Redbridge Health Inequalities

This is a condensed version of the Redbridge NHS Primary Care Trust Annual Public Health Report 2011-2012. This version was produced by Councillor Filly Maravala Labour Councillor for Loxford Ward and Member of the Health Scrutiny Committee and Shadow Health and Wellbeing Board. This report applies to the whole of Redbridge but has special emphasis for Ilford South where there are particular issues.

HEALTH  INEQUALITIES  IN  REDBRIDGE  &  LOXFORD

DEPRIVATION

Redbridge has a mix of deprived and affluent areas.  For example, whilst 8% of small areas in Redbridge are in the fifth most deprived areas in England, 4% of small areas are in the fifth least deprived areas.

Based on the Index of Multiple Deprivation Redbridge is currently ranked 134th out of 326 districts in England.

Loxford is ranked within the 40% most deprived areas in England and is a Lower Super Output area.

Loxford is in the 20% most deprived ward in the country and Loxford has a high population of children aged 0-14 yrs old.

LIFE EXPECTANCY IN LOXFORD

In the last decade improvement in life expectancy is seen across most of the electoral wards in Redbridge apart from few wards such as Clementswood, Cranbrook, Loxford & Newbury in males ad Fairlop, Fullwell, Loxford and Seven Kings in females.  Life expectancy in Hainault ward has increased by 4% in males and 5% in females during the same period.

Out of 21 wards in Redbridge, Loxford has the lowest Life Expectancy for both Males & Females. In Clayhall ward in the North of the Borough, Male life expectancy is 84 yrs as opposed to 73.3 yrs in Loxford – a difference of 10.7 yrs.  In Clayhall female life expectancy is 86.4 yrs as opposed to 78.8 yrs in Loxford, a difference of 7.6 yrs.

The latest ward based data reveals that Loxford is the only ward in Redbridge where male and female life expectancy at birth is significantly below the London and England average (73.3 years for males and 78.8 for females in 2005-2009). Valentines ward has significantly lower male life expectancy (75.9 years), and Seven Kings ward has significantly lower female life expectancy (79.7 years) than the regional and national average.

CHILD POVERTY

Poverty remains a major determinant of child health.  Based on 31 May 2010 data, the proportion of children (0-15 yrs) living in poverty in Redbridge is similar to national average of 22% and is lower to the regional average.  This means 1 in every 4 – 5 Redbridge children live in poverty and Loxford has the highest amount of children living in poverty.

INFANT MORTALITY RATE 2005-2009

Infant mortality is higher in the more deprived parts of Redbridge and among infants with fathers in routine and manual occupations.  In comparison to the neighbouring boroughs,  Redbridge has a higher relative gap in infant mortality between routine and manual group and the whole population.  In 2007-2009, the infant mortality rate among routine and manual group (6.0 deaths per 1,000 live births) was 17% higher compared to the total population.  However, this rate has reduced from 6.3 per 1,000 live births in 2006-08.

Ward based analysis of deaths in infancy reveals that Loxford experienced the highest percentage of infant deaths in comparison to other wards in Redbridge since 2000, and remains statistically significant to the regional and national average.

STILL BIRTHS IN LOXFORD

In 2005-2009, the stillbirth rates were highest among Hainault, Newbury and Fullwell wards followed by Loxford.   The rates in these four wards were significantly higher than the London and England average.

LOW BIRTHWEIGHT

This is defined as the percentage of live births less than 2500gms. Based on the most recent data (2009), the incidence of low birthweight births in Redbridge is 8.5% and remains statistically higher than the national average. The incidence of low birthweight births are higher in babies of mothers born in the New Commonwealth compared to babies of mothers born in the UK.  Ward based analysis of the latest available data (2007-09) reveals that Wanstead, Fullwell, Church End, Chadwell, Mayfield, Barkingside and Loxford have an incidence of low birthweight higher than 9%.

CHILD  IMMUNISATIONS

Redbridge has a smaller percentage of children who were immunised for measles, mumps and rubella (MMR) by their second birthday than in England as a whole, in 2010/11, 85% of children in Redbridge had been immunised compared to 89% nationally and 84% regionally. For MMR2 given at age 5, performance in Redbridge was 77%, much less than the national target of 90%.  It is expected that immunisation coverage will be lower in deprived wards such as Loxford ward.

