PROJET COFINANCE PAR LUNION EUROPEENNE (FEDER) FINANCED IN PART BY THE EUROPEAN UNION Health and...
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PROJET COFINANCE PAR L’UNION EUROPEENNE (FEDER) FINANCED IN PART BY THE EUROPEAN UNION Health and Health Behaviour The COSPH Project Dr. Ann Palmer Centre for Health Services Studies University of Kent 11 th January EUREGHA Conference – Inequalities in Health
PROJET COFINANCE PAR LUNION EUROPEENNE (FEDER) FINANCED IN PART BY THE EUROPEAN UNION Health and Health Behaviour The COSPH Project Dr. Ann Palmer Centre
PROJET COFINANCE PAR LUNION EUROPEENNE (FEDER) FINANCED IN PART
BY THE EUROPEAN UNION Health and Health Behaviour The COSPH Project
Dr. Ann Palmer Centre for Health Services Studies University of
Kent 11 th January EUREGHA Conference Inequalities in Health
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PROJET COFINANCE PAR LUNION EUROPEENNE (FEDER) FINANCED IN PART
BY THE EUROPEAN UNION En partenariat avec: In partnership with:
Avec le soutien de: With the support of: PROJET CONFINANCE PAR
LUNION EUROPEENNE (FEDER) FINANCED IN PART BY THE EUROPEAN
UNION
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Health and Social Survey Unit at CHSS Two regions, both have
distinct rural and urban areas, affluent and poor areas, both have
ex-mining areas, both have ex- dockyard EnglishFrench
Administrative AreaNumber of PeopleAdministrative AreaNumber of
People Region (Kent, Medway, East Sussex and Brighton and Hove)
2,600,624Rgion (Nord Pas de Calais)3,995,871 County or Unitary
Authority (4)492,324 (East Sussex); 250,000 (Medway) 1,370,000
(Kent) 248,000 (Brighton and Hove) Dpartement (2)2,555,020 Nord and
1,441,568 Pas-de-Calais Local Authority 5 East Sussex; 12 Kent;
Medway, Brighton and Hove 85,000 (Hastings) to 250,000 (Medway)
Arrondissements (13)99,249 (Montreuil) to 1,181,724 (Lille)
Electoral Wards249 (North Downs, Ashford) to 5666 (Beaver Ashford)
Pseudo-Cantons4919 (Le Quesnoy) to 93.531 Tourcoing 96,959 Roubaix
and 184,647 Lille Les deux rgions les agglomrations urbaines, le
pays rural, les zones riches et de pauvret, les bassins ex-mineurs,
les ports dockyards
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Health and Social Survey Unit at CHSS The key question? La
question la plus importante? Is the south east of England more or
less healthy than northern France? expectation of life at birth is
greater in France in both countries there is better health in the
south of the country than in the north there is a complexity of
pre- determinants including socio- economic factors, lifestyle and
health behaviour Est-ce que les gens du sud-est dAngleterre est
plus ou moins en bon sant que le nord de la France? Lesprance de la
vie est plus en la France quen Angleterre Les deux compagnies ont
plus bon sant au sud que le nord Il y a une complexit des
dterminants qui inclus les facteurs sociologiques, conomiques et en
plus les comportements de la sant Expectation of life / lesprance
de la vie France 82.8 for women and 75.3 for men England 79.9 for
women and 75 for men
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Health and Social Survey Unit at CHSS What indicators can we
use to compare health across the channel? Lesquels indicateurs nous
pouvons utiliser a faire une comparaison de la sant les deux cotes
de la Manche? Aim to develop / find key measures which will enable
comparisons to be made at local level between the 2 sides of the
channel. Variations in mortality and morbidity across geographical
areas Variations across socio-economic strata Access to health and
social care provision depending on availability, accessibility,
acceptability and quality of care What data are available?
