How do Glasgow and (West of) Scotland compare with European

cities and regions?David Walsh

Glasgow Centre for Population Health

HFF7, May 2008

Content

• Two separate projects, published as…

• Two separate reports, and thus…

• Two separate presentations

• All in 20 minutes

• But may feel longer…

Two projects/reports• The Aftershock of

Deindustrialisation -trends in mortality in Scotland and other parts of post-industrial Europe

• David Walsh, Martin Taulbut, Phil Hanlon

• Collaboration between GCPH and NHS Health Scotland

Two projects/reports

• Comparisons of health-related behaviours and health measures in Greater Glasgow with other regional areas in Europe

• Linsay Gray, MRC Social & Public Health Sciences Unit, University of Glasgow

The Aftershock of Deindustrialisation –Trends in mortality in Scotland and other parts of

post-industrial Europe

April 2008

Background

• Post-industrial decline (and associated factors) promoted as one of major reasons behind Scotland/WoS’s poor health profile

• Begs question: how have other similarly deindustrialised regions fared?

Project aims• Identify regions which have undergone

similar processes of deindustrialisation• Compare long-term trends in mortality (as

first step…)

Identification of areas

• Selection of areas based on combination of:

– extensive consultation with experts in European public health and European history

– analysis of regional industrial employment loss

European post-industrial regions

European post-industrial regions

1. Ruhr (D)

2. Saxony-Anhalt (D)

3. Saxony (incl. Chemnitzand Leipzig regions) (D)

4. Wallonia (B)

5. Lorraine (incl. Moselle) (F)

6. Nord-Pas-de-Calais (F)

7. Alsace (F)

8. Silesia (incl. Katowice) (P)

9. N. Moravia (Cz)

10. Limburg (NL)

11. Greater Manchester

12. Tees Valley & Durham

13. Northumb’d, Tyne & Wear

14. Merseyside

15. West Midlands

16. Swansea & S. Wales coalfields

17. N. Ireland

18. West of Scotland

Deindustrialisation in Scotland/the West of Scotland

• 44% decrease in levels of industrial employment* between 1971 and 2005 in Scotland

• Represents a loss of 360,000 industrial jobs• Not just a West of Scotland phenomenon…

*‘Industrial employment’: includes mining, manufacturing, utilities and construction

• But more marked in WoS: 62% decrease (from 500,000 to 190,000 industrial jobs)

MerseysideMerseyside

• 63% decrease in industrial employment between 1971 and 2005

• Represents loss of 200,000 industrial jobs

Ruhr areaRuhr area

• 55% decrease in industrial employment between 1970 and 2005

• Represents loss of 700,000 industrial jobs

Nord-Pas-de-Calais

• 43% decrease in industrial employment between 1970 and 2005

• Represents loss of >300,000 industrial jobs

Katowice (Silesia)

• 55% decrease in industrial employment between 1980 and 2005

• Represents loss of 475,000 industrial jobs

Mortality: how do these regions fare within their own countries?

All cause mortality EASRs 2001-03 by English counties (NUTS2), malesSource: Eurostat

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

Mersey

side

Greater

Man

ches

ter

Northu

mberla

nd, T

yne &

Wea

r

Tees V

alley

and D

urham

Wes

t Midl

ands

Lanc

ashir

e

South

Yorksh

ire

West Y

orksh

ireInn

er Lo

ndon

Shrops

hire a

nd S

taffor

dshir

e

Derbys

hire &

Nott

ingha

mshire

East R

iding

& N

. Linc

olnsh

ireChe

shire

Cumbri

aLin

colns

hire

Leice

stersh

ire, R

utlan

d & N

ortha

nts

Outer L

ondo

nKen

t

Herefor

dshir

e, W

orcs &

Wark

sEss

ex

Bedfor

dshir

e, Hert

fords

hire

Cornwall

and I

sles o

f Scil

ly

Glos, W

iltshir

e & N

. Som

erset

Berksh

ire, B

ucks

and O

xfords

hire

Devon

Hamps

hire a

nd Is

le of

Wigh

tEas

t Ang

lia

North Y

orksh

ire

Surrey

, Eas

t and

Wes

t Sus

sex

Dorset

and S

omers

et

English counties

Age

-sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

All cause mortality EASRs 2001-03 by Netherlands Province (NUTS2), malesSource: Eurostat

0

100

200

300

400

500

600

700

800

900

1000

Limburg Overijssel Groningen Gelderland Noord-Brabant

Zuid-Holland

Drenthe Utrecht Friesland Noord-Holland

Flevoland Zeeland

Netherlands province

Age

-sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

All-cause mortality, EASRs 2001-2003 by French région (NUTS2), malesSource: Eurostat

0

200

400

600

800

1000

1200

Nord - P

as-de

-Cala

isPica

rdie

Haute-

Norman

dieBret

agne

Lorra

ine

Champa

gne-A

rdenn

eAuv

ergne

Bourgo

gne

Basse

-Norm

andie

Alsace

Limou

sin

Franch

e-Com

téCors

e

Pays d

e la L

oire

Lang

uedo

c-Rou

ssillo

nAqu

itaine

Centre

Poitou

-Cha

rentes

Proven

ce-A

lpes-C

ôte d'

ARhô

ne-A

lpes

Midi-P

yréné

esÎle

de Fran

ce

French régions

Age

-sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

All-cause mortality, EASRs 2001-2003 by German Länder (NUTS1), malesSource: Eurostat; North Rhine-Westphalia Institute for Health and Work (LIGA)

0

200

400

600

800

1000

1200

Sachs

en-A

nhalt

Meckle

nburg

-Vorp

ommern

Brande

nburg

Saarla

ndRuh

r area

Sachs

en

Bremen

Nordrhe

in-W

estfa

len

Berlin

Nieders

achs

enRhe

inlan

d-Pfal

zSch

leswig-

Holstei

nHam

burg

Bayern

Hesse

n

Baden

-Würt

tembe

rg

German Länder (plus Ruhr)

Age

-sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Socio-economic profiles

• Very (very, very) approximate socio-economic overview…

GDP - Purchasing Power Parities Per Inhabitant (2004)Source: Eurostat

€ 25,264€ 23,946

€ 12,260

0

5000

10000

15000

20000

25000

30000

Silesia

N. Mora

via**

Chemnit

zSac

hsen

-Anh

alt

Swanse

a & th

e S. W

ales C

oalfie

lds**

Sachs

enLe

ipzig

Mersey

side

NPdC

Tees V

alley

& D

urham

Wall

onia

Mosell

eLo

rraine

N. Irela

ndThe

Ruh

r**

Northu

mberla

nd, T

yne a

nd W

ear

Alsace

South

Wes

tern S

cotla

ndG. M

anch

ester

W. M

idlan

dsLim

burg

(NL)

Scotla

nd

Euro

s

** Average of values for smaller NUTS3 regions

Unemployment rate, 2005Source: Eurostat

4.7

20.5

5.36.4

0

5

10

15

20

25

N. Irela

ndG. M

anch

ester

Scotla

ndLim

burg

(NL)

Mersey

side

Tees V

alley

& D

urham

Northu

mberla

nd, T

yne a

nd W

ear

W. M

idlan

ds

Swanse

a & th

e S. W

ales C

oalfie

ldsW

est o

f Sco

tland

Alsace

Lorra

ineMos

elle

Wall

onia

N. Mora

via

NPdCThe

Ruh

rChe

mnitz

Sachs

en

Silesia

Sachs

en-A

nhalt

Leipz

ig

unem

ploy

ed a

s %

of e

cono

mic

ally

act

ive

aged

15+

Long-term unemployment: % unemployed for 12 months or moreSource: Eurostat

13.5

0.8 1.21.6

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Greater

Man

ches

terSco

tland

Tyne T

ees a

nd D

urham

Wes

t Midl

ands

Northu

mberla

nd/Tyn

e & W

ear

SW S

cotla

ndMers

eysid

e

Limbu

rg

Alsace

Northe

rn Ire

land

Lorra

ine

Nord-P

as-de

-Cala

isW

allon

ia

Saxon

yChe

mnitz

Silesia

Leipz

igSax

ony-A

nhalt

% o

f eco

nom

ical

ly a

ctiv

e po

p ag

ed 1

5+

Not in employment: male (25+) non-employment rate, 2005Various sources - see Appendix 2

34.033.2

48.1

41.6

0

10

20

30

40

50

60

Northe

rn Mora

viaAlsa

ceSco

tland

Nord Pas

de C

alais

Northe

rn Ire

land

Limbu

rg

Greater

Man

ches

terW

est M

idlan

dsMers

eysid

eWall

onia

West o

f Sco

tland

Lorra

ine

Tees V

alley

& Durh

am

Northu

mberla

nd, T

yne &

Wea

rThe

Ruh

r

Swanse

a & S

. Wale

s Coa

lfields

Chemnit

zSile

siaSax

ony

Saxon

y-Anh

altLe

ipzig

% o

f mal

es a

ged

25+

econ

omic

ally

inac

tive

or u

nem

ploy

ed

Economic activity rate, 2005Source: Eurostat; RVR; Annual Population Survey; CSO

62.561.0

51.1

0

10

20

30

40

50

60

70

Wall

onia

Silesia

NPdCLo

rraine

Mersey

side

Swanse

a & th

e S. W

ales C

oalfie

ldsThe

Ruh

r

Northu

mberla

nd, T

yne a

nd W

ear

Tees V

alley

& D

urham

N. Mora

viaChe

mnitz

Sachs

en-A

nhalt

N. Irela

ndSac

hsen

Leipz

ig

Alsace

Wes

t of S

cotla

ndW

. Midl

ands

Limbu

rg (N

L)G. M

anch

ester

Scotla

nd

% o

f pop

age

d 15

+ w

ho a

re e

cono

mic

ally

act

ive

% of adult population (15+) with tertiary level qualifications: 2005Source: Eurostat; Urban Audit data for Ruhr (2001)

