London

Noise

Drugs

Mental health

Income

Smoking

Obesity

Life expectancy

Good health

Local health services

Green space

Binge drinking

Physical activity

Sport and fitness provision

Crystal Palace Park, Bromley

Noise
DEFRA’s report is based on traffic noise above 60 decibels – about the level of an average car going by. It is a broad indicator of the quieter and noisier boroughs, with those in outer London predictably scoring higher. Hillingdon is the red herring here as it suffers disproportionately high noise levels due to traffic generated from Heathrow – as well as the aircraft themselves.

According to a recent report by the Mayor’s office, noise pollution has been shown to have an adverse effect on levels of stress, children’s learning, sleep and cardiovascular health. Children, people with existing physical and mental illness and the elderly are most susceptible to noise pollution.

In general, the highest noise pollution is in boroughs outside the congestion zone. However, the worst impact of traffic is from road accidents: Westminster has the highest number of casualties from traffic accidents (2,415 in 2003), though inner boroughs in general tend to have lower rates due to traffic speed; Richmond has the lowest figures (296 in 2003).
See www.noisemapping.org

Percentage of borough where traffic noise is above 60 decibels

(Source: ‘Noise Mapping England: The London Road Traffic Noise Map’, September 2004, Department of the Environment and Rural Affairs)

Drugs
It’s estimated that at least one in 200 adult Londoners between the ages of 15-44 is undergoing treatment at a specialist drug agency. Camden and Islington record the most, and Bexley and Barnet the least.

Over half (57.2 per cent) of those treated stated that heroin was their main drug, and this increased to 59.4 per cent in inner London, which suggests a concentration of heroin use in deprived inner-city areas.

Many problem drug users, especially injecting users, suffer adverse health consequences including: contracting HIV, Hepatitis B and C; poor nutrition and blood poisoning.

The number of drug-related deaths in London has declined from a peak of 303 in 1998 to 150 in 2003, probably in part due to the number of needle exchange schemes.

Number of people in treatment

(Source: ‘Drugs: Numbers in Treatment 2004/5 (aged 15-44)’, The London Health Observatory)

Mental health
Suicide rates vary considerably across the capital, with inner London having significantly higher rates than the English average, and outer London having significantly lower rates. Suicide is strongly related to deprivation and unemployment – and unemployment is highest in the inner city. As with national trends, suicide is most common among men, accounting for 72 per cent of deaths – though this figure is lower than suicide rates for men across the rest of England. Many of the boroughs with high suicide rates have high hospital admission figures for schizophrenia.

Deaths by suicide

(Source: ‘Deaths From Suicide and Undetermined Injury Aged 15 Years and Over, 2001-2003’, London Health Observatory)

Richmond Park, Richmond

Income
Health experts consider income a highly important determinant of health: the poorer you are, the more unhealthy you are likely to be. London’s poorest boroughs, where health has the most to improve, are categorised as Spearhead boroughs (Hammersmith & Fulham, Newham, Greenwich, Barking & Dagenham, Hackney, Lewisham, Haringey, Lambeth, Islington, Southwark and Tower Hamlets) and as the wealthier communities get healthier, the poorer ones have to make more improvements to match them.

‘The wealthiest borough is no surprise,’ says Dr Bobbie Jacobson, director of the London Health Observatory. ‘And I am not surprised by the low rating for Waltham Forest. Half its wards are among the most deprived in England and it has a shorter life expectancy than the England average. It also has a high proportion of ethnic minority communities. London’s diversity is its biggest challenge. Apart from socio-economic problems, new immigrants might find it harder to register with GPs, and there can also be language problems. A decent income and a decent education are the two best routes out of poverty, and getting out of poverty is one of the best ways to improve your health.’

Average household income

(Source: ‘PayCheck 2005: an Analysis of Household Income Data for London’,Mayor of London publication)


Smoking
‘30 per cent of the health gap in London is caused by smoking and its related impact on health. If we could tackle one thing to bring boroughs’ health targets up, it would be smoking,’ says the LHO’s Dr Bobbie Jacobson.

