 54
Source: NHS Islington Photo Library
SEXUAL HEALTH
SEXUAL HEALTH
[55]
overty, deprivation, social exclusion and sexual health are inextricably linked18. Sexual health is influenced by many factors, from sexual behaviours, attitudes and societal factors, quality of sex and relationship education and access to services, to biological risk and genetic predisposition.
P
Over recent years sexual health has deteriorated across the population, with increases in sexually transmitted infections (STIs) and the prevalence of human immunodeficiency virus (HIV). Young people and young adults, gay and bisexual men, and men and women from African and Caribbean communities are the groups most at risk of poorer sexual health in Islington. Borough specific data are somewhat limited as Islington services provide open access clinics, treating many non-Islington patients, with some Islington residents choosing sexual health services in other areas. However, in 2007, the two local GUM clinics reported 4,447 new cases of STIs. 1,110 Islington residents were living with diagnosed HIV, significantly higher than the London average and the third highest across all London PCTs. In 2008/09, 19% of 15 to 24 year olds in Islington were tested for Chlamydia, with 8% of those testing positive.
To promote positive sexual health in Islington, there are a number of UNIVERSAL (across the whole population) and TARGETED (specific groups within Islington) multi-agency action points identified in the Sexual Health Strategy. Our universal actions will focus on raising the profile of positive sexual health across all partner agencies and promote early access to a range of Sexual and Reproductive Health Services across the whole population. Our targeted actions will focus on delivering high quality Sex and Relationships Education (SRE) to children and young people, particularly focusing on vulnerable young people in a range of settings (e.g. Pupil Referral Units, Youth Offending Services, Detached Youth work, work with teenage parents, etc). We will use social marketing approaches to deliver more appropriate services, by gaining insight from key groups more at risk of poor sexual health, like gay and bisexual men, men and women from BME communities, young people and younger adults, particularly those from more deprived communities.
18. Better prevention, better services, better sexual health. The National Strategy For Sexual Health and HIV. Department of Health, 2001.
55
SEXUAL HEALTH
Key risk factors for poor sexual health •
Living and experiencing socioeconomic deprivation
•
Young ethnically diverse population
•
Large lesbian, gay, bisexual and transgender population, particularly HIV risk for gay men
•
Poor access to an availability of appropriate sexual health services
Medium term priorities for action
56
•
Deliver the Joint Commissioning Strategy for Sexual Health and HIV Services (2009) which encourages collaborative working across services, the development of a sexual health network, and systematic collection and analysis of sexual health and HIV data locally
•
Deliver high quality, age-appropriate sex and relationship education and treatment services across the borough, as well as targeted interventions to groups with specific needs or higher risks
•
Link up sexual health promotion programmes with other healthy lifestyle approaches and link to programmes to reduce Islington’s overall deprivation status
Source: Ian Christie View of Islington from Hornsey Lane Bridge
57
SECTION 3
LONG TERM ACTION ON INEQUALITIES THE SOCIOECONOMIC DETERMINANTS OF HEALTH (2010–30)
THE IMPACT OF THE SOCIAL DETERMINANTS ON HEALTH INEQUALITIES THE ISLINGTON ENVIRONMENT ECONOMY & EMPLOYMENT HOUSING EDUCATION & LIFELONG LEARNING COMMUNITY SAFETY
58
[59]
SECTION 3 The impact of the social determinants on health inequalities he wider determinants or socioeconomic determinants of health refer to the social, economic and environmental circumstances where people live, and how it impacts on their health. For example, people who experience poverty, poor housing, homelessness, lower educational attainment, insecure employment are more likely to suffer poorer health and earlier deaths compared with the rest of the population. Poor social and economic circumstances affect health throughout life and contribute to health inequalities across society.
T
Source: Ian Christie
This section looks at the environment, economy and employment, housing, education and life-long learning and community safety, and how they influence the health of our residents.
Bridge over Regents Canal, N1
59
Source: Ian Christie
THE ISLINGTON ENVIRONMENT
Highbury Fields, N5
60
THE ENVIRONMENT
[61]
he environment where people live has a big impact on the types of lives they lead, the lifestyles they choose and their opportunities to succeed. Where a person lives influences the type of house they live in, types of employment, links to transport and access to a range of services and opportunities – like schools, transport links, shops, and health care services.
T
Islington is the smallest and most built up of all London boroughs, covering 14.86 km2. The dense, urban environment presents both challenges and opportunities. While access to local shops, services and public transport is generally good, Islington suffers high levels of air pollution from traffic, and the amount of green space is amongst the smallest amount per person of all London boroughs. In 2009, the population was estimated at 195,489, almost half of whom were aged 20 to 39 years. The population is increasing, and is anticipated to reach over 213,000 by 2019. There is considerable movement in and out of the borough every year. Three-quarters of the population are White and 32% of residents were born outside the United Kingdom. There are a range of ethnic groups living in Islington, including Irish, Somali, Bengali, Turkish, Arabic, Albanian, Portuguese, Spanish, Nigerian and Ghanaian communities. In 2009, about 12,140 Islington residents were receiving Incapacity Benefit. This is equivalent to 8.7% of the working age population. This compares to 6.2% for London and 7.1% for England. Just under half (46%) of the Islington population is categorised as “people renting flats in social housing, with another 46% categorised as “well-educated city dwellers”, higher than both London and England. The most striking difference between Islington and other London boroughs is the lack of diversity in the borough, i.e. only two Mosaic™ groups make up the majority of the population19. “Good health involves reducing levels of educational failure, reducing insecurity and unemployment and improving housing standards. Societies that enable all citizens to play a full and useful role in the social economic and cultural life of their society, will be healthier than those where people face insecurity, exclusion and deprivation.”20
19. Geodemographic tool which classifies the UK population into 15 lifestyle groups and 69 types based on different characteristics. 20. World Health Organisation (2003) Social determinants of health: the solid facts. 2nd edition. Edited by Richard Wilkinson and Michael Marmot. www.euro.who.int/document/e81384.pdf
61
Source: Ian Christie
ECONOMY & EMPLOYMENT
“In the last y ear we helpe d hundreds o residents find f Islington work. At Job centre Plus y search for jo ou can bs online, sp eak to expert on training co advisers, go urses, or start your own bu siness.“ Mick Hickey & Tony Frost , Jobcentre P lus Islington 62
ECONOMY & EMPLOYMENT
[63]
overty and employment are inextricably linked, and exclusion from sustained employment is a strong predictor of both poverty and ill health. Poverty has been described as the most important determinant of health, and also one of the most difficult areas in which to achieve change. Levels of disposable income affect the way people live, the quality of the home and work environment, and the ability of mothers to provide the kind of care they want for their children. The relationship between health and low income exists across almost all health indicators.
