PLYMOUTH’S public health boss has warned that a dramatic cultural shift is needed to tackle deep-rooted inequalities between the city’s richer and poorer neighbourhoods.

People in the city’s most deprived neighbourhood die on average 13 years earlier than those in the most affluent, according to figures released alongside the annual public health report.

Those living in the western communities are also much more likely to smoke, drink excessively, become obese and be one of the rapidly increasing number of Plymothians with a sexually transmitted disease.

Poorer areas will be hardest hit by a pensioners’ “time bomb”, with an ageing population set to overwhelm social care services in the next 20 years.

Debra Lapthorne, Plymouth’s director of public health, described her annual report as a ‘lever for action’, and said: “A child born in the most affluent area of the city is likely to live 13 more years than a child born in the poorest – that’s a phenomenal difference and it’s just unacceptable.”

Her report calls on a wide range of city agencies – including the council, health bodies and others in the local strategic partnership (LSP) – to work together to tackle the problems.

She said: “Life expectancy is not just about what we do in the NHS.

The things that make a difference are about education, housing, employment, having disposable income, access to leisure, support from family and friends and many other factors.

“That’s why the role of the local strategic partnership (LSP) and its ambitions to change Plymouth into a modern, thriving city are so vitally important.”

The report, sent to health and council bosses this week, issues key challenges to bring about changes to service planning – including giving higher priority to preventative measures.

Ms Lapthorne said the burden of long-term diseases such as cancer, heart disease and diabetes will be “huge” without preventative measures targeted at poorer communities.

She said: “Prevention services, such as smoking cessation and weight-management clinics, are actually incredibly good value for money – with enormous returns from curbing disease for relatively little layout.

We need to address all of these factors.

“But they often lose out in the debate on reducing waiting lists or how much money should be spent on the latest cancer drug, for example.”

Ms Lapthorne said work already being done in the city, such as with the smoking prevention service, weight-management clinics, healthy eating initiatives and exercise programmes, has been “transformational” but more is needed.

“I’m optimistic there can be change,” she said. “We are heading in the right direction. Life expectancy is improving over the city as a whole but the inequalities between areas isn’t progressing as fast as we need it to, it is in fact remaining static.

We need to keep the pressure on to close the gap through prevention and early intervention.

“We know that obesity leads to long-term conditions such as heart disease and diabetes and, of course, smoking to cancer and heart conditions.

“Fortunately for us, these things can be prevented by making sure young people are more active, have healthier diets, don’t smoke, drink within safe limits, practice safer sex.

It doesn’t mean people shouldn’t enjoy themselves, it means we need to reduce the risk factors.”

The report details specific areas of public health, such as alcohol abuse, smoking, over-eating and sexual health, where agencies urgently need to concentrate on prevention.

It states that alcohol misuse is a growing public health problem and alcohol-attributable harm is a “real and preventable source of health inequalities”.

The report warns: “The most deprived communities experience the greatest burden of poor health and premature deaths due to alcohol.

“Worryingly, there are growing numbers of hazardous, harmful and dependent drinkers and they are getting younger.

“To tackle this growing problem there needs to be a cultural shift in society so that excessive and binge-drinking become unacceptable and sensible drinking is promoted.

“This will require sustained social marketing campaigns and will need to be focused on young people in particular.”

Where smoking is concerned, the report stresses activity should be concentrated on controlling tobacco to protect children and young people as well as continuing the sustained efforts to help more people give up when they are ready to.

It also states that, in the long term, resources must be shifted from treatment to prevention if the city is to tackle obesity and the health inequalities associated with it.

It says: “To do this will require concentrated partnership work to change lifestyles. There is a need to change social norms dramatically, to make over-eating and under-exercising less acceptable, as with smoking, if health improvements are to be realised.”

In terms of rising sexual health problems in the city, it states: “Sexual health remains a key challenge facing Plymouth, as do clear links between sexual ill health, poverty and social exclusion.

A fuller range of services, including prevention schemes, screening and treatment, need to be developed further and delivered in communities, in places closer to people’s homes, if we are to truly tackle inequalities that exist and will persist in sexual health.”

Plymouth's health statistics

LIFE EXPECTANCY:

In individual neighbourhoods, life expectancy 2003 to 2005 was 72.5 in Devonport compared with 85.2 in Chaddlewood – a gap of nearly 13 years.

In 1991-3, the difference in life expectancy between the most deprived and least deprived groups was 2.5 years.

In 2004-06 this had risen to 2.8 years.

The report states: “The residents of the central, north-east, Plympton and Plymstock sub-localities have a life expectancy above that of the city average (79.4 years), while the residents of the south-east, south-west and north-west have a life expectancy below that of the city average.”

SMOKING:

Plymouth’s smoking rate is estimated to be 28 per cent (compared with 23 per cent nationally), with higher rates in routine and manual workers.

In 2006, health visitors recorded one or more parents smoked in 28.8 per cent of Plymouth families. This ranged from 40.4 per cent in the most deprived third and 18.7 per cent in the least deprived.

In 2006-07, 23 per cent of Plymouth pregnant mothers smoked. This ranged from 11.7 per cent in the least deprived areas and 33.5 per cent in the most deprived.

OBESITY:

There has been a marked increase in obesity among children.

In Plymouth, a survey carried out by school nurses from 1994 to 1996 found that 8.3 per cent of children in Year 1 and 6 combined were obese. This figure was 8.5 per cent in the most deprived and 6.6 in the least.

In the academic year 2007/08, levels of obesity in Reception and Year 6 children combined had risen to 13.6 per cent combined.

SEXUAL HEALTH:

HIV positive patients in Plymouth have doubled from 125 in 2003 to 250 in 2007, which may be partly due to people travelling to access services in the city.

The recorded number of people with herpes has risen from 96 in 2002 to 220 in 2007.

The number of people testing positive for chlamydia have almost doubled from 560 in 2000 to 1,065 in 2007.

In addition, the chlamydia screening programme, targeting young people aged under 25, screened an additional 1,345 young people in 2007 with a prevalence of 15 per cent testing positive. The national average is 10 per cent.

The report states: “Men and women from manual households have a median age at first intercourse about two years lower than those from professional households.

“Under-18 conception rates are highly correlated with indices of deprivation.”

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