HEA1 - Addressing health inequalities, improving health literacy

Since 2001-03 life expectancy has improved for both males and females in the city (from 75.7 to 78.9 years and from 80.4 to 82.7 years respectively); however male life expectancy has consistently been below the England average. The latest 2014-16 data reveals male life expectancy in Plymouth is around six months below the England average.

The neighbourhood of Beacon Park had the highest overall life expectancy in 2014-16 (84.9 years) which compares with Stonehouse where life expectancy was 75.0 years in the same period. On this basis the gap in life expectancy between the neighbourhoods with the highest and lowest life expectancy in 2014-16 is 9.9 years.

People’s health literacy, lifestyles and environment affect their health and wellbeing and each of these risk factors is unequally distributed across the city. Plymouth performs poorly against key public health outcomes in life expectancy and causes of death as a result of inequalities across the city. Health literacy is important as it is linked with unhealthy lifestyle behaviours and an increased risk of morbidity and premature death.

In 2015 Public Health England reported that in England 42 per cent of working-age adults are unable to understand and make use of everyday health information; this rises to 61 per cent when numeracy skills are also required for comprehension.

Organisations can influence health literacy through the provision of clear accessible information. People with limited health literacy are more likely to use emergency services, and less likely to successfully manage long-term health conditions.

Diseases such as cancer, cardiovascular and respiratory disease and stroke account for more than half of all deaths in Plymouth each year. These diseases have common risk factors: tobacco use, alcohol misuse, poor diet and physical inactivity. The 'Thrive Plymouth Programme' aims to make a significant difference in reducing the current health inequalities across the city, by improving health literacy and addressing the four risk factors which together contribute to the four chronic diseases and account for 54 per cent of deaths in Plymouth. This 4-4-54 construct is the origin of the Thrive Plymouth Programme: (Figure 2).

Figure 2: Thrive Plymouth Framework

Thrive Plymouth Programme has been developed to address these risk factors. By avoiding these in the first place, through encouraging lifestyle changes and building resilience through promoting positive mental wellbeing, we can reduce the proportion of deaths due to these diseases. Our approach recognises the impact of psychological factors including mental wellbeing and adverse experiences on health inequalities and outcomes in later life. This will require all partners to work together to ensure effective prevention, identifying and recognising wider social determinants, and delivering early intervention.

Commissioning wellbeing services that empower and enable people to live healthier lives for longer will be crucial to meet the future demand for services and support health promotion and positive health outcomes.

Additionally, wider problematic substance use is a behaviour that can be influenced with the right support. The city will aim to create an environment within which people can identify their motivation and move to a focus on longer term change supported by the person’s family, peers and community.

These four risk factors are also well recognised modifiable risk factors for poor mental health and more specifically dementia. With an ageing society, dementia is becoming increasingly more common and generating significant emotional, social, and financial costs to the person, family, community, and wider society. Understanding the local situation is very important to providing early diagnosis and appropriate support to people and their carers. Over 3,300 over-65s in Plymouth are predicted to be living with dementia in 2017 and the number of cases in Plymouth are predicted to increase to 4,735 by 2030.

Plymouth will remain a Dementia Friendly City, recognising the influence of the modifiable risk factors and the great diversity among individuals with dementia and their carers. It will promote the inclusion of people living with dementia in all areas of community life, respecting their decisions and lifestyle choice, anticipating and responding flexibly to their dementia related needs and preferences. Providing good information, advice and care co-ordination can also support people to live with dementia.

Nearly 26,600 people aged 18-64 years suffer from some form of common mental disorder in Plymouth. It is quite common for people to meet the diagnostic criteria for two or more mental health problems; there are over 11,900 people in Plymouth aged 18 and over estimated to have more than one mental health problem. Data from the national Mental Health of Children and Young People in England 2017 survey shows that one in eight (12.8%) 5 to 19 year olds had at least one mental disorder. Data from this survey series reveal a slight increase over time in the prevalence of mental disorder. This figure has been increasingly slightly over the year rising from 9.7% in 1999.