P
Islington is the eighth most deprived local authority in England and the fourth most deprived local authority in London. The child poverty rate, measured as the proportion of children in workless households (45.2%) is the second worst in London. Worklessness is a major issue within the borough with 18% of residents (approximately 25,090 people ) dependent on out of work benefits, including Jobseeker’s Allowance, Incapacity Benefit and Income Support. This compares with 13.5% for England. Of those claiming Jobseeker’s Allowance 14% have been claiming for over one year. The longer people are out of work, the more difficult it becomes to return to the work environment, which limits life chances and opportunities. One quarter of businesses in Islington employ three-quarters of the workforce. The majority of these businesses are Small and Medium sized Enterprises (SME), many of which are in the hospitality sector and experience high turnover, particularly during periods of economic downturn. A large proportion of the workforce in Islington commutes into the borough every day. Local jobs for local people, particularly vulnerable groups (lone parents, long-term unemployed returning to work, carers) are important to maximise opportunities for local people and to improve life chance and health outcomes. The proportion of children living in workless households (45.2%) excludes households in low paid work (below 60% median income) and therefore underestimates the scale of child poverty locally. Although the population is young, 11% are pensioners. 50% of older people in Islington are dependent on Pension Credit (a measure of pension poverty). In 2008, 6% (10,400) of Islington residents were receiving Disability Living Allowance.
63
ECONOMY & EMPLOYMENT
Key economic factors influencing risk of poor health outcomes Personal/familial •
Worklessness, particularly if long term (over 52 weeks)
•
Being a lone parent
•
Having a disability or a child with a disability
•
Living in social housing
•
Caring for three or more children
Social •
Local business economy characterised by small businesses with low survival rate
•
Poor opportunities for part time and starter jobs offering progression
•
Poor travel links to employment hotspots
Long term priorities for action •
Deliver a co-ordinated anti-poverty programme through the Islington Strategic Partnership, to improve effectiveness and efficiencies by co-ordinating strategies, commissioning and action planning of services that focus on income maximisation, worklessness, child poverty, debt and fuel poverty
•
The anti-poverty programme should support the objectives of the Sustainable Communities Strategy by: * mitigating the impact of the recession on young adults * supporting sustainable employment and business opportunities * preventing the newly unemployed from becoming long-term unemployed * continuing to prioritise child poverty * mitigating the poverty experienced by older people and those unable to enter the labour market through targeted income maximisation
64
[65]
HOUSING
Source: Ian Christie
Bemerton Estate & Thornhill Bridge Community Park (above) Canonbury housing (below).
Housing in Is lington is a m arket of extr 44% of Isling emes with ton’s housing in the social However, at rented secto £423,250 ave r. rage propert Islington are y prices in more than d ouble the na of £165,596. tional averag e 65
HOUSING ecent affordable housing is a cornerstone of good health and a major determinant of health inequalities. Overcrowded, badly designed and poorly built houses with inadequate heating, damp, lack of space, poor lighting and shared amenities are a major contributor to poor health. Poor housing and homelessness are not just a housing problem. They have profound implications for the health and wellbeing of the people affected, and for society as a whole.
D
Housing within Islington is a market of extremes. At one end, the borough contains properties at the high end of London prices occupied by high income households, whilst at the other end many residents live on low incomes in social housing. Forty-four per cent of Islington’s housing stock is in the social rented sector, compared to the England average of 18%. Following recent falls across the country and in London, average property prices in Islington are now increasing again and remain significantly higher than the national average. In April 2010 the average property price in Islington was £423,250, compared to the national average of £165,596. In March 2009, 75% of council homes had met the national Decent Homes Standard21. A survey of private sector dwellings22 showed that 26.4% failed the Decent Homes Standard, with older dwellings much more likely to fail, mainly because of a category 1 hazards (excess cold, fire hazards, risk of falling on stairs, damp and mould, and leaking roofs). Overcrowding and access to affordable housing are particular issues in Islington. The accommodation profile in Islington is high density semi-detached houses and flats. The Islington Housing Needs Assessment (2008) estimated that 4,344 affordable housing units are needed over the next five years to meet current and future housing needs. To alleviate overcrowding, more family-sized homes will be needed, particularly in the social rented sector. The majority of the borough’s current supply of new affordable housing is obtained through Section 10623 agreements.
Demolition work Highbury New Park, N5 21. In order to be decent, a home should be warm, weatherproof and have reasonably modern facilities. 22. Private Sector Stock Condition Survey (PSSCS) 2008. 23. Section 106 of the Town & Country Planning Act 1990 allows a local Planning Authority (LPA) to enter into a legally binding agreement (planning obligation) with a land developer over a related issue. S106 Agreements can act as a main instrument for placing restrictions on the developers, often requiring them to minimise the impact on the local community and to carry out tasks which will provide community benefits.
66
HOUSING
[67]
Key risk factors for poor health outcomes associated with housing need •
Potentially fewer new homes and fewer affordable housing units as a consequence of the economic downturn
•
Risk of increased severe overcrowding and reduction of space for families living in overcrowded conditions if larger homes are not built
•
Increased housing repossessions and homelessness as a result of economic downturn
•
Houses that are unsuitable and/or not reaching national Decent Homes Standards
Long term priorities for action •
Maximise the supply of affordable homes through new builds and reduce the number of empty properties
•
Reduce severe overcrowding through the development of larger family-sized homes, more efficient use of existing homes and family support strategies for the severely overcrowded
•
Encourage all developers to build properties that meet the “Lifetime Homes” standard
•
Ensure all Islington social housing meets the Decent Homes Standard by 2011
•
Ensure that all planners and developers work in association with public health to undertake health and social impact assessments on new developments
•
Reduce homelessness and improve access to accommodation through extending pre-crisis and early intervention work, offering advice on alternative options and providing support for tenancy sustainment
67
68
“You can bri ng your kids to Hargrave Centre - every Park Learnin one’s really fr g iendly and g people bring ets on so we their ideas an ll, d make them like to do art their own. W s and crafts a e t home but w on this scale.“ e can’t do th em Debbie (belo w) and Tracie (above) local the Hargrave mums attend Park Learnin ing g Centre, N1 9
Source: Ian Christie
EDUCATION & LIFELONG LEARNING
[69]
EDUCATION ducational attainment and health status are inextricably linked. The longer an individual spends in education and the higher their educational attainment, the better their overall health and wellbeing. Promoting educational attainment at all stages is crucial, to secure future socioeconomic opportunity and health and wellbeing outcomes. Young people most at risk of leaving education early are those from deprived socioeconomic backgrounds, teenage parents, children with physical and mental disabilities, young offenders and children living in care.