Whilst the increase in coverage in Redbridge is encouraging, improvements need to be made to achieve 95% coverage as recommended by the World Health Organisation.  The two areas that greater improvements need to be made are for the pre-school boosters and MMR2.

CHILD OBESITY

Obesity is an important risk factor for several chronic diseases including heart disease, high blood pressure, stroke, some cancers and Type 2 diabetes.  In 2009/10, the risk of obesity among Redbridge children was 11.6% in Reception year (age 4-5) and 21.2% in Year 6 (age 10-11).  Prevalence of obesity in Redbridge was higher than national average but similar to regional average in both age groups.  London has one of the highest rates of obesity in children.

In Redbridge the proportion of children aged 4-5 who were obese rose from 10.6% in 2006/07 to 11.6% in 2009/10.  There has been little change in prevalence recorded in Year 6 during the same period.


NATIONAL CHILD MEASUREMENT PROGRAMME (NCMP) – REDBRIDGE RESULTS 2009/10.

Findings from Redbridge results, 2009/10.

  • In Reception year (age 4-5), less than a quarter (23%) of the children measured were either overweight or obese.  In Year 6 (age 10-11), this rate was around one in three (36%).
  • The percentage of obese children in Year 6 (21.2%) was nearly double that of Reception (11.6%), whilst the percentage of overweight children was higher in Year 6 (14.8%) than in Reception (11.1%).
  • Among Reception year children, the prevalence of overweight pupils (11.1%) was nearly the same as the prevalence of those who were classified as obese  (11.6%).  In Year 6, the prevalence of overweight children (14.8%) is lower than that of obese children (21.2%).
  • In Reception and Year 6, more boys were obese than girls.  Approximately 24% (1 in 4) of the boys were either overweight or obese in the Reception year.  In Year 6, this rate was 2 in 5 boys (40%).
  • Obesity prevalence is higher than the Redbridge average for children in Reception year in the ‘Black’ and ‘Any other ethnic group’. In year 6, ethnic groups ‘Asian’, ‘Mixed’ and ‘Any other ethnic group’ show a high prevalence of obesity.
  • As before a strong positive relationship exists between deprivation and obesity prevalence for children in Reception and Year 6.
  • In Year 6, the wards Fairlop, Hainault, Loxford, Clayhall, Fullwell, Newbury and Valentines have a high obesity prevalence rate between 23%-27%.  This equates to approximately 1 in every 4 children aged 10-11 years are obese. In this category Redbridge average is 21.2% London: 21.2% and England: 18.7%).

ADULT  OBESITY  AND  PHYSICAL  ACTIVITY

In Redbridge, 22% of adults are now obese, which means 1 in every 4 – 5 adults are obese.  The percentage of adult population who are obese in Redbridge is statistically lower than the national average.  However, the percentage of adults undertaking the recommended level of physical activity is lower than the national average.

Ward estimates reveal that 6 out of the 21 wards in Redbridge have higher obesity prevalence than the national average.  Loxford being the 6th highest in Redbridge.


TEENAGE CONCEPTION RATE (15-17 YEARS) 2006-08

In Loxford the teenage conception rate is 58.2% the highest percentage in Redbridge.  This is the rate per 1,000 females aged 15-17.


STANDARDISED MORTALITY RATIO FROM CIRCULATORY DISEASES <75 years 2005-09.

Loxford ward has significantly high CVD mortality ratio to that of the England average particularly among the males.

REDBRIDGE  POPULATION  DEMOGRAPHICS:  GROWING  & CHANGING

The population in Redbridge is estimated to be 270,500 as per the latest Office for National Statistics (ONS) mid-year estimate 2010.  Based on the 2008 ONS sub-national population projections, the Redbridge population in 2011 is projected to be 273,800 with a growth of approximately 15,400 by 2016.


REDBRIDGE  POPULATION  PROJECTIONS

  Yr 2001       Yr 2006    Yr 2011 Yr 2016   Yr 2021    Yr 2026  Yr 2031

Population

(000)

242.0 254.8 273.8 289.2 303.9 316.0 326.2

While this projection equates to a growth of 5.6% by 2016, there are some significant changes in particular age groups of the population between 2011 and 2016.