Deaths caused by smoking, as percentage of all deaths

(Source: ‘Tobacco: the Preventable Burden’, London Health Observatory, 2001)

Marylebone Farmers' Market, Westminster

Obesity
This table only gives a statistical estimate of obesity rates. A survey due to be published by LHO this year will, for the first time, reveal the real obesity rates for Londoners. London has a higher rate of obesity than other regions.

Obesity, like many health indicators, is related to deprivation (the poorest having the poorest diets and least access to affordable healthy food) and is highest in the more deprived parts of the city. Research shows that boroughs with large south Asian communities – Newham, Tower Hamlets, Greenwich – have higher rates of what is called ‘central obesity’ (fat round their middles), along with lower levels of physical activity.

Percentage of obese persons

(Source: National Centre for Social Research, 2000-2002)

Vale Farm sports ground, Harrow

Life expectancy
A child born today in Kensington & Chelsea is likely to live almost seven years longer than one born just six miles away, in Tower Hamlets. A boy born in Kensington & Chelsea can reasonably expect to survive to the age of 80.8, a girl to 85.8. The corresponding figures for Tower Hamlets are 73.9 and 79.2.

While none of the London statistics at the bottom end of the table are as bad as those as those in Scotland where the average life expectancy in parts of Glasgow is less than 73 years, they reflect a gap which some researchers claim is at its widest since Victorian times.
The answer, as with many health indicators, is down to income: according to a survey published in the British Medical Journal in 2005, ‘The poorest 10 per cent in society now receive 3 per cent of the nation’s total income, whereas the richest tenth obtain more than a quarter.’

Average life expectancy at birth

(Source: July 2003 figures for life expectancy at birth, averaged between males and females, Office of National Statistics)


Good health
If you asked 100 people in Richmond to describe their health over the past year, 76 would reply: ‘good’ rather than ‘fairly good’ or ‘not good’. In Barking & Dagenham, in contrast, only 65 would respond so positively.

The results of this question in the last census can also be broken down by ethnicity. Pakistani and Bangladeshi men and women reported the highest rates of ‘not good’ health, around twice that of their white British counterparts. Chinese men and women were the least likely to report their health as ‘not good’.

Reporting poor health was also strongly linked to the use of health services. White Irish and Pakistani women had higher GP contact rates than women in the general population. Bangladeshi men were three times more likely to visit their GP than other men. In only seven boroughs (the five above plus Hackney and Waltham Forest) was the percentage of people considering themselves in ‘good’ health lower than the national average of 68.76.

The number of people who describe their health as ‘good’

(Source: Office of National Statistics, 2001 Census)

Local health services
Primary Care Trusts are the frontline health organisations in each borough. Their role is to address inequalities, improve primary care and arrange local health services.

The 2006 Healthcare Commission survey was the first to assess whether NHS trusts meet general standards on issues that matter to patients, such as safety, cleanliness and the d quality of care. The Commission rated all 570 NHS trusts in England on a four-point scale from ‘excellent’ to ‘weak’ for both quality of services and use of resources. Four per cent were rated excellent – though none are in London.
Thirty-six per cent were considered ‘good’ – a mark achieved by only seven trusts in the capital.

At the opposite end of the spectrum, Barnet was one of two London trusts to be graded ‘weak’ – a rating described as ‘extremely worrying’ by Helena Hart, Barnet Council’s cabinet member for public health: ‘A “weak” rating for quality of services must have a direct negative impact on patients. The advent of patient choice will mean that patients opt for hospitals where the quality of services is “good” or “excellent” instead of going to Barnet Hospital. This will not help the trust’s financial position as fewer patients will mean less income. The ratings quite obviously show that the current amalgamation of Barnet & Chase Farm Hospitals is not working.’

Overall, the primary care we receive in the capital is mediocre with a few pockets of above-average performance.

Primary Care Trusts rated by category

(Source: Healthcare Commission, 2006 NHS Trust ratings)


Green space
Green Flag Awards, managed by the Civic Trust, are the national benchmark for quality parks and green spaces, with winners judged to be welcoming, safe and well-maintained with strong involvement from the local community. In 2006, the tenth year of the scheme, a record 79 were awarded to green spaces in London boroughs, ranging from well-known locations like Hampstead Heath, Highgate Wood and Southwark Park to the small, tranquil Norman Leddy Memorial Gardens in Hillingdon.

