North-South divide in English health

Can DoH public health data help PCTs target local health priorities more successfully? Jacky Law investigates.

It is well known that GPs in southern England have an easier time keeping their populations in good health than their northern colleagues.

How much easier was revealed in a DoH public health report last month that shows for the second year running a detailed picture of England's health.

It reveals southerners showing no sign of relinquishing their lead on almost all of 31 selected health indicators. Kensington and Chelsea, for example, one of London's most affluent boroughs, registers the lowest number of early deaths from cancer, the lowest levels of obesity, the longest life expectancy for both women and men (86.2 years and 82.2 years respectively), and the lowest rates of diabetes.

It also scores well on indicators for healthy eating (percentage of people eating five portions of fruit and vegetables a day), being physically active (percentage of people doing sport or active recreation on at least 20 days in four weeks), and on number of deaths from smoking.

Go 200 miles up the M1 and you find a different profile. Men in Manchester have the lowest life expectancy in the UK - 72.5 years as compared with the national average of 76.9. Women in Manchester do not fare better, with an average life expectancy of 78.3 years, well short of the 81.1 national average.

The health profiles also show Manchester having the worst record for early deaths from heart disease and stroke, registering 151.3 such deaths for every 100,000 people when the national average is 90.5.

Again, a whole host of related factors can be seen. Numbers of deaths from smoking and cancer are way above the national average, as is the level of income deprivation, children's tooth decay and hospital stays due to alcohol.

This 2007 health profile builds on the picture uncovered in October 2006.

The idea, said outgoing public health minister Caroline Flint, was to help local councils and the NHS decide where to target resources.

In Calderdale, West Yorkshire, the local council decided to tackle men's health after the first profile showed male life expectancy to be 75.3 years, well below the national average.

The council also scored below the England average on indicators such as violent crime, mental health treatment, drug misuse, children's tooth decay and the category 'feeling in poor health'.

Tackling poor health
Calderdale PCT public health resource manager Tony Burgin said these poor figures provided the impetus for a series of co-ordinated projects and events that took place this month.

A team of community matrons, in the style of the TV programme Street Doctors, confronted men in the street about their smoking and drinking habits, BP and BMI. Another initiative saw extensive 'MOT testing' on an Asian community in the South East to focus attention on their relatively high rates of CHD, BP and cholesterol.

Results from such initiatives are hard to assess, and GPs battling against unhealthy lifestyles may wonder how helpful such initiatives, and even the background profiles themselves, are.

Such scepticism was validated by a professor of epidemiology at University College, London, who said campaigns aimed at persuading people to stop drinking and smoking have little or no effect on poorer people. Professor Michael Marmot said that, while many middle-class smokers have given up, 42 per cent of unskilled workers still smoke.

'It's not because they don't know that smoking is bad for you,' he said. 'It is because, on their list of priorities, giving up smoking is way down the list.'

What was needed, he added, was not more public health campaigns but an in-depth look at what was at the root of poverty and these continued inequalities.

Dr Stephen Munday, director of public health in Solihull, West Midlands, said the value of this kind of data is that it brings together a wide range of sources in a user-friendly format.

'They may not show anything new, but the public health issues they reveal do tend to get taken more seriously because they are produced centrally,' he said.

Dr Peter Fink, Manchester LMC secretary, said the results were unsurprising but 'flagged up the need for additional resources'. 'In that sense they are helpful,' he said.

Nita Farouhi, a Medical Research Council clinical investigator and public health physician, said: 'As an epidemiologist, the health profiles are useful in that they give basic pointers to the state of public health.

The results have their limitations because they are usually based on people reporting what they do - inherently unreliable.'

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