203
Trends in mortality in the (West of) Scotland and other parts of post-industrial Europe David Walsh, Martin Taulbut, Phil Hanlon June 2008
Trends in mortality in the (West of) Scotland and other
parts of post-industrial Europe
David Walsh, Martin Taulbut, Phil HanlonJune 2008
a.k.a…• “The Aftershock of
Deindustrialisation…”• Collaborative project
between Glasgow Centre for Population Health and NHS Health Scotland
• Published April 2008
Topics/contents
1. Background & aims2. Twenty post-industrial regions in Europe3. In-depth mortality analysis of ten post-
industrial regions4. Some initial hypotheses/explanations5. Conclusions6. Next steps
1. Background & aims
Background
• Post-industrial decline (and associated factors) promoted as one of major reasons behind Scotland/WoS’s poor health profile
• Begs question: how have other similarly deindustrialised regions fared?
Project aims• Identify regions which have undergone
similar processes of deindustrialisation• Compare long-term trends in mortality (as
first step…)
2. Twenty post-industrial regions in Europe
Identification of areas
• Selection of areas based on combination of:
– extensive consultation with experts in European public health and European history
– analysis of regional industrial employment loss
European post-industrial regions
European post-industrial regions
1. Ruhr (D)
2. Saxony-Anhalt (D)
3. Saxony (incl. Chemnitzand Leipzig regions) (D)
4. Wallonia (B)
5. Lorraine (incl. Moselle) (F)
6. Nord-Pas-de-Calais (F)
7. Alsace (F)
8. Silesia (incl. Katowice) (P)
9. N. Moravia (Cz)
10. Limburg (NL)
11. Greater Manchester
12. Tees Valley & Durham
13. Northumb’d, Tyne & Wear
14. Merseyside
15. West Midlands
16. Swansea & S. Wales coalfields
17. N. Ireland
18. West of Scotland
Deindustrialisation in Scotland/the West of Scotland
• 44% decrease in levels of industrial employment* between 1971 and 2005 in Scotland
• Represents a loss of 360,000 industrial jobs• Not just a West of Scotland phenomenon…
*‘Industrial employment’: includes mining, manufacturing, utilities and construction
• But more marked in WoS: 62% decrease (from 500,000 to 190,000 industrial jobs)
MerseysideMerseyside
• 63% decrease in industrial employment between 1971 and 2005
• Represents loss of 200,000 industrial jobs
Ruhr areaRuhr area
• 55% decrease in industrial employment between 1970 and 2005
• Represents loss of 700,000 industrial jobs
Nord-Pas-de-Calais
• 43% decrease in industrial employment between 1970 and 2005
• Represents loss of >300,000 industrial jobs
N. Moravia
• 20% decrease in industrial employment between 1993 and 2005
• Represents loss of 80,000 industrial jobs
Katowice (Silesia)
• 55% decrease in industrial employment between 1980 and 2005
• Represents loss of 475,000 industrial jobs
Mortality: how do these regions fare within their own countries?
• We already know that areas within the West of Scotland have the worst health (highest mortality) in the country
• Is this also true of the other post-industrial regions in relation to their parent countries?
Mortality: how do these regions fare within their own countries?
All cause mortality EASRs 2001-03 by English counties (NUTS2), malesSource: Eurostat
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
Mersey
side
Greater
Man
ches
ter
Northu
mberla
nd, T
yne &
Wea
r
Tees V
alley
and D
urham
Wes
t Midl
ands
Lanc
ashir
e
South
Yorksh
ire
West Y
orksh
ireInn
er Lo
ndon
Shrops
hire a
nd S
taffor
dshir
e
Derbys
hire &
Nott
ingha
mshire
East R
iding
& N
. Linc
olnsh
ireChe
shire
Cumbri
aLin
colns
hire
Leice
stersh
ire, R
utlan
d & N
ortha
nts
Outer L
ondo
nKen
t
Herefor
dshir
e, W
orcs &
Wark
sEss
ex
Bedfor
dshir
e, Hert
fords
hire
Cornwall
and I
sles o
f Scil
ly
Glos, W
iltshir
e & N
. Som
erset
Berksh
ire, B
ucks
and O
xfords
hire
Devon
Hamps
hire a
nd Is
le of
Wigh
tEas
t Ang
lia
North Y
orksh
ire
Surrey
, Eas
t and
Wes
t Sus
sex
Dorset
and S
omers
et
English counties
Age
-sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
All cause mortality EASRs 2001-03 by Netherlands Province (NUTS2), malesSource: Eurostat
0
100
200
300
400
500
600
700
800
900
1000
Limburg Overijssel Groningen Gelderland Noord-Brabant
Zuid-Holland
Drenthe Utrecht Friesland Noord-Holland
Flevoland Zeeland
Netherlands province
Age
-sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
All-cause mortality, EASRs 2001-2003 by French région (NUTS2), malesSource: Eurostat
0
200
400
600
800
1000
1200
Nord - P
as-de
-Cala
isPica
rdie
Haute-
Norman
dieBret
agne
Lorra
ine
Champa
gne-A
rdenn
eAuv
ergne
Bourgo
gne
Basse
-Norm
andie
Alsace
Limou
sin
Franch
e-Com
téCors
e
Pays d
e la L
oire
Lang
uedo
c-Rou
ssillo
nAqu
itaine
Centre
Poitou
-Cha
rentes
Proven
ce-A
lpes-C
ôte d'
ARhô
ne-A
lpes
Midi-P
yréné
esÎle
de Fran
ce
French régions
Age
-sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
All-cause mortality, EASRs 2001-2003 by German Länder (NUTS1), malesSource: Eurostat; North Rhine-Westphalia Institute for Health and Work (LIGA)
0
200
400
600
800
1000
1200
Sachs
en-A
nhalt
Meckle
nburg
-Vorp
ommern
Brande
nburg
Saarla
ndRuh
r area
Sachs
en
Bremen
Nordrhe
in-W
estfa
len
Berlin
Nieders
achs
enRhe
inlan
d-Pfal
zSch
leswig-
Holstei
nHam
burg
Bayern
Hesse
n
Baden
-Würt
tembe
rg
German Länder (plus Ruhr)
Age
-sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Socio-economic profiles: how do the regions compare?
• Very (very, very) approximate socio-economic overview…
GDP - Purchasing Power Parities Per Inhabitant (2004)Source: Eurostat
€ 25,264€ 23,946
€ 12,260
0
5000
10000
15000
20000
25000
30000
Silesia
N. Mora
via**
Chemnit
zSac
hsen
-Anh
alt
Swanse
a & th
e S. W
ales C
oalfie
lds**
Sachs
enLe
ipzig
Mersey
side
NPdC
Tees V
alley
& D
urham
Wall
onia
Mosell
eLo
rraine
N. Irela
ndThe
Ruh
r**
Northu
mberla
nd, T
yne a
nd W
ear
Alsace
South
Wes
tern S
cotla
ndG. M
anch
ester
W. M
idlan
dsLim
burg
(NL)
Scotla
nd
Euro
s
** Average of values for smaller NUTS3 regions
Unemployment rate, 2005Source: Eurostat
4.7
20.5
5.36.4
0
5
10
15
20
25
N. Irela
ndG. M
anch
ester
Scotla
ndLim
burg
(NL)
Mersey
side
Tees V
alley
& D
urham
Northu
mberla
nd, T
yne a
nd W
ear
W. M
idlan
ds
Swanse
a & th
e S. W
ales C
oalfie
ldsW
est o
f Sco
tland
Alsace
Lorra
ineMos
elle
Wall
onia
N. Mora
via
NPdCThe
Ruh
rChe
mnitz
Sachs
en
Silesia
Sachs
en-A
nhalt
Leipz
ig
unem
ploy
ed a
s %
of e
cono
mic
ally
act
ive
aged
15+
Long-term unemployment: % unemployed for 12 months or moreSource: Eurostat
13.5
0.8 1.21.6
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
Greater
Man
ches
terSco
tland
Tyne T
ees a
nd D
urham
Wes
t Midl
ands
Northu
mberla
nd/Tyn
e & W
ear
SW S
cotla
ndMers
eysid
e
Limbu
rg
Alsace
Northe
rn Ire
land
Lorra
ine
Nord-P
as-de
-Cala
isW
allon
ia
Saxon
yChe
mnitz
Silesia
Leipz
igSax
ony-A
nhalt
% o
f eco
nom
ical
ly a
ctiv
e po
p ag
ed 1
5+
Not in employment: male (25+) non-employment rate, 2005Various sources - see Appendix 2
34.033.2
48.1
41.6
0
10
20
30
40
50
60
Northe
rn Mora
viaAlsa
ceSco
tland
Nord Pas
de C
alais
Northe
rn Ire
land
Limbu
rg
Greater
Man
ches
terW
est M
idlan
dsMers
eysid
eWall
onia
West o
f Sco
tland
Lorra
ine
Tees V
alley
& Durh
am
Northu
mberla
nd, T
yne &
Wea
rThe
Ruh
r
Swanse
a & S
. Wale
s Coa
lfields
Chemnit
zSile
siaSax
ony
Saxon
y-Anh
altLe
ipzig
% o
f mal
es a
ged
25+
econ
omic
ally
inac
tive
or u
nem
ploy
ed
Economic activity rate, 2005Source: Eurostat; RVR; Annual Population Survey; CSO
62.561.0
51.1
0
10
20
30
40
50
60
70
Wall
onia
Silesia
NPdCLo
rraine
Mersey
side
Swanse
a & th
e S. W
ales C
oalfie
ldsThe
Ruh
r
Northu
mberla
nd, T
yne a
nd W
ear
Tees V
alley
& D
urham
N. Mora
viaChe
mnitz
Sachs
en-A
nhalt
N. Irela
ndSac
hsen
Leipz
ig
Alsace
Wes
t of S
cotla
ndW
. Midl
ands
Limbu
rg (N
L)G. M
anch
ester
Scotla
nd
% o
f pop
age
d 15
+ w
ho a
re e
cono
mic
ally
act
ive
% of adult population (15+) with tertiary level qualifications: 2005Source: Eurostat; Urban Audit data for Ruhr (2001)
23.522.3
8.9
28.4
0
5
10
15
20
25
30
N. Mora
viaThe
Ruh
rSile
siaLo
rraine
NPdC
Tees V
alley
& Durh
am
Northu
mberla
nd, T
yne a
nd W
ear
Mersey
side
W. Midl
ands
N. Irela
ndG. M
anch
ester
Limbu
rg (N
L)Alsa
ceSac
hsen
-Anh
altWall
onia
South
Wester
n Sco
tland
Scotla
ndChe
mnitz
Sachs
enLe
ipzig
% p
opul
atio
n ag
ed 1
5+ w
ith te
rtia
ry q
ualif
icat
ions
Mortality analysis
• ‘Raw’ mortality data requested from national and regional statistical agencies
• Requested by age, sex, year (25 years if possible) for 17 causes including:– Various cancers (all; breast; lung; oesophageal;
colorectal; stomach; prostate)– Circulatory system diseases (incl. IHD and stroke)– COPD and related causes– External causes (incl. suicide and MVTAs)– Chronic liver disease and cirrhosis
• Data received for all regions, although for more limited time periods in some areas
Results
Two sets of results:A. Life expectancy (all twenty regions)B. Detailed age/sex/cause specific mortality
analysis (ten regions)
A. Life expectancy
Life expectancy - RuhrEstimates of male life expectancy at birth: Ruhr area compared to Scotland, West of
Scotland and GGC, 1982-2005 (3-year averages)Source: GRO(S) mortality & population data (Scotland); NRW lögd mortality & population data (Ruhr)
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of male life expectancy at birth: Ruhr area compared to Scotland, West of Scotland and GGC, 1982-2005 (3-year averages)
Source: GRO(S) mortality & population data (Scotland); NRW lögd mortality & population data (Ruhr)
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Ruhr area
Life expectancy - RuhrEstimates of female life expectancy at birth: Ruhr area compared to Scotland, West of
Scotland and GGC, 1982-2005 (3-year averages)Source: GRO(S) mortality & population data (Scotland); NRW lögd mortality & population data (Ruhr)
71.0
72.0
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
81.0
82.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of female life expectancy at birth: Ruhr area compared to Scotland, West of Scotland and GGC, 1982-2005 (3-year averages)
Source: GRO(S) mortality & population data (Scotland); NRW lögd mortality & population data (Ruhr)
71.0
72.0
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
81.0
82.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Ruhr area
Life expectancy - French regionsEstimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace
compared to Scotland, West of Scotland and GG&C, 1983-2003Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)
66.0
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
77.0
1983 1987 1991 1995 1999 2003
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003
Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)
