Healthy Life Expectancy

As life expectancy has risen, it is important to measure what proportion of these additional years of life is being spent in good health. Healthy Life Expectancy estimates this and the measure underlines the importance of wellbeing and lifestyle services. These services, commissioned for the West Sussex population, include: health checks for the general population of adults aged 40 to 74, and adults with learning disability; services to maintain the health of carers; alcohol prevention and early identification of risk; smoking cessation services for pregnant women and other adults; healthy weight services; harm reduction approaches for substance misuse, and emotional wellbeing programmes. These services have their own KPIs and action plans, and many are key to reducing the risks of developing cardiovascular disease and diabetes.

Healthy life expectancy is influenced by a vast range, and complex interaction, of factors running through each individual's life. These include: maternal health and wellbeing, parental relationships and influences in the early years of life, including breastfeeding, diet and physical activity; access to health and other services, and wider influences such as income, education, skills and employment. Therefore this measure is linked to other measures in the Future West Sussex Plan.

The data for this measure is sourced from the ONS statistical release on Healthy Life Expectancy at Birth by Upper Tier Authoriites.

Quarter 4 - Year end 2017 Update

As anticipated West Sussex figures are better than the England average and this is expected due to the county’s total above average level of affluence. We set the target to improve and achieve a bench mark of Amber or Green when West Sussex is compared to the average score for the South East of England. The addition of new data points to the Public Health Outcomes Framework show there is no discernible trend in healthy life expectancy for the South East of England, with the value rising between 2013/ 14 and 2014/15, and then falling again in 2015/16. The Health Foundation, in its 2017 publication Healthy Lives for People in the UK uses an adapted version of Dahlgren and Whitehead’s (1991) model to illustrate the range of influencers on our wellbeing and health. Figure 1 (right) .The factors that influence an individual’s health and wellbeing. Adapted from Dahlgren G,Whitehead M. Policies and Strategies to Promote Social Equity in Health.Sweden: Institute for Futures Studies; 1991. Healthy life expectancy is a consequence of multiple, complex interacting factors, only some of which are within the direct control of the County Council. Many of the factors contributing to this outcome have been acting over long term trends (for decades or generations). There are increasingly suggestions that a complex system wide method considering social determinants and potentially a “health in all policies “ approach, should be considered in the future to determine where local resources are focused.

The greatest influences on our wellbeing and health are factors such as education and employment, housing and the extent to which the community facilitates healthy habits and social connection. While health behaviours have a big direct impact on health; socio- economic and other factors have a big impact on health behaviours. (LGA, September 2016- Health in All Policies). For example obesity is associated with lower educational attainment, which in turn is linked to inequality and deprivation. Most of the determinants of health have nothing to do with health services and have everything to do with broader public services, the environments in which we live, and people’s opportunities to lead healthy lives. (Eisenstadt N, speaking in: The Health Foundation. Healthier lives: a listening exercise. [Video] 2016. Available from: Access to health care accounts for as little as 10% of a population’s health and wellbeing. Whilst the quality of the healthcare system remains important, by itself, a safe and effective health service, will not improve the health of people in the UK. If the causes of ill health are social, economic and environmental then the solutions need to be too. There is not a single sector that will have there source to address the complexity.

The Health in all Policies approach recognises that our greatest health challenges, those that impact on life expectancy, are highly complex and that a collaborative approach to decision-making across all sectors and policy areas are needed. “The causes of the causes” is how the social determinants of health are referred to,and these should be the main focus of any strategy to improve life expectancy,health and health inequalities. (Marmot, cited in LGA 2016) West Sussex has increasing recognised the importance of addressing“the causes of the causes” with some of its services and the case study below from the Prescription Plus project in Crawley is an example of this. Mrs X is 76. Her husband passed away 9 years ago and she has also ‘lost’ four of her friends over the last 12 months. She sees her daughter once a week. Mrs X still drives and tries to get out twice a week as she enjoys good company and chatting. She is however very lonely. Mrs X and her husband visited South Africa for over 20 years and has very fond memories of travelling and spending time with her husband and friends. Since her friends have passed away, Mrs X has become more anxious about going out and meeting new people. She agreed to try out Age UK on a Tuesday. Mrs Z is 83 and has a few medical conditions. She used to volunteer with Meals On Wheels and as an escort on a school bus assisting disabled children. Mrs Z has become every anxious about leaving her house and has commented that ‘it happened just like that’ … there was no trigger. She never joined any clubs in the past and her anxiety has gotten so bad, that she even feels uncomfortable going up to the local shop and to her son’s house for dinner. Mrs Z’s daughter-in-law confirmed this with the Coordinator and actually wished her luck in getting Mrs Z to participate. The Coordinator arranged to collect Mrs X and Mrs Z to attend the Tuesday session at Age UK. Both were nervous and had to link arms to enter the main hall. They were made to feel very welcome and have decided to go back. The Coordinator was given permission to share the contact details of both and now Mrs X will be collecting Mrs Z to go along to the Tuesday session.

Quarter 3 - December 2016

Health-related quality of life –Healthy Life Expectancy / Quality of Life of Older People This goal is measured by monitoring annual updates to the GP patient survey item about the health of people aged 65 and over. (Please note that the figures for West Sussex at any one time may include a small percentage of people living in other counties that border West Sussex). The Health Related Quality of Life (HRQL) GP Patient’s Survey question asks people to describe their health status against five areas: Mobility, Self-care, Ability to do usual activities, Pain /discomfort, Anxiety / depression. This indicator has been updated on the Public Health Outcomes Framework (indicator 4.13), the latest data are: The value for West Sussex has reduced from 0.76 in 2012/13 to 0.751 in 2013/14. The value for the South East remained constant at 0.755. The West Sussex value is not significantly different from the South East value, and so remains amber. However, the figure is better than the score for England, 0.726.

Quarter 1 - June 2016

Health-related quality of life – Healthy Life Expectancy / Quality of Life of Older People This goal is measured by monitoring annual updates to the GP patient survey item about the health of people aged 65 and over. (Please note that the figures for West Sussex at any one time may include a small percentage of people living in other counties that border West Sussex). This goal is expected to be updated in December 2016. ONS have yet to provide a date for the release of any new data. The latest data relates to 2012/13. Performance against the target is currently Amber (similar to the South East average).