Agenda item

Jonathan O’Sullivan, Acting Director of Public Health and Mahnaz Shaukat, Head of Health Care Intelligence were present and outlined the presentation, copy interleaved

·       Population, Deprivation and health inequalities in Islington – health inequalities are largely due to the unfair and unjust inequalities in society in which people are born, live and age. These inequalities are structural and a consequence of the social and economic organisation of society and can be avoided. Inequalities are driven by a high level of deprivation amongst some communities affecting all aspects of people’s lives including income, employment, education, housing and neighbourhood. These factors drive inequalities in physical and mental health. Poverty is also a key determinant of poor outcomes in health and linked to a higher level of risk behaviours and fewer protective levels for health. COVID 19 has exposed these inequalities  and the risk of dying or becoming seriously ill with COVID was much higher amongst people suffering from deprivation and disadvantage

·       L.B.Islington has an estimated population of 244400 people. Pre COVID was expected to increase by approx. 2% by 2026, with the largest growth expected amongst the older population (65 and over)

·       The population is relatively young compared with the national average and is one of the most ethnically diverse places in the country. Approximately 33% of Islington residents are from BAME communities, with the largest groups being Other white and Black and African and Black Caribbean groups. There is a lot of uncertainty about the population and this may have been affected by COVID

·       Deprivation – Islington is the 6^th. Most deprived London Borough and the 53^rd. most deprived in England. The geographic pattern of deprivation is different to many other areas. Islington’s mix of housing means that deprivation is very disseminated across the borough and is strongly concentrated into social housing estates

·       Islington residents have lower life expectancy and women lower life expectancy compared to the rest of London, but are similar to national averages. Inequality in life expectancy within Islington (the difference between the least and most deprived areas in Islington) is 9.8 years for men, compared to 7.2 in London and 9.4 in England. Inequality in life expectancy in Islington has widened and improvements in life expectancy slowed. The main causes of early death are cardiovascular disease, respiratory disease and cancer and those living in deprived communities have a higher death rate from avoidable g compared to the NCL average

·       The impacts of COVID relate to the immediate and direct consequences of COVID but the longer term consequences will extend far beyond. COVID has exacerbated existing health inequalities and directly disproportionately impacted men, BAME communities, most deprived communities, people living in care homes, those with learning disabilities, those with a mental health condition, those with underlying health conditions and physical disabilities

·       There have been a total of 1,627 COVID admissions to hospital up until July 2021.The highest proportion was for other ethnic groups, which is 2.85 times higher than the average in Islington. The black and Asian populations also have a higher rate of COVID admissions than the Islington average, whilst those from a white group or mixed group had a lower of similar level of COVID admissions compared to the Islington average. The rate of admissions was higher for men, although the rate is significantly different from the Islington average. Residents aged 55 or over had higher rates of COVID admissions, compared to the Islington average, similar to national patterns

·       COVID Impacts mortality – the cumulative total of deaths up until 15 October is 161.3 (391 deaths with COVID mentioned, and this compares to 228.9 for London, and 251.4 for England. There have been two major waves, and ethnicity is not recorded on the death certificates but details have been obtained by linking deaths data from GP’s and hospitals. People from white British group were less likely to have died from COVID than average and those from Black and Asian groups more likely than average

·       Disparity of risks and outcomes in COVID – national study showed men are disproportionately affected by COVID and despite making up to 46% of cases they make up almost 60% of deaths and 70% of admissions to intensive care. Similar ratios are found in Islington. Rates of diagnosis increase with age and the majority of patients in critical care are between 50-70 years of age. Those aged over 80 were 70 times more likely to die from COVID than those under 40. Ethnicity – highest in those of other ethnicity, followed by black ethnicity, and disparity in death rates also existed. A similar position was seen in Islington during the first wave, in the second wave rates amongst Asian communities as a whole was higher than amongst black communities

·       Those living in deprived communities were more likely to be infected by COVID and had poorer outcomes, and urban areas such as London had higher rates of COVID diagnoses and deaths. Islington had a lower mortality rate than the national average. Co-morbidities included on the death certificate mainly were diabetes, hypertensive diseases, chronic kidney disease, COPD and dementia. The most profound link was with diabetes which was listed on 21% of death certificates. Occupations - Nursing auxiliaries and assistants saw an increase in all cause deaths linked to COVID 19 and subsequent analysis has shown that health, social care and transport workers had a significantly higher risk of severe COVID

·       Long COVID – wide range of symptoms reported including fatigue, breathlessness, aches, sleep disturbance, cognitive impacts. An estimated 1.15% of the London population report long COVID symptoms, which equates to 2.788 people in Islington. Of those with confirmed COVID an estimated 7.5% experience long COVID symptoms that impact significantly affect their daily life. Diagnosis rates are lower than this, which suggests many people may be unaware of sources of support in Islington