23.522.3

8.9

28.4

0

5

10

15

20

25

30

N. Mora

viaThe

Ruh

rSile

siaLo

rraine

NPdC

Tees V

alley

& Durh

am

Northu

mberla

nd, T

yne a

nd W

ear

Mersey

side

W. Midl

ands

N. Irela

ndG. M

anch

ester

Limbu

rg (N

L)Alsa

ceSac

hsen

-Anh

altWall

onia

South

Wester

n Sco

tland

Scotla

ndChe

mnitz

Sachs

enLe

ipzig

% p

opul

atio

n ag

ed 1

5+ w

ith te

rtia

ry q

ualif

icat

ions

Mortality analysis

• ‘Raw’ mortality data requested from national and regional statistical agencies

• Requested by age, sex, year (25 years if possible) for 17 causes including:– Various cancers (all; breast; lung; oesophageal;

colorectal; stomach; prostate)– Circulatory system diseases (incl. IHD and stroke)– COPD and related causes– External causes (incl. suicide and MVTAs)– Chronic liver disease and cirrhosis

• Data received for all regions, although for more limited time periods in some areas

Results

Two sets of results:A. Life expectancy (all twenty regions)B. Detailed age/sex/cause specific mortality

analysis (ten regions)

A. Life expectancy

Life expectancy - RuhrEstimates of male life expectancy at birth: Ruhr area compared to Scotland, West of

Scotland and GGC, 1982-2005 (3-year averages)Source: GRO(S) mortality & population data (Scotland); NRW lögd mortality & population data (Ruhr)

64.0

66.0

68.0

70.0

72.0

74.0

76.0

78.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of male life expectancy at birth: Ruhr area compared to Scotland, West of Scotland and GGC, 1982-2005 (3-year averages)

Source: GRO(S) mortality & population data (Scotland); NRW lögd mortality & population data (Ruhr)

64.0

66.0

68.0

70.0

72.0

74.0

76.0

78.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Ruhr area

Life expectancy - RuhrEstimates of female life expectancy at birth: Ruhr area compared to Scotland, West of

Scotland and GGC, 1982-2005 (3-year averages)Source: GRO(S) mortality & population data (Scotland); NRW lögd mortality & population data (Ruhr)

71.0

72.0

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

81.0

82.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of female life expectancy at birth: Ruhr area compared to Scotland, West of Scotland and GGC, 1982-2005 (3-year averages)

Source: GRO(S) mortality & population data (Scotland); NRW lögd mortality & population data (Ruhr)

71.0

72.0

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

81.0

82.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Ruhr area

Life expectancy - French regionsEstimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace

compared to Scotland, West of Scotland and GG&C, 1983-2003Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

77.0

1983 1987 1991 1995 1999 2003

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003

Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

77.0

1983 1987 1991 1995 1999 2003

Life

exp

ecta

ncy

at b

irth

WoS

Estimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003

Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

77.0

1983 1987 1991 1995 1999 2003

Life

exp

ecta

ncy

at b

irth

WoS Nord Pas de Calais

Estimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003

Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

77.0

1983 1987 1991 1995 1999 2003

Life

exp

ecta

ncy

at b

irth

WoS Lorraine Nord Pas de Calais

Estimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003

Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

77.0

1983 1987 1991 1995 1999 2003

Life

exp

ecta

ncy

at b

irth

WoS Alsace Lorraine Nord Pas de Calais

Life expectancy - French regionsEstimates of female life expectancy at birth: France, Nord Pas de Calais, Lorraine and

Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)

70.0

72.0

74.0

76.0

78.0

80.0

82.0

84.0

1983 1987 1991 1995 1999 2003

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of female life expectancy at birth: France, Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003

Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)

70.0

72.0

74.0

76.0

78.0

80.0

82.0

84.0

1983 1987 1991 1995 1999 2003

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Alsace Lorraine Nord Pas de Calais

Saxony – life expectancyEstimates of male life expectancy at birth: Saxony compared to Scotland, West of Scotland

and GGC, 1983-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and the Statistical Office of Free State of Saxony

64.0

66.0

68.0

70.0

72.0

74.0

76.0

78.0

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of male life expectancy at birth: Saxony compared to Scotland, West of Scotland and GGC, 1983-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and the Statistical Office of Free State of Saxony

64.0

66.0

68.0

70.0

72.0

74.0

76.0

78.0

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Saxony

Saxony – life expectancyEstimates of female life expectancy at birth: Saxony compared to Scotland, West of

Scotland and GGC, 1982-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and the Statistical Office of Free State of Saxony

70.0

72.0

74.0

76.0

78.0

80.0

82.0

84.0

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of female life expectancy at birth: Saxony compared to Scotland, West of Scotland and GGC, 1982-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and the Statistical Office of Free State of Saxony

70.0

72.0

74.0

76.0

78.0

80.0

82.0

84.0

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Saxony

Saxony-AnhaltEstimates of male and female life expectancy at birth:

Saxony-Anhalt compared to West of Scotland, 1995-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and Landesamt für Verbraucherschutz Sachsen-

Anhalt

70.0

72.0

74.0

76.0

78.0

80.0

82.0

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS females WoS males

Estimates of male and female life expectancy at birth: Saxony-Anhalt compared to West of Scotland, 1995-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and Landesamt für Verbraucherschutz Sachsen-Anhalt

70.0

72.0

74.0

76.0

78.0

80.0

82.0

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS females WoS males Saxony-Anhalt males

Estimates of male and female life expectancy at birth: Saxony-Anhalt compared to West of Scotland, 1995-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and Landesamt für Verbraucherschutz Sachsen-Anhalt

70.0

72.0

74.0

76.0

78.0

80.0

82.0

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS females Saxony-Anhalt females WoS males Saxony-Anhalt males

Life expectancy – N. MoraviaEstimates of male life expectancy at birth, Northern Moravia compared to Scotland, West of Scotland

and Greater Glasgow & Clyde, 1982-2005 (3-year averages)Source: Calculated from GRO(S) and Institute of Health Information & Statistics (CZ) data

65.0

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of male life expectancy at birth, Northern Moravia compared to Scotland, West of Scotland and Greater Glasgow & Clyde, 1982-2005 (3-year averages)

Source: Calculated from GRO(S) and Institute of Health Information & Statistics (CZ) data

65.0

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Northern Moravia

Life expectancy – N. MoraviaEstimates of female life expectancy at birth, Northern Moravia compared to Scotland, West of

Scotland and Greater Glasgow & Clyde, 1982-2005 (3-year averages)Source: Calculated from GRO(S) and Institute of Health Information & Statistics (CZ) data

72.0

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of female life expectancy at birth, Northern Moravia compared to Scotland, West of Scotland and Greater Glasgow & Clyde, 1982-2005 (3-year averages)

Source: Calculated from GRO(S) and Institute of Health Information & Statistics (CZ) data

72.0

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Northern Moravia

Katowice (Silesia)Estimates of male life expectancy at birth: Katowice compared to Scotland, West of Scotland

and GGC, 1975-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and Cancer Center & Institute of Oncology, Warsaw

60.0

62.0

64.0

66.0

68.0

70.0

72.0

74.0

76.0

1975

-1977

1976

-1978

1977

-1979

1978

-1980

1979

-1981

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of male life expectancy at birth: Katowice compared to Scotland, West of Scotland and GGC, 1975-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and Cancer Center & Institute of Oncology, Warsaw

60.0

62.0

64.0

66.0

68.0

70.0

72.0

74.0

76.0

1975

-1977

1976

-1978

1977

-1979

1978

-1980

1979

-1981

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Katowice

Katowice (Silesia)Estimates of female life expectancy at birth: Katowice compared to Scotland, West of

Scotland and GGC, 1982-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and Cancer Center & Institute of Oncology, Warsaw

70.0

71.0

72.0

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

1975

-1977

1976

-1978

1977

-1979

1978

-1980

1979

-1981

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of female life expectancy at birth: Katowice compared to Scotland, West of Scotland and GGC, 1982-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and Cancer Center & Institute of Oncology, Warsaw

70.0

71.0

72.0

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

1975

-1977

1976

-1978

1977

-1979

1978

-1980

1979

-1981

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Katowice

Life expectancy - LimburgEstimates of male life expectancy at birth, Limburg compared to Scotland, West of Scotland and

Greater Glasgow & Clyde, 1982-2005 (3-year averages)Source: calculated from mortality & population data from GRO(S) (Scotland) and CBS Statsline (NL)

64.0

66.0

68.0

70.0

72.0

74.0

76.0

78.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC

Estimates of male life expectancy at birth, Limburg compared to Scotland, West of Scotland and Greater Glasgow & Clyde, 1982-2005 (3-year averages)

Source: calculated from mortality & population data from GRO(S) (Scotland) and CBS Statsline (NL)

64.0

66.0

68.0

70.0

72.0

74.0

76.0

78.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Limburg

Life expectancy - LimburgEstimates of female life expectancy at birth, Limberg compared to Scotland, West of Scotland and

Greater Glasgow & Clyde, 1982-2005 (3-year averages)Source: calculated from mortality & population data from GRO(S) (Scotland) and CBS Statsline (NL)

72.0

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

81.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

Scotland WoS GGC Limburg

English & Welsh regions (male)Estimates of male life expectancy at birth: selected English and Welsh regions compared to

West of Scotland, 1988-2005 (3-year averages) Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS Scotland GGC

Estimates of male life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS

Estimates of male life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS

Estimates of male life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS English & Welsh regions average

English & Welsh regions (female)Estimates of female life expectancy at birth: selected English and Welsh regions compared

to West of Scotland, 1988-2005 (3-year averages) Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

81.0

82.0

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS Scotland GGC

Estimates of female life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

81.0

82.0

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS

Estimates of female life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

81.0

82.0

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS

Estimates of female life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)

Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)

73.0

74.0

75.0

76.0

77.0

78.0

79.0

80.0

81.0

82.0

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS English & Welsh regions average

Northern IrelandEstimates of male and female life expectancy at birth,

Northern Ireland compared with West of Scotland , 1982-2005 (3-year averages)Source: calculated from mortality & population data from GRO(S) and NISRA

68.0

70.0

72.0

74.0

76.0

78.0

80.0

82.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS males WoS females

Estimates of male and female life expectancy at birth, Northern Ireland compared with West of Scotland , 1982-2005 (3-year averages)

