More than 1.5 million people across the Black Country and West Birmingham make up our fantastically diverse communities. Local people are striving to support themselves and each other to live healthy and happy lives. Unfortunately, with the area’s industrial history and current levels of low income this ambition is harder than it should be for people to reach.
Across the area people generally live shorter lives than other areas in England and spend more of their lives living with health conditions.
You can find more detail on each of our places by clicking on the links below:
Across the Black Country and West Birmingham (BCWB), the average number of years that people can expect to live (life expectancy) is 78 years for men and 82 years for women. This is less than the average life expectancy in England of 80 years for men and 83 years for women.
Healthy life expectancy (HLE) – the average number of years that someone can be expected to live in good health in BCWB is 58 years for both men and women. This compares to HLE in England of 63 years for men and 64 years for women.
The gap in life expectancy and HLE between BCWB and England is driven by wider determinants of health, our health behaviours and lifestyles, the places and communities we live in and with, and our health services.
We know that access to healthcare can influence how healthy people are, but there is much more to what makes us healthy. We talk a lot about the wider determinants of health. To explain this idea let’s consider the example of lung disease:
What causes lung disease? Is it the fact that someone smokes? Or is the reasons why they smoke?
We can take many of the big killer conditions such as heart disease, cancer, obesity, and apply the same questions. To really understand the causes of ill health we must look at wider issues – those circumstances in which people are born, live, grow, work and age. It is these factors or wider determinants of health that can see people thrive or struggle to survive.
Wider determinants are the most important driver of health. They include income, employment, education, skills and training, housing, access to services, the environment and crime. These are measured by the index of multiple deprivation (IMD). The latest data is from 2019 and demonstrates that BCWB is the second most deprived STP in England.
Our health behaviours and lifestyles are the second most important driver of health. They include smoking, alcohol consumption, diet and exercise. Smoking reductions have been a key factor in rising life expectancy since the 1950s but adult smoking prevalence in BCWB is still higher than for England (15% vs 14%). Obesity rates have increased and now pose a significant threat to health. Both child (41% vs 34%) and adult (69% vs 62%) obesity rates are higher in BCWB than for England, whilst physical activity levels (58% vs 67%) are significantly lower. Rates of admission for alcohol are high (706 vs 664 per 100,000 people).
There is now increasing recognition of the key role that places and communities play in our health. Our local environment has an important influence on health behaviours. Areas in BCWB have poor air quality and unhealthy fast food is easily available. More households are living in fuel poverty, meaning people are exposed to the risk of cold housing in winter. There is also strong evidence of the impact of social relationships and community networks on our health – particularly our mental health. In BCWB many users of social care say they feel socially isolated.
All these drivers lead to greater morbidity with higher prevalence of many long term conditions, in particular those where lifestyles are a risk factor. The BCWB has higher prevalence of hypertension, diabetes, chronic kidney disease, chronic heart disease, depression and dementia. There is higher mortality from conditions considered preventable and some of the highest infant mortality rates in the country, which leads to our lower life expectancy and healthy life expectancy overall.
This demonstrates the inequalities that exist between BCWB and England as a whole, with HLE lower for both men and women in all five of our places. However we also have many inequalities within BCWB and COVID-19 has exacerbated these.
- There is a marked difference between our most- and least-deprived communities. Although none of our PCNs rank in the most affluent two quintiles, three are in the middle quintile, 10 are in the second most deprived quintile and 18 are in the most deprived quintile. Deprivation is correlated with our lifestyles and behaviours and disease prevalence, with higher rates in the more deprived PCNs.
- 26% of the BCWB population is from BAME communities (compared to 9% for England) and this includes growing numbers of refugees and asylum seekers. About 4% of BCWB households have no one who has English as their main language. Nationally HLE is lower in most BAME communities.
- People with mental health problems and learning disabilities have shorter life expectancies (18 years less for males and 15 for females) which is driven by their physical health.
Drivers of poor life expectancy and healthy life expectancy cumulate over the life course and start in childhood. In BCWB we have some of the highest infant mortality rates in the country, whilst smoking rates in pregnancy remain high and breastfeeding rates are low. By the time a child starts school, they are much less likely to be ready for school than in other areas. Starting school ill-prepared makes it more difficult to catch up later, which is reflected in poorer GCSE results. In turn this leads to poorer employment opportunities, less earning potential, and greater likelihood of teenage pregnancy or unemployment.
Now more than ever, and with greater determination, we need to progress initiatives aimed at supporting healthier lifestyle choices and mental wellbeing, address the socio-economic and environmental issues that contribute to poor health and inequalities, and encourage resilience in our communities.
As a strategic commissioner BCWB CCG plays a key role in the Healthier Futures Partnership , working with partners to address these wider issues that our communities face.