66.0
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
77.0
1983 1987 1991 1995 1999 2003
Life
exp
ecta
ncy
at b
irth
WoS
Estimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003
Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)
66.0
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
77.0
1983 1987 1991 1995 1999 2003
Life
exp
ecta
ncy
at b
irth
WoS Nord Pas de Calais
Estimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003
Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)
66.0
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
77.0
1983 1987 1991 1995 1999 2003
Life
exp
ecta
ncy
at b
irth
WoS Lorraine Nord Pas de Calais
Estimates of male life expectancy at birth: Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003
Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)
66.0
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
77.0
1983 1987 1991 1995 1999 2003
Life
exp
ecta
ncy
at b
irth
WoS Alsace Lorraine Nord Pas de Calais
Life expectancy - French regionsEstimates of female life expectancy at birth: France, Nord Pas de Calais, Lorraine and
Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
1983 1987 1991 1995 1999 2003
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of female life expectancy at birth: France, Nord Pas de Calais, Lorraine and Alsace compared to Scotland, West of Scotland and GG&C, 1983-2003
Source: GRO(S) death reg'ns/population estimates (Scotland); INSERM deaths/population data (France)
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
1983 1987 1991 1995 1999 2003
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Alsace Lorraine Nord Pas de Calais
Saxony – life expectancyEstimates of male life expectancy at birth: Saxony compared to Scotland, West of Scotland
and GGC, 1983-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and the Statistical Office of Free State of Saxony
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of male life expectancy at birth: Saxony compared to Scotland, West of Scotland and GGC, 1983-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and the Statistical Office of Free State of Saxony
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Saxony
Saxony – life expectancyEstimates of female life expectancy at birth: Saxony compared to Scotland, West of
Scotland and GGC, 1982-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and the Statistical Office of Free State of Saxony
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of female life expectancy at birth: Saxony compared to Scotland, West of Scotland and GGC, 1982-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and the Statistical Office of Free State of Saxony
70.0
72.0
74.0
76.0
78.0
80.0
82.0
84.0
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Saxony
Saxony-AnhaltEstimates of male and female life expectancy at birth:
Saxony-Anhalt compared to West of Scotland, 1995-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and Landesamt für Verbraucherschutz Sachsen-
Anhalt
70.0
72.0
74.0
76.0
78.0
80.0
82.0
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS females WoS males
Estimates of male and female life expectancy at birth: Saxony-Anhalt compared to West of Scotland, 1995-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and Landesamt für Verbraucherschutz Sachsen-Anhalt
70.0
72.0
74.0
76.0
78.0
80.0
82.0
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS females WoS males Saxony-Anhalt males
Estimates of male and female life expectancy at birth: Saxony-Anhalt compared to West of Scotland, 1995-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and Landesamt für Verbraucherschutz Sachsen-Anhalt
70.0
72.0
74.0
76.0
78.0
80.0
82.0
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS females Saxony-Anhalt females WoS males Saxony-Anhalt males
Life expectancy – N. MoraviaEstimates of male life expectancy at birth, Northern Moravia compared to Scotland, West of Scotland
and Greater Glasgow & Clyde, 1982-2005 (3-year averages)Source: Calculated from GRO(S) and Institute of Health Information & Statistics (CZ) data
65.0
66.0
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of male life expectancy at birth, Northern Moravia compared to Scotland, West of Scotland and Greater Glasgow & Clyde, 1982-2005 (3-year averages)
Source: Calculated from GRO(S) and Institute of Health Information & Statistics (CZ) data
65.0
66.0
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Northern Moravia
Life expectancy – N. MoraviaEstimates of female life expectancy at birth, Northern Moravia compared to Scotland, West of
Scotland and Greater Glasgow & Clyde, 1982-2005 (3-year averages)Source: Calculated from GRO(S) and Institute of Health Information & Statistics (CZ) data
72.0
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of female life expectancy at birth, Northern Moravia compared to Scotland, West of Scotland and Greater Glasgow & Clyde, 1982-2005 (3-year averages)
Source: Calculated from GRO(S) and Institute of Health Information & Statistics (CZ) data
72.0
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Northern Moravia
Katowice (Silesia)Estimates of male life expectancy at birth: Katowice compared to Scotland, West of Scotland
and GGC, 1975-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and Cancer Center & Institute of Oncology, Warsaw
60.0
62.0
64.0
66.0
68.0
70.0
72.0
74.0
76.0
1975
-1977
1976
-1978
1977
-1979
1978
-1980
1979
-1981
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of male life expectancy at birth: Katowice compared to Scotland, West of Scotland and GGC, 1975-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and Cancer Center & Institute of Oncology, Warsaw
60.0
62.0
64.0
66.0
68.0
70.0
72.0
74.0
76.0
1975
-1977
1976
-1978
1977
-1979
1978
-1980
1979
-1981
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Katowice
Katowice (Silesia)Estimates of female life expectancy at birth: Katowice compared to Scotland, West of
Scotland and GGC, 1982-2005 (3-year averages)Source: Calculated from data from GRO(S) (Scotland) and Cancer Center & Institute of Oncology, Warsaw
70.0
71.0
72.0
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
1975
-1977
1976
-1978
1977
-1979
1978
-1980
1979
-1981
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of female life expectancy at birth: Katowice compared to Scotland, West of Scotland and GGC, 1982-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and Cancer Center & Institute of Oncology, Warsaw
70.0
71.0
72.0
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
1975
-1977
1976
-1978
1977
-1979
1978
-1980
1979
-1981
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Katowice
Life expectancy - LimburgEstimates of male life expectancy at birth, Limburg compared to Scotland, West of Scotland and
Greater Glasgow & Clyde, 1982-2005 (3-year averages)Source: calculated from mortality & population data from GRO(S) (Scotland) and CBS Statsline (NL)
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC
Estimates of male life expectancy at birth, Limburg compared to Scotland, West of Scotland and Greater Glasgow & Clyde, 1982-2005 (3-year averages)
Source: calculated from mortality & population data from GRO(S) (Scotland) and CBS Statsline (NL)
64.0
66.0
68.0
70.0
72.0
74.0
76.0
78.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Limburg
Life expectancy - LimburgEstimates of female life expectancy at birth, Limberg compared to Scotland, West of Scotland and
Greater Glasgow & Clyde, 1982-2005 (3-year averages)Source: calculated from mortality & population data from GRO(S) (Scotland) and CBS Statsline (NL)
72.0
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
81.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
Scotland WoS GGC Limburg
English & Welsh regions (male)Estimates of male life expectancy at birth: selected English and Welsh regions compared to
West of Scotland, 1988-2005 (3-year averages) Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS Scotland GGC
Estimates of male life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS
Estimates of male life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS
Estimates of male life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)
67.0
68.0
69.0
70.0
71.0
72.0
73.0
74.0
75.0
76.0
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS English & Welsh regions average
English & Welsh regions (female)Estimates of female life expectancy at birth: selected English and Welsh regions compared
to West of Scotland, 1988-2005 (3-year averages) Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
81.0
82.0
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS Scotland GGC
Estimates of female life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
81.0
82.0
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS
Estimates of female life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
81.0
82.0
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS
Estimates of female life expectancy at birth: selected English and Welsh regions compared to West of Scotland, 1988-2005 (3-year averages)
Source: Calculated from data from GRO(S) (Scotland) and ONS (England & Wales)
73.0
74.0
75.0
76.0
77.0
78.0
79.0
80.0
81.0
82.0
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS English & Welsh regions average
Northern IrelandEstimates of male and female life expectancy at birth,
Northern Ireland compared with West of Scotland , 1982-2005 (3-year averages)Source: calculated from mortality & population data from GRO(S) and NISRA
68.0
70.0
72.0
74.0
76.0
78.0
80.0
82.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS males WoS females
Estimates of male and female life expectancy at birth, Northern Ireland compared with West of Scotland , 1982-2005 (3-year averages)
Source: calculated from mortality & population data from GRO(S) and NISRA
68.0
70.0
72.0
74.0
76.0
78.0
80.0
82.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Life
exp
ecta
ncy
at b
irth
WoS males Northern Ireland males WoS females Northern Ireland females
3. In-depth mortality analysis of ten post-industrial regions
B. Age/sex/cause-specific mortality analysis
• Comparator areas reduced from 20 to 10• One region per country basis (except
Germany)• Each region has worst/among worst
mortality rates in their respective countries
10 post-industrial regions • Ruhr (West Germany)• Saxony (East Germany) • Katowice • Northern Moravia • Nord Pas de Calais • Wallonia• Limburg• Northern Ireland• Swansea & the South Wales Coalfields• Merseyside
Analysis
• Age standardised rates, 3-year rolling averages– here compared to West of Scotland only