Source: calculated from mortality & population data from GRO(S) and NISRA

68.0

70.0

72.0

74.0

76.0

78.0

80.0

82.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS males Northern Ireland males WoS females Northern Ireland females

B. Age/sex/cause-specific mortality analysis

• Comparator areas reduced from 20 to 10• One region per country basis (except

Germany)• Each region has worst/among worst

mortality rates in their respective countries

10 post-industrial regions • Ruhr (West Germany)• Saxony (East Germany) • Katowice • Northern Moravia • Nord Pas de Calais • Wallonia• Limburg• Northern Ireland• Swansea & the South Wales Coalfields• Merseyside

Analysis

• Age standardised rates, 3-year rolling averages– here compared to West of Scotland only

• Five age groups:– Infants (<1)– Children (1-14)– Younger working age (15-44)– Older working age (45-64)– Elderly (65+)

• Presented here in summarised format…

Infant mortalityInfant mortality: infant deaths per 1,000 live births (three year rolling averages)

West of Scotland in context of maximum, minimum & mean rates for selected European regions

0.0

5.0

10.0

15.0

20.0

25.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Rat

e pe

r 1,0

00 li

ve b

irths

Maximum

Mean

Minimum

Number of regions in analysis

3 3 4 5 5 5 5 6 7 7 9 9 9 9 10 11 11 11 10 10 10 10 10 10

Infant mortality: infant deaths per 1,000 live births (three year rolling averages)West of Scotland in context of maximum, minimum & mean rates for selected European

regions

0.0

5.0

10.0

15.0

20.0

25.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Rat

e pe

r 1,0

00 li

ve b

irths

Maximum

Mean

Minimum

Number of regions in analysis

3 3 4 5 5 5 5 6 7 7 9 9 9 9 10 11 11 11 10 10 10 10 10 10

Children (1-14)Children (1-14): all-cause EASRs (3 year rolling averages), 1980-2005, males

West of Scotland in context of maximum, minimum & mean rates for selected European regions

0.0

10.0

20.0

30.0

40.0

50.0

60.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

4 5 5 5 5 6 8 8 9 10 10 1033 10 10 9 9 9 9 9 9 9 8

Children (1-14)Children (1-14): all-cause EASRs (3 year rolling averages), 1980-2005, femalesWest of Scotland in context of maximum, minimum & mean rates for selected

European regions

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

4 5 5 5 5 6 8 8 9 10 10 1033 10 10 9 9 9 9 9 9 9 8

Working age 15-44

All cause, maleWorking age 15-44: all-cause EASRs (3 year rolling averages), 1980-2005, males

West of Scotland in context of maximum, minimum & mean rates for selected European regions

0.0

50.0

100.0

150.0

200.0

250.0

300.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

stan

dard

ised

rate

per

100

,000

pop

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Working age 15-44: all-cause EASRs (3 year rolling averages), 1980-2005, malesWest of Scotland in context of maximum, minimum & mean rates for selected European

regions

0.0

50.0

100.0

150.0

200.0

250.0

300.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

stan

dard

ised

rate

per

100

,000

pop

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

External causes, maleExternal causes mortality: male working age 15-44 EASRs (3 year rolling averages),

1980-2005; West of Scotland in context of maximum, minimum & mean rates for selected European regions

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Suicide & undetermined intent, maleSuicide (incl. deaths from undetermined intent): male working age 15-44 EASRs (3

year rolling averages), 1983-2005; West of Scotland in context of maximum, minimum & mean rates for selected European regions

0.0

10.0

20.0

30.0

40.0

50.0

60.0

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

6 6 6 6 7 9 9 9 10 10 10 10 10 9 9 9 9 9 9 9 8

Suicide & undetermined intent, femaleSuicide (incl. deaths from undetermined intent): female working age 15-44 EASRs (3

year rolling averages), 1983-2005; West of Scotland in context of maximum, minimum & mean rates for selected European regions

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

6 6 6 6 7 9 9 9 10 10 10 10 10 9 9 9 9 9 9 9 8

Chronic liver disease & cirrhosis, maleChronic liver disease & cirrhosis mortality: male working age 15-44 EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &

mean rates for selected European regions

0.0

5.0

10.0

15.0

20.0

25.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Chronic liver disease & cirrhosis mortality: male working age 15-44 EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &

mean rates for selected European regions

0.0

5.0

10.0

15.0

20.0

25.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Chronic liver disease & cirrhosis, femaleChronic liver disease & cirrhosis mortality: female working age 15-44 EASRs (3 year rolling averages), 1982-2005; West of Scotland in context of maximum, minimum &

mean rates for selected European regions

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 10 10 10 9 9 9 9 9 9 9 8

Working age 45-64

All cause - maleWorking age 45-64: all-cause EASRs (3 year rolling averages), 1980-2005, malesWest of Scotland in context of maximum, minimum & mean rates for selected

European regions

0.0

500.0

1000.0

1500.0

2000.0

2500.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

All cause - femaleWorking age 45-64: all-cause EASRs (3 year rolling averages), 1980-2005, females

West of Scotland in context of maximum, minimum & mean rates for selected European regions

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

900.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Female 45-64 mortality - cancersAll malgnant neoplasms mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &

mean rates for selected European regions

0.0

50.0

100.0

150.0

200.0

250.0

300.0

350.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Lung cancer mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum & mean

rates for selected European regions

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Breast cancer mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2004; West of Scotland in context of maximum, minimum & mean

rates for selected European regions

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1980-1982

1981-1983

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Oesophageal cancer mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &

mean rates for selected European regions

0.0

2.0

4.0

6.0

8.0

10.0

12.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Female 45-64 mortality - otherIHD mortality: female working age 45-64 all-cause EASRs (3 year rolling averages),

1980-2005; West of Scotland in context of maximum, minimum & mean rates for selected European regions

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Cerebrovascular disease mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &

mean rates for selected European regions

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

COPD mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum & mean rates for

selected European regions

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Chronic liver disease & cirrhosis mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1982-2005; West of Scotland in context of maximum,

minimum & mean rates for selected European regions

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Male 45-64 – causes notably above/below average

IHD mortality: male working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum & mean rates for selected

European regions

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

COPD mortality: male working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum & mean rates for

selected European regions

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

1980

-1982

1981

-1983

1982

-1984

1983

-1985

1984

-1986

1985

-1987

1986

-1988

1987

-1989

1988

-1990

1989

-1991

1990

-1992

1991

-1993

1992

-1994

1993

-1995

1994

-1996

1995

-1997

1996

-1998

1997

-1999

1998

-2000

1999

-2001

2000

-2002

2001

-2003

2002

-2004

2003

-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Suicide mortality: male working age 45-64 all-cause EASRs (3 year rolling averages), 1983-2005; West of Scotland in context of maximum, minimum & mean rates for

selected European regions

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

Chronic liver disease & cirrhosis mortality: male working age 45-64 all-cause EASRs (3 year rolling averages), 1982-2005; West of Scotland in context of maximum,

minimum & mean rates for selected European regions

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Age

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Number of regions included in analysis

5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8

• Worth remembering:– Each region has the highest, or among the

highest, level of mortality in their parent country

– Thus, being “average” isn’t good– Had we included the other 10 regions, WoS’s

relative position would be even worse

Mortality analysis

Conclusions

• Health of virtually all comparable European post-industrial regions improving faster than Scotland/West of Scotland

• Trends driven especially by younger male (15-44) and middle-aged (45-64) females

• This despite (apparently) worse socio-economic profiles

Explanations/hypotheses

• Report tentatively discusses some possible explanations including:– Severity of deindustrialisation?– Deprivation?– Income inequalities?– Population change?– Health behaviours?

• All of which require more explanatory data and research…

• …which is next step of project..

Health indicators in Health indicators in Greater Glasgow Greater Glasgow

compared to selected compared to selected European areasEuropean areas

Linsay GrayLinsay Gray

AimsAims

To compare data on health behaviours To compare data on health behaviours and health outcomes in adults in and health outcomes in adults in Greater Glasgow with those in other Greater Glasgow with those in other cities/regions in UK/Europe, cities/regions in UK/Europe, establishing the extent to which establishing the extent to which socioeconomic circumstances explain socioeconomic circumstances explain differencesdifferences

AimsAims

To compare data on To compare data on health behaviourshealth behavioursand health outcomes in adults in and health outcomes in adults in Greater Glasgow with those in other Greater Glasgow with those in other cities/regions in UK/Europe, cities/regions in UK/Europe, establishing the extent to which establishing the extent to which socioeconomic circumstances explain socioeconomic circumstances explain differencesdifferences

NoteNote

Comparisons of health survey (not mortality) dataComparisons of health survey (not mortality) dataDifferent areas from postDifferent areas from post--industrial projectindustrial projectAreas in Areas in England, Northern Ireland, the Republic of England, Northern Ireland, the Republic of Ireland, Wales, Sweden, Finland, Norway, Spain, Ireland, Wales, Sweden, Finland, Norway, Spain, Belgium and GermanyBelgium and GermanyBut some overlap i.e.:But some overlap i.e.:

Greater Manchester; (Cheshire &) Merseyside; Greater Manchester; (Cheshire &) Merseyside; Northumberland, Tyne & Wear Northumberland, Tyne & Wear (Eastern) Northern Ireland(Eastern) Northern IrelandThree cities in Wallonia (Belgium) Three cities in Wallonia (Belgium) Two relevant areas in Germany (incl. Saxony)Two relevant areas in Germany (incl. Saxony)

SocioSocio--economic characteristicseconomic characteristics

Aim of project: “…Aim of project: “…establishing the extent to establishing the extent to which socioeconomic circumstances explain which socioeconomic circumstances explain differences”differences”But in fact makes very little difference because But in fact makes very little difference because Greater Glasgow’s socioGreater Glasgow’s socio--economic profile economic profile seemingly not very different from the other seemingly not very different from the other areasareas