·       Impact of COVID on start well – maternal, ante-natal and early years –

·       Changes in availability and support in pregnancy and for new parents, concerns about changes in unplanned pregnancy rates, risk of reduced access to immunisations, impacts on early socialisation and development, impacts on parental income and employment. School age children – educational attainment gap due to school closures, differential home schooling provision, reductions in physical activity and diet issues. Transition to adulthood – disruption to education and exams, financial consequences, possible disproportionate effect on young people’s employment, impact of early unemployment and debt. Safeguarding and mental health – fewer opportunities to identify and monitor safeguarding concerns and reduced access to support for children, domestic and child abuse increases, stress factors affecting the mental health of children and young people, isolation, lack of routine, stress, anxiety and bereavement

·       Islington is the most income deprived borough in London for income deprivation affecting children. In 2019 28% of residents under 18 living in families facing income deprivation. Islington has similar outcomes for GCSE attainment compared to London and better than the national average. Nearly a quarter of children in London are obese, and there are similar levels to London. Hospital admissions for self-harm amongst young people are significantly lower than national averaged, although higher than the London average. Islington has a lower rate of childhood immunisations compared to London and England. MMR uptake is far below the herd immunity for measles. The pandemic is likely to have widened the gap between children in poverty and others

·       Live Well – Islington has one of the highest prevalence of common mental health illness in London. Smoking, alcohol and obesity are major risk factors and higher in Islington than London or nationally, although these have reduced over time. Islington has 11,500 people living with diabetes, 3,800 with heart disease, and approximately 4,000 with COPD. Air pollution levels are improving but remain higher in Islington compared to England

·       Age well – Islington has the 4^th. Highest level of income deprivation affecting older people in London. 34% of residents over the age of 60 wer facing income deprivation, compared to a London average of 22%. NHS screening programmes to prevent early death are in place but there is  a low uptake of bowel screening, and aortic aneurysm compared to London and England

·       A lower proportion of older people live alone in Islington, although the trend is increasing and levels of dementia are higher than the London average. However this is due to much higher levels of early diagnosis, rather than population differences

·       Moderate or severe frailty prevalence is high in Islington, and there is also relatively higher rates of alcohol admissions among older people

·       Impact of COVID on Live Well and Age Well – physical activity – limited by lockdown, increase in sedentary behaviour, opportunity to encourage active travel. Healthy eating – evidence of change in dietary behaviours, impact of lockdown of food choices, rising food insecurity and increased use of foodbanks. Smoking – mixed evidence of trends during lockdown, increased economic circumstances associated with increased smoking, disruption to smoking cessation services. Alcohol – changes in patterns of use, concern about problematic drinking, bereavement, isolation, troubled relationships, job insecurity can contribute to this. Substance misuse – changes and disruption to services during lockdown, and impact on recovery, changes in drug supply, reports of increased on line gang recruitment and activity

·       Physical health impacts COVID– temporary include managing delayed diagnosis of long term conditions, additional costs to health and social care system, medical organisational approach, loss of social connection. Short/Medium term – delayed diagnosis due to missed appointments, backlog of waiting lists, changes in service delivery due to lockdowns, disproportionate impact of virus on BAME, carers, older people, dementia, mental health needs, learning disabilities. Long

Term service pressures, inequalities in health, distrust, potential increase in obesity.  Large national surveys have shown higher numbers of people experiencing anxiety and depression than before the pandemic. Local residents and stakeholders views show that a large majority 81% of residents are somewhat or very worried about the impact of COVID, 26% on mental health and wellbeing. Modelling predicts there may be 28,266 new cases of . moderate/severe anxiety and 38,671 new cases of depression in the borough. Social isolation is more widespread and residents living alone are much more likely to experience extreme loneliness

·       Some people have suffered more from COVID affects than others on mental health and wellbeing and levels are highest amongst women, young adults, people who live alone or with children or urban areas, or are BAME

·       COVID resident engagement – engagement findings highlighted social inequalities and BAME communities were significantly more worried than others. Mental health was the most common concern. Also finances, employ

ment, relationships and access to services. VCS and community groups have played a key role however in supporting residents through the pandemic

·       Going forward – COVID will exacerbate further inequalities and poorer health outcomes in coming years. Working with NHS a population health management approach to improve wellbeing and reducing health inequalities is being developed across NCL. There needs to be a strong focus on recovery of evidence based preventative interventions, together with planned hospital care, targeting most affected groups. Mental health is also important, with more individualised support for people with complex mental health problems

·       A Member referred to the fact that Islington had one of the highest deprivation income levels in London, and it was illogical the way Government were making funding decisions on health services. Noted that work was taking place to address this issue with the CCG and ICS

·       Noted that there had been investment in mental health services improvements, however there is a need to make the case to NCL to invest more funding to address health inequalities. Also noted that population health management would be assisted by the information gathered from the pandemic

·       Reference was made to the Health Inequalities report referred to at the previous meeting and that an update on the recommendations should be provided to a future meeting of the Committee to assess progress

·       Noted that poor housing conditions have a detrimental effect on health and that many poorer residents lived in unsatisfactory accommodation, exacerbating health inequalities

·       Reference was made to the fact that many BAME residents who were elderly tended to be more deprived, due to migration and lower income employment. The Chair stated that this may be a possible topic for a scrutiny review in the next municipal year

                 RESOLVED:

That the report be noted and that an update on the recommendations on   the Health Inequalities scrutiny review 2019/20 be considered at the next meeting of the Committee to assess progress