The 2013 challenge is to bridge the public health gap

By on 24/12/2012 in Blog, Cllr Bedser

life expectancy variations in Birmingham

Cllr Steve Bedser is Birmingham city council's cabinet member for health and wellbeing. Dr Adrian Phillips is the city's new director of public health. Together they are charged with steering the city through next April's handover of public health responsibilities to local authority control.

As we bid farewell to 2012 and look ahead to the next 12 months it's a time for reflection and of course those hard to live up to New Year's resolutions.

If the top ten lists we see in the lifestyle sections of newspapers every year are accurate, many of us will head into 2013 determined to lose weight, quit smoking, drink less and generally lead fitter, healthier lives.

Well our New Year's resolution for the whole of Birmingham incorporate each of those worthy intentions, because as the council prepares to take responsibility for public health across the city next April, the overall aim is crystal clear.

We must start to reduce the health inequalities that continue to blight the lives of thousands of people in this city - often simply based on where they happen to live.

Like local authorities across the country we assume responsibility for a wide range of public health issues in April 2013 and, while this long overdue transition is welcome, do not underestimate the challenges – challenges that are starkly illustrated if we look at the variations in life expectancy across the city.

It's startling that just eight miles separates the highest and lowest life expectancy areas in the city. If we use the cross-city rail network to illustrate the issue, we find that:

  • Within only eight stops you can shave nine years off the average life expectancy of a citizen.
  • Within eleven stops you can shave eleven years off the average life expectancy of a male citizen.
  • Within only five stops you can shave five years off the average life expectancy of a female citizen.

The most sobering thing is that the main conditions responsible for the gap in life expectancy are preventable. Three types of disease areas that are contributing the most to this gap:

  1. Cardiovascular and Circulatory diseases
  2. Cancers
  3. Respiratory diseases

These three combined represent the biggest gap between Birmingham and England and yet premature deaths from these conditions are clearly avoidable.

The main causes of preventable illnesses are:

  • Smoking
  • Alcohol use
  • Obesity and poor diet
  • Physical inactivity
  • Poor education
  • Poor living conditions
  • Poverty/Deprivation

If we take the top one (smoking), there are around 190,000 smokers (26 per cent of adults) in Birmingham. 40 per cent of these smokers live in the most deprived wards while just 14 per cent come from the most affluent.

But there is hope. Our Smoking Services in Birmingham have grown from strength to strength since they were launched in 2001, going from helping just 300 in the first year to over 10,000 in the last 12 months. That's a UK record. And there are huge benefits if we continue to build on that success.

There are a number of other challenges if we are to reduce those health inequalities and again a look at the cross-city train line illustrates the scale of those challenges.

  • Within only six stops the rate of Infant Mortality rises from zero (Sutton Coldfield) to 14.3 (Duddeston)
  • Within only five stops the amount of obese people living in wards almost doubles (from University to Gravelly Hill)

Now the moral argument for tackling these inequalities is irrefutable but there’s also a huge financial cost if we fail to act.

Put bluntly, our current health and social care system is unsustainable and will buckle under the weight of demand unless we re-engineer our planning and service provision to promote healthy choices, protect health, prevent sickness and intervene early to minimise the need for costly hospital treatment. We need to reform all of our systems, services and plans so that they actively promote health rather than simply treatment a rising tide of illness and long term conditions.

So what are we looking to achieve in Birmingham?

  • A city where people are physically active, eat well, drink alcohol in moderation, and do not smoke
  • A city where people have aspiration, are able to achieve during childhood, and succeed economically as adults
  • A city where people live long, independent lives, in their own homes

Stating those aims is the easy bit but the hard work is already underway to make 2013 the year we start to make real headway in the public health challenge facing Birmingham.

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