  • 500 more children aged 0-4 (2.4% growth)
  • 5,400 more children aged 5-14 (15% growth)
  • 3,900 more adults aged 25-39 (5.7% growth)
  • 4,500 more adults aged 45-59 (9.1% growth)
  • 1,700 more adults aged 65-74 (10.2% growth)
  • 600 more persons over 80 (6.1% growth)

There are important projected increases in the population of children and older people among the Redbridge population as shown in the table below.

POPULATION  GROWTH  IN  REDBRIDGE  BY  AGE  GROUP

POPULATION  GROWTH

   In the last 5 years In the next 5 years   In the next 10 years
AGE GROUP     2006-2011 2011-2016  2011-2021
0-4 20.5 % 2.4 % 5.7 %
5-14 9.4 % 15.0 %  24.7 %
15-24 1.8 % -1.5 %  3.3 %
25-44 7.8 % 4.3 %                    7.8 %
45-64 7.9 % 6.8%  12.8 %
65-74 1.2 % 10.2 % 15.7 %
75-84 1.7 %  0.0 %  4.3 %
85 + 8.9 % 6.1 %  20.4 %
TOTAL 7.5 %                5.6 % 11.0 %           

According to the ONS mid-year estimate 2010, almost 27% of the population in Redbridge were aged less than 20 years old, compared to less than a quarter (24%) in England and London.

In 2010, 7.6% of the Redbridge population was aged less than 5 years, similar to the London average (7.5%), but higher than the England average (6.3%).  Further, the number of children and infants aged less than 5 years is rising faster in Redbridge in England.  As per the 2008-based ONS projections, there are 21% more Redbridge children aged less than 5 years old in 2011 than in the last five years.

One explanation of the higher percentage of young children in Redbridge is the higher than average fertility rate.  In 2010, the general fertility rate in Redbridge was 15% higher than the England average (75.0 live births per 1,000 women aged 15-44 years, compared to 65.5), and the London rate (72.1) was 10% higher than the England average.  England and London fertility rates show similar trends over time. Redbridge rate has increased by 5% since 2006, the London rate has risen by 10% and England by 9%.

The number of births in Redbridge is on the rise year on year with an average annual increase of 5 – 6% in recent years.  In the last decade from 2003 to 2010, birth figures have grown by nearly 32%.  In 2010, there have been 4,464 births in Redbridge, compared to 3,376 births in 2003 as per the annual birth extracts from ONS.

DIVERSITY  IN  REDBRIDGE

There are also expected changes in the ethnic composition of the population by 2016 from the 2011 baseline:

  • 5,300 less White persons (-5.0% growth)
  • 2,800 more Black persons (9.1% growth)
  • 10,800 more Asian persons (12% growth)
  • 600 more Other persons (8.7% growth).

Redbridge is one of the most ethnically diverse boroughs in London.  The Greater London Authority 2010 Round Ethnic Group Projections indicate that nearly half of the Redbridge population belongs to a Black or Minority Ethnic Group (BME) at present.  This trend is expected to grow to approximately 60% by 2031.

Within Redbridge, ethnic composition differs across various age groups with the largest ethnic minority in the 0-14 years category (66%).

Redbridge has a significant population of Asian origin made up mainly of people from India, Pakistani and Bangladeshi backgrounds although there are significant numbers of people identified as ‘Asian Other’ originating from a range of different backgrounds.  The number of Asian people is projected to have grown by 17.4% between 2006 and 2011 and is further projected to grow by 12% from 2011 to 2016.  A smaller but significant minority of the population identified themselves as Black of either Caribbean or African origin.  The numbers of African people is projected to have  increased by 16.2% between 2006 and 2011 and a further increase of 9.1% is projected by 2016.

INCOME  DEPRIVATION

In 2005-08, five out of six single parents (85%) did not have weekly income sufficient for an acceptable standard of living.  Single pensioners, people in some ethnic minority groups (particularly the Pakistani and Bangladeshi population) and disabled people, were among other groups of Londoners most likely to live in households with a weekly income insufficient for an acceptable standard of living.  In 2005, the percentage of people who were in receipt of means-tested benefits in Redbridge was 18.6%, lower than the London average of 20.6% but higher than the England average (15.5%).

