PROJET COFINANCE PAR LUNION EUROPEENNE (FEDER) FINANCED IN PART BY THE EUROPEAN UNION Health and...

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

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

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

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

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

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

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

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

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 + southeast english regions = 100

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

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

Health and Social Survey Unit at CHSS Mortality from respiratory diseases: Men, all ages 1996-2002 La mortalit des maladies respiratoires: hommes toutes ages

Health and Social Survey Unit at CHSS Mortality from respiratory diseases: Women, all ages La mortalit des maladies respiratoires: Femmes toutes ages 1996-2002

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

Health and Social Survey Unit at CHSS Results: Prevalence of Health Behaviours Rsultats: Les comportements de la Sant

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

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?

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)

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

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

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]

PROJET COFINANCE PAR LUNION EUROPEENNE (FEDER) FINANCED IN PART BY THE EUROPEAN UNION Health and...

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