E
In Islington, educational outcomes for Foundation stage children are lower than national averages, although outcomes at Key Stage 1 and 2 are broadly similar to the national average. The percentage of 16 year olds achieving more than 5 A* to G GCSEs and more than 5 A* to C GCSEs or equivalent grades has increased over the past five years, but is below national averages.
Source: Ian Christie
The Islington school population is extremely diverse, with 70% from BME communities. Hornsey had the highest proportion of BME child populations at 77%, while Canonbury has the lowest at 64%. There are approximately 120 different languages spoken by children at home in Islington. Hornsey and Barnsbury have the largest numbers of children with English as an additional language24. Approximately 30% of Islington school children have special educational needs, with a small proportion of looked after children at each key stage in Islington schools.
Islington College, Camden Road, N7
24. Area Children and Young People’s Partnership Profile (2008). [online] Available from: www.islington.gov.uk/ DownloadableDocuments/CommunityandLiving/Pdf/Area_Children_and_Young_Peoples_Partnership_Profile.pdf [accessed 12 November 2009]
69
EDUCATION & LIFELONG LEARNING
Key risk factors for poor health outcomes associated with education and lifelong learning •
Living in socioeconomic deprivation
•
Low educational and life aspirations that impact on leaving education early without qualifications
• Physical and/or mental disabilities that limit opportunities to remain in education
Long term priorities for action
70
•
To provide the best start in life for young children and support their learning, development and achievement through an outstanding range of early years settings with associated excellent children’s services building on the Children’s Centre model and best practice
•
To raise standards of achievement and attainment, to narrow the gap in attainment between different groups in the borough and meet or exceed the best performance nationally. To achieve this through effective partnership between schools, children’s services, pupils, parents and the wider community
•
To positively change the life chances of the most disadvantaged members of the community with a specific emphasis on improving the pathways into education, employment and training for young people
•
To support community capacity, social cohesion and wellbeing through schools and children’s centres that are “fit for purpose” and to provide centres of learning for their communities
[71]
Source: Islington Council Photo Library
COMMUNITY SAFETY
“The Safer Is lington Partn ership is the partnership re statutory sponsible for improving sa reducing crim fety and e in Islington . This partne together a n rship brings umber of sta tutory agenci NHS Islington e s, including and Islington Council to w residents and o rk with the wider co mmunity for Islington. a safer The partners hip involves residents in a such as throu variety of wa gh participato ys, ry budgeting problem solv and direct ing with their street manag to ensure a cl ement teams ear understa nding of the how they ma p ro blems and y be resolved .“ Alva Bailey, H ead of Comm unity Safety, Islington. 71
COMMUNITY SAFETY nstances of crime and disorder, intimidating behaviour and community perceptions of crime have detrimental effects on the quality of life and the health of individuals and communities. Inner city deprived boroughs like Islington, with high density residential and transient populations (particularly commuters and students) and major transport routes are likely to experience high crime rates. High rates are also linked to frequent episodes of alcohol and substance misuse.
I
Over the last four years, Islington has seen a continual decline in crime figures, with notable reductions in violent crime, sexual offences and racially motivated crime. Although overall levels of crime have dropped, the rate of decline in Islington is slower compared to other boroughs across the Metropolitan Police Service area.25 Crime records alone do not capture the full extent of crime in Islington. Domestic violence, hate crime and alcohol-related crimes are often unrecorded, three-quarters of assaults that result in hospital treatment do not appear on police records.26
Islington’s team of Street Management Officers are out and about offering a highly visible, reassuring presence on the streets of Islington.
72
25.
I-Quanta Database - Performance Strategy Directorate of Home Office.
26.
Shepherd, J. (2007) Preventing Violence - Caring for Victims. Surgeon 5:2 114 – 121.
COMMUNITY SAFETY
[73]
Key risk factors for poor health outcomes associated with community safety • Living in socioeconomic deprivation and hardship • High density residential and transient populations linked to major arterial transport routes • A vibrant night-time economy, linked to alcohol related crime • Current high level of crime • Low levels of public confidence, disengagement and dissatisfaction
Long term priorities for action • Implement the Islington Multi-agency Partnership Plan and the priorities identified in Islington’s Crime and Disorder Strategic Assessment •
Lead, implement and evaluate Islington’s Victims of Violence programme, identifying vulnerable victims (domestic violence, alcohol-related violence and hate crime) in The Whittington Hospital, who are not on police records and provide care pathways to appropriate support services
•
Restore public confidence by communicating more effectively with the diverse local population through the Community Engagement Strategy, identifying local perceptions of need and safety
•
Link up community safety programmes with other health and social workstreams to tackle root causes of inequality – deprivation and social disadvantage, community disengagement and low aspirations
73
SECTION 4
Source: Ian Christie
CONCLUSION AND RECOMMENDATIONS
View from Highgate Hill.
74
CONCLUSION ackling health inequalities in Islington must remain a priority and it is not the responsibility of one organisation alone. It can only be achieved across partners.
T
In the short term Actions on CVD and cancer are primarily the responsibility of the NHS. This requires early prevention and detection of disease together with improving access to and availability of the correct services at the right time. This will remain a NHS priority.
In the medium term Promoting healthy lifestyles should be a priority across all agencies. A lifestyle approach should range from information and education sessions right through to creating a healthy environment through our strategies and policies, where making the healthy choice is the easier choice.
