Health

Choosing health in Hertfordshire

The government's Public Health White Paper 'Choosing Health' was published in November 2004. The NHS is responsible for carrying out this health improvement agenda and does so by working in close partnership with local authorities. This year's Health section of the report has been designed to show how Hertfordshire performed in terms of the major new health themes.

The 7 key priority action areas of the agenda requiring more people to make healthier choices are:

Tackling health inequalities
Reducing the number of people who smoke
Reducing obesity, improving diet and nutrition
Increasing physical activity
Improving sexual health
Improving mental health and well-being
Encouraging sensible drinking and reducing harm

These priorities have become an integral part of the NHS, it's core day-to-day business and it's planning. Since they are so important (and as some of the previously reported indicators have not changed) this section will reflect on those priorities instead.

1. Tackling health inequalities

Life expectancy at birth (a summary measure of the mortality rate of a population into a single figure) and Infant death rates (children aged under 1) are both very important indicators of population health. The variation in Life Expectancy At Birth (HE1) and Infant Mortality (HE2) can be used as a measure of health inequality and as a starting point to address the 'Tackling Health Inequalities' priority.

Apart from Stevenage and Watford, life expectancy at birth for men and women living in the county was, on average, generally higher than that for England. It ranged from 76.6 to 78.7 years in men, with the lowest in Stevenage and highest in Dacorum and for women ranged between 80.5 to 82.2 years - again lowest in Stevenage but highest in East Hertfordshire. Previous studies suggest a correlation between life expectancy and deprivation in men.¹

Indicator HE1 - Life expectancy

Hertfordshire districts: Average life expectancy at birth 2002-2004

National Statistics; Compendium of clinical and health indicators February 2006
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Indicator HE2 - Mortality in Children under 1

Hertfordshire district mortality in children aged under one year old 2002 - 2005

National Statistics; Compendium of clinical and health indicators October 2006
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Infant death rates were relatively lower in most of the county than the England average. The lowest rates were in St Albans, a 25% fall from 3.1 in 2002- 4 to 2.1 infant deaths per thousand livebirths in 2003-5, a significant difference. In 2003-5 death rates in Stevenage fell by about 20% from 5.9 to 4.7/ 1000 livebirths and was lower than England's 5.2 average. Rates also improved in Watford, reducing by 11% from 6.0/1000 to 5.2/1000 livebirths but this was still slightly above the England average.

2. Reducing the number of people who smoke

The prevalence of smoking in Hertfordshire for 2002-4 was highest in Stevenage where a quarter of the population smoke, followed closely by Broxbourne.

Chart 1: Smoking prevalence in Hertfordshire 2002-4

Source: Eastern region public health observatory 2006
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These were above the county average yet St Albans and East Hertfordshire districts had much lower rates and were lowest in the county. The smoking attributable mortality rate in Watford and Stevenage were higher than even the national rate. St Albans was lowest in the county.

Chart 2: Smoking related deaths (Attributable Mortality) in Hertfordshire 2002-4

Source: Eastern region public health authority 2006
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3. Reducing obesity, improving diet and nutrition

Statistics suggest that the incidence of childhood obesity has quadrupled in the last 30 years. Studies carried out by Bedfordshire and Hertfordshire Public Health Intelligence found that the highest rate of childhood and adult obesity occurred in the more deprived areas of the county². It also found that:

73 Hertfordshire schools were identified 'at risk', having 3 or more obese children
Of these, 36 did not belong to the Healthy Schools initiative
St Albans, Harpenden and South East Herts had the largest number of schools in the county in the 'at risk' category.³

4. Increasing physical activity

In the East of England region around 65% of men and 75% of women were not sufficiently active to benefit to their health and 3 in 10 boys and 4 in 10 girls aged 2-15 were not reaching recommended physical activity levels. Hertfordshire has targets to encourage children, young and older people to increase their activity in its Local Area and Public Service Agreements. These are jointly supported and monitored by activities of Primary Care Trusts, Local Authorities, Education and other partner agencies.

5. Improving sexual health

Estimates show that up to 10% of young people aged 16-24 may have been infected with Chlamydia. A treatment and screening programme has been extended across the county to help manage the disease. Rates of Gonorrhoea have also risen and PCTs and the Department of Health (DoH)³ are supporting the national health campaign targeting and enabling young people to reduce risks associated with sexually transmitted infections.

6. Improving mental health and well-being

A public consultation on the future of Hertfordshire's mental health services, 'Investing In Your Mental Health'⁴ took place in 2005/06.

7. Reducing harm and encouraging sensible drinking

Estimates suggest Stevenage and Welwyn Hatfield have the highest levels of binge-drinkers in the county (about 18.1% each). Between 2002-4, about 1336 deaths in the county were estimated to be attributable to alcohol. Standardised Mortality Rates are used as a measure of alcohol-related deaths and the variation in these between localities is shown in the following graph with relatively high rates for men in Hertsmere and women in Dacorum. All of the areas in Hertfordshire, however, were below the average for males in England but Dacorum was slightly higher than England's female average.

Alcohol related deaths in Hertfordshire Local Authoritires 2002-4 standardised mortality ratio

Source: Eastern Region Public Health Authority 2006: NWPHO, using mortality and population data from Office for National Statistics
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1 For additional information on deprivation see the Beds & Herts Public Health Intelligence website
2 From data available at the time
4 See www.doh.gov.uk
5 See www.investinginyourhealth.org.uk/mentalhealth