We know that often critical to enabling and supporting parents with a route out of poverty is ensuring that they are able to access mental health support. Within the economic constraints that affect public service commissioning and delivery, partners across the city will focus on how mental health services can continue to meet the needs of the population. Key elements to the approach will be to promote mental wellbeing, improve prevention, support recovery and improve access to mental health services, particularly to those in crisis.

Physical activity is one of the best preventative medicines and if people who are currently physically inactive or have a low level of physical activity increased their activity to a moderate level this would substantially reduce their risk of developing heart disease and contribute to their good mental health and wellbeing. There is also emerging evidence suggesting that the arts, heritage and cultural activities, as well as other interventions that promote cognitive stimulation, can be instrumental in improving wellbeing, including reducing the impact of mild to moderate dementia and slowing the cognitive decline in people who already have dementia.

In order to ensure that people have access to opportunities to increase their physical activity it is essential that appropriate facilities are provided, existing facilities are protected and decisions relating to facilities are based on robust assessments of need, alongside supporting physical activity being incorporated into everyday activities, such as travel.

Tackling food poverty is also recognised as an effective measure in reducing health inequalities. The Health and Wellbeing Board identified obesity and healthy weight as a priority for tackling health inequalities across the city and the city is committed to taking co-ordinated and integrated action to tackle the issue through inter-agency working.

The Plymouth Report 2018 identifies that across the city 24.4 per cent of children in Reception Classes are identified as having excess weight (overweight or obese). The comparable figure in Year Six is 33.2 per cent. Schools are supported in gaining the Healthy Child Quality Mark which ensures that nutrition is taught and that schools facilitate healthier behaviour in children. A contributory measure is to protect the food environment around schools so that uses such as hot food take aways are carefully controlled and healthy food options provided. See the Joint Local Plan to see how this will be tackled through the planning process. Having successfully delivered Food Plymouth's Food Charter and Action Plan (2011-2014), the city is now working towards the Sustainable Food Cities (SFC) Silver award, aiming to achieve this by the early 2020s. This award is designed to recognise and celebrate the success of places taking a joined up, holistic approach to food and that are achieving significant positive change on a range of key food issues. Having successfully achieved bronze status, Food Plymouth and Thrive Plymouth are working in partnership across the six SFC strands to help move Plymouth towards food system transformation. This includes raising awareness of the importance of a nutritious balanced diet and improving the availability of affordable healthy food. It will also provide a wide range of community growing and other food related activities to improve physical and mental health for people of all ages, with a strong emphasis on connecting communities. The range of green spaces within Plymouth will also play an important role, both in terms of facilitating opportunities for residents to grow their own healthy food and for improving socialisation, tackling isolation and increasing physical activity.

A Child Poverty Needs Assessment and consultation with stakeholders has identified children's dental health as a critical health inequality that needs to be addressed. More than half of children (55 per cent) living in the most deprived areas of Plymouth are affect by dental decay and approximately 700 children aged 0-16 have teeth removed under general anaesthetic each year. This has detrimental effect on children’s all round health and can affect a child’s ability to eat, sleep and play with other children.

Though lifestyle factors that affect health can be identified (smoking, lack of physical activity, poor diet and excess alcohol), there are usually complex social and wider factors that influence lifestyles and health.

Social support is particularly important in increasing resilience and promoting recovery from illness. Strong social capital can also improve the chances of avoiding lifestyle risks such as smoking. However, in the most deprived communities, almost half of people report severe lack of support making people who are at greater risk less resilient to the health effects of social and economic disadvantage. To address these issues, a number of Wellbeing Hubs are being established across the city. The vision for Wellbeing Hubs is to develop 'A network of integrated resources working together to enable and support people in the local community to live independently and make life choices that will improve their health and wellbeing.'