In the long term This strategy shows that tackling the root causes of inequalities are linked to deprivation and poverty. Supporting the local population to become economically independent through lifelong education and learning, affordable housing and the provision of a safe and prosperous borough should remain a long-term priority for all agencies across Islington, as identified in the Sustainable Community Strategy.
The key risk factors and priority actions identified throughout all the sections of this strategy provide a valuable tool to inform the commissioning of world class services that will improve health and wellbeing and reduce unacceptable inequalities in Islington.
75
SECTION 5
APPENDICES APPENDIX 1 Life Expectancy by wards and slope index of deprivation in Islington
76
APPENDIX 1
[77]
Life Expectancy by wards and slope index of deprivation in Islington Table 1: Life Expectancy at Birth by wards in Islington, 2003-2007 MEN Ward Clerkenwell Barnsbury Highbury East St Peter’s Bunhill Hillrise Junction Canonbury Finsbury Park Caledonian St Mary’s Highbury West Mildmay St George’s Holloway Tollington Islington average
Life Expectancy
95% Confidence Interval Lower 75.5 74.1 74.2 73.1 72.8 72.4 72.4 71.9 72.2 72.3 71.8 72.2 71.7 71.4 71.3 70.9 74.1
77.8 76.2 76.2 74.9 74.8 74.3 74.2 74.1 74.0 74.0 73.9 73.9 73.8 73.5 73.1 72.6 74.5
Upper 80.1 78.4 78.3 76.7 76.8 76.2 76.1 76.4 75.9 75.7 75.9 75.6 76.0 75.6 74.9 74.4 75.0
WOMEN Ward St George’s Highbury West Bunhill Canonbury Junction Barnsbury Highbury East St Mary’s Mildmay Caledonian Clerkenwell Tollington Holloway St Peter’s Hillrise Finsbury Park Islington average
Life Expectancy 82.5 82.4 82.3 82.0 81.5 80.8 80.5 80.4 80.1 79.9 79.5 79.5 79.3 78.7 78.4 78.1 80.3
95% Confidence Interval Lower 80.1 80.3 80.1 79.7 79.7 79.3 78.7 78.5 78.4 78.0 77.1 77.5 77.5 77.1 76.9 76.5 79.8
Upper 85.0 84.5 84.5 84.4 83.2 82.4 82.3 82.3 81.8 81.8 82.0 81.5 81.2 80.4 80.0 79.6 80.7
Source: NHS Information Centre, 2009. www.nchod.nhs.uk 77
APPENDIX 1 Life expectancy and deprivation There are further differences in life expectancy depending on deprivation level. The extent of inequalities in life expectancy can be calculated using the slope index of inequalities, which gives the gap in life expectancy in number of years between the best-off and worst-off within the PCT. Rather than comparing e.g. only the top and bottom deprivation deciles, the slope index[*] is based on a robust statistical model of the life expectancy and deprivation scores across the whole PCT. For men in Islington, there was a difference of 6.7 years between the best-off and worst-off in 2004-08, while the equivalent figure was 4.4. years for women (Figures A & B). This can be compared to the England average, which was 8.6 years for men and 5.8 years for women in the same period. However, the values for both men and women in Islington were not significantly different from those in England overall. NOTE: the majority of the population in Islington is deprived and life expectancy is low overall. Therefore, the difference between the best-off and worst-off is likely to be comparatively limited in Islington compared to England.
*
78
The slope index is based on local deprivation deciles (tenths) within a PCT and is calculated by taking the life expectancy for each deprivation decile and then fitting a regression line through those points. Local deprivation deciles are calculated by ranking all Lower Super Output Areas (approximately 1500 households) within a PCT by the Index of Multiple Deprivation (2007) score and then dividing them into ten roughly equal groups. Further information on the slope index of inequalities can be found at: www.apho.org.uk/resource/view.aspx?RID=75050
APPENDIX 1
[79]
Figure A: Life expectancy at birth by deprivation deciles showing the slope index of inequality for Islington, males, 2004-08.
One is the most deprived and ten the least deprived decile. Slope Index of Inequality = 6.7 years (95% Confidence Interval: 3.4 to 9.9)
95
ife Expectancy ith 95% confidence li its
i e E pectanc at irth
ears
Ine uality slope
90
85
80
75
70
65
60 10%
20%
30%
40%
50%
60%
Percentage o population ran ed ro
70%
high to lo
80%
I
90%
100%
score
Figure B: Life expectancy by deprivation deciles showing the slope index of inequality for Islington, females, 2004-08.
One is the most deprived and ten the least deprived decile. Slope Index of Inequality = 4.4 years (95% Confidence Interval: 1.2 to 7.6)
95
i e E pectanc at irth
ears
ife Expectancy ith 95% confidence li its Ine uality slope
90
85
80
75
70
65
60 10%
20%
30%
40%
50%
60%
Percentage o population ran ed ro
70%
high to lo
80%
I
90%
100%
score 79
APPENDIX 2 Health Inequalities Strategy - Performance indicators
80
81
revention case finding early diagnosis
Cardiovascular Disease
Priorit areas
e
ealth
anage ent of disease ris registers
Chec progra
ctions
in ed to Islington trategic artnership I he e group ealth and ell eing artnership oard3
har acy
ri ary Care
ho deli ers locall
u er of ealth Chec s co pleted across all participating Co unity har acies against the target tly and annual u er of ealth Chec s co pleted ithin the Co unity setting against the target tly and annual
2
3
5 Decrease the gap et een recorded and expected prevalence of tro e
4 Decrease the gap et een recorded and expected prevalence of Coronary eart Disease C D
u er of ealth Chec s co pleted across all participating ractices against the target tly and annual
1
S o issioning Strateg Plan
Expansion of capacity of cardiac reha C D Co lan
C D and o esity I Incentive che e
6 7 8
ocal
issioning Angina
Develop ent of outreach and co unity odels
5
ocal
es
ascular Ris Assess ents
C D and o esity I Incentive che e
C D o ing and Dentists
S Islington progra
4
3
1
ther
SHORT TERM ACTIONS ON INEQUALITIES - PREVENTING EARLY DEATHS (2010-14)
ealth and ellbeing Partnership oard target o ing cessation progra e u er of uitters per uarter
ocal rea gree ent
S uitters
S
S
S
ortality o ing
C D
AAAC
tro e Care
ational Indicators I S ital Signs indicators S I ortality rate fro all circulatory diseases at ages under 75
Islington has chosen 21 National Indicators (NI) as targeted priorities including locally developed indicators1. There are 16 statutory education NI’s. Vital Signs are national NHS performance indicators2.
