THE PEOPLE OF GLASGOW AND CLYDE HAVE SPOKEN:
PERSPECTIVES FROM THE 2008 HEALTH & WELLBEING SURVEY
Between August and December 2008, the fourth in a series of health and wellbeing population surveys was carried out in the NHS Greater Glasgow and Clyde (NHSGGC) area. The baseline survey was carried out in 1999, with follow-ups in 2002 and 2005.
The 2008 survey was designed to provide information on people’s perceptions of their health and illness, their use of health services, health behaviours, their feelings about local neighbourhoods and their individual circumstances, such as household size, educational qualifications, employment and financial well-being.
A total of 8,278 face-to-face interviews were conducted amongst adults aged over 16. The final sample is representative of the NHSGGC population in terms of age, gender and deprivation using 15% most deprived and other areas based on the 2006 Scottish Index of Multiple Deprivation as a marker for deprivation.(15) The 2008 survey is the first to cover the integrated NHSGGC area.
The survey illustrates how health is shaped by environmental and social factors as well as biological, political and behavioural factors as discussed in the last Director of Public Health’s report.(16) We can see this when we explore feelings about local neighbourhoods; safety; trust and feelings about the local environment in different neighbourhoods across NHSGGC. This analysis demonstrates that our most deprived areas continue to be different from our other areas in many ways. The survey is broad ranging and information on financial well-being, alcohol consumption, obesity and physical activity will be presented elsewhere in this report.
This chapter focuses on self-reported health and illness, the use of health services, feelings about neighbourhood and smoking and will include comparisons of the findings from the current survey with those from 2005. Results from the survey will be published in full towards the end of 2009.(17)
To further complement this report, the Director of Public Health commissioned a series of ‘vox pop’ interviews in June 2009 to obtain people’s opinions on the key issues highlighted in each chapter. The interviews were conducted in a variety of locations across the NHS Board area in order to reflect accurately a wide a range of views. These real life views are quoted throughout this report to support the evidence presented in individual chapters.
PERCEPTIONS OF HEALTH & ILLNESS
The NHS routinely collects a great deal of information on the health of the population from GP consultations, out-patient attendances, hospital admissions and disease registers. This
information, however, does not tell us how people view their own health and well-being, a gap which the health and wellbeing survey addresses.
Self perceived health and well-being
Firstly, we asked people how they felt about their general health over the past year. Seventy one percent felt their health had been good or excellent, although older people and those from the most deprived areas were less likely to view their health this way, (46% and 66% respectively). Eleven percent felt their health had been poor, with the over 65s and those from the most deprived areas being most likely to express this view, (21% and 14% respectively).
NHSGGC Health and Wellbeing Survey, 2008
% of Respondents Expressing a Positive View of well-being by Deprivation Area
We also asked people to rate their physical well-being, general mental and emotional wellbeing, and their overall quality of life, as illustrated in Figure 1. Eighty five percent of people viewed their quality of life and mental and emotional well-being positively; 80% expressed a % expressing positive view of their physical well-being. People from the most deprived areas, however, were less likely to express a positive view of any of these measures. Twelve percent of those aged 65 plus had a negative view of their physical well-being and approximately 6% overall had a negative view of their mental and emotional well-being, or quality of life. There was little difference between men and women in any of these measures.
When asked if they were currently receiving treatment for any conditions or illnesses, 37% said they were being treated for at least one, with 6% being treated for three or more. The most frequently mentioned conditions were arthritis, rheumatism and painful joints, and high blood pressure. One in ten reported that they were currently receiving treatment for one of these. This figure rises to seven in ten for those aged over 65. Up to one fifth of the Scottish population have a long-term limiting illness or disability and employment rates in this group are low.(18) In 2007, 12% of the NHSGGC working age population were unable to work due to illness or disability.(19) Twenty percent of the people we interviewed said they had a long-term condition or illness which interfered with their day-to-day activities. Twenty three percent of those from the most deprived areas and 39% of those aged 65 plus, had such a condition. Seven in ten people said that their condition interfered with their ability to take up training, obtain or hold down a job, and approximately nine in ten stated that it interfered with taking physical exercise or social activities.