The London Health inequalities Strategy was published by the Mayor in April 2010 and sets out the need to address health inequalities in the capital.  It presents a framework for action to improve the wellbeing of all Londoners and to reduce the gap between those with the best and worst health outcomes.  The Mayor’s strategy stresses the importance of addressing the wider social and economic determinants of health inequalities.


THE  MARMOT  REVIEW

In November 2008, Professor Sir Michael Marmot was asked by the Secretary of State for Health to Chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010.  The strategy will include policies and interventions that address the social determinants of health inequalities.

The Review had four tasks:

  1. Identify, for the health inequalities challenge facing England, the evidence most relevant to underpinning future policy and action.
  2. Show how this evidence could be translated into practice
  3. Advise on possible objectives and measures, building on the experience of the current PSA target on infant mortality and life expectancy
  4. Publish a report of the Review’s work that will contribute to the development of a post-2010 health inequalities strategy.

EXECUTIVE  SUMMARY

Key messages of this Review

1. Reducing health inequalities is a matter of fairness and social justice.  In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 and 2.5 million extra years of life.
2. There is a social gradient in health – the lower a person’s social position, the worse his or her health.  Action should focus on reducing the gradient in health.
3. Health inequalities result from social inequalities.  Action on health inequalities requires action across all the social determinants of health.
4. Focusing solely on the most disadvantaged will not reduce health inequalities sufficiently.  To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage.  We call this proportionate universalism.
5. Action taken to reduce health inequalities will benefit society in many ways.  It will have economic benefits in reducing losses from illness associated with health inequalities.  These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.
6. Economic growth is not the most important measure of our country’s success.  The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.
7. Reducing health inequalities will require action on six policy objectives:

  • Give every child the best start in life
  • Enable all children young people and adults to maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure healthy standard of living for all
  • Create and develop healthy and sustainable places and communities
  • Strengthen the role and impact of ill health prevention

8. Delivering these policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups.  National policies will not work without effective local delivery systems focused on health equity in all policies.
9. Effective local delivery requires effective participatory decision-making at local level.  This can only happen by empowering individuals and local communities.

POLICY  OBJECTIVE  ‘A’

GIVE EVERY CHILD THE BEST START IN LIFE

PRIORITY OBJECTIVES

1. Reduce inequalities in the early development of physical and emotional health, and cognitive, linguistic, and social skills
2. Ensure high quality maternity services, parenting programmes, childcare and early years education to meet need across the social gradient.
3. Build the resilience and well-being of young children across the social gradient.

POLICY   RECOMMENDATIONS

1. Increase the proportion of overall expenditure allocated to the early years and ensure expenditure on early years development is focused progressively across the social gradient.
2. Support families to achieve progressive improvements in early child development, including:

  • Giving priority to pre- and post-natal interventions that reduce adverse outcomes of pregnancy and infancy
  • Providing paid parental leave in the first year of life with a minimum income for healthy living
  • Providing routine support to families through parenting programmes, children’s centres and key workers, delivered to meet social need via outreach to families.
  • Developing programmes for the transition to school.

3. Provide good quality early years education and childcare proportionately across the gradient.  This provision should be:

  • Combined with outreach to increase the take-up by children from disadvantaged families.
  • Provided on the basis of evaluated models and to meet quality standards.



POLICY  OBJECTIVE  ‘B’

ENABLE ALL CHILDREN, YOUNG PEOPLE AND ADULTS TO MAXIMISE THEIR CAPABILITIES AND HAVE CONTROL OVER THEIR LIVES

PRIORITY OBJECTIVES

1. Reduce the social gradients in skills and qualifications.
2. Ensure that schools, families and communities work in partnership to reduce the gradient in health, well-being and resilience of children and young people.
3. Improve the access and use of quality life-long learning across the social gradient.