Table 1. Improving health outcomes in Islington.
82
revention case finding early diagnosis
Cancer
Cardiovascular Disease cont d
Priorit areas
ational Cancer creening progra es o el Cervical reast
ctions
ri ary care in ed to I ealth and ell eing artnership oard
ho deli ers locall
ercentage screened cancer cervical y ractice uarterly and annual ercentage screened cancer o el y ractice uarterly and annual ercentage screened cancer reast y ractice uarterly and annual
1
2
3
8 Increase in prescri ing of lipid lo ering drugs anti hypertensives and statins
7 Decrease the gap et een recorded and expected prevalence of Dia etes
6 Decrease the gap et een recorded and expected prevalence of ypertension
S o issioning Strateg Plan
rescri ing costs associated ith CO D case finding CO D pilot and evaluation of targeted spiro etry in s o ing clinics Cancer creening tatic site for reast screening Cancer creening in ri ary care
5
6 7
es
4
CO D case finding anage ent in pri ary care E
CO D ocial ar eting ca paign cough and reathlessness
2
3
o ing s o efree and cessation
ilot ascular ris case finding sche e in phar acy
S Islington progra
1
9
ther
ocal rea gree ent
reast o ee
S 31 Day tandard for u se uent Cancer reat ents Che otherapy and urgery ational re uire ent
Extension of o el Cancer creening rogra e to en and o en aged 70 up to 75th irthday 75
S
Extension of reast creening rogra e to o en aged 47 49 and 71 73
S
S y pto ait
S u ers of practices ith C validated registers of patients ithout sy pto s of cardiovascular disease ut ho have an a solute ris of C D events greater than 20% over the next 10 years
ational Indicators I S ital Signs indicators S S SI local priorit ercentage of eligi le population ith ris score
83
Infant
ortality4
Cancer cont d
Reducing infant ortality through the related or strea s and actions plans E g reducing teenage conceptions increasing i unisations pro oting reastfeeding safeguarding children
Acute trust aternity units Islington Children s services ocial services
Cancer revention diagnosis
early
o of preter irths a ies orn 37 ee s gestation annual ercentage of infant unisation coverage
2
3 i
ercentage of early antenatal oo ing y 12 ee s and 22 ee s a ong disadvantaged groups specifically teenage others and routine and anual groups uarterly and annual
1
Children and oung eople CA arenting olihull odel
8
AAAC
o ing
S 68 s reastfeeding
S eenage regnancy
S Early access to aternity service
nder 18 I conception rate
S uitters
S Cancer ortality
S
S All o en to receive results of cervical screening tests ithin t o ee s
S Extended 62 Day Cancer reat ent argets ational Re uire ent
S 31 Day tandard for u se uent Cancer reat ents Radiotherapy
84
easonal excess deaths
Infant ortality cont d
Priorit areas
Islington Afforda le trategy5
ctions
ar th
Afforda le ar th Coordinator lin ed to I he e group ealth and ell eing artnership oard
ho deli ers locall
S o issioning Strateg Plan
u er of teenage parents supported to continuing education annual ercentage of fa ilies ith infants living in overcro ded conditions annual u er of a ove fa ilies rehoused uarterly and annual ercentage of fa ilies ith infants clai ing enefits
6
7
8
9
2
u er of Older eople ad itted to hospital ith falls
10 pta e of reastfeeding his progra e o or ill be urther de eloped in 1 u er of excess inter deaths as easured through inter deaths Dec ar inus average of non inter deaths
u er of teenage conceptions co pleted pregnancies annual
5
es
ercentage nu er of pregnant s o ers and ne parents offered stop s o ing support annual
S Islington progra
4
ther
ocal rea gree ent
ational Indicators S ital Signs
I
85
ealthy Eating
o ing
Priorit areas
es
Islington ood trategy
o acco control progra e
ctions areas progra
C Council Co unity oluntary sector lin ed to I he e group ealth and ell eing artnership oard
har acy lin ed to Islington trategic artnership I he e group ealth and ell eing artnership oard
ri ary care
ho deli ers locall
Annual health e uity audit of the top o ing service Annual health e uity audit s o ing related diseases e g coronary heart disease stro e respiratory disease o of s o ing related do estic fires tly and annual o of or places non co pliant ith o efree legislation tly and annual roportion of adults easured in ractice ith I greater than or e ual to 30 annual ercent of a ove patients ith an intervention in last year annual roportion of over eight and o ese children in year 6 annual source C
3 4
5
1
2
3
6
o of referrals to the service y source tly and annual
2013/14 - 2000 quits.
2011/12 - 2068 quits.
u er of 4 ee s uits annual Eg 2010/11 - 2218 quits.