SocioSocio--economic characteristicseconomic characteristics

0%

20%

40%

60%

80%

100%

GR

EATE

R G

LASG

OW

Sach

sen

Berli

n

Bade

n-W

ürtte

mbe

rg

Ham

burg

Baye

rn

Nor

drhe

in-W

estfa

len

Brem

en

Sevi

lle

Nie

ders

achs

en

Barc

elon

a

Vale

ncia

Mal

aga

Mad

rid

Stoc

khol

m

Wes

t Fla

nder

s

Nor

thum

berla

nd T

yne

& W

ear

Hai

naut

East

Fla

nder

s

Gre

ater

Man

ches

ter

Antw

erpe

n

Lièg

e

Che

shire

& M

erse

ysid

e

Hel

sing

borg

Nam

ur

Mal

mo

East

ern

Nor

ther

n Ire

land

Car

diff

Brus

sels

Lund

Semi- / unskilled Skilled Professional / managerial

AnalysesAnalyses

Alcohol consumptionAlcohol consumptionSmokingSmokingPhysical activityPhysical activityObesityObesity

DiabetesDiabetesGeneral healthGeneral healthLongstanding illnessLongstanding illnessGHQ12GHQ12

Greater Glasgow significantly Greater Glasgow significantly different…different…

Smoking Smoking -- ♂♂

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

Eas

t Nor

ther

n Ire

land

Dub

lin

Car

diff

Mal

mö

Hel

sing

borg

Lund

Sto

ckho

lm

Osl

o

Sou

ther

n Fi

nlan

d

Bru

ssel

s

Ant

wer

p

Eas

t Fla

nder

s

Hai

naut

Lièg

e

Wes

t Fla

nder

s

Nam

ur

Mad

rid

Bar

celo

na

Val

enci

a

Sev

ille

Mal

aga

Ber

lin

Ham

burg

Bav

aria

Bad

en-W

ürtte

mbe

rg

N R

hine

-Wes

tpha

lia

Bre

men

Low

er S

axon

y

Sax

ony

Age-adjusted odds ratios and 95% confidence intervalsSocio-economic- and age-adjusted odds ratios and 95% confidence intervals

Smoking Smoking -- ♀♀

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Dub

lin

Car

diff

Mal

mö

Hel

sing

borg

Lund

Sto

ckho

lm

Osl

o

Sou

ther

n Fi

nlan

d

Bru

ssel

s

Ant

wer

pen

Eas

t Fla

nder

s

Hai

naut

Lièg

e

Wes

t Fla

nder

s

Nam

ur

Mad

rid

Bar

celo

na

Val

enci

a

Sev

ille

Mal

aga

Ber

lin

Ham

burg

Bav

aria

Bad

en-W

ürtte

mbe

rg

N R

hine

-Wes

tpha

lia

Bre

men

Low

er S

axon

y

Sax

ony

Obesity Obesity -- ♂♂

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Dub

lin

Car

diff

Mal

mö

Hel

sing

borg

Lund

Sto

ckho

lm

Osl

o

Sou

ther

n Fi

nlan

d

Bru

ssel

s

Ant

wer

pen

Eas

t Fla

nder

s

Hai

naut

Lièg

e

Wes

t Fla

nder

s

Nam

ur

Mad

rid

Bar

celo

na

Val

enci

a

Sev

ille

Mal

aga

Ber

lin

Ham

burg

Bav

aria

Bad

en-W

ürtte

mbe

rg

N R

hine

-Wes

tpha

lia

Bre

men

Low

er S

axon

y

Sax

ony

Age-adjusted odds ratios and 95% confidence intervalsSocio-economic- and age-adjusted odds ratios and 95% confidence intervals

Obesity Obesity -- ♀♀

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Dub

lin

Car

diff

Mal

mö

Hel

sing

borg

Lund

Sto

ckho

lm

Osl

o

Sou

ther

n Fi

nlan

d

Bru

ssel

s

Ant

wer

pen

Eas

t Fla

nder

s

Hai

naut

Lièg

e

Wes

t Fla

nder

s

Nam

ur

Mad

rid

Bar

celo

na

Val

enci

a

Sev

ille

Mal

aga

Ber

lin

Ham

burg

Bav

aria

Bad

en-W

ürtte

mbe

rg

N R

hine

-Wes

tpha

lia

Bre

men

Low

er S

axon

y

Sax

ony

High GHQ12 High GHQ12 -- ♂♂

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Mal

mö

Hel

sing

borg

Lund

Sto

ckho

lm

Bru

ssel

s

Ant

wer

pen

Eas

t Fla

nder

s

Hai

naut

Lièg

e

Wes

t Fla

nder

s

Nam

ur

Age-adjusted odds ratios and 95% confidence intervalsSocio-economic- and age-adjusted odds ratios and 95% confidence intervals

High GHQ12 High GHQ12 -- ♀♀

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Mal

mö

Hel

sing

borg

Lund

Sto

ckho

lm

Bru

ssel

s

Ant

wer

pen

Eas

t Fla

nder

s

Hai

naut

Lièg

e

Wes

t Fla

nder

s

Nam

ur

Eh, is there any good news?Eh, is there any good news?

Excess alcohol Excess alcohol -- ♂♂

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Age-adjusted odds ratios and 95% confidence intervalsSocio-economic- and age-adjusted odds ratios and 95% confidence intervals

Excess alcohol Excess alcohol -- ♀♀

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Physical activity Physical activity -- ♂♂

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Car

diff

Age-adjusted odds ratios and 95% confidence intervalsSocio-economic- and age-adjusted odds ratios and 95% confidence intervals

Physical activity Physical activity -- ♀♀

0.00

1.00

2.00

Gre

ater

Man

ches

ter

N'la

nd, T

yne

& W

ear

Che

shire

& M

erse

ysid

e

E N

Irel

and

Car

diff

Overall conclusions• Both studies confirm Glasgow’s and the West of

Scotland’s poor health profile compared to other parts of the UK and Europe

• Post-industrial comparisons arguably more relevant

• WoS being ‘left behind’ by other, comparable post-industrial regions

• Behavioural issues are clearly relevant – but only one of a number of explanations

• Further research underway shortly…

Further details…

• Both reports available from GCPH website: www.gcph.co.uk

• ‘Aftershock of deindustrialisation’ report:– Email: david.walsh@drs.glasgow.gov.uk

– Tel: 0141 221 9439

• European health survey comparisons:– Email: linsay@sphsu.mrc.ac.uk

– Tel: 0141 357 7540

How do Glasgow and (West of) Scotland compare with European

cities and regions?David Walsh

Glasgow Centre for Population Health

HFF7, May 2008

Excess mortality in the Glasgow conurbation: UK City

comparisons

James Reid

Main Aims

• Compare cities and conurbations in terms of deprivation

• Compare population health of same entities

• Allow for deprivation factors in comparisons of population health

All cities (pop>275,000)

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

1 2 3 4 5 6 7 8 9 10

Carstairs Decile

Pop

ulat

ion

(%)

1981 Census1991 Census2001 Census

Edinburgh

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

1 2 3 4 5 6 7 8 9 10

Carstairs Decile

Popu

latio

n (%

)

1981 Census1991 Census2001 Census

Manchester

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

1 2 3 4 5 6 7 8 9 10

Carstairs Decile

Popu

latio

n (%

)

1981 Census1991 Census2001 Census

Liverpool

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10

Carstairs Decile

Popu

latio

n (%

)

1981 Census1991 Census2001 Census

Glasgow

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

1 2 3 4 5 6 7 8 9 10

Carstairs Decile

Popu

latio

n (%

)

1981 Census1991 Census2001 Census

Carstairs deprivation profiles

• Cities, unsurprisingly, have large proportions of their populations living in deprived areas

• Glasgow, Liverpool and Manchester stand out – more deprived than most other cities

• Edinburgh and Bristol show untypical patterns

Age and sex SMR for various cities, 1981-2001

90

95

100

105

110

115

120

125

130

1981 1991 2001

Age

and

Sex

SM

R

GlasgowManchesterLiverpoolAll cities

Age, sex and Carstairs decileSMR summary

90

95

100

105

110

115

120

1981 1991 2001

SMR

GlasgowManchesterLiverpoolAll cities

SMR points to ponder

• Glas, Liv and Manc all have rising SMR’s despite marginal improvements or stability in terms of deprivation profiles

• Adjustment for deprivation brings Liverpool back into line and to a lesser extent for Manchester. Not so for Glasgow – very curious!

Age specific mortality – All cities

0.020.040.060.080.0

100.0120.0140.0160.0180.0

15 25 35 45 55 65 75

Age Group

Age

spe

cific

mor

talit

y ra

tio

198119912001

Age specific mortality – Glasgow

1.001.201.401.601.802.002.202.402.602.803.00

15 25 35 45 55 65 75

Age group

smr

198119912001

Discussion points

• In urban settings, excess mortality is driven by high death rates in young and middle aged men.

• The enormous mortality rates among men of working age contributes to Glasgow’s overall excess mortality

Components of Carstairs

• Carstairs – a combination of four standardised census variables– Overcrowding– No car– Social class IV and V– Male unemployment

• These components used as covariates in regression models of death rates.

Comparison of Carstairs elements – large cities

90

95

100

105

110

115

120

125

130

1981 1991 2001

SMR

nocarcrowdingsoc classunempage and sex

Comparison of Carstairs elements - Glasgow

90

100

110

120

130

140

150

160

170

180

1981 1991 2001

SMR

nocarcrowdingsoc classunempage and sex

So, is there a Glasgow effect?

• YES: – Carstairs deprivation explains more of the excess

mortality in other cities than in Glasgow. – SMR in Glasgow is still rising despite

improvements in Carstairs deprivation– Does deprivation explain the rise in age specific

mortalities in young men? I’m not sure.• NO:

– Looking more closely at the variables which compose Carstairs, most of Glasgow’s excess can be explained.