Comparisons with the 2005 survey
The majority of the people interviewed viewed their health and well-being positively. It gives cause for concern, however, that those from our most deprived areas and older people were less likely to express this view. It is also a concern that such a high proportion of those we interviewed who had a long-term illness or condition, found this to be a barrier to taking up training, obtaining a job or just socialising. Encouragingly, comparisons with the 2005 survey indicate that there have been improvements. Overall, 5% less people were being treated for at least one condition or illness in 2008 compared with 2005. The proportion of people from the most deprived areas who felt their general health over the past year had been good or excellent or who expressed a positive view of their general mental and emotional well-being, has increased by 5%, and 3% more people from the most deprived areas had a positive view of their overall quality of life.
USE OF HEALTH SERVICES
Types of service used
Eight in ten people had visited their GP surgery at least once in the past year. The majority went to see their GP (79%). Many GP surgeries also offer appointments with the practice nurse, midwife, and other health professionals including physiotherapists, chiropodists, dieticians and psychologists. Almost 40% of people had seen a nurse or midwife and about 15% used one of the other services offered by their surgery. Older people, women and people from the most deprived areas were most likely to visit their GP surgery at least once in the past year. Nine in ten people over 65 visited their GP surgery at least once in the past year, visiting, on average, eight times compared with five overall.
Just over two-fifths (43%) had used another health service at least once in the past year. Approximately 40% had visited an out-patient department or had seen a pharmacist for advice. Thirteen percent had contacted NHS24 and 10% had attended Accident and Emergency or been admitted to hospital. Three percent had used GP out-of-hours service in NHSGGC. Forty three percent had visited their dentist in the last six months. In contrast to GP services, people from the most deprived areas were less likely to use another health service than those from other areas, (42% and 44% respectively).
Accessing health services
We asked people about their experiences of accessing a range of health services. Thirteen percent said they found it difficult to obtain a hospital appointment. Just over one in ten (11%) said they found it difficult to get an appointment to see a GP and nine percent found it difficult to get to see someone at their GP surgery within 48 hours. Relatively few people, just over one in 20, had found it difficult to access health services in an emergency, travel to hospital or get a dentist appointment.
Involvement in decisions affecting health service delivery
We received mixed messages about people’s satisfaction with the opportunities they were given to get involved in decisions affecting their health service delivery. Encouragingly, the majority of people (95%) who expressed an opinion felt that they were given adequate information about their condition or treatment. Approximately 85% felt that they participated to at least some extent in the decisions affecting their health or treatment and that their views and circumstances were understood and valued and 68% percent felt that they had a say in service delivery. However, one third of people felt they did not have a say in the delivery of their health service and approximately 15% felt that they did not participate in decisions or that their views were not understood.
The majority of people interviewed in 2008 were satisfied with the NHS services they used and felt they could access services easily. However, the survey does show that there is room for improvement in the proportion of people who felt they had a say in the delivery of their health services. The NHSGGC community engagement team is looking at new ways of involving patients and community members in planning health services.
“As I live near Glasgow Green I feel that it does affect my health in a way that it is a positive influence on me. There is a lot of exercise activities that are there on the Green because it’s
close to me I can join in and see what’s going on and feel that I want to be part of that.”(20)
Perceptions of neighbourhood, feelings of safety, social support and quality of services are associated with positive health and well-being.(21) This section explores how these issues vary between the most deprived and other areas of NHSGGC.
View of neighbourhood
Overall, across NHSGGC, it is encouraging that 85% of people are positive about their neighbourhood as a place to live. When we look at our most deprived areas, however, just 77% are positive compared to 88% in other areas. Older people were more likely to be positive about their neighbourhood than younger people, (90% and 84% respectively).
It is encouraging that the majority of those we interviewed felt safe in their own home and felt safe using public transport. There was little difference between the most deprived and other areas; men and women or older people compared to younger people. There is a difference, however, when we explore feelings of safety when walking alone after dark. In the most deprived areas, only around half, compared with two thirds of people from other areas, felt safe walking alone after dark. Younger people were more likely to feel safe than older people, while men were more likely to feel safe than women. Feelings of safety govern behaviour. People
are more likely to participate in physical activities and social activities if they feel safe in their neighbourhood.