2
1
S o issioning Strateg Plan
o ing o efree and cessation C D dentists
2 3
2
1
O esity u lic ealth Interventions Children and oung eople
ealth pro otion ehaviour change prisons or place health
Annual record of test purchases and illicit sales sei ures
Evaluation of o efree social ar eting ca paigns
5
6
o of education and prevention sessions ithin young peoples educational settings including R s children s centres pri ary secondary and colleges
4
o ing and
Oral ealth
S Islington es
1
ther progra
reastfeeding eer upport et or a y riendly Initiative target of 54 2% prevalence
ealth and ellbeing Partnership oard
ealth and ellbeing Partnership oard o ing cessation progra e nu er of uitters per uarter
ocal rea gree ent
MEDIUM TERM ACTIONS ON INEQUALITIES - PROMOTING HEALTHTY LIFESTYLES (2010–20)
C D
AAAC ortality
tro e Care
o ing
S Childhood O esity
I O esity in pri ary school age children in ear 6
S uitters
S Cancer ortality rate
rate
S
S
S
I ortality rate fro all circulatory diseases at ages under 75 see cardiovascular disease)
ational Indicators S ital Signs indicators S
I
86
hysical activity
ealthy Eating cont d
Priorit areas
roactive Islington hysical Activity trategy
ctions areas progra
es
C Council Co unity oluntary ector lin ed to I he e group ealth and ell eing artnership oard
ho deli ers locall
ercent of a ove patients ith a healthy eating related intervention in last year annual CO 8 Increase in upta e and duration of reastfeeding
u ers of referrals to exercise on prescription tly u ers of people supported y ealth trainers tly roportion of adults underta ing 30 inute or ore of oderate exercise at least 3 ti es a ee port England active people survey Annual Esti ate
7
8
1 2
3
5
ercent of a ove patients offered a physical activity related intervention in last year annual
or fit
u er of fast food outlets in proxi ity to Islington schools annual
6
u er of referrals to uarterly
roportion of eligi le and non eligi le children consu ing school eals uarterly and annual
5
4
u ers of children in E D and ini E D uarterly
4
S o issioning Strateg Plan
ealth ro otion and ehaviour Change in rovider ide incl Co creating health
3
ealth ro oting hospitals
O esity u lic ealth Interventions Children and oung eople
2
4
ealth pro otion ehaviour change prisons or place health
1
reast eeding C 1 reast eeding et or
ealth ro oting hospitals
4
5
ealth ro otion and ehaviour Change in rovider ide incl Co creating health
S Islington es
3
ther progra
E G CO 6 he percentage of Islington schools achieving national expectations in ealthy schools che e for each of the the es
CO 4 he proportion of the population having at least 5 portions of fruit vegeta les daily as easured through the AA Residents urvey ealth and ellbeing Partnership oard ports Activities target to deliver o introduce 1 ne physical activity clu in 98 settings 2008 11 o introduce 2 ne physical activity clu s in 40 settings 2009 11
CO 8 Increase in upta e and duration of reastfeeding
ports Activities target to deliver o introduce 1 ne physical activity clu in 98 settings 2008 11 o introduce 2 ne physical activity clu s in 40 settings 2009 11
ealthy chools 60 schools to achieve ealthy chool tatus
ocal rea gree ent ational Indicators S ital Signs indicators S
I
87
ental health
hysical activity cont d
Islington ental ealth ro otion trategy
C Council Co unity oluntary ector lin ed to I he e group ealth and ell eing artnership oard 5
% patients using IA ractice tly
4
u er of patients ho enefits annual
fro
u ers of patients fro underserved groups tly
3
each
each
ove of
er of patients entering tly
ercentage of patients fro ractice tly
u IA
2
1
ocial
ental ealth al ing therapies I and ro ect anager ental ealth Co unity Develop ent or er Irish Co unity
4
ental health A asic ental health s ills training
ental health ar eting
o of adult cycle training sessions provide y Islington Council annual
3
2
1
5
ocal ro ote early intervention and i proved outco es for adults ith ental health pro le s
CO 9 u er of older people ta ing oderate intensity physical activity easured through nu er of attendees over 50 ee period at EverActive classes in Islington
CO 7 ercentage of Islington school pupils participating in at least 2 hours of high uality E sport physical activity in a typical ee co pared ith national perfor ance
1 E 2 ealthy eating 3 hysical activity 4 E otional health and ell eing
S eople ith depression and or anxiety disorders ith access to psychological therapies
S E otional health and ell eing and child and adolescent ental health services CA
88
ental health cont d
Priorit areas
ctions areas
ho deli ers 6
u er of A Islington trainees tly and annual
S o issioning Strateg Plan
ealth ro oting hospitals
6
olihull
C CA arenting odel
S Islington es
5
ther progra
e
CO 12 u er of older people having active and fulfilling lives in the co unity as easured through AA Residents urvey
E G CO 6 he percentage of Islington schools achieving national expectations in ealthy chools che e for each of the the es 1 E 2 ealthy eating 3 hysical activity 4 E otional health and ell eing
ental ell eing Cha pions rogra
Enhancing ental ealth irst Aid target of 400 people co pleting A training
ealth and ellbeing Partnership oard Enhanced IA e site easured on ho any hits on the e site and target of 240 people accessing IA
ocal rea gree ent ational Indicators I S ital Signs indicators S SI local priorit I proving the uality of the patient experience and health outco es
89
Islington u stance isuse trategy and action plan
Islington eenage regnancy action plan
eenage pregnancy
Islington Alcohol ar Reduction trategy
u stance isuse
Alcohol
C Council Co unity oluntary ector lin ed to I he e groups ealth and ell eing artnership oard afer Islington artnership C Council Co unity oluntary ector lin ed to I he e groups
C Council Co unity oluntary ector lin ed to I he e groups ealth and ell eing artnership oard afer Islington artnership
u ers on long acting contraception tly and annual u ers of teenagers seen through co unity services tly and annual u er of under 18 conceptions annual
2
3
u ers of contacts triages treated at tier 2 uarterly
3
1
u er of rief interventions in eneral ractice and A E uarterly
u er of e ergency ad issions for alcohol related har tly
2
1 Alcohol of I
2
eenage regnancy Condo Distri ution sche e and outreach roo
1
eenage regnancy E Ca den C
ealth pro otion ehaviour change prisons and or place health
1
3
ealth ro oting hospitals
5
eenage regnancy E I C Ad in ead
ealth ro otion and ehaviour Change in rovider ide incl Co creating health
4
2
ealth ro otion and ehaviour Change ealth rainers
3
ull expansion
Alcohol alcohol har ini isation
1
C D
AAAC ortality
S
AAAC
S eenage pregnancy
I nder 18 conception rate
S u er of Drug sers recorded as eing in effective treat ent
I Drug related Class A offending rate
S Cancer ortality rate
S rate
S
I erceptions of anti social ehaviour
90
or place ealth ro otion trategy in progress
or place health6
es