– Probable that no census variable can explain excess mortality

What can the latest Community Health Profiles tell us

Bruce WhyteGlasgow Centre for Population

Health

Background• Community and constituency health

profiles(Health Scotland, 2004) (http://www.scotpho.org.uk/communityprofiles)

• ‘Let Glasgow Flourish’ report ( GCPH, April 2006) (http://www.gcph.co.uk/background/programmes/strength/strength1.htm)

• New Community Profiles (GCPH, Feb 2008, GCPH)

• ISD Scotland – Scotland profiles (rest of the CHPs and Scotland context) [June 2008]

PurposeMale Life Expectancy at birth in Greater Glasgow and Clyde CH(C)Ps, 2001-2005

Source: Compiled by GCPH using GROS population estimates and death registrations

73.9

68.2

70.1

70.8 70.9 71.171.4

72.5

76.5

77.4

68.1

62.0

64.0

66.0

68.0

70.0

72.0

74.0

76.0

78.0

80.0

Scotland East GlasgowCHCP

North GlasgowCHCP

South WestGlasgow CHCP

West GlasgowCHCP

Inverclyde CHP WestDunbartonshire

CHP

South EastGlasgow CHCP

RenfrewshireCHP

EastRenfrewshire

CHCP

EastDunbartonshire

CHP

CHP/CHCP

Estim

ated

life

exp

ecta

ncy

in y

ears

at b

irth A boy born today in East

Dunbartonshire might live on average for 9 more years than one born in

East Glasgow

Breast Feeding at 6/8 weeks

45.5

35.2

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g

Scotland

SE Glasgow

Provide CHP/CHCPs and communities with up-to-date and locally-relevant public health intelligence Show trends in key indicators

Highlight health and social inequalities

Provide local level informationto aid priority-setting and the targeting of resource

Developing knowledge and understanding of the complexities around health and health inequalities

Indicators70+ indicators are included covering a range of health outcomes (e.g. life expectancy, mortality, hospitalisation) and health determinants (e.g. smoking levels, breastfeeding, income, employment, crime, education).

Indicators lie within the following themes:

Population demographics Mortality

Drugs, alcohol and smoking Hospitalisation and injury

Mental health and function Social work

Prosperity/Poverty Education

Crime Housing and transport

Child and maternal health

Geography• 10 CHP/CHCPs in Greater Glasgow and Clyde (GGC residents in

Lanarkshire CHPs not included) are covered

• Health indicators are presented for the overall ‘community’ but also for smaller areas within each CH(C)P

• In Glasgow City, these smaller areas are ‘neighbourhood’ localitiesThere are 55 ‘neighbourhood’ areas (as defined for Housing Forums) within Glasgow City, ranging in population size from 1,400 to 19,500.

• Outside Glasgow – in the rest of the Greater Glasgow and Clyde –intermediate zone geographies are used.The intermediate zones are aggregations of data zones within local authorities and contain between 2,500 and 6,000 people.

• These localities were chosen through consultation and enable geographical inequalities in social circumstances and health within each CH(C)P area to be investigated.

Examples of the smaller geographiesIntermediate zones within East Dunbartonshire

Neighbourhood Population (2006)

Auchinairn 4,922Barloch 3,084Bishopbriggs North and Kenmure 5,658Bishopbriggs West and Cadder 5,703East Clober and Mains Estate 3,489Harestanes 3,410Hillhead 3,972Kessington East 2,852Kessington West 3,222Keystone and Dougalston 3,957Kilmardinny East 2,833Kilmardinny West 3,443Kirkintilloch South 3,126Kirkintilloch West 3,918Lennoxtown 4,376Lenzie North 5,738Lenzie South 3,545Milton of Campsie 4,015North Castlehill and Thorn 4,539Rosebank and Waterside 3,340South Castlehill and Thorn 4,328Torrance and Balmore 2,943Twechar and Harestanes East 2,994West Clober and Mains Estate 3,037Westerton East 3,217Westerton West 2,729Woodhill East 2,567Woodhill West 4,503

Neighbourhoods within East Glasgow

Neighbourhood Population (2006)

Baillieston & Garrowhill 17,670Calton & Bridgeton 12,960Dennistoun 10,816Easterhouse 9,239Haghill & Carntyne 8,490Mount Vernon & East Shettleston 12,203Parkhead & Dalmarnock 6,200Riddrie & Cranhill 10,749Ruchazie & Garthamlock 6,929Springboig & Barlanark 13,271Tollcross & West Shettleston 15,297

Content

• Maps• Spine graphs• Trend graphs• Comparison graphs• Interpretation• Notes and caveats

North Glasgow CHCP

Brief statistical interlude• Please stay awake • Indicators are shown in a number of ways in the profiles:

• as percentages, rates e.g. % of children in population• as numbers e.g. numbers of social work clients/hospital patients, etc.• and, occasionally, in other ways e.g. life expectancy in terms of estimated years of life from birth• in comparison to the Scottish average (with a few exceptions)

• Rates of patient hospitalisation or death are shown as age/sex standardised rates. This is to take account of differences in the age/sex structure of an area’s population that might affect the rate.

• Summary notes on the source and definition of each indicator are included at the end of the profiles. More detailed notes are provided in excel files for each indicator available on the GCPH web site.

Spine Graphs

East Dunbartonshire vs.

East Glasgow

Robroyston & Millerstonvs.

Ruchill & Possilpark

(both within North Glasgow)

Trend Graphs

Trends - Inverclyde (1)

Trends – Inverclyde (2)

Demography

Demography - Children

% of population under 16, CHPs within Greater Glasgow & Clyde, 2005 Source: GROS

14%

17%18% 18% 18% 18% 19% 19% 19%

21%

0%

5%

10%

15%

20%

25%

West GlasgowCHCP

South EastGlasgow CHCP

North GlasgowCHCP

East GlasgowCHCP

Inverclyde CHP WestDunbartonshire

CHP

RenfrewshireCHP

South WestGlasgow CHCP

EastDunbartonshire

CHP

EastRenfrewshire

CHCP

Scotland

Demography - Adults

% of population 16-64 years, CHPs within Greater Glasgow & Clyde, 2005 Source: GROS

63%64%

65% 65% 66%66%

68%

69%

72%

65%

55%

60%

65%

70%

75%

EastRenfrewshire

CHCP

EastDunbartonshire

CHP

Inverclyde CHP RenfrewshireCHP

South WestGlasgow CHCP

WestDunbartonshire

CHP

East GlasgowCHCP

North GlasgowCHCP

South EastGlasgow CHCP

West GlasgowCHCP

Scotland

Demography - Elderly

% of population 65 and over, CHPs within Greater Glasgow & Clyde, 2005 Source: GROS

14% 14%15%

16% 16% 16% 16%17% 17% 17%

0%

5%

10%

15%

20%

South EastGlasgow CHCP

West GlasgowCHCP

North GlasgowCHCP

South WestGlasgow CHCP

RenfrewshireCHP

East GlasgowCHCP

WestDunbartonshire

CHP

EastRenfrewshire

CHCP

Inverclyde CHP EastDunbartonshire

CHP

Scotland

Life Expectancy & Mortality

Male Life ExpectancyMale Life Expectancy in Greater Glasgow and Clyde CHP/CHCPs, 1994-1998 vs 2001-2005

Source: Compiled by GCPH using GROS population estimates and death registrations

72.3

67.5

66.8

68.1

69.2 69.3

70.5

69.7

71.5

75.675.0

73.9

68.1 68.2

70.1

70.8 70.9 71.171.4

72.5

76.6

77.4

60.0

62.0

64.0

66.0

68.0

70.0

72.0

74.0

76.0

78.0

80.0

Scotland East GlasgowCHCP

North GlasgowCHCP

South WestGlasgow CHCP

West GlasgowCHCP

Inverclyde CHP WestDunbartonshire

CHP

South EastGlasgow CHCP

RenfrewshireCHP

EastRenfrewshire

CHCP

EastDunbartonshire

CHP

CHP/CHCP

Eatim

ated

life

exp

ecta

ncy

in y

ears

at b

irth

1996 2003

Female Life ExpectancyFemale Life Expectancy in Greater Glasgow and Clyde CHP/CHCPs, 1994-1998 vs 2001-2005

Source: Compiled by GCPH using GROS population estimates and death registrations

77.9

74.6 74.7

75.776.0

76.9 76.8

76.3

77.4

80.2

79.379.1

76.0

75.4

76.7

77.7 77.8 77.778.0

78.3

81.4

80.9

70.0

72.0

74.0

76.0

78.0

80.0

82.0

Scotland East GlasgowCHCP

North GlasgowCHCP

South WestGlasgow CHCP

West GlasgowCHCP

Inverclyde CHP WestDunbartonshire

CHP

South EastGlasgow CHCP

RenfrewshireCHP

EastRenfrewshire

CHCP

EastDunbartonshire

CHP

CHP/CHCP

Eatim

ated

life

exp

ecta

ncy

in y

ears

at b

irth

1996 2003

Life Expectancy Male Life Expectancy

78.981.5

55

60

65

70

75

80

85

90

95

100

1994-1998 1996-2000 1999-2003 2001-2005

Life

exp

ecta

ncy

in y

ears

Female Life Expectancy

83.380.1

55

60

65

70

75

80

85

90

95

100

1994-1998 1996-2000 1999-2003 2001-2005

Life

exp

ecta

ncy

in y

ears

Kilmardinny West

Male Life Expectancy

70.4 69.3

55

60

65

70

75

80

85

90

95

100

1994-1998 1996-2000 1999-2003 2001-2005

Life

exp

ecta

ncy

in y

ears

Female Life Expectancy

77.174.2

55

60

65

70

75

80

85

90

95

100

1994-1998 1996-2000 1999-2003 2001-2005

Life

exp

ecta

ncy

in y

ears

Hillhead, East Dunbartonshire

Life expectancy trend by deprivation

Estimates of male life expectancy, least and most deprived Carstairs quintiles, 1981/85 - 1998/2002 (areas fixed to their deprivation quintile in 1981)

Greater Glasgow Source: calculated from GROS death registrations and Census data (1981, 1991, 2001)

69.4

71.2

73.3

60

65

70

75

80

85

1981-1985 1988-1992 1998-2002

Estim

ated

life

exp

ecta

ncy

at b

irth

Scotland Males

Estimates of male life expectancy, least and most deprived Carstairs quintiles, 1981/85 - 1998/2002 (areas fixed to their deprivation quintile in 1981)