• Five age groups:– Infants (<1)– Children (1-14)– Younger working age (15-44)– Older working age (45-64)– Elderly (65+)
• Presented here in summarised format…
Infant mortalityInfant mortality: infant deaths per 1,000 live births (three year rolling averages)
West of Scotland in context of maximum, minimum & mean rates for selected European regions
0.0
5.0
10.0
15.0
20.0
25.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Rat
e pe
r 1,0
00 li
ve b
irths
Maximum
Mean
Minimum
Number of regions in analysis
3 3 4 5 5 5 5 6 7 7 9 9 9 9 10 11 11 11 10 10 10 10 10 10
Infant mortality: infant deaths per 1,000 live births (three year rolling averages)West of Scotland in context of maximum, minimum & mean rates for selected European
regions
0.0
5.0
10.0
15.0
20.0
25.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Rat
e pe
r 1,0
00 li
ve b
irths
Maximum
Mean
Minimum
Number of regions in analysis
3 3 4 5 5 5 5 6 7 7 9 9 9 9 10 11 11 11 10 10 10 10 10 10
Children (1-14)Children (1-14): all-cause EASRs (3 year rolling averages), 1980-2005, males
West of Scotland in context of maximum, minimum & mean rates for selected European regions
0.0
10.0
20.0
30.0
40.0
50.0
60.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
4 5 5 5 5 6 8 8 9 10 10 1033 10 10 9 9 9 9 9 9 9 8
Children (1-14)Children (1-14): all-cause EASRs (3 year rolling averages), 1980-2005, femalesWest of Scotland in context of maximum, minimum & mean rates for selected
European regions
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
4 5 5 5 5 6 8 8 9 10 10 1033 10 10 9 9 9 9 9 9 9 8
Working age 15-44
All cause, maleWorking age 15-44: all-cause EASRs (3 year rolling averages), 1980-2005, males
West of Scotland in context of maximum, minimum & mean rates for selected European regions
0.0
50.0
100.0
150.0
200.0
250.0
300.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
stan
dard
ised
rate
per
100
,000
pop
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Working age 15-44: all-cause EASRs (3 year rolling averages), 1980-2005, malesWest of Scotland in context of maximum, minimum & mean rates for selected European
regions
0.0
50.0
100.0
150.0
200.0
250.0
300.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
stan
dard
ised
rate
per
100
,000
pop
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
External causes, maleExternal causes mortality: male working age 15-44 EASRs (3 year rolling averages),
1980-2005; West of Scotland in context of maximum, minimum & mean rates for selected European regions
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Suicide & undetermined intent, maleSuicide (incl. deaths from undetermined intent): male working age 15-44 EASRs (3
year rolling averages), 1983-2005; West of Scotland in context of maximum, minimum & mean rates for selected European regions
0.0
10.0
20.0
30.0
40.0
50.0
60.0
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
6 6 6 6 7 9 9 9 10 10 10 10 10 9 9 9 9 9 9 9 8
Suicide & undetermined intent, femaleSuicide (incl. deaths from undetermined intent): female working age 15-44 EASRs (3
year rolling averages), 1983-2005; West of Scotland in context of maximum, minimum & mean rates for selected European regions
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
6 6 6 6 7 9 9 9 10 10 10 10 10 9 9 9 9 9 9 9 8
Chronic liver disease & cirrhosis, maleChronic liver disease & cirrhosis mortality: male working age 15-44 EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &
mean rates for selected European regions
0.0
5.0
10.0
15.0
20.0
25.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Chronic liver disease & cirrhosis, femaleChronic liver disease & cirrhosis mortality: female working age 15-44 EASRs (3 year rolling averages), 1982-2005; West of Scotland in context of maximum, minimum &
mean rates for selected European regions
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 10 10 10 9 9 9 9 9 9 9 8
Working age 45-64
All cause - maleWorking age 45-64: all-cause EASRs (3 year rolling averages), 1980-2005, malesWest of Scotland in context of maximum, minimum & mean rates for selected
European regions
0.0
500.0
1000.0
1500.0
2000.0
2500.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
All cause - femaleWorking age 45-64: all-cause EASRs (3 year rolling averages), 1980-2005, females
West of Scotland in context of maximum, minimum & mean rates for selected European regions
0.0
100.0
200.0
300.0
400.0
500.0
600.0
700.0
800.0
900.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Female 45-64 mortality - cancersAll malgnant neoplasms mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &
mean rates for selected European regions
0.0
50.0
100.0
150.0
200.0
250.0
300.0
350.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Lung cancer mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum & mean
rates for selected European regions
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Breast cancer mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2004; West of Scotland in context of maximum, minimum & mean
rates for selected European regions
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1980-1982
1981-1983
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Oesophageal cancer mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &
mean rates for selected European regions
0.0
2.0
4.0
6.0
8.0
10.0
12.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Female 45-64 mortality - otherIHD mortality: female working age 45-64 all-cause EASRs (3 year rolling averages),
1980-2005; West of Scotland in context of maximum, minimum & mean rates for selected European regions
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
200.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Cerebrovascular disease mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum &
mean rates for selected European regions
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
COPD mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum & mean rates for
selected European regions
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Chronic liver disease & cirrhosis mortality: female working age 45-64 all-cause EASRs (3 year rolling averages), 1982-2005; West of Scotland in context of maximum,
minimum & mean rates for selected European regions
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Male 45-64 – causes notably above/below average
IHD mortality: male working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum & mean rates for selected
European regions
0.0
100.0
200.0
300.0
400.0
500.0
600.0
700.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
COPD mortality: male working age 45-64 all-cause EASRs (3 year rolling averages), 1980-2005; West of Scotland in context of maximum, minimum & mean rates for
selected European regions
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
1980
-1982
1981
-1983
1982
-1984
1983
-1985
1984
-1986
1985
-1987
1986
-1988
1987
-1989
1988
-1990
1989
-1991
1990
-1992
1991
-1993
1992
-1994
1993
-1995
1994
-1996
1995
-1997
1996
-1998
1997
-1999
1998
-2000
1999
-2001
2000
-2002
2001
-2003
2002
-2004
2003
-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Suicide mortality: male working age 45-64 all-cause EASRs (3 year rolling averages), 1983-2005; West of Scotland in context of maximum, minimum & mean rates for
selected European regions
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
Chronic liver disease & cirrhosis mortality: male working age 45-64 all-cause EASRs (3 year rolling averages), 1982-2005; West of Scotland in context of maximum,
minimum & mean rates for selected European regions
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
180.0
1982-1984
1983-1985
1984-1986
1985-1987
1986-1988
1987-1989
1988-1990
1989-1991
1990-1992
1991-1993
1992-1994
1993-1995
1994-1996
1995-1997
1996-1998
1997-1999
1998-2000
1999-2001
2000-2002
2001-2003
2002-2004
2003-2005
Age
sta
ndar
dise
d ra
te p
er 1
00,0
00 p
op
Number of regions included in analysis
5 6 6 6 6 7 9 9 9 10 10 1044 10 10 9 9 9 9 9 9 9 8
• Worth remembering:– Each region has the highest, or among the
highest, level of mortality in their parent country
– Thus, being “average” isn’t good– Had we included the other 10 regions, WoS’s
relative position would be even worse
Mortality analysis
4. Some initial hypotheses/explanations
• NB This is first and foremost a report on mortality trends
• Detailed exploration of health determinant factors will be undertaken as part of the project’s next stage
• Thus, Part Four of the report merely a tentative exploration of some relevant issues
4. Some initial hypotheses/explanations
Seven hypotheses briefly examined:1. Trends affected by data quality issues2. Trends influenced by an ‘age cohort’ effect3. Trends influenced by migration4. WoS has greater income inequalities than other
regions5. Health behaviours are worse in WoS6. WoS is more deprived7. WoS has suffered more severe form of
deindustrialisation
4. Some initial hypotheses/explanations
Seven hypotheses briefly examined:1. Trends affected by data quality issues2. Trends influenced by an ‘age cohort’ effect3. Trends influenced by migration4. WoS has greater income inequalities than other
regions5. Health behaviours are worse in WoS6. WoS is more deprived7. WoS has suffered more severe form of
deindustrialisation
Migration
• Trends generally flat in all regions, but some exceptions
• WoS: 11% decrease over 20 years• Saxony: 17% decrease in females - quite
perplexing given:– evidence that female migrants better educated– ‘healthy migrant’ evidence– but still very fast improvement in overall health in
Saxony• But more detailed research required to quantify
any possible effect
Income inequalities
• Two measures presented in the report, but neither is ideal
• Gini coefficient data not available for all regions of interest (incl. WoS), so country or larger region data used
Income inequalitiesEstimated Income Inequality (using the Gini Coefficient),
Selected European Regions: Mid-1990sSources: Ezcurra, Pascual and Rapun (2007); Forster, Jesuit and Smeeding (2002)
0.33
0.24
0.34
0.00
0.05
0.10
0.15
0.20
0.25
0.30
0.35
0.40
Saxony SouthPoland
Netherlands NorthernMoravia
Nord-Pas deCalais
Norrth RhineWestphalia
Wallonia Wales Scotland North WestEngland
NorthernIreland
GIN
I Coe
ffici
ent
Health behaviours
• As with other possible explanations, our understanding of role of health inequalities hampered by lack of high quality comparable data.
• However:– Other relevant work has highlighted that Greater
Glasgow has higher levels of obesity compared to some other relevant regions (e.g. parts of Wallonia and Saxony)
– In the report we show some limited data for smoking and alcohol consumption….
