Life expectancy, healthy life expectancy and well-being: Summary  



















Life expectancy in Greenwich is substantially shorter than the national average. This is true at birth and at age 75, and is true for both males and females. Healthy life expectancy estimates the average number of these life years that are lived without illness or disability. Again, it is substantially shorter in Greenwich than it is in England on average, for both males and females. Local preventative initiatives aimed at addressing risk factors including smoking, physical activity, hypertension, diet and obesity have been effective in improving outcomes amongst men, and the challenge will be to replicate this success in women. Well-being is complex to measure, but Greater London Authority data show that well-being is also likely to be substantially poorer in Greenwich than it is on average in London. However, the Adult Social Care Survey shows that people receiving social care in Greenwich report a higher quality of life than the London average for people receiving social care. They are also more likely to feel that they have control over their daily life. Significant inequality runs as a strong theme across these measures. A male baby who lives in the most deprived 20% of the borough can expect to live a full 7.4 years less than a male born in the least deprived 20%. For his sister, this figure is 5.6 years. The most deprived males can expect 7.6 years less of healthy life, and the females 7.0 years. There are also great inequalities in well-being. Two of the 17 Greenwich wards have greater well-being than the London average; in the remainder, it is lower. The poorest well-being is in Woolwich Riverside: only six of London’s 625 wards are worse. The continued regeneration of the borough (in particular of those areas which currently achieve low wellbeing scores) will be key to improving the economic security, access, living environment and safety of its residents – all of which contribute towards improving wellbeing. Some causes of death are potentially amenable to healthcare. Mortality due to these causes is slightly worse in Greenwich than the national and London average for males, and moderately worse for females. This does not explain the difference entirely. The major disease contributors to poor life expectancy and healthy life expectancy in Greenwich are circulatory disease (coronary heart disease and stroke), cancers (with lung cancer being particularly important), respiratory disease (particularly chronic obstructive airways disease). The greatest burden reducing healthy life expectancy is mental disorders, particularly depression and anxiety. These also have an impact on life expectancy, but that impact is smaller. Taken together, coronary heart disease, stroke, lung cancer, chronic obstructive airways disease and mental disorders account for 55% of the life expectancy gap between Greenwich males and the London average, and 47% for females.

1

Life expectancy, healthy life expectancy and well-being The aim of this section is to provide an overview of three key summary measures of health and quality of life in Greenwich. These are life expectancy, healthy life expectancy, and well-being. Each of the three Outcomes Frameworks (for the NHS, for Adult Social Care, and for Public Health) contains key indicators related to these measures. The vision of the Public Health Outcomes Framework is to “improve and protect the nation’s health and well-being, and improve the health of the poorest fastest”. It sets two outcome measures allied to this: 1. Increased healthy life expectancy, ie taking account of the health quality as well as the length of life 2. Reduced differences in life expectancy and healthy life expectancy between communities (through greater improvements in more disadvantaged communities) It also includes the indicator ‘self-reported quality of life’. The NHS Outcomes Framework has three overarching indicators that are relevant here:   

Potential Years of Life Lost from causes considered amenable to healthcare Life expectancy at age 75 Health-related quality of life for people with long-term conditions

The Adult Social Care Outcomes Framework includes, in the domain “Enhancing quality of life for people with care and support needs”:   

Social care-related quality of life, as the overarching measure Carer-reported quality of life The proportion of people who use services who have control over their daily life

This section of the JSNA establishes the current position in Greenwich in terms of life expectancy, healthy life expectancy and well-being, drawing on these Outcome Framework indicators (where data is available) and on other data sources. Life expectancy In Greenwich and in England as a whole, life expectancy has tended to increase over the last decade. But for both men and women, life expectancy in Greenwich has remained below the England average (see figure 1). The most recent data (2008-2010) show that women in Greenwich have a life expectancy at birth of 81.8 years, 0.8 years less than the national average of 82.6 years. The gap for men is greater. Men have a life expectancy of 76.7 years in Greenwich, 1.9 years less than the national average of 78.6 years. In 2005-2007, women in Greenwich could expect to live 0.4 years less than the national average. The most recent data show this gap increasing to 0.8 years in 2008-10. The trend for men is different. The gap was narrowing slowly between 2005 and 2008. The most recent data show a more marked reduction. In 2005-2007, men in Greenwich could expect to live 2.8 years less than the national average. The most recent data show that the gap has been closed by nearly one year, to 1.9 years; 2