Greater Glasgow Source: calculated from GROS death registrations and Census data (1981, 1991, 2001)

72.2

76.2

69.4

71.2

73.373.9

60

65

70

75

80

85

1981-1985 1988-1992 1998-2002

Estim

ated

life

exp

ecta

ncy

at b

irth

Males -Dep Quin 1 (least deprived)

Scotland Males

Estimates of male life expectancy, least and most deprived Carstairs quintiles, 1981/85 - 1998/2002 (areas fixed to their deprivation quintile in 1981)

Greater Glasgow Source: calculated from GROS death registrations and Census data (1981, 1991, 2001)

72.2

76.2

65.3 64.8 64.4

69.4

71.2

73.373.9

60

65

70

75

80

85

1981-1985 1988-1992 1998-2002

Estim

ated

life

exp

ecta

ncy

at b

irth

Males -Dep Quin 1 (least deprived)Males - Dep Quin 5 (most deprived)Scotland Males

Life Expectancy in European Context

Male life expectancy at birth, West of Scotland and ten selected regionsCalculated from original source mortality and population data - see Appendix 4 for details

Limburg

N Ireland

Saxony

Swansea/SW Coalfields

Ruhr

Merseyside

WoS

Nord Pas de Calais

N. Moravia

Katowice

Wallonia

65.0

66.0

67.0

68.0

69.0

70.0

71.0

72.0

73.0

74.0

75.0

76.0

1982-1984

1983-1985

1984-1986

1985-1987

1986-1988

1987-1989

1988-1990

1989-1991

1990-1992

1991-1993

1992-1994

1993-1995

1994-1996

1995-1997

1996-1998

1997-1999

1998-2000

1999-2001

2000-2002

2001-2003

2002-2004

2003-2005

Life

exp

ecta

ncy

at b

irth

WoS, male

MALE LIFE EXPECTANCY

Heart Disease Mortality

Coronary Heart Disease mortality trend (Under 75s), 1994-1998 to 2001-05 for Greater Glasgow and Clyde CH(C)Ps and Scotland

Source: GCPH calculated from GRO(S) death and population data

0

20

40

60

80

100

120

140

160

180

200

1994-1998 1996-2000 1999-2003 2001-2005

Age

/Sex

sta

ndar

dise

d ra

te p

er 1

00,0

00

Scotland East Dunbartonshire CHP East Glasgow CHCPEast Renfrewshire CHCP Inverclyde CHP North Glasgow CHCPRenfrewshire CHP South East Glasgow CHCP South West Glasgow CHCPWest Dunbartonshire CHP West Glasgow CHCP

Cancer Mortality

Cancer mortality trend (Under 75s), 1994-1998 to 2001-05 for Greater Glasgow and Clyde CH(C)Ps and Scotland

Source: GCPH calculated from GRO(S) death and population data

50

100

150

200

250

1994-1998 1996-2000 1999-2003 2001-2005

Age

/Sex

sta

ndar

dise

d ra

te p

er 1

00,0

00

Scotland East Dunbartonshire CHP East Glasgow CHCPEast Renfrewshire CHCP Inverclyde CHP North Glasgow CHCPRenfrewshire CHP South East Glasgow CHCP South West Glasgow CHCPWest Dunbartonshire CHP West Glasgow CHCP

Cerebrovascular Disease Mortality

Cerebrovascular Disease mortality trend (Under 75s), 1994-1998 to 2001-05 for Greater Glasgow and Clyde CH(C)Ps and Scotland

Source: GCPH calculated from GRO(S) death and population data

0

10

20

30

40

50

60

1994-1998 1996-2000 1999-2003 2001-2005

Age

/Sex

sta

ndar

dise

d ra

te p

er 1

00,0

00

Scotland East Dunbartonshire CHP East Glasgow CHCPEast Renfrewshire CHCP Inverclyde CHP North Glasgow CHCPRenfrewshire CHP South East Glasgow CHCP South West Glasgow CHCPWest Dunbartonshire CHP West Glasgow CHCP

Alcohol related deathsAlcohol related mortality trend, 1994-1998 to 2001-05 for

Greater Glasgow and Clyde CH(C)Ps and ScotlandSource: GCPH calculated from GRO(S) death and population data

0

10

20

30

40

50

60

70

80

1994-1998 1996-2000 1999-2003 2001-2005

Age

/Sex

sta

ndar

dise

d ra

te p

er 1

00,0

00

Scotland East Dunbartonshire CHP East Glasgow CHCPEast Renfrewshire CHCP Inverclyde CHP North Glasgow CHCPRenfrewshire CHP South East Glasgow CHCP South West Glasgow CHCPWest Dunbartonshire CHP West Glasgow CHCP

Suicides

Suicide trend, 1994-1998 to 2001-05 for Greater Glasgow and Clyde CH(C)Ps and Scotland

Source: GCPH calculated from GRO(S) death and population data

0

5

10

15

20

25

30

1994-1998 1996-2000 1999-2003 2001-2005

Age

/Sex

sta

ndar

dise

d ra

te p

er 1

00,0

00

Scotland East Dunbartonshire CHP East Glasgow CHCPEast Renfrewshire CHCP Inverclyde CHP North Glasgow CHCPRenfrewshire CHP South East Glasgow CHCP South West Glasgow CHCPWest Dunbartonshire CHP West Glasgow CHCP

Deprivation

Deprivation – Income Deprived

% of population who are 'Income Deprived', CHPs within Greater Glasgow & Clyde, 2006

Source: SIMD

13.9%

7.4% 7.5%

14.9%

19.3% 19.7%20.4%

21.8%

24.3%

27.7%

29.8%

0%

5%

10%

15%

20%

25%

30%

35%

Scotland EastDunbartonshire

CHP

EastRenfrewshire

CHCP

RenfrewshireCHP

Inverclyde CHP WestDunbartonshire

CHP

West GlasgowCHCP

South EastGlasgow CHCP

South WestGlasgow CHCP

North GlasgowCHCP

East GlasgowCHCP

% o

f pop

ulat

ion

Deprivation – Employment Deprived

% of working age population who are 'Employment Deprived', CHPs within Greater Glasgow & Clyde, 2006

Source: SIMD

12.8%

7.9% 8.2%

13.9%

16.0%17.0%

17.5%

18.8%19.8%

22.5%

25.1%

0%

5%

10%

15%

20%

25%

30%

Scotland EastRenfrewshire

CHCP

EastDunbartonshire

CHP

RenfrewshireCHP

West GlasgowCHCP

WestDunbartonshire

CHP

South EastGlasgow CHCP

Inverclyde CHP South WestGlasgow CHCP

North GlasgowCHCP

East GlasgowCHCP

% o

f wor

king

age

pop

ulat

ion

Improvements

Smoking trends

Prevalence of adult (16+) cigarette smoking, GB, Scotland, Greater Glasgow and Clyde, Glasgow City, 1978 to 2006

0

5

10

15

20

25

30

35

40

45

50

1978 1982 1986 1990 1994 1998 1998 1999 2000 2001 2002 2003 2004 2005 2006

% s

mok

ing

ciga

rette

s

Great Britain

Smoking trends

Prevalence of adult (16+) cigarette smoking, GB, Scotland, Greater Glasgow and Clyde, Glasgow City, 1978 to 2006

0

5

10

15

20

25

30

35

40

45

50

1978 1982 1986 1990 1994 1998 1998 1999 2000 2001 2002 2003 2004 2005 2006

% s

mok

ing

ciga

rette

s

Great Britain Scotland

Smoking trends

Prevalence of adult (16+) cigarette smoking, GB, Scotland, Greater Glasgow and Clyde, Glasgow City, 1978 to 2006

0

5

10

15

20

25

30

35

40

45

50

1978 1982 1986 1990 1994 1998 1998 1999 2000 2001 2002 2003 2004 2005 2006

% s

mok

ing

ciga

rette

s

Great Britain Scotland Greater Glasgow & Clyde

Smoking trends

Prevalence of adult (16+) cigarette smoking, GB, Scotland, Greater Glasgow and Clyde, Glasgow City, 1978 to 2006

0

5

10

15

20

25

30

35

40

45

50

1978 1982 1986 1990 1994 1998 1998 1999 2000 2001 2002 2003 2004 2005 2006

% s

mok

ing

ciga

rette

s

Great Britain Scotland Greater Glasgow & Clyde Glasgow

SmokingModelled estimates of smoking prevalence based on 2001 Census and 2003/04

Scottish Household Survey,Greater Glasgow and Clyde CHP/CHCPs

Source: Moon et al for NHS Health Scotland

19.2%

26.5%

30.3% 30.6% 31.3%33.3% 34.0%

37.5% 37.5%

27.2%

18.6%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Scotland EastDunbartonshire

CommunityHealth

Partnership

EastRenfrewshireCommunity

Health & CarePartnership

RenfrewshireCommunity

HealthPartnership

West GlasgowCommunity

Health & CarePartnership

InverclydeCommunity

HealthPartnership

South EastGlasgow

CommunityHealth & Care

Partnership

WestDunbartonshire

CommunityHealth

Partnership

South WestGlasgow

CommunityHealth & Care

Partnership

East GlasgowCommunity

Health & CarePartnership

North GlasgowCommunity

Health & CarePartnership

%

WorklessWorkless Trend, 1999-2006 for

Greater Glasgow and Clyde CH(C)Ps and ScotlandSource: GCPH calculated from GRO(S) death and population data

36%

32%

27%

15%

18%

21%

11%

9%

20%

16%18%

27%

23%

20%

29%

38%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

1999 2000 2001 2002 2003 2004 2005 2006

Age

/Sex

sta

ndar

dise

d ra

te p

er 1

00,0

00

Scotland East Dunbartonshire CHP West Dunbartonshire CHPInverclyde CHP East Renfrewshire CHCP Renfrewshire CHPWest Glasgow CHCP North Glasgow CHCP South West Glasgow CHCPSouth East Glasgow CHCP East Glasgow CHCP