Health behaviours - smoking
Estimates of male adult smoking prevalence, selected geographiesVarious sources: See Appendix 2
27
3635
32
0
5
10
15
20
25
30
35
40
N. Ireland(2002)
Merseyside(2004/05)
Swansea &SW
Coalfields(2005)
NorthRhein
Westphalia(2003)
SouthernPoland(1997)
Scotland(2003)
Saxony(2005)
Wallonia(2003)
CzechRepublic(2000/03)
Limburg(2003)
GreaterGlasgow(2003)
Nord Pasde Calais(2002/03)
% o
f adu
lts w
ho a
re c
urre
nt s
mok
ers
Estimates of female adult smoking prevalence, selected geographiesVarious sources: See Appendix 2
19
31
35
0
5
10
15
20
25
30
35
40
Saxony(2002)
North RheinWestphalia(2004/05)
SouthernPoland(1997)
Wallonia(2005)
Nord Pasde Calais
(2004)
CzechRepublic(2003)
N. Ireland(2000/03)
Merseyside(2003)
Swansea &SW
Coalfields(2003)
Limburg(2002/03)
Scotland(2003)
GreaterGlasgow(2003)
% o
f adu
lts w
ho a
re c
urre
nt s
mok
ers
Health behaviours – alcohol consumption% adult population drinking alcohol daily, selected European countries: 2003/07
Sources: Eurobarometer 2007; Scottish Health Survey 2003
18
1
12
0
2
4
6
8
10
12
14
16
18
20
Poland Czech Republic UK Germany Scotland Belgium France Netherlands
% a
dult
popu
latio
n dr
inki
ng a
lcoh
ol d
aily
Deprivation
• Clearly an important issue• Again, hampered by lack of comparable
data across all regions• But, on balance, seems unlikely that
deprivation per se explains the higher levels of mortality in Scotland/WoS relative to the other post-industrial areas…
Deprivation
• Regional measures of unemployment and male worklessness show Scotland’s/WoS’sposition is advantageous relative to many regions
• Specific mortality and deprivation (Carstairs) analysis undertaken for WoS and Merseyside…
All age SMRs for Clydeside conurbation relative to Merseyside
100101102103104105106107108109
1981 1991 2001
Adjusting for age & sex onlyAdjusting for age, sex and Carstairs deprivation
Severity of deindustrialisation
• Important hypothesis• Time series data on industrial employment• ‘Base year’/2005 comparisons
– circa. 1970 for West Europe, 1980 for Katowice; circa.1992 for E Germany
• Number of measures of severity shown in report…
% of industrial employment lost, base year to 2005
16
62 63
0
10
20
30
40
50
60
70
Limburg(1968)
NorthernMoravia(1993)
NorthernIreland(1971)
Wallonia(1970)
Nord pas deCalais(1970)
Saxony(1991)
Swansea &SWC(1971)
The Ruhr(1970)
Katowice(1980)
West ofScotland(1971)
Merseyside(1971)
% in
dust
rial e
mpl
oym
ent l
ost
Severity of deindustrialisation
• Deindustrialisation ‘dose’ more serious in West of Scotland compared to the majority of the regions
• More research required (esp. timing/speed)
5. Conclusions
• Health of virtually all comparable European post-industrial regions improving faster than Scotland/West of Scotland
• Trends driven especially by younger age groups (15-44) (especially male) and middle-aged (45-64) females
• This despite (apparently) worse socio-economic profiles
• Detailed information on health determinants now needed to understand what is driving the trends
• This is one of the next steps…
Next steps
• Dependent (to varying degrees) on funding/resources etc etc…
• Collaborative research focussing on the four regions discussed today
• Aimed at:– Accessing/analysing/understanding broad health
determinant data for these regions compared to WoS– Helping to understand the trends presented in the report
Further details
David Walsh: • Email: [email protected]• Tel: 0141 221 9439
Martin Taulbut:• Email: [email protected]• Tel: 0141 354 2946
• Report available from: www.gcph.co.uk
Germany: the experience of the Ruhr
Dr. Wolfgang Hellmeier
Liga, NRW Institute of Health and Work
ConferenceExploring health in Scotland and other parts of
postindustrial EuropeWednesday June 18th 2008
http://www.liga.nrw.de/gesundheit.html
Experience Ruhr Glasgow, 18.06.082
The Ruhr area; the institute LIGA
Employment in the Ruhr area
Population structure
Health and health determinants
Policies in the Ruhr area
Differences between Glasgow and Ruhr?
Contents
Experience Ruhr Glasgow, 18.06.083
The Ruhr area within Germany
The Netherlands
Belgium
Experience Ruhr Glasgow, 18.06.084
The Ruhr area within North Rhine-Westphalia
NRW
54 districts
23 cities
31 counties
18 mill.
inhabitants
Ruhr
15 districts
11 cities
4 counties 5,3 mill.
inhabitants
Experience Ruhr Glasgow, 18.06.085
The Ruhr area, internal structure
Ruhr-City NRW
Ruhr kernel
7 cities
Ruhr outer
regions
4 cities
4counties
2,7 mill. 2,6 mill.
inhabitants
No common political authority, but
an association of cities (RVR) since 1920
Experience Ruhr Glasgow, 18.06.086
State institute of NRW
Health monitoring; health reporting; health information
If possible data on district level
prevention
Consultant of Ministry of Health NRW
LIGA, the institute
Experience Ruhr Glasgow, 18.06.087
Employed, subject to social security insuranceWithout self employed and civil servants
Absolute number of employees in the Ruhr area in 2004: 1.5 mill.
1980: 1,8 mill.
RVR Regionalverband Ruhrgebiet
Employment in the Ruhr area
Experience Ruhr Glasgow, 18.06.088
Employees in the Ruhr area as percentage of NRW
Employment in the Ruhr area
RVR Regionalverband Ruhrgebiet
Experience Ruhr Glasgow, 18.06.089
Arbeitslosenquote in Ruhr-City verglichen mit NRW, Trend 1994 - 2004 im Regionalvergleich
0 5 10 15 20
W esel
Ennepe-Ruhr-Kreis
Mülheim a.d. Ruhr
Hagen
Unna
Recklinghausen
Bottrop
Hamm
Ruhr-City
Essen
Oberhausen
Duisburg
Herne
Dortmund
Gelsenkirchen
Kreise und Städte
Quote in %
2004 1994
NRW 11%
Indikator 2.21Ruhr-City
BK
BRZ
BK = Ballungskern, BKZ = Ballungsrandzone
kernel
Outer regions
Ruhr area
Unemployed persons in the Ruhr region1994 and 2004
Employment in the Ruhr area
Experience Ruhr Glasgow, 18.06.0810
Welfare recipients in the Ruhr area(per 1000 inhabitants)
Sozialhilfeempfänger, Ruhr-City nach Ballungskern und Ballungsrandzone im Vergleich zu NRW, 2003
0
10
20
30
40
50
60
Ballungskern Ballungsrandzone Ruhr-City
je 1 000 Einwohner
NRW 37,8
Available income in districts
Ruhr area Kernel
Ruhr area
Population structure
Kernel outer regions Ruhr
Experience Ruhr Glasgow, 18.06.0811
Ruhr area Kernel
Ruhr region
Population structure
Lfd. Ballungskern,Nr. Ballungsrandzone
weiblich je 1000 Frauen männlich je 1000
Männer insgesamt je 1000 Einwohner
1 Ballungskern 179 869 127,92 200 060 151,05 379 929 139,14
2 Ballungsrandzone 117 945 89,15 124 728 99,89 242 673 94,37
3 Ruhr-City 297 814 109,13 324 788 126,23 622 602 117,42
4 NRW ohne Ruhr-City 641 111 97,98 680 843 109,28 1321 954 103,49
5 Nordrhein-Westfalen 938 925 101,26 1005 631 114,23 1944 556 107,58
Datenquelle:Landesinstitut für den öffentlichen Gesundheitsdienst NRW (lögd):Indikator (L) 2.6, 2004
Ausländische Bevölk. am 31.12.d. J.
Indikator 2.6Ruhr-City
Ausländische Bevölkerung nach Geschlecht, Ruhr-City nachBallungskern und Ballungsrandzone, 2004
Old age dependency ratio Persons with foreign nationality in the Ruhr area
Ruhr area
Experience Ruhr Glasgow, 18.06.0812
Population structure
Poverty regions of NRW belong to the Ruhr area
Experience Ruhr Glasgow, 18.06.0813
Life expectancy in different age groups
Differenz der Lebenserwartung in Ruhr-Citynach Altersgruppen zum NRW-Durchschnitt, 2002 - 2004
-1,4
-1,2
-1,0
-0,8
-0,6
-0,4
-0,2
0,0
0,2
0,4
0,6
0 15 30 45 60 75 90Alter in Jahren
Differenz in Jahren
BallungskernBallungsrandzoneRuhr-CityNRW (ohne Ruhr-City)NRW
Lebenserwartung bei Geburt: NRW 78,51 Jahre; Ballungskern 77, 35 Jahre; Ballungsrandzone 78,23 Jahre; Ruhr-City 77,77 Jahre
Health
Kernel
Outer regions
Ruhr area
NRW without Ruhr
NRW
Experience Ruhr Glasgow, 18.06.0814
Life expectancy in districts of NRW (Ruhr highlighted)
Life expectancy at birth (female)Life expectancy at birth (male)
Ruhr area Kernel
Ruhr area
Ruhr area Kernel
Ruhr area
Health
Experience Ruhr Glasgow, 18.06.0815
Infant mortality in the Ruhr region
Säuglingssterblichkeit in Ruhr-City und NRW ohne Ruhr-City,Abweichungen vom NRW-Durchschnitt in %, Mittelwert 2002 - 2004
-5
0
5
10
15
20
Ballungskern Ballungsrandzone Ruhr-City NRW ohne Ruhr-City
%
Säuglingssterblichkeit NRW 4,98 ‰
Kernel outer regions Ruhr
Health
Ruhr area Kernel
Ruhr area
Experience Ruhr Glasgow, 18.06.0816
Avoidable deaths(Partly attributable to life style)
Liver diseases
Ischemic heart diseases
Health
Experience Ruhr Glasgow, 18.06.0817
Avoidable deaths (in districts of NRW): lung cancer (age group 15 – 64)
Health
Ruhr area Kernel
Ruhr area
Experience Ruhr Glasgow, 18.06.0818
Health behaviour in districts of NRW
Regular smokers (age > 15, %) Overweight (age > 15, %)
Ruhr area
Ruhr area Kernel
Health behaviour
Ruhr area Kernel
Ruhr area
Experience Ruhr Glasgow, 18.06.0819
Some universities were founded (1970s)
Environmental improvements (against air pollution and for
leisure activities)
Special economic branches were funded
Cultural events were started in the Ruhr area
Now “Health in the Ruhr” is a main goal (in economic terms)
There were political actions to support the Ruhr area (some taken in whole NRW, but with emphasis on the Ruhr area):
Policies for the Ruhr area
Experience Ruhr Glasgow, 18.06.0820
Trends in medical staff, the Ruhr area and other parts of NRW:The Ruhr area is better off than the rest of NRW
Policies for the Ruhr area
Physicians
Nurses
nursing staff
Nursing staffchildren
Nursing staffwith lowqualification
RVR Regionalverband Ruhrgebiet
Experience Ruhr Glasgow, 18.06.0821
General situation is quite similar to Glasgow
Potential reasons for better performance:
NRW better off than Scotland?