Islington s oint Co issioning trategy for exual ealth and I ervices
ctions areas progra
exual health
eenage pregnancy cont d
Priorit areas
ho deli ers locall ealth and ell eing artnership oard u er of ter inations in under 18s annual u ers of repeat ter inations of pregnancies annual u er of teenage parents supported to continuing education annual
4 5
6
S o issioning Strateg Plan
1
ealth pro otion ehaviour change prisons and or place health
exual ealth Chla ydia i prove ent upta e of screening levels his progra e o or is being de eloped o er
or ith parents on addressing RE ith children
5
6
eenage regnancy E C expansion
eenage regnancy E Ca den C
3 4
eenage regnancy E I C Ad in ead
eenage regnancy Condo Distri ution sche e and outreach roo
exual ealth Chla ydia i prove ent upta e of screening levels
or ith parents on addressing RE ith their children
eenage regnancy E C expansion
S Islington es
2
1
6
5
4
ther progra
ocal rea gree ent
S Chla ydia creening
S ital Signs indicators S S Chla ydia creening
91
Oral health
Dentist
u er of children receiving fluoride varnish rushing for life pac s tly Referrals to secondary care for adults children tly taff in co unity setting trained in pro oting oral health for adults and children tly
5 6
tly
er of residents accessing dental services locally
nits of dental activity
tly
u
u er of Islington children and adults accessing dental services locally tly
4
3
2
1
u er of people e ployed in Islington ased usinesses u er of Islington ased e ployees on lo inco e ini u age irregular insecure e ploy ent roportion of e ployees on long ter sic leave Oral ealth Oral ealth arious
3
4
5
2 C D o ing and dentists
1
u er of Islington ased or places annual
2
SI local priorit I proving the uality of the patient experience and health outco es
S Dental ervices
92
reen space Cli ate patial planning
Environ ent including
Priorit areas
Islington trategic artnership I he e group Environ ent and ustaina ility
ustaina le Co unities trategy7
Islington Core trategy8
ho deli ers locall
ctions areas progra es
S o issioning Strateg Plan
ther S Islington progra es
SS Enhance ent in io diversity as de onstrated y the area of land approved for i proved nature conservation ithin the D C24 S E GE he nu ber o Green lag or Green Pennant ccredited par s and open spaces in Islington at
SS a otal reductions in CO2 e issions fro Islington Cli ate Change artnership e ers % reduction on 2005 6 aseline orough ide CO2 e issions fro gas and electricity usage and transport c he percentage annual increase in the nu er of schools ith an approved school travel plan re uired to achieve 100% coverage y arch 2010
SS a ercentage of household aste arisings hich have een sent y the authority for recycling and co posting Increase in the percentage of unicipal aste recycled
SS he difference in reported use of Islington par s and open spaces y residents ith a long ter illness or disa ility as co pared to all other residents
ocal rea gree ent
I
I I proved street and environ ental cleanliness levels of litter detritus graffiti and fly posting
I lanning to Adapt to Cli ate Change
I er capita reduction in CO2 e issions in the A area
ational Indicator
LONG TERM ACTIONS ON INEQUALITIES – THE SOCIO ECONOMIC DETERMINANTS OF HEALTH (2010–30)
93
1 Environ ent cont d
SS S E GE he proportion of relevant land and high ays expressed as a percentage in the ondon orough of Islington s land use areas contained ithin the na ed 1 high and 2 lo density social housing estates that fall holly or partly ithin the five OAs that are the ost deprived in Islington as at 31 03 05 that is assessed as having co ined deposits of litter and detritus 31 03 05 that is assessed as having
SS u er of hectares of pu licly accessi le par s and open spaces
SS Increase in residents use of par s as easured through the annual AA survey 1 ercentage of residents ho say they use par s and open spaces in Islington 2 ercentage of residents ho say they are satisfied ith the uality of par s and open spaces 3 Resident satisfaction ith par s and open spaces as easured y the three yearly I survey 119e %
*At least four of the parks which contribute to the enhancement are within, or within a straight line distance of 100m of the boundary of, one of the 10% most deprived SOAs nationally *Of these four, at least one of the parks which contributes to the enhancement is within, or within a straight line distance of 100m of the boundary of, one of the 10% most deprived SOAs in Islington
94
Econo y
Environ ent cont d
Priorit areas
Islington Council usiness support anagers
ustaina le Co unities trategy10
ctions areas progra es
he e group usiness o s and raining
I
ho deli ers locall
1
u er of teenage parents supported to continuing education annual
S o issioning Strateg Plan
or place health pro otion progra e
ther S Islington progra es
E E u er of usiness start up rates y E entrepreneurs
SS An increase in the percentage of a andoned vehicles re oved ithin 24 hours fro the point here the local authority is legally entitled to re ove the vehicle I 218 E E Average total household inco e in households ith an inco e of less than 40 000 per annu in the 10% ost deprived OAs in Islington
SS a ercentage of residents reporting increased satisfaction ith their neigh ourhoods and In disadvantaged areas sho ing a narro ing of the gap et een these areas and the rest
SS Environ ental uality as easured through a Average ocal Environ ental uality tandard score for the orough I199a 89 satisfaction ith the cleanliness of pu lic land easured y the three yearly I survey 89 % c Resident satisfaction ith cleanliness annual proxy easure of derived fro AA Residents urvey
co ined deposits of litter and detritus that fall elo an accepta le level
ocal rea gree ent
I
I roportion of children in poverty
I % of people ho feel they can influence decisions in their locality
ational Indicator
95
Child poverty pilot
ustaina le Co unities trategy11
Econo y cont d
E ploy ent
he e group usiness o s and raining
I
ental ealth al ing therapies pro oting return to e ploy ent
or place health pro otion progra e
EDE11 Increase the nu er of people ith ental health pro le s supported into
E E S E u er of people ho have een in receipt of Incapacity enefit for a ini u of 26 ee s supported y the usiness o s and raining artnership into sustained e ploy ent
E E RE C AR E I prove household inco e for pensioner households through increasing upta e of enefits As easured through 1 Clai ant caseload for ension Credit to Islington residents aged 60 and over 2 Clai ant caseload for Attendance Allo ance to Islington residents aged 65 and over 3 Clai ant caseload for Council ax enefit to Islington residents
E E he nu er of people resident in the 10% ost deprived OAs in Islington ho have een une ployed for at least six onths ho gain sustaina le e ploy ent
E E he value of contracts to provide goods and services generated y a or develop ents in Islington on y Islington ased usinesses
E E he a ount of Islington council s expenditure spent in the Islington econo y
