West Lothian - Health Improvement

Health Improvement Activity in West Lothian

The Health Improvement Team is a multi-disciplinary and multi-agency team working within the auspices of the West Lothian Community Health & Care Partnership. it is taking an integrated approach to drive forward health improvement strategy. The team comprises staff employed by West Lothian Council (Social Policy, Education and Cultural Services and Development and Regulatory Services) and NHS Lothian (West Lothian division and the Health Promotion Service).

See link to HIT Team web page with staff contact details on the right hand column.

The indicators of poor health & health inequalities used by the Health Improvement Team (some of which also feature as part of the SIMD) have been used to build a profile of key health inequality factors, and were used in the locality planning exercise.

For locality Planning, it was agreed that the following indicators, which can be viewed in the reports would be used:

NOTE: Previous local health indicator data has been (or will be) removed from the site as the disclosure policy within ISD has recently been tightened and for sensitive topics at low geographic levels such as datazone it is now the policy to suppress all numbers under 10.

Breastfeeding The World Health Organization recommends that babies should be breastfed from birth until six months. Numbers are low in the UK, and mothers in low-income groups are up to 25% less likely to breastfeed than those in higher income groups. Latest Info: The latest provisional figures are for babies born in 2008 (for NHS Boards that use the Child Health Surveillance Programme Pre-School system).

The provisional data for 2008 (released in May 2009) show that 46.5% of mothers were recorded as breastfeeding their babies at all at the health visitors first visit (around 10 days) and 35.6% of mothers were recorded as breastfeeding their babies at 6-8 weeks. This compares with 46.0% and 35.2% respectively in 2007. The measure now used however, is whether childrehn are being exclusively breastfed, and the table below illustrates these figures. Unfortunately as will be seen the trend is now downwards.

Breastfeeding in West Lothian at 1st Visit & at 6 week review (2008 data are provisional)
	2001	2002	2003	2004	2005	2006	2007	2008
1st Visit Reviews	2,045	1,992	2,103	2,125	2,180	2,157	2,257	2,309
% Breastfed (mixed breast and formula)	42.5%	45.9%	45.5%	44.9%	46.1%	46.1%	46.0%	46.5%
% Exclusively breastfed	39.4%	42.0%	39.7%	39.7%	39.0%	38.5%	38.9%	36.6%

6-8 Week Reviews	2,031	1,948	2,047	2,052	2,126	2,152	2,248	2,107
% Breastfed (mixed breast and formula)	32.9%	35.3%	34.3%	33.6%	36.4%	34.5%	35.2%	35.6%
% Exclusively breastfed	25.9%	27.2%	25.1%	24.7%	28.0%	25.6%	25.3%	26.6%
Source: ISD Child Health Data Note: These figures have been amended to match those on the ISD website (which is the main source). These differ slightly from those given on the Scottish Neighbourhood Statistics Website.

Low Birth Weight Low birth weight (less than 2500 grammes), is a major cause of infant mortality in developed countries including the UK. In singleton births a low birth-weight baby is 3 times more likely to be born to a mother living in an area of high deprivation than to a mother living in an area of low deprivation.
The latest information on births & babies on the ISD website is on the births & babies summary page. There is also a link to more specific information about low birthweight & its causes.

Low Birth Weight Babies (under 2500g) in West Lothian
	2000-02	2001-03	2002-04	2003-05	2004-06	2005-07
Live singleton births	5,248	5,379	5,472	5,535	5,673	5,756
Low weight births (under 2500g)	127	138	135	135	134	133
Low weight rate per 1000	24.20	25.66	24.67	24.39	23.62	23.11
Source: Scottish Neighbourhood Statistics. The year shown refers to the year of discharge from hospital. Three Year Aggregate Data.

Smoking in Pregnancy Maternal smoking is associated with preterm and/or low birthweight babies, an increased risk of miscarriage, stillbirth and Sudden Infant Death Syndrome (SIDS). Smoking during pregnancy is also closely linked with deprivation, as nearly 40% of women from the most deprived areas of Scotland smoke during pregnancy compared with just 14% of women in less deprived areas. In 2007 provisional figures suggested that around 20.9% of pregnant women in Scotland are smokers at the start of their pregnancy (down from 28.7% 1n 1998). In West Lothian this figure was 22.7% in 2007 down from 29.6% in 1998. Note: These data have been revised. For further information see the: ISD Smoking and Pregnancy webpage.

Women smoking at booking in West Lothian Excludes home births and births at non-NHS hospitals.
	2000-02	2001-03	2002-04	2003-05	2004-06	2005-07
Number booked	5,697	5,828	5,919	6,043	6,194	6,277
Never Smoked	3,606 (63.3%)	3,734 (64.1%)	3,865 (65.3%)	3,920 (64.9%)	4,062 (65.6%)	4,185 (66.7%)
Former Smokers	386 (6.8%)	435 (7.5%)	456 (7.7%)	497 (8.2%)	493 (8.0%)	477 (7.6%)
Smoking - Not known	154 (2.7%)	119 (2.0%)	87 (1.5%)	75 (1.2%)	93 (1.5%)	122 (1.9%)
Smoking at Booking	1,551 (27.2%)	1,540 (26.4%)	1,511 (25.5%)	1,551 (25.7%)	1,546 (25.0%)	1,493 (23.8%)
Source: Scottish Neighbourhood Statistics. Data on smoking behaviour is based on self-reported information obtained from mothers at their ante-natal booking visit in the community or at hospital. The smoking at booking data item was introduced in 1993/94 and it should be noted that, particularly in the earlier years and again more recently, this information is not always recorded and therefore can affect the results. Because of concerns about the quality of smoking at booking data, care should be taken in interpreting the results.