Ruhr area is larger more potential for new starts?
More political actions taken in the Ruhr area?
Ruhr area is sited in the middle of Europe an
advantage for getting new firms?
Differences / similarities between the Ruhr and Glasgow(Hypotheses and questions, which may explain something):
Experience Ruhr Glasgow, 18.06.0822
Thank you
Open for discussion
Experience Ruhr Glasgow, 18.06.0823
Employment trends in industry and service sector
Industry
Service sector
Employment in the Ruhr area
RVR Regionalverband Ruhrgebiet
Experience Ruhr Glasgow, 18.06.0824
Total mortality
Ruhr region Kernel
Ruhr region
Comparison of districts of NRW (Ruhr highlighted)
Experience Ruhr Glasgow, 18.06.0825
Avoidable deaths: ischemic heart diseases (age group 35 – 64)
Ruhr region Kernel
Ruhr region
Comparison of districts of NRW (Ruhr highlighted)
Experience Ruhr Glasgow, 18.06.0826
Avoidable deaths: liver diseases diseases (age group 15 – 74)
Ruhr region Kernel
Ruhr region
Comparison of districts of NRW (Ruhr highlighted)
Nord – Pas-de-CalaisDemography, Industry and
Mortality and some comparisons with South East
England
Olivier Lacoste, Gilles Poirier, ORS Nord – Pas-de-CalaisAnn Palmer, CHSS University of Kent
Nord – Pas-de-Calais - demography
Administrative Area Number of People
Région (Nord Pas de Calais) 3,995,871
Département (2) 2,555,020 Nord and 1,441,568 Pas-de-Calais
Arrondissements (13) 99,249 (Montreuil) to 1,181,724 (Lille)
Pseudo-Cantons 4919 (Le Quesnoy) to 93.531 Tourcoing 96,959 Roubaix and 184,647 Lille
Demographics(1) Overal population (2) Number of city (3) % of régional population (4) Density
20 % of the population of the region live in the coastal areaThe suburbs (CA) of Calais and the urban (CU) parts of Dunkerque have greater density than the rest of the region
SITUATION DÉMOGRAPHIQUE EN 1999Population
totale(1)
Nombre de communes
(2)
Part de la population
régionale (%)(3)
Nombre d’habitants au
Km2(4)
C. U. de Dunkerque Grand Littoral 208 634 18 5,22 819
Pays des Moulins de Flandre 62 221 55 1,56 103
C. A. de Saint Omer 65 246 19 1,63 355
Pays de Saint-Omer 115 735 82 2,9 158
C. A. du Calaisis 98 498 5 2,46 1013
Pays du Calaisis 156 213 63 3,91 232
C. A. du Boulonnais 122 760 22 3,07 599
Pays du Boulonnais 163 031 74 4,08 257
Pays maritime et rural du Montreuillois 70 555 70 1,77 110
Bassin de vie du Littoral 797 161 420 19,95 202
Nord - Pas-de-Calais 3 995 871 1 547 100 322
Source Insee : Rgp 1999 , Traitement ORS Nord - Pas-de-CalaisCU=Communauté urbaine, CA communauté d'agglomération
(CA = suburb CU = town)
Nord – Pas-de-Calais - demography• Nord Pas de Calais is one of the most urbanized regions in France. • Lille Metropole with its 1.1 millions citizens (one fourth of the population of
the region) ranks fourth biggest city in France. • Other main towns and agglomerations over 100,000 habitants are:
Dunkerque, Boulogne sur Mer, Calais, Bethune, Valenciennes, Douai-Lens. • Nord Pas de Calais is the densest region in France • The unemployment rate at regional level is higher than for France (12.2%
compared to 9.3%). • Nord Pas de Calais is the third region in France as for the density of
employment in industry. The four main sources of revenue are agriculture, industry, construction and services.
• The GIP per habitant is 82 versus 104 for France that places the Nord Pas de Calais among the poorest French regions.
The People of Northern France• The region is characterized by the youngest population in the whole of
France (28 % under 20 years old in 1999).
• Nord Pas de Calais is inhabited mostly by French (including 2.99% immigrants having the French nationality). Foreigners constitute 4.4% of total population in Nord and 1.6% in Pas de Calais. They come in majority from Spain, Portugal and Italy, as well as from Algeria, Morocco and Turkey.
• The reproduction rate in Nord Pas de Calais is high and the migration rate relatively low (87% of the population was born locally)
• The region is characterized by the worst heath indicators all over the France. – Life expectancy at birth is among the lowest both for men and women, the general
mortality rate the highest in France, for both genders.
– According to the Regional Health Observatory (ORS) SMR for men in the region is 126%.
• It is thought this results from high incidence of diseases related to alcohol, bad nutritional habits of population and high proportion of workers who used to be exposed to risk factors in industrial areas and in mines.
The population is living mainly in an urban environment(1) Urban population (2) Peri-urban population (3) rural population
The majority of the population live in an urban environment notably in the suburbs (CA) of Calais (100%)
0
20
40
60
80
100
120
C. U
. de
Dun
kerq
ueG
rand
Litt
oral
Pays
des
Mou
lins
deFl
andr
e
C. A
. de
Sain
tO
mer
Pays
de
Sain
t-O
mer
C. A
. du
Cal
aisi
s
Pays
du
Cal
aisi
s
C. A
. du
Bou
lonn
ais
Pays
du
Bou
lonn
ais
Pays
mar
itim
eet
rura
l du
Mon
treu
illoi
s
Bas
sin
de v
ie L
ittor
al
Nor
d - P
as-d
e-C
alai
s
Source Insee : Rgp 1999, traitement ORS Nord - Pas-de-Calais CA=Communauté d'agglomération, CU=Communauté urbaine
Population vivantdans un pôleurbain (%) (1)
Population vivantdans unecommunepériurbaine oumultipolarisée(%) (2)
Population vivantdans unecommune del’espace àdominante rurale(%) (3)
(CA = suburb CU = town)
A young populationUnder 20 years / 65 years or more
Most areas show indication of re-juvenation greater than the region as a wholeThis is more so in the suburbs (CA) and the countryside around Calais and in the urban parts of Dunkerque
2,4
22,2
2,12,2 2,3
21,9
1,5
21,9
0
0,5
1
1,5
2
2,5
3
C. U
. de
Dun
kerq
ueG
rand
Litt
oral
Pays
des
Mou
lins
deFl
andr
e
C. A
. de
Sain
tO
mer
Pays
de
Sain
t-O
mer
C. A
. du
Cal
aisi
s
Pays
du
Cal
aisi
s
C. A
. du
Bou
lonn
ais
Pays
du
Bou
lonn
ais
Pays
mar
itim
e et
rura
l du
Mon
treu
illoi
s
Bas
sin
de v
ie L
ittor
al
Nor
d - P
as-
de-C
alai
s
Source Insee : Rgp 1999, traitement ORS Nord - Pas-de-CalaisCA=Communauté d'agglomération, CU=Communauté urbaine
Indice de renouvellement (moins de 20 ans/65 ans ou plus) (1)
(CA = suburb CU = town)
Unemployment in 1999(1) men unemployment rate, (2) women unemployment rate (3) Social help rate
Apart from St-Omer, the suburbs (CA) have an unemployment rate above that of the region and Coastal area. Unemployment is worse for women.The suburbs (CA) of Calais attain, for both sexes, an unemployment rate higher than the % required for strongest social minimum
0
5
10
15
20
25
30
C. U
. de
Dun
kerq
ueG
rand
Litto
ral
Pays
des
Mou
lins
deFl
andr
e
C. A
. de
Sain
tO
mer
Pays
de
Sain
t-Om
er
C. A
. du
Cal
aisi
s
Pays
du
Cal
aisi
s
C. A
. du
Bou
lonn
ais
Pays
du
Bou
lonn
ais
Pays
mar
itim
e et
rura
l du
Mon
treu
illoi
s
Bas
sin
de v
ie L
ittor
al
Nor
d - P
as-
de-C
alai
s
Source Insee : Rgp 1999, ** Source : ARCAF 2005 (Association Régionale des Caisses d'Allocations Familiales), traitement ORS Nord - Pas-de-Calais
CA=Communauté d'agglomération, CU=Communauté urbaine
Taux de chômagemasculin (%) (1)
Taux de chômageféminin (%) (2)
Populationcouverte par lesminima soc. en2005(AAH+API+RMI)**(%) (3)
(CA = suburb CU = town)
Categories of Space in 1999
Calculating the Townsend Score
Step 1: The following variables are extracted from the 1991 Census; V1 = % economically active residents aged 16-59/64 who are unemployed
V2 = % private households which do not possess a car V3 = % private households which are not owner-occupied
V4 = % private households with more than one person per room Step 2: The distributions of the extracted variables are 'normalised' using the following transformations;
N1 = LN(V1+1) N2 = LN(V2+1) N3 = SQRT(V3) N4 = LN(V4+1)
Step 3: The variables are standardised by subtracting the mean and dividing by the standard deviation;S1 = (N1 - mean of N1)/ S.D. of N1 S2 = (N2 - mean of N2)/ S.D. of N2 S3 = (N3 - mean of N3)/ S.D. of N3 S4 = (N4 - mean of N4)/ S.D. of N4
Step 4: The Townsend Score is calculated by summing the standardised variables; i.e. Townsend Score = S1 + S2 + S3 + S4.
Using Townsend Scores to compare deprivation across SE England and N France
•More concentrated deprivation in northern France•Coastal deprivation•Central belt of deprivation through the mining regions of France
Nord – Pas-de-Calais - Industry
• Present– Chemical industry
around Dunkerque– Port at Calais,
Dunkerque– Fishing at Boulogne
• Past– Bassin des mineurs
Density of employees in industry
Gains / losses of employees in industry during the period 1993-2003
Mortality indicators for comparison of Nord – Pas-de-Calais and South East England
• More recent mortality data is available in England, older data only available from 1986
• French mortality data is available at Canton level from 1979 - 2001.
• Agreed that French mortality at Canton level would cover the years 1997-2001 whilst English mortality data would cover 1999-2003.