Demography Social Indicators Mortality indicators Health indicators
from the local health surveys Health service data How comparable
are data across the channel? Collection and interpretation Use of
standard measures Date of data Geographical and administrative
boundaries Le but est chercher les mesures qui faciliteront les
comparaisons au niveau locale les deux cot s de la manche Les
variations de la mortalit et la morbidit spatiales Les variations
socio-conomiques Laccs au soins de la sant et sociaux Notre
concentration pour la commencement du projet tait les mesures
suivantes Les dmographiques Les indicateurs sociologiques Les
indicateurs de la mortalit Les indicateurs qui suivre des enqu tes
de sant publiques dans les localits Est-ce que les indicateurs sont
comparable les deux c tes de la Manche? Collection et interprtation
Utilisation des mesures standardis s Dates des donns Les sources
les plus importantes nous avons utiliss sont le Census, les
personnes dcds and les enqutes
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Health and Social Survey Unit at CHSS Using Townsend Scores to
compare deprivation across SE England and N France La comparaison
entre le nord de la France et la sud de lAngleterre des ingalits
utilisant lIndice de Townsend More concentrated deprivation in
northern France Coastal deprivation Central belt of deprivation
through the mining regions of France La dfavorisation est plus
concentr au nord de la France et aux rgions de la ct On trouve les
zones de dfavorisation centrale dans les rgions anciennes des
mineurs
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Health and Social Survey Unit at CHSS Mortality indicators -
are they comparable? La mortalit est-ce que cest bien comparable?
More recent mortality data is available in England, older data only
available from 1986 French mortality data is available at Canton
level from 1979 - 2001. Agreed that French mortality at Canton
level would cover the years 1997-2001 whilst English mortality data
would cover 1999-2003. Time trend data would be a three year
rolling average from 1979 (France) and 1986 (England) at regional
and departmental level. In France ICD 9 was used for coding deaths
between 1979 and 1999 and ICD 10 from 2000; in England ICD 9 was
used to the end of year 2000 and ICD 10 from the beginning of 2001
Les donnes de la mortalit en Angleterre sont des annes 1986 2003
Pour la France les donnes sont possible des annes 1979 mais
seulement au 2001 La comparaison des Electoral Wards avec les
Cantons (plus grands, plus de peuple) Pour les tendances 3 ans
dagrgations Lutilisation de ICD 9 et ICD 10 cest chang en la France
2000 et en Angleterre lan 2001
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Health and Social Survey Unit at CHSS Hommes, 1996-2002 - Carte
des SMR prmaturs (0-64 ans) toutes causes Men : premature mortality
(0-64 years) 1996-2002 All causes The mortality in Nord
Pas-de-Calais is higher than in Southeast of England. In France,
some areas show very high rates of mortality (areas with old mining
industry, areas around Dunkerque,) Lisss par la mthode locale de
Marshall using Local Linear Empirical Bayes Smoother SMR :
Nord-Pas-de-Calais + south-east english regions = 100
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Health and Social Survey Unit at CHSS Women, mortality
1996-2002 - SMR all cause and all ages Femmes, mortalit 1996-2002 -
SMR toutes causes et tous ges Lisss par la mthode locale de
Marshall Local Linear Empirical Bayes Smoother SMR :
Nord-Pas-de-Calais + south- east english regions = 100
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Health and Social Survey Unit at CHSS Mortality from cancer -
Men : All ages, 1996-2002 La mortalit des cancers hommes toutes
ages 1996-2002 SMR of Kent, Medway, East-Sussex, Brighton &
Hove, Nord Pas-de-Calais = 100 Local Linear Empirical Bayes
Smoother
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Health and Social Survey Unit at CHSS Mortality from
circulatory diseases - Women : All ages, 1996-2002 La mortalit des
maladies circulatoires femmes toutes ages, 1996-2002 SMRs for Kent,
Medway, East-Sussex, Brighton & Hove, Nord Pas-de-Calais = 100
Local Linear Empirical Bayes Smoother
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Health and Social Survey Unit at CHSS Mortality from
respiratory diseases: Men, all ages 1996-2002 La mortalit des
maladies respiratoires: hommes toutes ages
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Health and Social Survey Unit at CHSS Mortality from
respiratory diseases: Women, all ages La mortalit des maladies
respiratoires: Femmes toutes ages 1996-2002
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Health and Social Survey Unit at CHSS Survey data Les donnes
des enqu tes de la sant Three health surveys Enqute Sant 2002-2003
Extension rgionale Nord/Pas-de-Calais Survey of people in East
Sussex, Brighton & Hove 2003 Kent and Medway Health and
Lifestyles surveys Nord Pas-de-Calais Kent and Medway East Sussex,
Brighton & Hove Population4.0 million1.6 million740,000
Sample4,0338,0715,936 Timing Date October 2002 - September 2003 5
waves June 2001May 2003 Age0+16+ registered with GP18+ registered
with GP WeightingOfficial INSEEAge and gender
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Health and Social Survey Unit at CHSS Results: Prevalence of
Health Behaviours Rsultats: Les comportements de la Sant
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Health and Social Survey Unit at CHSS Comparison of Survey Data
Smoking (women) Comparaison des donnes des enqutes Tabagisme
(femmes) ESBH and K&M Nord Pas-de-Calais
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Health and Social Survey Unit at CHSS The focus group findings
In the COSPH focus groups, participants were asked: Question What
do you think are the most important things that can be done to
improve the health of the nation or the population or the community
that you live in? What do you think can be done to reduce health
inequalities? Question What can the general public do to stop
becoming sick? How do you think the general public could help
government to create policies to reverse such inequalities?