This is likely to be a direct result of targeted interventions via local preventative initiatives (including through primary care) aimed at addressing risk factors including smoking, cholesterol, physical activity, hypertension, diet and obesity. Figure 1: Life expectancy at birth, Greenwich and England, 1996-2010

Source: NHS Information Centre using Office for National Statistics data

‘Life expectancy at age 75 years’ is a measure of how many more years an individual can expect to live, on average, having reached their 75th birthday. As with life expectancy at birth, males in Greenwich have consistently lagged behind England as a whole in this measure (see figure 2). In recent times, this gap was greatest in 2005-07, at which time Greenwich men aged 75 years could expect to live 1.2 years less than the national average. The most recent data, for 2008-10, show that this gap has narrowed to 0.8 years. The trend for females has been more complex. Over the last decade, female life expectancy at age 75 years in Greenwich has been similar to the national average (see figure 3). In some years it has been higher, in some lower. The most recent data show Greenwich dipping below the national average by 0.3 years. These changes have been small and are not likely to be significant, so the safest conclusion is that female life expectancy at age 75 years in Greenwich is similar to the national average. For both males and females, Greenwich lags behind the London average for life expectancy at age 75 years.

3

Figure 2: Male life expectancy at age 75 years, 1996-2010

Source: NHS Information Centre, using Office for National Statistics data Figure 3: Female life expectancy at age 75 years, 1996-2010

Source: NHS Information Centre, using Office for National Statistics data

4

There is major inequality in life expectancy in Greenwich for both men and women. Those who live in the more deprived parts of the borough live shorter lives than those who live in the more affluent parts. The difference is marked (see Figures 4 and 5). Women in the most deprived 20% of the borough can expect to live for five years less than women in the least deprived 20%. The trend for men is worse still. Men in the most deprived 20% have a life expectancy that is seven years less than men in the least deprived 20%. The measure of deprivation used here is the Index of Multiple Deprivation (IMD). This combines indicators of deprivation that illustrate seven dimensions of deprivation: income, employment, health deprivation and disability, education/skills and training, barriers to housing and services, crime, and living environment. Areas within the borough have been divided into five quintiles based on their IMD score. Quintile 1 is the most deprived 20%, and quintile 5 the least deprived 20%. This allows us to explore the impact of deprivation on health outcomes. Figure 4: Male life expectancy in Greenwich by deprivation quintile, 2007-2009

Source: ONS Public Health Mortality Files 2007-09, ONS mid 2007-09 population projections for LSOAs

5

Figure 5: Female life expectancy in Greenwich by deprivation quintile, 2007-2009

Source: ONS Public Health Mortality Files 2007-09, ONS mid 2007-09 population projections for LSOAs The Slope Index of Inequality (SII) provides another informative measure of the extent to which life expectancy is related to socio-economic deprivation. The SII shows the difference in life expectancy between the best-off and worst-off in a borough. A difference between the best-off and worst-off is seen in every borough, but the SII helps to quantify how great this difference is. A low SII value indicates a small gap in life expectancy. A high SII value indicates a large gap, and therefore greater health inequality. The Slope Index of Inequality shows that Greenwich has very high inequality for both men and women (see figures 6 and 7). The degree of inequality is greater in Greenwich than it is in London or England as a whole. It is also greater in Greenwich than it is on average in boroughs of similar deprivation1. In terms of trend, the most recent data suggest that this life expectancy inequality is widening slightly for women, but narrowing for men. As referred to above, local preventative initiatives aimed at addressing risk factors including smoking, physical activity, hypertension, cholesterol, diet and obesity have been effective in improving outcomes amongst men. The challenge will be to replicate this success in women. Differences in the age at which women develop disorders such as CHD (on average 7 years later than men) mean that we would predict a delay in seeing the same effects in women.