• Time trend data would be a three year rolling average from 1979 (France) and 1986 (England) at regional and departmental level.
• In France ICD 9 was used for coding deaths between 1979 and 1999and ICD 10 from 2000; in England ICD 9 was used to the end of year 2000 and ICD 10 from the beginning of 2001
Trends in mortality – men (top) and women (bottom) all ages
5 0 0
7 0 0
9 0 0
1 1 0 0
1 3 0 0
1 5 0 0
1 7 0 0
1 9 7 5 1 9 8 0 1 9 8 5 1 9 9 0 1 9 9 5 2 0 0 0 2 0 0 5
Per
10
0 0
00
Eu
rope
an S
tan
dard
pop
ula
tion
N o r d - P a s - d e - C a la is K e n t a n d M e d w a y S H A S u r r e y a n d S u s s e x S H AB r ig h t o n a n d H o v e U A E n g la n d F r a n c e m e t r o p o lit a n
• In both countries the trend is downwards
• Men in NPC have 26% higher mortality than France, England and SE England
• French women have 29-30% lower mortality than women in England but women in NPC are less healthy and similar to England
• The expected variations in SE England are demonstrated i.e. Sussex is more healthy than Kent
4 0 0
4 5 0
5 0 0
5 5 0
6 0 0
6 5 0
7 0 0
7 5 0
8 0 0
8 5 0
1 9 7 5 1 9 8 0 1 9 8 5 1 9 9 0 1 9 9 5 2 0 0 0 2 0 0 5
Per
10
0 0
00
Eu
rope
an S
tan
dard
pop
ula
tion
N o rd - P a s -d e -C a la is Ke n t a nd M e d w a y SHA Su rre y a nd Su s se x SHABr igh to n a nd Ho v e U A Eng la nd F ra n ce me t ro p o lit a n
Women, mortality 1996-2002 - SMR all cause and all ages
< 50
50 - 70
70 - 90
90 - 110
110 - 130
130 - 150
150 et +
SMR
50 100 150
0.00
50.
015
0.02
5
SMR
Prop
ortio
n
Lissés par la méthode locale de MarshallLocal Linear Empirical BayesSmoother SMR : Nord-Pas-de-Calais + south-east english regions = 100
< 50
50 - 70
70 - 90
90 - 110
110 - 130
130 - 150
150 et +
SMR
50 100 150
0.00
50.
010
0.01
5
SMR
Prop
ortio
n
Men : premature mortality (0-64 years) 1996-2002 –All causes
The mortality in Nord – Pas-de-Calais is higher than in Southeast of
England. In France, some areas show very high
rates of premature mortality (areas with old mining industry, areas around
Dunkerque,…)
Lissés par la méthode locale de Marshallusing Local Linear Empirical Bayes Smoother SMR : Nord-Pas-de-Calais + south-east english regions = 100
Mortality from all circulatory diseases – women all ages1996-2002 ICD9 390-459 adjusted, ICD10 I00-I99)
Women
100
150
200
250
300
350
1975 1980 1985 1990 1995 2000 2005
Per
10
0 0
00
Eu
rope
an S
tan
dard
pop
ula
tion
Nord - Pas-de-Calais Kent and Medway SHA Surrey and Sussex SHABrighton and Hove UA England France metropolitan
• Trends for mortality from circulatory disease are similar for men and for women, although male mortality is higher
• Mortality is lower in France than in England, the trend is downwards on both sides of the channel
• Circulatory deaths in NPC are 28% above French national average but below English, in Surrey and Sussex deaths are 13% below English average; for both countries the trend is downward.
Mortality from circulatory diseases - Women All ages, 1996-2002SMRs for Kent, Medway, East-Sussex, Brighton & Hove, Nord – Pas-de-Calais = 100
Local Linear Empirical Bayes Smoother
< 50
50 - 70
70 - 90
90 - 110
110 - 130
130 - 150
150 et +
SMR
50 100 150 200
0.00
50.
015
SMR
Prop
ortio
n
Mortality from all cancers at all ages (ICD9 140-208 adjusted, ICD10 C00-C97)
• Female cancer mortality is much lower than male – both countries
• Male cancer mortality is higher in France, female is higher in England
• In Nord Pas de Calais cancer mortality is much higher than the national average
• In SE England it is average (KM) or below (Surrey and Sussex)
Men
150
200
250
300
350
400
450
1975 1980 1985 1990 1995 2000 2005
Per
100
000
Eu
rope
an S
tan
dard
pop
ula
tion
Nord - Pas-de-Calais Kent and Medway SHA Surrey and Sussex SHA
Brighton and Hove UA England France metropolitan
Women
100
110
120
130
140
150
160
170
180
190
200
1975 1980 1985 1990 1995 2000 2005
Per
10
0 0
00
Eu
rope
an S
tan
dard
pop
ula
tion
Nord - Pas-de-Calais Kent and Medway SHA Surrey and Sussex SHABrighton and Hove UA England France metropolitan
Mortality from cancer - Men : All ages, 1996-2002SMR of Kent, Medway, East-Sussex, Brighton & Hove, Nord – Pas-de-Calais = 100
Local Linear Empirical Bayes Smoother
< 50
50 - 70
70 - 90
90 - 110
110 - 130
130 - 150
150 et +
SMR
40 60 80 100 120 140
0.00
50.
015
0.02
5
SMR
Prop
ortio
n
Mortality from respiratory diseases:Men, all ages 1996-2002
< 50
50 - 70
70 - 90
90 - 110
110 - 130
130 - 150
150 et +
SMR
50 100 150 200 250
0.00
50.
010
0.01
5
SMR
Prop
ortio
n
Mortality from respiratory diseases:Women all ages
< 50
50 - 70
70 - 90
90 - 110
110 - 130
130 - 150
150 et +
SMR
100 200 300 400
0.00
20.
004
0.00
6
SMR
Prop
ortio
n
Correlation of Townsend Scores and Mortality
• Using unweighted data:– Strong positive correlation exists between Townsend deprivation score
and overall mortality (+) or premature mortality (++), for both regions and for both genders
– In the Nord Pas-de-Calais, this correlation is weaker for women – Statistical relationship between deprivation and overall mortality is
stronger for South-East England than for Northern France. This result does not hold for premature mortality
• Using weighted data (ie taking into account differences in sizes of areas):– Correlation between deprivation and mortality remains– But, the difference between South-East England and Northern France
disappears
Health Survey dataThree health surveys
• Enquête Santé 2002-2003 – Extension régionale Nord/Pas-de-Calais• Health Counts - Survey of people in East Sussex, Brighton & Hove 2003• Kent and Medway Health and Lifestyles survey 2001
Nord– Pas-de-Calais
Kent and Medway
East Sussex, Brighton & Hove
Population 4.0 million 1.6 million 740,0008,071
June 2001
Age 0+ 16+ registered with GP
18+ registered with GP
Weighting Official INSEE Age and gender Age and gender
Sample 4,033 5,936Timing –
Date
October 2002 -September 2003
5 wavesMay 2003
Health Status - Etat de SanteFemale - Feminin (by age)
0%
20%
40%
60%
80%
100%
18-24 25-44 45-64 65-74 75+ 18-24 25-44 45-64 65-74 75+
Excellent - Excellente Very good - Très bonne Good - BonneFair - Médiocre Poor - Mauvaise
ESBH and K&M Nord –Pas-de-Calais
In general, would you say your health is..(women)
Source: Enquete Sante 2002-3; Kent and Medway Survey 2001; Health Counts 2003
Results: Prevalence of Health BehavioursAge standardised prevalence rates
Taux de prévalence standardisé sur l’âge
25% 21% 20%18%13% 9%
39% 36% 35%
16% 12% 15%
79%70%
60%
N-PdC ES-BH K-M
Daily smoker - Fumeur quotidien Daily drinker - Buveur quotidienPhysical activity - Activité physique Obesity - ObésitéFruit and vegetable - Fruits et légumes
Summary 1• All cause mortality – English women are 33% higher than French
women• Both countries are experiencing a reduction in female mortality• Nord – Pas-de-Calais has a worse mortality than France as a whole
whereas south east England is lower than English national rate• Women in Nord – Pas-de-Calais experience similar all cause
mortality rates and trends to South East England• There is more variation across south east England (? due to
methodology – electoral wards are smaller)• Premature mortality in Northern France is higher
Summary 2
• Cancer mortality is low for both countries and very little variation, some coastal wards in England have SMRs above 100
• For circulatory disease, northern France is 26% higher than France as a whole, but lower than South East England which is at or below England national rate
• There is greater variation in south east England with pockets of high mortality
• There are some regions in south east England with very high respiratory mortality – these are mostly in the deprived coastal wards however any theory this might be due to port and mining health is disproved by low rates amongst women living in the industrial and mining regions in France unless there are lifestyle differences for example it is reported that french miners bath and change at the pit head
Transition and health in Central and Eastern Europe
Martin Bobak
University College London
Central and Eastern Europe in 1990
0
0.1
0.2
0.3
0.4
0.5
0.6
0 20 40 60 80 100 120
GDP per capita (PPP), West=100%
Gin
i coe
ffici
ent
??
CEE
West
LA
From Unicef
Russia 1989-2000 (Data from UNICEF)
0
0.1
0.2
0.3
0.4
0.5
0.6
0 20 40 60 80 100 120
GDP per capita (PPP), West=100%
Gin
i coe
ffici
ent
West
LA
Russia1989
Russia2000
Poland and Czech Rep. 1989-2000 (Data from UNICEF)
0
0.1
0.2
0.3
0.4
0.5
0.6
0 20 40 60 80 100 120
GDP per capita (PPP), West=100%
Gin
i coe
ffici
ent
West
LA
Poland1989
Poland2000
Czech1989
Czech 2000
Trends in Gini after 1989
0
0.1
0.2
0.3
0.4
0.5
0.6
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Gin
i coe
ffici
ent
Czech Poland Hungary Estonia Russia
From Unicef, Social Monitor 2003
Change in GDP after 1989 by country
0
20
40
60
80
100
120
140
1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Calendar year
Cha
nge
in G
DP
Czech Poland Hungary Estonia Russia
Index , 1989 = 100From Unicef, Social Monitor 2003
Impact of transition differs by:
• Geography• Socioeconomic status• …?