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Health and Social Survey Unit at CHSS Deprivation at the coast?
Docks and Ports? I was surprised that the low life expectancy are
mainly on coastal areas - that was my first thoughts I would have
thought that in the coastal environment where food is supposed to
be that much better, sea breezes and all this should constitute a
better lifestyle and from a health point of view, but it doesnt
seem to (Focus Group 2) Yeah it makes sense. You can see, they are
all first of all most of them are industrial areas which are run
down - nearly all of them actually - and you have got the dock area
around Dover, parts of that is and then if you come to Folkestone,
another run-down area. (Focus Group 9) Theres high unemployment
around the Dover area which of course has made them areas of
deprivation we know around the Sheppey area there is high
unemployment again from the sense of theres less theres dock work
(Focus Group 9)
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Health and Social Survey Unit at CHSS And ex-mining areas in
East Kent Well one of the social factors here, specific to this
ward, is it's an ex-mining community and theres obviously a lot of
respiratory disease here. But that is specific to this area. (Focus
Group 13) Also particularly around Dover which, you know, we know
well, is because of the unemployment because the closure of the
pits all of those were mining areas, the pits closed, the ferry
closed http://home.freeuk.com/eastkent/mining/index.htm
http://www.dover.gov.uk/kentcoal/intro.asp
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Health and Social Survey Unit at CHSS Summary Sommaire..
Mortality from circulatory diseases is more important in England
and the regions of south east England Health behaviour, especially
consumption of fat, smoking in England There is less circulatory
disease in France and in the north of France but premature
mortality is a bigger issue Female cancer is more important in
England Smoking has reduced quicker in England Premature mortality
is more important in Nord Pas-de-Calais than in south east England
for both sexes in Nord Pas-de-Calais there has been a great deal of
industrialisation in the past (mining, port health) favouring
industrial and environmental diseases including asbestosis A poorer
socio-economic situation leading to Stress related disease
including smoking, alcoholism Less likely to use health services
Less likely to take part in screening campaigns La mortalit des
maladies circulatoires est plus importante en Angleterre et les
rgions du sud-est Angleterre Les comportements de la sant,
espcialement de la graisse, et le tabagisme en Angleterre Au nord
de la France la mortalit prmature est plus importante Chez les
femmes le cancer est plus importantes en Angleterre La rduction du
tabagisme en Angleterre a t plus rapide La mortalit prmature est
plus importante en Nord Pas-de-Calais quen Sud Est Angleterre pour
les deux sexes En Nord Pas-de-Calais il y avait plus
dindustrialisation (le bassin de mineurs, la sant du port) qui
inclus le cancer de la plvre La situation socio-conomique est
suivie par Les problmes du stress Moins daccs aux soins Moins de
participation aux services de dpistage
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PROJET COFINANCE PAR LUNION EUROPEENNE (FEDER) FINANCED IN PART
BY THE EUROPEAN UNION Health and Health Behaviour The COSPH Project
Dr. Ann Palmer Centre for Health Services Studies University of
Kent 11 th January EUREGHA Conference Inequalities in Health
[email protected]