‘Everyone should have easy access to superb green space,’ says scheme manager Paul Todd. ‘The winners are all places of pride and freely accessible, providing time out from the stresses of modern-day living. They help improve the quality of life for everyone.’

Number of Green Flag Awards

(Source: Green Flag Awards, 2006)

Binge drinking

Binge drinking is defined by the Department of Health as ‘eight or more units of alcohol for men, and six or more units of alcohol for women,
on their heaviest drinking day in the past week’. This table shows that, in Wandsworth and Hammersmith & Fulham, one in five adults is a binge drinker. The boroughs with the lowest rates are those where cultural, religious and socio-economic factors play a part: Newham’s large Muslim population puts it top for obvious reasons.

As a whole, Londoners binge drink less often compared to the rest of England: 18 per cent of London men compared to 22 per cent nationally, and 6 per cent of London women compared to 10 per cent nationally. In February 2006, the London Alcohol Forum was launched to co-ordinate work across boroughs.

Percentage of population reported by Primary Care Trust as binge drinkers

(Source: National Centre for Social Research, 2006: Percentage reporting binge drinking by Primary Care Trust)

Physical activity
The Active People survey is a year-long project, interviewing more than 350,000 Britons about their physical activity levels. The table is based on the interim results from October 2005 to April 2006, and records ‘the percentage of adults taking part in at least 30 minutes of moderate intensity sport and active recreation (including recreational walking) on three or more days a week’.

It’s no surprise that leafy Richmond tops the list, along with London’s most affluent boroughs. In exactly half of the capital’s boroughs, the participation rate exceeds the national d average of 20.1 per cent. However, more significant is that two of the five Olympic boroughs are rock-bottom of the table, further justifying the decision to use the 2012 Games as a means of improving public health in east London.

Speaking at the launch of the survey, Sports Minister Richard Caborn was disappointed by the findings: ‘In the last decade, we have invested £3 billion into providing new state-of-the-art facilities that are both accessible and affordable. But the Government can only do so much. Individuals must start to take responsibility for their health and fitness. The public has to get motivated if participation is going to rise.’

However, according to Neville Rigby from the International Obesity Taskforce, ‘The evidence shows that it’s very difficult to sustain longer-term regular exercise. A lot of people are put off by the gym culture and the competition in sports. We need to encourage general activity – walking and climbing stairs – to improve people’s physical fitness.’

People doing 30 minutes of active recreation 3 days per week

(Source: Active People interim survey, conducted by Ipsos MORI for Sport England, 2006)


Sports and fitness provision
Westminster has 52 private gyms and 26 private swimming pools. Kensington & Chelsea has 17 private gyms and ten private pools. However, we’ve excluded the commercial sector from our calculations because members of such places are likely to come from all over the capital as they’re usually near to where they work. Also, wealth is one of the key determinants of private-sector gym membership.

Instead, most users of public sports and leisure facilities live in the borough where they’re located. So we asked the Leisure Database Company to research the number of gyms and pools in each borough listed on the Active Places website (www.activeplaces.com) as offering public access. Some of these are ‘dual use’ centres on school sites with public access in the evenings and at weekends. We then divided the number of facilities by the population to show each borough’s commitment to making exercise accessible and affordable to its residents.

The five boroughs with the best provision are in the ‘wrong’ half of the table when it comes to life expectancy. One of the issues, clearly, is encouraging more residents to use their local facilities. This is already well underway in Barking & Dagenham, which is starting from a very low participation rate (see Physical activity, p18). The borough scooped the 2005 Health and Physical Activity Recognition Award from the Institute of Leisure and Amenity Management for its innovative use of physical activity to improve health. For example, its ‘Just Walk’ programme of six free walks every week.

Facilities relative to population

(Source: The Leisure Database Company, an official data supplier to the Sport England – Active Places website, 2006. Populations from 2001 Census)

With thanks to the London Health Observatory (www.lho.org.uk), the Leisure Database Company (www.theleisuredatabase.com) and Tom Mendelsohn in compiling this feature.