-7-6-5-4-3-2-10123
0 0.05 0.1 0.15 0.2
Change in Gini coefficient, 1989-95
Cha
nge
in li
fe e
xpec
tanc
y at
bir
th, 1
989-
95
(yea
rs)
Slo SvkCze
Pol
HunRom
Bul
Bel EstLit
Mol
Rus
CHANGE IN LIFE EXPECTANCY BY INCREASE IN INCOME INEQUALITY, 1989-95
Marmot & Bobak, BMJ 2001
CHANGE IN LE BY SOCIAL STRESS IN 12 RUSSIAN REGIONS, 1989-94
-8
-7
-6
-5
-4
-3
-212 14 16 18 20 22
*UNEMPLOYMENT, LABOUR TURNOVER,CHANGE IN MARRIAGE AND DIVORCE RATE
CHANGE IN MALELIFEEXPECTANCY
(Cornia 1997)
STRESS CAUSED BY UNEXPECTED SITUATIONS
Mortality gradient in the Czech Republic in 1990: North to South
(From Dzurova, Health & Place 2000)
Mortality gradient in the Czech Republic in 1996: East to West
(From Dzurova, Health & Place 2000)
Trends in probability of survival in men by education (relatives’ study)
0.4
0.45
0.5
0.55
0.6
0.65
0.7
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Calendar year
45 p
20
elementary university
45 p20 = probability of living to 65 yrs when aged 20 yrs
Age-sex adjusted prevalence of poor self-rated health and
life expectancy at age 15 (r -0.73, p=0.005, n=13)
BGR
CZ E
SVK
HUN
POL
ROM
SLO
BLR
UKR
RUS
ESTLVA
LIT
52
54
56
58
606
2L
ife
ex
pec
tanc
y a
t ag
e 1
5 (y
ea
rs)
10 15 20 25Prevalence of poor health (%)
Bobak et al, JECH 2007
Odds ratios (95% confidence intervals) of poor health by
societal characteristics in different multi-level models
Societal characteristic, unit of effectOdds ratio adj. for
age and sexOdds ratio adj. for
age, sex and individual SES
GDP PPP, per $5000 increase 0.75 (0.65-0.86) 0.79 (0.68-0.93)
Annual growth, per 1% 0.90 (0.83-0.98) 0.93 (0.85-1.02)Max. economic contraction, per 10% 1.10 (1.01-1.20) 1.08 (0.99-1.19)
Gini coefficient, per 0.1 unit increase 1.15 (0.95-1.39) 1.12 (0.93-1.34)
Corruption index, per 1 unit (0 to 10) 1.20 (1.08-1.33) 1.15 (1.03-1.29)
Homicide rates (per 10/100,000 increase) 1.09 (1.00-1.19) 1.08 (0.98-1.18)
Ratio of 80th/20th income percentile, per 1 unit increase
1.13 (0.92-1.39) 1.05 (0.84-1.32)
Ratio of 90th/10th income percentile, per 1 unit increase
1.02 (0.95-1.11) 1.00 (0.93-1.09)
Bobak et al, JECH 2007
The Czech HAPIEE study
Czech HAPIEE Study
• 4,123 men and 4,729 women• Response rate 59%• Random population samples• Aged 45-69 at baseline (2002-2005)• 7 cities in total• 2 cities in North Moravia (Havirov &
Karvina)
Life expectancy at birth in Czech town in 2001-2005
64666870727476788082
Men Women
KarvinaKromerizLiberecJihlavaHradec
Karvina / Havirov (North Moravia)
• Centre of mining & heavy industry before 1990• Massive closures of enterprises• Huge losses in employment after 1990
• In top 10 cities by – Unemployment (13%, highest in the country)– Crime– Out-migration – Quality of living– …
Do these differentials exist in micro-data?
• Health• Health behaviours / risk factors• Socioeconomic status• Psychosocial factors
And…… do these factors explain the health
disadvantage?
Prevalence (%) of health outcomes by town
0
5
10
15
20
25
30
Poor SRH
Past M
ILow
PFDiab
etes .
Poor SRH
Past M
ILow
PFDiab
etes
Karvina Other
Men Women
Health behaviours and risk factors by town (%)
0102030405060708090
Smoking
Daily a
lcohol
CAGE 2+Hyp
erten
sion .
Smoking
Daily a
lcohol
CAGE 2+Hyp
erten
sion
Karvina Other
Men Women
Socioeconomic status by town (%)
0102030405060
Universi
tyUnem
pl.
Ever u
nempl.>
1yr
Problem
s money .
Universi
tyUnem
pl.
Ever u
nempl.>
1yr
Problem
s money
Karvina Other
Men Women
Psychosocial factors by town (%)
05
1015202530354045
Depres
sion
Feel u
nsafe
nightMem
bersh
ip .Dep
ressio
nFee
l uns
afe night
Membe
rship
Karvina Other
Men Women
Do these factors explain differences in
poor self-rated health?
Life expectancy vs. self-rated health
0
2
4
6
8
10
12
14
16
18
70 70.5 71 71.5 72 72.5 73 73.5 74 74.5 75
Life expectancy (yrs)
Poo
r he
alth
(%)
0
2
4
6
8
10
12
14
16
77.5 78 78.5 79 79.5 80
Life expectancy (yrs)
Poo
r hea
lth (%
)
Men (r=-0.87) Women (r=-0.57)
Odds ratios of poor health for Karvina vs. other towns
Adjusted for Men Women
Age 1.66 (1.30-2.11) 1.33 (1.05-1.70)
Age + RF 1.54 (1.15-2.06) 1.18 (0.88-1.58)
Age + SES 1.43 (1.10-1.86) 1.10 (0.84-1.43)
Age + PS 1.58 (1.20-2.08) 1.30 (0.99-1.70)
Fully adjusted 1.24 (0.89-1.72) 0.90 (0.64-1.26)
Odds ratios of poor SRH for Karvina vs. other towns
0.8
1
1.2
1.4
1.6
1.8
2
Men Women
ageage + RFage + SESage + PSFully adj.
Adjusted for:
Odds ratios of poor SRH for Karvina vs. other towns
0.8
1
1.2
1.4
1.6
1.8
2
Men Women
ageage + RFage + SESage + PSFully adj.
Adjusted for:
Conclusions
• Societal transition had differential effects– by socioeconomic group– by geography
• Increasing inequalities• Can affect health of whole populations• A number of potential mediators• Explanation requires individual level data
Exploring health in Scotland and other parts of post-industrial Europe
The experience of Poland
Witold ZatońskiMarta Mańczuk
Royal College of Physicians and Surgeons of Glasgow232-242 St Vincent Street, Glasgow G2 5RJ
Wednesday June 18th 2008
1
„Where observation is concerned, chance favours only the prepared mind”
„Dans les champs de l'observation le hasard ne favourise que les esprits préparés”
Louis PasteurFrench biologist & bacteriologist (1822 - 1895)
2
• Closing the Gap -Reducing Premature Mortality. Baseline for Monitoring Health Evolution Following Enlargement (HEM) –action no 2003121
• The final report will be available by the end of June 2008 at the project website:www.hem.waw.pl
33
History of the project
• The project was submitted to the European Commission and has been accepted among other European Union programs in the field of public health for years 2003-2008 (grant agreement no 2003121)
• End of the project – April 2008
44
HEM – Closing the Gap TEAMCancer Epidemiology and Prevention Division:
• Witold Zatonski• Marta Manczuk• Urszula Sulkowska• Joanna Didkowska• Urszula Wojciechowska• Wojciech Tarkowski• Krzysztof Przewozniak• Jakub Gumkowski• Kinga Janik-Koncewicz
Principal Co-Investigators:• Paolo Boffetta• Hannia Campos• Carlo LaVecchia• John Powles• Jurgen Rehm• Walter Willet
Steering Committee
Eva NegriLeif AaroPeter BoyleAnna GilmoreEric JouglaAlbert LowenfelsFred PaccaudRichard PetoVesna Kerstin PetricPekka Puska
Country Coordinators:Jurate Klumbiene – LithuaniaIveta Pudule – LatviaRaul Kiivet, Ain Aaviksoo – EstoniaTit Albreht – SloveniaCsilla Kaposvari - HungaryPlamen Dimitrov – BulgariaIvana Holcatova, Alexandra Pilipcinova, Rudolf Poledne – Czech Rep.Daniela Marcinkova – SlovakiaFlorentina Furtunescu - Romania
Country Collaborators:
Vincenzo Bagnardi, Dolly Baliunas, JanaBrozova,Hana Vrbanova, Monika Bene,Robert West, Martin Jarvis, Gabriella Bohm, Michael Kunze, Lydia Gisle, Luk Joossens, Hans
Storm, Tiina Laatikainen, Jeal-Jouis Wilquin / SylvianeRatte, Rene Thyrian, Sylvano Gallus, TarquiniaZeegers, Trudy Prins, Esteve Fernandez
Munoz,Ann-Sofie Karlsson, Ewa Halicka, Johan Lund, Jacek Moskalewicz, Jayadip Patra, Gerard Pavillon, Svetlana Popova, Lorenza Scotti, Beniamin Taylor
55
Aims of the project
• To improve understanding of underlying causes of health differences between the new and old EU member states.
• To identify and quantify major health determinants responsible for the gap existing between the new and old EU member states.
• To define priorities for intervention: general (all accession countries) as well as country-specific;
• To produce a Blueprint including major indications for public health intervention /action plan for intervention/;
• To present the Blueprint to the European Commission and Governments of accession countries, in order to finalize priorities for intervention on a public health scale.
• To widely disseminate the evidence- and science-based data on health status and the possibilities for reducing premature mortality, especially in all accession countries in local languages.
66
• Geographic scope:– The project includes 25 European Union countries with a special reference to
EU10: Poland, Czech Republic, Slovakia, Slovenia, Latvia, Lithuania, Estonia, Hungary – EU members since May 2004 (Malta and Cyprus excluded from the analysis) + Romania, Bulgaria – EU members since January 2007; and to EU15 countries (EU members before 2004). The Russian Federation is included in some comparisons.
• Age groups of interest:– Basic age groups : 20-44, 45-64, for some conditions 20-64 and for comparison
65+, 0+
• Time scope:– Longitudinal epidemiological descriptive analyses: the period of interest consists
mainly of time trends we have been using data for EU10 and EU15 countries since the year 1969 until the year 2002;
– Cross sectional analyses: of attributable burdens the year of reference was 2002, for considered risk factors distributions and for mortality.