Breast feeding by CHP/CHCPBreast feeding at 6/8 weeks, by CHP/CHCP, 2004-2006

Source: Women and Children Team, ISD Scotland

23.325.0

30.5 31.233.3

44.5 45.5 46.848.6

20.8

0

10

20

30

40

50

60

East GlasgowCHCP

WestDunbartonshire

CHP

Inverclyde CHP South WestGlasgow CHCP

RenfrewshireCHP

North GlasgowCHCP

West GlasgowCHCP

South EastGlasgow CHCP

EastDunbartonshire

CHP

EastRenfrewshire

CHCP

%

Scotland = 36.4

Breast feeding trendsSouth East Glasgow East Renfrewshire

North Glasgow West Glasgow

Breast Feeding

45.5

35.2

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Breast Feeding

48.646.1

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Breast Feeding

44.5

37.4

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Breast Feeding

33.3

21.0

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Greater Gorbals

Breast Feeding

40.1

14.9

05

1015202530354045505560657075

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Hospital Patients with Alcohol Attributable & Related Conditions

24552447

0200400600800

1000120014001600180020002200240026002800

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

Age

/sex

sta

ndar

dise

d ra

te p

er 1

00,0

00 p

op

Male Life Expectancy

61.463.4

55

60

65

70

75

80

85

90

95

100

1994-1998 1996-2000 1999-2003 2001-2005

Life

exp

ecta

ncy

in y

ears

Female Life Expectancy

75.172.0

55

60

65

70

75

80

85

90

95

100

1994-1998 1996-2000 1999-2003 2001-2005

Life

exp

ecta

ncy

in y

ears

No real improvement

Breast feeding trendsEast Glasgow Inverclyde

Renfrewshire West Dunbartonshire

Breast Feeding

25.025.5

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Breast Feeding

31.231.0

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Breast Feeding

23.322.5

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Breast Feeding

20.816.7

0

10

20

30

40

50

60

97-99 98-00 99-01 00-02 01-03 02-04 03-05 04-06

% o

f mot

hers

bre

astfe

edin

g at

6/8

wee

ks

Smoking in PregnancySmoking at booking, 2002-2004, Greater Glasgow and Clyde CH(C)Ps and

ScotlandSource: Women and Children Team, ISD Scotland

12.9

16.4

20.3

25.5 25.827.7

29.0 29.030.4

31.8

0

5

10

15

20

25

30

35

EastRenfrewshire

CHCP

EastDunbartonshire

CHP

South EastGlasgow CHCP

RenfrewshireCHP

WestDunbartonshire

CHP

Inverclyde CHP South WestGlasgow CHCP

West GlasgowCHCP

North GlasgowCHCP

East GlasgowCHCP

%

Scotland = 24.3

Smoking in PregnancySmoking at booking, 2002-2004, Greater Glasgow and Clyde CH(C)Ps and

ScotlandSource: Women and Children Team, ISD Scotland

1.22.7 3.2 3.2 3.8 3.9 4.1 4.1 4.8 4.9

41.142.6 43.0

45.2 45.4 46.4 47.4 47.8 48.1 48.6

0

10

20

30

40

50

60

Whitec

raigs

/Sou

th Giffn

ock

Merryle

e and

Braidb

arKes

singto

n Wes

tHou

ston S

outh

Williamwoo

d

Mearns

kirk a

nd Sou

th Kirk

hill

Whitec

raigs

and B

room

Pollok

shiel

ds W

est

Clarks

ton an

d She

dden

sGou

rock E

ast…

Renfre

w Nort

h

Corkerh

ill & N

orth P

ollok

Torygle

nRuc

hill &

Pos

silpa

rk

Kilbow

ieHard

gate/

Faifley

Paisley

Foxba

rDrum

chap

el

Greeno

ck C

entre

/East C

entra

l

Priesth

ill & H

ouse

hillw

ood

%

Scotland = 24.3

Serious AssaultSerious Violent Crime per 10,000 population, 3 year average (04-05 to 06-07)

Source: Violence Reduction Unit

6.7 7.6

18.2

22.0 22.4

26.728.4

29.6

39.6

44.9

0

5

10

15

20

25

30

35

40

45

50

EastRenfrewshire

CHCP

EastDunbartonshire

CHP

RenfrewshireCHP

Inverclyde CHP WestDunbartonshire

CHP

North GlasgowCHCP

South EastGlasgow CHCP

South WestGlasgow CHCP

East GlasgowCHCP

West GlasgowCHCP

Rat

e pe

10,

000

popu

latio

n

Scotland

Violent crime - victimsVictims of violent crime per 1,000 population, Glasgow City, July 2002 - June 2005Datazones with 10 highest rates vs. datazones with 10 lowest rates (over 3 years)

Source: Violence Reduction Unit, Strathclyde Police

5 7 8 9 9 9 9 9 10 11

118 119 120 121 123129

139 142 144

168

0

20

40

60

80

100

120

140

160

180

Jorda

nhill

Hyndla

ndCarm

unno

ckMax

well P

arkVict

oria P

arkNew

lands

Hyndla

ndCath

cart

Partick

Hyndla

ndAnd

erston

Roysto

nQue

enslie

Pollok

shaw

sPoll

oksh

aws

Roysto

nCow

lairs

Cowlai

rsTory

glen

Kingsto

n

Location of datazone (named after relevant electoral ward)

Vict

ims

per 1

000

popu

latio

n

Worsening

Drug related deaths over 10 years (1996-2005) per 100,000 popuationGreater Glasgow and Clyde CHP/CHCPs

Source: GRO(S)

31

54

79

105

122 122130

190199

30

60

25

50

75

100

125

150

175

200

225

Scotland EastDunbartonshire

CommunityHealth

Partnership

EastRenfrewshireCommunity

Health & CarePartnership

RenfrewshireCommunity

HealthPartnership

WestDunbartonshire

CommunityHealth

Partnership

InverclydeCommunity

HealthPartnership

West GlasgowCommunity

Health & CarePartnership

South EastGlasgow

CommunityHealth & Care

Partnership

South WestGlasgow

CommunityHealth & Care

Partnership

North GlasgowCommunity

Health & CarePartnership

East GlasgowCommunity

Health & CarePartnership

Cru

de ra

te p

er 1

00,0

00 p

opul

atio

n

Drug related deaths - rates

Drug related deaths

Drug related deaths over 10 years (1996-2005)Greater Glasgow and Clyde CHP/CHCPs

Source: GRO(S)

7488 93

124

150163

190

254

3228

0

50

100

150

200

250

300

EastRenfrewshireCommunity

Health & CarePartnership

EastDunbartonshire

CommunityHealth

Partnership

WestDunbartonshire

CommunityHealth

Partnership

InverclydeCommunity

HealthPartnership

RenfrewshireCommunity

HealthPartnership

South EastGlasgow

CommunityHealth & Care

Partnership

South WestGlasgow

CommunityHealth & Care

Partnership

West GlasgowCommunity

Health & CarePartnership

North GlasgowCommunity

Health & CarePartnership

East GlasgowCommunity

Health & CarePartnership

Dea

ths

Calton & Bridgeton 66

Liver cirrhosis mortality

Liver cirrhosis mortality age standardised rates among men aged 15-74 yearsScotland in context of maximum, minimum, and mean rates for 16 Western European countries

Source: WHOSIS (Dec 2004)

0

20

40

60

80

100

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Year of death

Rat

e pe

r 100

.000

pop

ulat

ion

per y

ear

Maximum

Mean

Minimum

ICD 6/7: A105ICD8: A102ICD9: B347ICD10: K70, K73, K74

Scotland's rank: 11 11 10 12 11 1 0 10 9 5

Liver cirrhosis mortality age standardised rates among men aged 15-74 yearsScotland in context of maximum, minimum, and mean rates for 16 Western European countries

Source: WHOSIS (Dec 2004)

0

20

40

60

80

100

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Year of death

Rat

e pe

r 100

.000

pop

ulat

ion

per y

ear

Maximum

Mean

Minimum

ICD 6/7: A105ICD8: A102ICD9: B347ICD10: K70, K73, K74

Scotland's rank: 11 11 10 12 11 1 0 10 9 5

Liver cirrhosis mortality age standardised rates among men aged 15-74 yearsScotland in context of maximum, minimum, and mean rates for 16 Western European countries

Source: WHOSIS (Dec 2004)

0

20

40

60

80

100

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Year of death

Rat

e pe

r 100

.000

pop

ulat

ion

per y

ear

Maximum

Mean

Minimum

ICD 6/7: A105ICD8: A102ICD9: B347ICD10: K70, K73, K74

Scotland's rank: 11 11 10 12 11 1 0 10 9 5

Greater Glasgow

Patients with alcohol attributable and related conditions

Patients with alcohol attributable and related conditions by CHP/CHCP, annual average patient discharges, 2004-06

Source: ISD Scotland

611 655

989

1,115

1,319 1,338

1,460

1,629 1,651

1,963

0

500

1000

1500

2000

2500

EastRenfrewshire

CHCP

EastDunbartonshire

CHP

WestDunbartonshire

CHP

Inverclyde CHP North GlasgowCHCP

West GlasgowCHCP

South EastGlasgow CHCP

South WestGlasgow CHCP

RenfrewshireCHP

East GlasgowCHCP

Ann

ual a

vera

ge p

atie

nt d

isch

arge

s

Obesity/OverweightThe changing proportion of adults in NHS Greater Glasgow and Clyde

who are overweight or obese between 1995 and 2003(Source: Scottish Health Surveys)

49.0

15.3

55.7

19.1

61.1

22.1

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

% overweight % obese

perc

enta

ge

1995 1998 2003

Obesity/OverweightSource: ScotPHO report, derived from Obesity in OECD countries, percentage of adult population, aged from 15 years

and over, with a BMI>30kg/m2

Traffic GrowthBackground traffic growth from 2001, Scotland & Glasgow*

Source: Scottish Executive

0

5

10

15

20

25

30

2001 2006 2011 2021

% g

row

th fr

om 2

001

Scotland

Glasgow City

* all traffic originating from Glasgow City

‘Non-car’ Commuting% of commuters who travel to work by foot, bike or public transport, Greater Glasgow and Clyde