Over half of those we interviewed exchange favours with their neighbours. Women were more likely to do this than men. Three quarters of people felt they could trust others in their neighbourhood. Those living in the most deprived areas, however, were less likely to feel this way, while older people were more likely to feel they could trust their neighbours.
We asked about a range of social issues that might affect people, such as unemployment, burglary, vandalism, assaults and drug activity. The issues that were of most concern are shown in Figure 2.
NHSGGC Health and Wellbeing Survey, 2008
Perceived Social Problems by Deprivation Area
When we compare the most deprived areas with other areas, some stark differences emerge. For example, half of those from the most deprived areas were concerned about the level of unemployment in their area whereas in other areas, a little over a quarter expressed concern. Just over one third of people from the most deprived areas were concerned about levels of alcohol and drug misuse, compared with one fifth from other areas. The issue of alcohol in our communities is described in more length in the alcohol chapter of this report.
We also explored a range of environmental issues, such as rubbish; noise; vacant land and abandoned cars, as studies elsewhere have shown that the quality of certain physical characteristics of the local neighbourhood has an impact on both physical and mental health of residents.(22,23) The issues that were of most concern are shown in Figure 3.
NHSGGC Health and Wellbeing Survey, 2008
Perceived Environmental Problems by Deprivation Area
Once again there are stark differences in the proportion of people who are concerned about these issues in the different neighbourhoods across NHSGGC. For example, one quarter of those from the most deprived areas shared a concern about the amount of dogs’ dirt in their neighbourhood whereas only 15% from other areas felt this way. Across NHSGGC as a whole, 16% of people were concerned about traffic levels, however, this was felt more keenly in the most deprived areas where one fifth shared this concern compared to only one sixth in other areas. Almost a quarter of people from our least deprived areas were concerned about the availability of safe play areas, whereas only one tenth of those from other areas shared this concern.
Satisfaction with local services
We asked people to rate their satisfaction with local services. Many people were positive about local services. For example, people were most positive about the quality of local schools (78% positive); public transport (73% positive); the quality of local food shops (61% positive); quality of sports facilities (47% positive). Fewer people from the most deprived areas, however, shared these views.
Comparisons with the 2005 survey
This section highlights that in the most deprived areas there is less satisfaction with services and environment and a more negative perception of anti-social behaviours than in other areas. Further, people from the most deprived areas are less likely to feel positive about their neighbourhood and less likely to feel they can trust their neighbours. However, there has been a six percent increase in the number of people who felt that they could trust their neighbour compared with the 2005 survey. Further comparisons between 2008 and 2005 indicate that there have also been improvements in other measures. For example, people’s general feelings
of safety have increased since 2005; there has been a four percent increase in the number of people who felt safe in their own home and a six percent increase in feelings of safety when walking about after dark. In 2008, 12% more people feel safe using public transport than in 2005, i.e. nine out of ten people now feel safe using public transport. There has also been a drop in the proportion of people expressing a concern about the social and environmental issues mentioned above; approximately 10% less people in the present survey expressed concerns over the levels of alcohol, drugs, dogs’ dirt and traffic, and 16% less people felt there was a problem with the availability of safe play areas in their neighbourhood than in 2005. All of these improvements are encouraging. However, despite these improvements differences remain in the ways people from our most deprived areas view their local neighbourhood compared to those from other areas.
“If you could look at places like Bearsden and Drumchapel they are so close so it obviously must affect in some way the places they stay. The poverty on each side of these places is so different its from one end of the spectrum to the other so it does affect where you stay.” (20)
In response to health risks and growing public concern, the Scottish Executive (now Scottish Government) introduced Smokefree legislation in March 2006, prohibiting smoking in most enclosed public places. One year on, in September 2007, outcomes of the national evaluation of the impact of Scotland’s Smokefree legislation were presented and showed that the legislation
had an overwhelmingly positive effect.
The evaluation found that after the legislation came into force there was a 17% reduction in heart attack admissions to nine Scottish hospitals. This compares with an annual reduction in Scottish admissions for heart attack of three percent per year in the decade before the ban. There was a 39% reduction in second-hand smoke exposure in 11-year-olds and in adult nonsmokers (24); an 86% reduction in second-hand smoke in bars(25); an increase in the proportion of households with smoking restrictions (26); no evidence of smoking shifting from public places into the home (26); and high public support for the legislation even among smokers, whose support increased once the legislation was in place.