7
History of health in Poland
8
Percentage of deaths before the age of 5 years Poland vs. England and Wales, both sexes
England and Wales Poland
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
1820 1840 1860 1880 1900 1920 1940 1960 1980 2000 2020
9
Total mortality trends in Poland at age 0-14 years at age 15-64 years, males
0
200
400
600
800
1000
1200
1400
1600
1950 1967 1977 1987
mor
talit
y at
age
0-1
4 ye
ars
400
450
500
550
600
650
700
750
800
850
mor
talit
y at
age
15-
64 y
ears
Mortality at age 0-14 yearsMortality at age 15-64 years
Increase of Premature Mortality
• Divergence of mortality trends in age groups in Poland
• Dramatic increase in young and middle-aged adults
• Systematic decline in age group 0-14 years
10
0
50
100
150
200
250
300
1958 1966 1974 1982 1990rok
Finland Poland
deaths / 100,000
0
20
40
60
80
100
120
140
160
1959 1969 1979 1989
Poland Great Britain
deaths / 100,000
0
5
10
15
20
25
30
35
40
45
1958 1966 1974 1982 1990
Poland Finland
deaths / 100,000Lung cancer Cardiovascular diseases External causes
Male deaths at age 15-59, 1959-1990
11
Total mortality in Poland and UK, 1963-1991
Poland
UK
0
50
100
150
200
250
300
350
400
450
1958 1969 1980 1991 2002
0-19 20-64
UK
Poland
0
100
200
300
400
500
600
700
800
900
1000
1958 1969 1980 1991 2002
12
PROBABILITY OF DYING BY Region, 1990( data adapted from Murray i Lopez, 1994)
0
10
20
30
40
EME CHN MEC LAC OAI IND POL SSA
perc
enta
ge
Communicable diseasesNon-Communicable diseasesInjuries
Males, age 15-59
EME – Established Market EconomiesPOL - PolandCHN - ChinaLAC – Latin America and the Caribbean
OAI – Other Asia and IslandsMEC – Middle Eastern CrescentIND - IndiaSSA – Sub-Saharan Africa
0
10
20
30
EME POL CHN LAC OAI MEC IND SSA
perc
enta
ge
Communicable diseasesNon-Communicable diseasesInjuries
Males, age 0-14
13
Cigarette consumption per capita, Poland 1923-1980
0
500
1000
1500
2000
2500
3000
3500
4000
1915 1925 1935 1945 1955 1965 1975 1985 1995 2005
PER CAPITA
PER ADULTAGED 15+
• Dramatic increase of cigarette consumption
• In the 1980s in Poland there was observed the highest tobacco consumption in the world
14
Recorded per capita consumption of alcohol, Poland 1950-1980
0
1
2
3
4
5
6
7
8
9
10
1945 1955 1965 1975 1985 1995 2005
Litre
s of
pur
e al
coho
l
• In the post war period alcohol consumption had been increasing dramatically until 1980
• Form 3 to almost 9 litres of pure alcohol per capita per year
Increase of alcohol consumption in the period
1950–1980 by 180%
3 litres
8.4 litres
15
Caloric intake in Poland in the period 1936-1980 (kcal/cap/day)
2000
2500
3000
3500
4000
1936 1947 1958 1969 1980
kcal
/cap
/day
Poland EU15
• Linear increase of caloric intake in Poland
• Level appreciably higher than in the EU15
Source: for years 1936and 1949: Budzynski F. W. Przemiany i prognozy konsumpcji żywności. PWN, Warszawa, 1975, p. 183; for years 1961-1980: FAO Food Balance Sheets
16
1990
* Former socialist economies** Established market economies
FSE* EME**Number of
physicians per 1,000
inhabitants
4,7 2,5
Number of hospital beds
per 1,000 inhabitants
11 8
Source: Feachem R. Health decline in eastern Europe. Nature. 1994;367:313-314
This dramatic increase of premature mortality took place during increased access to medical service
17
Democracy is healthier
18
Time trends of mortality from selected causes, Polish men aged 20-64 years
CVD
Cancer
Injuries
Infectious disease
0
50
100
150
200
250
300
350
1962 1972 1982 1992 2002
• For 30 years, in the period 1960-1991 dramatic increase of premature mortality from non-communicable diseases
• Infectious diseases are fully controlled
• Since 1991 cardiovascular disease, cancer and injuries mortality has been declining
19
Cardiovascular disease mortality in Poland and Finland in the period 1963-2002
Poland
Finland
0
200
400
600
800
1000
1200
1962 1972 1982 1992 2002
men women
Poland
Finland
0
50
100
150
200
250
300
350
400
1962 1972 1982 1992 2002
20
Lung cancer mortality in Poland and the UK, men aged 20-64 years, 1959-2003
0
10
20
30
40
50
60
70
80
1958 1970 1982 1994 2006
deat
hs /
100,
000
Poland UK
• Extraordinary increase of lung cancer mortality in Poland until early 1990s (unlike as in the UK)
• After 1991 decline parallel to the one observed in the UK
21
Life expectancy at birth, Poland, men, 1963-2002*
65
66
67
68
69
70
71
1955 1965 1975 1985 1995 2005
• Since the beginning of 1990s great systematic increase of life expectancy at birth in Poland
* 5-year moving average
22
Cigarette consumption per capita, Poland 1923-2004
0
500
1000
1500
2000
2500
3000
3500
4000
1915 1925 1935 1945 1955 1965 1975 1985 1995 2005
PER CAPITA
PER ADULTAGED 15+ • In the 1980s in Poland there was
observed the highest tobacco consumption in the world
• In mid 1990s the consumption of cigarettes began to fall down, first due to economic crisis and then due to health intervention
23
Daily smoking, males and females 20+ yearsPoland 1974-2004
62.465.2
54.8
50.5
44.6 43.4
18.6
31.6
26.1 25.423.5
25.8
0
10
20
30
40
50
60
70
1974 1982 1985-1988
1990-1994
1995-1999
2000-2004
Males
Females• In early 1980s there was a
very big proportion of smokers in Polish population: almost 70% of adult men and 32% of adult women were daily smokers
• Since then, the percentage of daily smokers has been declining, firstly due to economical crisis and then as a result of health intervention
24
Recorded per capita consumption of alcohol Poland 1950-2001
0
1
2
3
4
5
6
7
8
9
10
1945 1955 1965 1975 1985 1995 2005
Litre
s of
pur
e al
coho
l
• In the post war period alcohol consumption had been increasing dramatically until 1980
• When the martial law was introduced and alcohol was rationed, the consumption dropped and since then there has been stagnation observed
25
Consumption of vegetable oils in Poland and EU15 (kg/cap/year)
0
5
10
15
20
25
1960 1967 1974 1981 1988 1995 2002
EU15
Poland• Dramatic increase of
vegetable oils consumption since early 1990s
• In 2002 consumption of vegetable oils reached the average level in the EU15 countries
26
Consumption of vegetable oils and butterin Poland in 1970-2000 (kg/capita/year)
vegetable oils
butter
0
2
4
6
8
10
12
14
16
18
20
1965 1975 1985 1995 2005
kg/c
apita
/yea
r
• One of the hypothesis, which tries to explain cardiovascular disease mortality decline, is change of fat consumption structure
• At the beginning of 1990s consumption of vegetable oil began to rise dramatically with simultaneous decline of butter consumption
27
Consumption of exotic fruits in Poland, 1983-2002
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1980
1985
1990
1995
2000
2005
• Exponential increase of exotic fruits consumption
Availability of fruits and vegetables (antioxidants) whole year through
28
Poland, womenBEST Rank within EU10 WORST
1 2 3 4 5 6 7 8 9 10
1990 77.8 73.2 75.6
2002
1990
2002
1990
2002
1990
2002
1990
2002
1990
2002
1990
2002
1990
2002
80.5 74.7 78.8
12.2 19.2 15.5
10.1 16.7 12.0
232 383 298
189 327 227
55 127 105
33 122 58
22 55 25
20 63 21
5 20 6
4 12 6
3 33 4
4 29 5
6 16 10
4 26 153.9 8Lung cancer mortality
1.9 6Liver cirrhosis mortality
-0.1 8Suicide mortality
-1.3 5Injuries mortality
-3.7 1Cardiovascular disease mortality
-2.0 3All cause mortality
-3.5& 3Risk of dying, age group 20-64 years (%)
3.2# 1Life expectancy at birth (years)
HEALTH INDICATOR Best in EU10
Worst in EU10 Poland Change APC* Rank
of APC
Sta
ndar
dise
d m
orta
lity
rate
s pe
r 100
,000
per
son-
year
s,
age
grou
p 20
-64
year
s
* APC - Annual percentage change in the period 1990-2002# for life expectancy at birth it is the difference between value for 2002 and 1990 expressed in years& for risk of dying it is the difference between value for 2002 and 1990 expressed in percentage points
Very good
Improvement
Worsening
Very bad
29
Poland, menBEST Rank within EU10 WORST
1 2 3 4 5 6 7 8 9 10
1990 69.8 64.2 66.5
2002
1990
2002
1990
2002
1990
2002
1990
2002
1990
2002
1990
2002
1990
2002
72.6 64.7 70.3
29.4 41.0 36.3
23.8 43.1 29.5
618 968 816
487 1040 628
163 371 309
104 371 192
107 278 158
87 333 121
18 71 32
23 112 34
9 85 14
22 97 22
48 85 74
42 82 60-1.6 6Lung cancer mortality
5.1 6Liver cirrhosis mortality
0.6 6Suicide mortality
-2.0 2Injuries mortality
-3.2 2Cardiovascular disease mortality
-1.9 3All cause mortality
-6.8& 3Risk of dying, age group 20-64 years (%)
3.8# 2Life expectancy at birth (years)
HEALTH INDICATOR Best in EU10
Worst in EU10 Poland Change APC* Rank
of APC
Very good
Improvement
Worsening
Very bad
Sta
ndar
dise
d m
orta
lity
rate
s pe
r 100
,000
per
son-
year
s,
age
grou
p 20
-64
year
s
* APC - Annual percentage change in the period 1990-2002# for life expectancy at birth it is the difference between value for 2002 and 1990 expressed in years& for risk of dying it is the difference between value for 2002 and 1990 expressed in percentage points
30
The same phenomena which were observed in Poland apply
as well to Katowice
31
Total mortality in Poland (and Katowice) and UK, 1963-2002
Poland
UK
Katowice
0
50
100
150
200
250
300
350
400
450
1958 1969 1980 1991 2002
0-19 20-64
UK
Poland
Katowice
0
100
200
300
400
500
600
700
800
900
1000
1958 1969 1980 1991 2002
Thank youPlease visit our website:
www.hem.waw.pl