1

Boroughs with similar deprivation to Greenwich are Haringey, Brent, Lewisham, Lambeth, Southwark, Hammersmith and Fulham (based on the rank of average ranks of IMD scores) 6

Figure 6: Slope Index of Inequality (SII) showing the difference in life expectancy between the most deprived and least deprived: Males, 2001-2010

Source: APHO Figure 7: Slope Index of Inequality (SII) showing the difference in life expectancy between the most deprived and least deprived: Females, 2001-2010

Source: APHO Although this section of the JSNA has identified widening health inequalities, other sections document the preventive programmes that appear to be resulting in some marked improvements in the health outcomes amongst the male population. We are currently undertaking a needs assessment for coronary heart disease (CHD) (as one of the major contributors to reduced female 7

life expectancy) to understand where along the pathway of prevention, recognition of symptoms by patients and professionals, management of the acute episode and rehabilitation, we can gain better health outcomes. We would currently expect to see the improvements from prevention as the result of NHS Health Checks 5-10 years later than in men, and so are expecting to see improvements in the next couple of years as the programme will have run for 5 years this year. Healthy life expectancy As well as increasing life expectancy and reducing the inequalities in life expectancy, we are also interested in quality of life and in health during life. ‘Healthy life expectancy’ provides one measure of this. It illustrates the years of life lived without disability and illness. The most recent data about this are from 1999-2003, having been recorded as part of the 2001 Census2They showed healthy life expectancy in Greenwich to be 59.6 years for men, and 62.5 years for women. For both men and women, this is lower than the England and London averages by around two years. As with life expectancy, there is considerable inequality (see figures 8 and 9). Women living in the 20% most deprived parts of the borough could expect a full seven years less of healthy life than those in the 20% least deprived. The figure for men was 6.6 years. Figure 8: Average healthy life expectancy (years lived free of disability and illness) for males by ward deprivation quintile, Greenwich, 1999-20033

Source: ONS Experimental Statistics

2

Data from the 2011 Census are expected in 2013 Healthy Life Expectancy data were provided by the Office for National Statistics experimentally and there are no more recent data available 3

8

Figure 9: Average healthy life expectancy (years lived free of disability and illness) for females by ward deprivation quintile, Greenwich, 1999-20033

Source: ONS Experimental Statistics

Well-being Alongside life expectancy and healthy life expectancy, the third in the trio of important summary measures is well-being. Well-being is a complex concept, more difficult to measure than life expectancy. The Greater London Authority calculates well-being scores for every ward in London. These take account of a wide range of factors that affect people’s well-being. The score is calculated based on 12 separate indicators, relating to ten different aspects of life that can affect well-being (see figure 10). Different people would weigh the importance of these differently. To some, health is more important than safety, for example. To others, the reverse is true. As a construct, well-being is relatively novel. The science of well-being is therefore very much under development. There is no clear answer about how these different aspects should be weighed to accurately reflect the well-being of the population. It is also worth noting that these indicators do not attempt to measure well-being directly. Instead, they measure aspects of life that are known to have an impact on well-being. Examples of data that do measure well-being directly are included in the Positive Mental Health section of this JSNA.

9

Figure 10: Indicators used in calculation of Greater London Authority Ward Well-Being Score Contributor to wellbeing Health

Indicator(s) included - Life expectancy - Incapacity Benefits claimant rate

Economic security

- Unemployment rate - Income Support claimant rate

Safety

- Crime rate - Deliberate fires

Education

- GCSE point scores

Children

- Unauthorised pupil absence

Families

- Children in out-of-work families

Access

- Public transport accessibility scores

Environment

- Access to public open space and nature

Community

- Elections turnout

If we assume that each of the indicators in the GLA Ward Well-Being score impacts well-being equally, we can calculate a single score for each ward in Greenwich. In contrast with life expectancy in years, the score itself is difficult to interpret. But the relative scores illustrate how well-being differs between places. The score is scaled such that the average well-being in London is called ‘0’. Positive scores are therefore better than average, and negative scores are worse. According to this GLA Ward Well-Being Score, just two of the 17 wards in Greenwich have better well-being than the London average (see figure 11). These are Eltham North and Blackheath Westcombe. At the other end of the spectrum is Woolwich Riverside, with a well-being score of -14. Only six of London’s 625 wards score lower.