One third of the people interviewed said they were smokers and smoked on average 16.2 cigarettes a day. Fifteen percent were ‘heavily addicted’, i.e. smoked 20 or more cigarettes a day. Those from the most deprived areas were more likely to be smokers, (42% compared with 29% from other areas) as were men (36%) and those under 65 years of age (38%).
Exposure to second-hand smoke
Nearly two-fifths (39%) of people in our survey stated that they are exposed to second-hand smoke at least some of the time. People from the most deprived areas were much more likely to experience this (48%) as were men (42%). Forty three per cent of younger people were exposed to second-hand smoke at least some of the time, compared to 23% of people aged 65 plus. Just over one third of people said that they were never exposed to second-hand smoke, with women and those over 65 being more likely to say this, (36% and 47% respectively).
Intention to quit and use of nicotine replacement therapy (NRT)
We asked smokers two additional questions in 2008 which were not asked in previous surveys. Firstly, we asked whether they intended to stop smoking. Encouragingly, one third said yes, with women more likely than men, (37% compared with 29%) and those under 65 were much more likely to wish to quit, (34% compared with 18%). Secondly, we asked whether they had used any form of NRT in the past year. Eighteen percent had used a gum, patch, spray or inhaler.
Twenty three percent of those who had used NRT also used one of the NHSGGC smoking support services. The most commonly used service was pharmacy (39%); approximately one third used either community groups or hospital-based services, and four percent used the pregnancy service.
Comparisons with the 2005 survey
Comparisons with the 2005 survey show that the situation has improved.
NHSGGC Health and Wellbeing Survey, Trends 2005 to 2008
Current Smokers and Exposure to Second-hand Smoke by Deprivation Area
There has been an overall reduction of four percent in smoking prevalence and eight percent in the most deprived areas. Exposure to second-hand smoke has fallen by 16% between 2005 and 2008, 14% in the most deprived areas. It is very likely the legislation on smoking in public places is having a positive effect on smoking behaviours and people’s exposure to second-hand smoke, especially in the most deprived areas.
“Right the smoking ban, it has affected me because I used to go out all the time but now I would rather get a carry-out and sit in the house but I don’t like sitting in the house smoking, either because the kids are in the house and it affects the kids as well so it’s not really that good.”(20)
Smokefree legislation has been successfully implemented and has had a positive impact on health. Comparisons between the 2005 and 2008 surveys provide further evidence that the smoking ban is having a positive effect on adults’ experience of exposure to second-hand smoke. More action is needed, however, to reduce further children’s exposure to second-hand smoke within the home and car. Children’s smaller airways, faster breathing rates and immature immune systems make them more vulnerable than adults to the harmful effects of second-hand smoke.
Research shows that the Smokefree legislation in Scotland has not displaced smoking to the home but has contributed to a reduction in smoking in the home. More people should take measures to reduce exposure to second-hand smoke in the home to safeguard the health of future generations. Evidence suggests that a multi-faceted approach to reducing children’s exposure is likely to be most effective. This is being taken forward through the local delivery of the Scottish Government’s National Smoking Action Plan “Scotland’s Future is Smoke-Free”.(27)
PUBLIC HEALTH MESSAGES
The 2008 Health and Wellbeing survey provides evidence of significant differences in the way people view their health, their involvement in the delivery of their health services, their neighbourhood and their smoking behaviours. These differences are apparent by age, gender and particularly between those who live in the most deprived and other areas of NHSGGC. Comparisons with the findings of the 2005 survey show that for the majority of these measures the situation is improving. Despite these improvements, however, substantial differences remain between NHSGGC’s most deprived and other areas.
MOVING FORWARD: DISSEMINATING THE FINDINGS
It is our intention to work with CH(C)Ps to present the findings from this survey to local people through a series of local health summits. CH(C)Ps will be able to present information at an NHSGGC-wide level and explore differences between their local communities and the Board area to gain local perspectives on why these differences exist. In this way, the views of local people will be used and developed into action to shape local health priorities and plans at a strategic level.