Teenage Pregnancies Britain has the highest rate of teenage pregnancy in Western Europe. Teenage pregnancy is both a cause and a consequence of social health and economic inequalities. The latest information on the ISD website is for the year ending December 2007 and each period is shown as a three year rolling aggregate. Teenage Pregnancies

Discussion on the new method of deriving teenage pregnancy data from birth and stillbirth registrations and notifications of therapeutic abortions.

The teenage pregnancy rate is counted as the number of deliveries combined with the number of abortions. It does not include miscarriages. Available information is used to estimate the woman's age at the likely time of conception.

There have been some changes in the balance between teenage pregnancies which are aborted and pregnancies which are delivered. Over recent years, there has been a slight rise in the rate of abortions in all the teenage age groups.

There is a strong deprivation gradient. The most deprived groups have approximately ten times the rate of delivery as the least deprived, and twice the rate of abortion. These proportions have not varied much over the most recently available seven years, and do not vary much with age. There are considerable variations in teenage pregnancy rates between different geographical areas. For the NHS Boards, Tayside has a consistently high rate.

Teenage Pregnancy in West Lothian.
	2002-04	2003-05	2004-06	2005-07
Under 16 (13-15) Count & rate per 1000	92 (9.4)	89 (8.9)	73 (7.3)	58 (5.8)
Under 18 (15-17) Count & rate per 1000	455 (46.5)	446 (45.6)	412 (41.8)	397 (40.1)
The year shown refers to the year of conception. Age shown is based on age at conception. Information on the number of pregnancies in young women is presented, including cases based on maternities (pregnancies ending in a live or stillbirth) and pregnancies ending in a therapeutic abortion. The method used to calculate teenage pregnancies has been revised and full details can be found on ISD's Teenage Pregnancy Website. Data for the 3-year period 04-06 was found to be incorrectly compiled and was rectified on 12th March 2009.

Self Harm Self-harm (cutting, burning, bruising or poisoning), doesn't usually mean that someone wants to commit suicide, but if people are not helped their urge to hurt themselves could grow into a wish to end their lives. The number of children talking to ChildLine about self-harm has also grown steadily over the last ten years. Over 60% of these callers are aged between 12 and 15, and twelve times as many girls call about self harming as boys.

We have requested further data on self-harm in West Lothian & are currently consulting on defginitional issues in order to count patients as well as episodes (as some people may have had a number of admissions in any year).

Dental Conditions The original indicator identified by the Health Improvement Team (Hospital Admissions for Dental Treament for Children aged 0-14), had to be changed, as variations in referral practice meant that the data were not suitable to be used as an indicator.

Dental decay is a preventable disease, and although improvements have been seen, unfortunately many people in Scotland still suffer this condition. In fact the treatment of dental conditions is still the commonest reason for children under 15 years of age in Scotland to be electively admitted to hospital.

Dental decay is, like many other diseases, closely associated with deprivation. Data on the level of dental decay in children is collected via the National Dental Inspection Programme.

In 2005/06, 47.9% of P1 children in West Lothian had no obvious signs of dental decay, this was lower than the Lothian average of 55.2%. The SOA states that by 2007/08 this figure had risen to 50.4%.

For P7 children in West Lothian in 2006/07, 65.1% had no obvious signs of dental decay with the average for Lothian being 66.2%.

New data on the oral health of P1 children in 2007/08 will be released in March 2009. Further information on dental health results for primary schoolchildren across Scotland is is available on the Scottish Dental Website.

Dental Registrations:

Dental Registrations in West Lothian
	0-2	3-5	6-12	13-17	All Children	Adults	All People
Sept 07	41.2%	78.3%	80.3%	75.4%	72.1%	58.9%	61.9%
Sept 08	41.1%	86.2%	88.5%	85.3%	79.2%	68.9%	71.3%
Source: MIDAS (Management Information & Dental Accounting System).

Accidents Hospital Admissions for Children aged 0-14 & People aged 65+. The number of unintentional injuries for those aged under 15 as a result of an accident at home is higher than the Scottish average and this is being addressed through the Community Safety Strategy within West Lothian, which aims to reduce this number, particularly amongst under 5’s in areas of multiple deprivation. We are therefore in the process of negotiating an update to the accident statistics at small area level.

The longer term objective is to extend the range of indicators included here to address the full range of health topics for which data are available such as alcohol & drugs misuse, the various causes of mortality.

GP Practice Profiles & Maps

Some exploratory work was previously undertaken to match GP practice boundaries to datazones, but this has not been carried forward as practice boundaries overlap and patients can choose a practice & may not be registered in their 'catchment' practice. It would therefore would be very difficult to provide an accurate representation unless NHS Lothian provided details of how many patients were were registered in each datazone.

Data

External Health Links

Health Improvement Team

Publications

Directory of Health Homeless Services - June 2009