10

Figure 11: Well-being score by ward, Greenwich, 2010

Source: Greater London Authority. 2010 data, compiled in 2012. Composite measure reflecting indicators of economic security, safety, education, families, children, environment, access, health, and community. Regeneration and Wellbeing The continued regeneration of the borough (in particular of those areas which currently achieve low wellbeing scores) will be key to improving the economic security, access, living environment and safety of its residents – all of which contribute towards improving wellbeing. Figure 12 examines how each aspect included in the ward well-being score varies by ward. This shows that there is a high level of correlation between many of the different aspects – wards that have poor health tend to have poor economic security, poor safety, and poor education, family and community measures. The access and environment measures are the exception to this. They do not correlate closely with the others. Woolwich Riverside, for example, scores more highly than any other ward for access, but has the lowest score of all wards on several other measures.

11

Figure 12: Contributors to well-being by ward, as per GLA Ward Well-Being Score

12

The Outcomes Frameworks include a number of indicators of well-being and quality of life: 

The Public Health Outcomes Framework includes, in the Health Improvement domain, selfreported well-being



The NHS Outcomes Framework includes, as the overarching indicator for one of its five domains, healthcare-related quality of life of people with long-term conditions



The Adult Social Care Outcomes Framework includes, in the domain “Enhancing quality of life for people with care and support needs”:  Social care-related quality of life, as the overarching measure  Carer-reported quality of life  The proportion of people who use services who have control over their daily life

At the time of writing, data are only available for two of these five indicators. These are ‘social carerelated quality of life’ and ‘the proportion of people who use (social) services who have control over their daily life. Both of these measures are captured through the Adult Social Care Survey. The Personal Social Services User Experience Survey of Carers 12-13 has recently been completed in the borough. This is the first official collection of a statutory survey undertaken to be undertaken annually by all local authorities nationwide. The survey will be used to populate outcome measures for carers in the Adult Social Care Outcomes Framework (ASCOF) and the results have been given to social care commissioners who are developing a more responsive support offer to carers in the borough. More information is available in the JSNA chapter on carers. ‘Social care-related quality of life’ is scored based on the responses that social care recipients give to eight key questions in the Adult Social Care Survey (ASCS). These questions gauge whether the individual’s needs are met in the following areas: control, dignity, personal care, food and nutrition, safety, occupation, social participation and accommodation. This information is used to calculate a score, with a high score representing better quality of life than a low score. Greenwich performance across all these measures is encouraging; scoring 18.5 on this measure, Greenwich is placed above the London average of 18.1 and improved on all comparable measures used in the 2010/11 ASCS. In Greenwich, London and England, reported quality of life is slightly higher (0.1 in each case) amongst male social care users than females. Greenwich scores better than the national and London average for quality of life amongst social care users aged 65 years and over, but less well for those aged under 65 years (see figure 13).

13

Figure 13: Social care-related quality of life score, as per Adult Social Care Outcomes Framework, 2011-12

Source: NHS Information Centre, from Adult Social Care Survey 2011-12 Having control over daily life is one key element of quality of life. This is the second Adult Social Care Outcomes Framework indicator for which data are available. In Greenwich, 73% of those receiving social care services report having control over their daily life (see figure 14). This is below the national average but better than the London average.

14

Figure 14: Percentage of people who use social care services who have control over their daily life, 2011-12

Source: NHS Information Centre, from Adult Social Care Survey 2011-12

What is impacting life expectancy, healthy life expectancy and well-being in Greenwich? The NHS Outcomes Framework includes the indicator ‘Potential Years of Life Lost from causes considered amenable to healthcare’. This will illustrate the potential to improve life expectancy by improving healthcare quality. Data for this indicator are not yet available. Data are available for a related measure - ‘mortality from causes amenable to healthcare’. These data relate to people aged under 75 years only. For both males and females, in Greenwich and in England as a whole, mortality from causes considered amenable to healthcare has fallen by approximately half over the last fifteen years (see figures 15 and 16). It has, however, been consistently higher in Greenwich than the England average. Over the five year period 2005-2010, there have been an average of 40 excess male deaths and 12 excess female deaths per 100,000 people per year, relative to the England average. Thus over this period, mortality from causes amenable to healthcare has been 35% higher than the England average for males and 15% for females. Year-to-year trends in such data are difficult to interpret and may not be significant, but there has been a notable improvement for males over the last three years for which data are available, and a worsening for females in the most recent year.

15

Figure 15: Male mortality from causes considered amenable to healthcare, directly standardised rate,