I or ing age people on out of or enefits
96
E ploy ent cont d
Priorit areas
ctions areas progra es
ho deli ers locall
S o issioning Strateg Plan
ther S Islington progra es
•
•
SS a
u er of people volunteering through I funded volunteering pro ects in Islington u er of Islington residents involved in the follo ing specific volunteering activities hich ill e po er the to have a greater voice and influence over local decision a ing and delivery of services e ership of an Islington school governing oard e ership of an Islington par s
c A reduction y 2007 08 of at least 2 percentage points in the difference et een the overall enefits clai ant rate for England and the overall rate of ins ury ar hese t o indicators target the 532 local authority ards identified y D as having the orst initial la our ar et position ins ury ar is the only Islington ard on this list
A reduction in the overall enefits clai ant rate for Islington
E E a A reduction y 2007 08 of at least 2 percentage points in the overall enefits clai rate for those living in the ins ury ar ard
E E u er of Islington residents e ployed in the construction phase and end use of a or develop ents in Islington
e ploy ent place ents training and volunteering
ocal rea gree ent
ational Indicator
I
97
Education lifelong learning
ousing
E ploy ent cont d
ustaina le Co unities trategy14
Islington ousing trategy 2009 201413
Islington Core trategy12
I he e group Children s oard
I he e group Environ ent and ustaina ility
1
u er of teenage parents supported to continuing education annual
ocal u er of severely overcro ded households oved to ore suita le acco odation ithin a 3 year period
friends of group eing an Eye for Islington articipation in the Islington Citi ens anel
E E he nu
er of people co pleting a
SS ercentage of organisations funded y the I funded Co unity Chest progra e active in the 10% ost deprived OAs in Islington ealth and ellbeing Partnership oard • Overcro ding o assist 160 severely overcro ded households oved to a ore suita le acco odation ithin a 3 year period • Rent uarantee che e 70 clients successfully supported into private rented sector acco odation 11 • oung eople s Rent uarantee che e 45 Clients successfully supported into private rented sector acco odation 2009 11 • ife ills rogra e variety of training of staff and clients to support the selves 2009 11 E E RE C u er of people ith no existing ualifications ho achieve a full evel 2 ualification through enrol ent and attendance at City and Islington College
c) An increase in the nu er of people recorded as or reporting that they have engaged in for al volunteering on an average of at least t o hours per ee over the past year
• •
I irst ti e entrants to the outh ustice yste aged 10 17
I Achieve ent of a evel 3 ualification y the age of 19
I ercentage of vulnera le people achieving independent living
u er of afforda le I ho es delivered gross
I et additional ho es provided
98
Co unity safety
Education lifelong learning cont d
Priorit areas
Islington ulti Agency artnership lan 2008 2011
ctions areas progra es
I
he e group afer Islington artnership
ho deli ers locall
S o issioning Strateg Plan
ental ealth irst Aid training in prisons
ealth pro otion prison progra e
ther S Islington progra es
er of accidental d elling er of fire related fatalities
u
ocal u or in uries
ocal fires
ocal % o e ire afety visits
ocal % of reported do estic violence incidents hich resulted in sanctioned detections
ocal u er of incidents of do estic violence reported to the police
E E he nu er of people co pleting a ills for ife course
ocal rea gree ent
I
erious violent cri e
I ercentage of vulnera le people achieving independent living see Seasonal e cess deaths
I irst ti e entrants to the outh ustice yste aged 10 17
I Drug related Class A offending rate
I articipation in regular volunteering
I % of people ho feel they can influence decisions in their locality
I Re offending rate of prolific and other priority offenders
I erceptions of anti social ehaviour
I rate
Statutor Is I 072 I 073 I 075 I075 I083 I087 I092 I093 I094 I095 I096 I097 I098 I099 I100 I101 I % of people ho elieve people fro different ac grounds get on ell together in their local area
I 16 to 18 year olds ho are not in education training or e ploy ent EE
ational Indicator
99
16. [online] Available from: http://www.localpriorities.communities.gov.uk/LAAResults.aspx [accessed 12 March 2010]
15. [online] Available from: https://www.islington.gov.uk/DownloadableDocuments/CommunityandLiving/isp_laa_targets_bjt.pdf [accessed 12 March 2010]
14. Islington Sustainable Communities Strategy, 2008 - 2011 http://www.islington.gov.uk/Community/islingtonstrategicpartnership/scs.asp
13. Islington’s Housing Strategy 2009 – 2014 http://www.islington.gov.uk/DownloadableDocuments/Housing/Pdf/hsg_strat_2009.pdf
12. [online] Available from; http://www.islington.gov.uk/Environment/planning/PlanningPolicy/localdevelopmentframework/CoreStrategy/ [accessed 15 October 2010]
11. Islington Sustainable Communities Strategy, 2008 - 2011 http://www.islington.gov.uk/Community/islingtonstrategicpartnership/scs.asp
10. Islington Sustainable Communities Strategy, 2008 - 2011 http://www.islington.gov.uk/Community/islingtonstrategicpartnership/scs.asp
9. online] Available from: https://www.islington.gov.uk/DownloadableDocuments/CommunityandLiving/isp_laa_targets_es.pdf [accessed 12 March 2010]
8. [online] Available from: http://www.islington.gov.uk/Environment/planning/PlanningPolicy/localdevelopmentframework/CoreStrategy/ [accessed 15 October 2010]
7. Islington Sustainable Communities Strategy, 2008 – 2011. http://www.islington.gov.uk/Community/islingtonstrategicpartnership/scs.asp
6. [online] Available from: http://www.nice.org.uk/search/guidancesearchresults.jsp?keywords=workplace&searchSite=on&searchType=Guidance&newSearch=1 [accessed 17 December 2009]
5. Islington Affordable Warmth strategy, 2009. [online] Available from: http://www.islington.gov.uk/DownloadableDocuments/Environment/Pdf/AWS_web_version. pdf [accessed 10 April 2010]
4. Inequalities in Infant Mortality: A Good Practice Guide Review of the health inequalities infant mortality PSA target, December 2007. http://www.dh.gov.uk/en/ publicationsandstatistics/publications/publicationspolicyandguidance/dh_081337
3. [online] Available from: http://www.islington.gov.uk/DownloadableDocuments/CommunityandLiving/isp_laa_targets_hoppb.pdf [accessed 12 March 2010]
2. [online] Available from: http://www.islington.nhs.uk/vital-signs.htm [accessed 14 April 2010] 16 April 2010]
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References
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Insect mosaic from Thornhill Bridge Community Gardens, Regents Canal, Caledonian Road, N1
103
© NHS Islington, 2010 For further information about health inequalities in Islington please contact: NHS Islington, Public Health Department, 338 – 346 Goswell Road, London EC1V 7LQ T 020 7527 1000. www.islington.nhs.uk