POLICY RECOMMENDATIONS

1. Ensure that reducing social inequalities in pupils’ educational outcomes is a sustained priority.
2. Prioritise reducing social inequalities in life skills, by:

  • Extending the role of schools in supporting families and communities and taking a ‘whole child’ approach to education.
  • Consistently implementing ‘full service’ extended school approaches
  • Developing the school-based workforce to build their skills in working across school-home boundaries and addressing social and emotional development, physical and mental health and well-being.

3. Increase access and use of quality lifelong learning opportunities across the social gradient,    by:

  • Providing easily accessible support and advice for 16-25 year olds on life skills, training and employment opportunities.
  • Providing work-based learning, including apprenticeships, for young people and those changing jobs/careers
  • Increasing availability of non-vocational lifelong learning across the life course.

POLICY  OBJECTIVE  ‘C’

CREATE FAIR EMPLOYMENT AND GOOD WORK FOR ALL

PRIORITY OBJECTIVES

1. Improve access to good jobs and reduce long-term unemployment across the social gradient.
2. Make it easier for people who are disadvantaged in the labour market to obtain and keep work.
3. Improve quality of jobs across the social gradient.

POLICY RECOMMENDATIONS

1. Prioritise active labour market programmes to achieve timely interventions to reduce long-term unemployment.
2. Encourage, incentivise and, where appropriate, enforce the implementation of measures to improve the quality of jobs across the social gradient, by:

  • Ensuring public and private sector employers adhere to equality guidance and legislation.
  • Implementing guidance on stress management and the effective promotion of well-being and physical and mental health at work.

3. Develop greater security and flexibility in employment, by:

  • Prioritising greater flexibility of retirement age
  • Encouraging and incentivising employers to create or adapt jobs that are suitable for lone parents, carers and people with mental and physical health problems.

POLICY  OBJECTIVE  ‘D’

ENSURE A HEALTHY STANDARD OF LIVING FOR ALL 

PRIORITY OBJECTIVES

1. Establish minimum income for healthy living for people of all ages.
2. Reduce the social gradient in the standard of living through progressive taxation and other fiscal policies.
3. Reduce the cliff edges faced by people moving between benefits and work.

POLICY RECOMMENDATIONS

1. Develop and implement standards for minimum income for healthy living.
2. Remove ‘cliff edges’ for those moving in and out of work and improve flexibility of employment.
3. Review and implement systems of taxation, benefits, pensions and tax credits to provide a minimum income for healthy living standards and pathways for moving upwards.

POLICY  OBJECTIVE  ‘E’

CREATE AND DEVELOP HEALTHY AND SUSTAINABLE PLACES AND COMMUNITIES

PRIORITY OBJECTIVES

1. Develop common policies to reduce the scale and impact of climate change and health inequalities.
2. Improve community capital and reduce social isolation across the social gradient.

POLICY RECOMMENDATIONS

1. Prioritise policies and interventions that reduce both health inequalities and mitigate climate change, by:

  • Improving active travel across the social gradient.
  • Improving the availability of good quality open and green spaces across the social gradient
  • Improving the food environment in local areas across the social gradient
  • Improving energy efficiency of housing across the social gradient

2. Fully integrate the planning, transport, housing, environmental and health systems to address the social determinants of health in each locality.
3. Support locally developed and evidence based community regeneration programmes that:

  • Remove barriers to community participation and action
  • Reduce social isolation

POLICY  OBJECTIVE  ‘F’

STRENGHTEN THE ROLE AND IMPACT OF ILL-HEALTH PREVENTION   

PRIORITY OBJECTIVES

1. Prioritise prevention and early detection of those conditions most strongly related to health inequalities.
2. Increase availability of long-term and sustainable funding in ill health prevention across the social gradient.

POLICY RECOMMENDATIONS

1. Prioritise investment in ill health prevention and health promotion across government departments to reduce the social gradient.
2. Implement an evidence-based programme of ill health preventive interventions that are effective across the social gradient by:

  • Increasing and improving the scale and quality of medical drug treatment programmes
  • Focusing public health interventions such as smoking cessation programmes and alcohol reduction on reducing the social gradient
  • Improving programmes to address the causes of obesity across the social gradient

3. Focus core efforts of public health departments on interventions related to the social determinants of health proportionately across the gradient.

 

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