CH(C)Ps and Scotland, 2001. Source: Census

23.4%

14.6%18.5% 18.0% 19.6% 20.4% 22.0% 21.8%

26.0% 27.3%

33.5%

19.9%

22.7%20.3%

23.7%23.0%

26.0%

32.7% 34.2%

32.3% 31.9%

29.4%

1.3%

0.4%0.5%

0.7% 0.2%

0.6%

0.9%0.9%

0.6% 1.1%

1.4%

0%

10%

20%

30%

40%

50%

60%

70%

SCOTLAND East RenfrewshireCommunity Health& Care Partnership

EastDunbartonshire

Community HealthPartnership

RenfrewshireCommunity Health

Partnership

InverclydeCommunity Health

Partnership

WestDunbartonshire

Community HealthPartnership

South WestGlasgow

Community Health& Care Partnership

South EastGlasgow

Community Health& Care Partnership

East GlasgowCommunity Health& Care Partnership

North GlasgowCommunity Health& Care Partnership

West GlasgowCommunity Health& Care Partnership

% by foot %public transport % by bike

Greenspace map of West Glasgow

Summary (1)• There has been an overall improvement in health in

Greater Glasgow and Clyde in the last 10 years but– Improvements in health are slow compared to other parts of

Scotland/UK/Europe– Inequalities in relation to gender, geography and deprivation

persist– Health and health trends often vary greatly in neighbouring

communities

• There have been impressive reductions in mortality from chronic diseases but increases in mortality in young people (Leyland et al, 2007)

• Deprivation is still a key part of the story of ill-health in the West of Scotland but it does not explain everything

Summary (2)• In terms of what has been improving, smoking trends are

downward, as are mortality rates from cancer, stroke and heart disease, levels of worklessness and some local breast feeding trends

• Areas where there has been little improvement, if any, include: breast feeding in many areas, violence, smoking in pregnancy

• Issues that are clearly worsening, include: drug related deaths, alcohol harm, obesity, transport trends and inequalities in many health related areas

However in relation to physical activity and obesity perhaps there are opportunities -

• Impetus of Commonwealth Games• Relatively high levels of active commuting• Use of greenspace

For more information contact:

Bruce Whyte Glasgow Centre for Population Health

0141 221 9439Bruce.whyte@drs.glasgow.gov.uk

World’s apart or singing from the same songsheet?

Community responses to the Let Glasgow Flourish report

Dr John McKendrickScottish Poverty Information Unit

Glasgow’s Healthier Future Forum, Radisson SAS Hotel, Glasgow, 28th May 2008

Presentation

• Introduction– Scottish Poverty Information Unit– Let Glasgow Flourish– About the SPIU study for GCPH– Overview of presentation

• Recognising key findings• Accounting for key findings• Acknowledging the social determinants of

health• Key health issues in Greater Glasgow

• Conclusion

Glasgow Healthier Future Forum, May 28th 2008

Recognition of key findings, 1 of 3

Surprised21%

Not Surprised79%

Glasgow Healthier Future Forum, May 28th 2008

Recognition of key findings, 2 of 3

Variation in recognition - across key findings

• Ranged from 93% recognition to 44% recognition

• Most surprise was noted at a key finding which presented a ‘positive’ health trend in recent years (failing deaths from heart disease and strokes), whilst least surprise was noted at a key finding which presented as ‘negative’ health trend in recent years (rising alcohol related deaths).

• Lowest levels of surprise were expressed at key findings that described enduring social problems (problems of alcohol, substance misuse, crime and poor housing).

• For all but one key finding, at least two thirds of the people of Greater Glasgow share the opinion of not being surprised.

Glasgow Healthier Future Forum, May 28th 2008

Recognition of key findings, 3 of 3

Variation in recognition - across social groups

• No discernable differences (men 77% agree, women 82% agree)

Variation in recognition - across social groups for individual key findings

• Cautious interpretation and speculative conclusions only• Area Type: variations in recognition for 8 of 20 key findings

– E.g. More surprise in ‘excluded’ areas that “On average, men from South Cambuslang live 10 years longer than men from West Easterhouse”

• Work status: variations in recognition for 4 of 20 key findings– E.g. More surprise in households with less work that “Almost one fifth of

the working age population of Greater Glasgow are classified as being unable to work due to illness or disability.”

Glasgow Healthier Future Forum, May 28th 2008

Presentation

• Introduction– Scottish Poverty Information Unit– Let Glasgow Flourish– About the SPIU study for GCPH– Overview of presentation

• Recognising key findings• Accounting for key findings• Acknowledging the social determinants of

health• Key health issues in Greater Glasgow

• Conclusion

Glasgow Healthier Future Forum, May 28th 2008

Accounting for key findings, 1 of 3

Types of explanation

• SPIU identified 5 broad explantory types– Social structural– Government / service providers– People– Environment– Beyond local control

Nature of explanations offered

• The majority of the people of Greater Glasgow drew on one type of explanation to account for the Let Glasgow Flourish key findings (55%)

• More straightforward (uni-dimensional) explanations to be posited for issues pertaining to the physical environment (environmentalissues, poor housing and traffic are all ranked in the bottom five) and social factors (crime and trust in the community).

• The most straightforward interpretations were made for women smoking during pregnancy.

Glasgow Healthier Future Forum, May 28th 2008

Accounting for key findings, 2 of 3

Glasgow Healthier Future Forum, May 28th 2008

12

36

1516

299

2534

1722

376

1013

2848

0 10 20 30 40 50

Media

Chance

Economy

Beyond Local Control **

Community

Neighbourhood

Environmental **

Age

Poverty

Socio-structural **

Individual

Familial

People **

Generic Central Govt.

Regulation

Education

Provision

Government / Service Provider **

Presentation

• Introduction– Scottish Poverty Information Unit– Let Glasgow Flourish– About the SPIU study for GCPH– Overview of presentation

• Recognising key findings• Accounting for key findings• Acknowledging the social determinants of

health• Key health issues in Greater Glasgow

• Conclusion

Glasgow Healthier Future Forum, May 28th 2008

Acknowledging impact on health, 1 of 3

Glasgow Healthier Future Forum, May 28th 2008

No12%

Yes88%

Acknowledging impact on health, 2 of 3

Focus

• Focus is on the 11 of the 20 key findings which were more directly concerned with social issues.

Variation in acknowledgement - across key findings

• For all 11 key findings, at least two thirds of respondents share the opinion that the interplay of social and structural circumstances (‘social factors’) impact upon health

• One third of the respondents did not consider that living in a lone parent family would impact on health (32%) and one in five did not consider that the expansion of the middle class in Glasgow would have an impact on health (21%).

• The vast majority of respondents considered smoking during pregnancy to impact upon health (86%). But the other 14% may be as significant a finding.

Glasgow Healthier Future Forum, May 28th 2008

Acknowledging impact on health, 3 of 3

Variation in acknowledgement - across social groups

• No discernable differences

Variation in acknowledgement - across social groups by key finding

• Cautious interpretation and speculative conclusions only• Gender: women more likely than men to acknowledge impact on

health • Most affected or most involved in social issues are more likely to

perceive that these issues have a health impact.– Women are more likely than men to perceive that lone parenthood and

smoking during pregnancy have a health impact.– Those groups closest to Greater Glasgow’s economic growth are more

likely to perceive that the growing numbers of middle class and the high number of children living in workless households have an health impact

– Respondents with young children were more likely than those without to consider that the high volume of traffic had a health impact.

Glasgow Healthier Future Forum, May 28th 2008

Presentation

• Introduction– Scottish Poverty Information Unit– Let Glasgow Flourish– About the SPIU study for GCPH– Overview of presentation

• Recognising key findings• Accounting for key findings• Acknowledging the social determinants of

health• Key health issues in Greater Glasgow

• Conclusion

Glasgow Healthier Future Forum, May 28th 2008

Key health issues in G/Glasgow, 1 of 3

Key personal and city health issues

PovertyFamilyFood

AlcoholService Provision

InactivityDrugs

Glasgow Healthier Future Forum, May 28th 2008

Key health issues in G/Glasgow, 2 of 3

Poverty

• Stress induced by poverty is a key health concern among struggling and ‘getting by’ populations

• Respondents reported management strategies• Impact of worklessness on mental well being was stressed• Poverty was also reported to limit solutions to health problems

Family

• Lack of family support becomes an issue when health care services fail• Deemed citical for older Minority Ethnic groups• Health has an impact on immediate and wider family

Food

• Stress of shopping with young children• Aware of healthy eating, but healthy eating is not always the attractive option• Concern over fast food availability

Glasgow Healthier Future Forum, May 28th 2008

Key health issues in G/Glasgow, 3 of 3

Alcohol

• Problem perceived of a wide range of groups• Culture of consumption is prevalent• Concern over local supply• Concern over the consumption of Others

Service Provision

• Perceived need for more client-centred approaches• Deemed citical for older Minority Ethnic groups• Health has an impact on immediate and wider family

Drugs and Inactivity

• Problems in own right• Part of wider social problems of unhealthy lifestyles

Glasgow Healthier Future Forum, May 28th 2008

Presentation

• Introduction– Scottish Poverty Information Unit– Let Glasgow Flourish– About the SPIU study for GCPH– Overview of presentation

• Recognising key findings• Accounting for key findings• Acknowledging the social determinants of

health• Key health issues in Greater Glasgow

• Conclusion

Glasgow Healthier Future Forum, May 28th 2008

Conclusion

• Familiarity with issues raised in LGF• Understand the complex nature of health• Acknowledge influence of social factors on

health• Acknowledge improvements in service delivery• Familiar with health improvement messages• Some reticence in accepting personal

experiences• Mental well being is significant

• Radical approaches to alcohol and fast food supply

• Poverty and deep-rooted culture are main barriers

• “We know what needs to be done, we want to do it, but we find it difficult” Glasgow Healthier Future Forum, May 28th 2008

THANK YOU FOR LISTENINGI would be delighted to answer any questions you may wish to pose

j.mckendrick@gcal.ac.ukwww.povertyinformation.org

Scottish Poverty Information Unit