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Exercise across Birmingham A Health Equity Audit 1.

Introduction

To quote the Chief Medical Officer “Physical activity not only contributes to well-being, but is also essential for good health. People who are physically active reduce their risk of developing major chronic diseases – such as coronary heart disease, stroke and type 2 diabetes – by up to 50%, and the risk of premature death by about 20-30%. The annual costs of physical inactivity in England are estimated at £8.2 billion – including the rising costs of treating chronic diseases such as coronary heart disease and diabetes. This does not include the contribution of inactivity to obesity – an estimated further £2.5 billion cost to the economy each year.” (Source: At least five a day, Department of Health, 2004) 1.1. 

 

Recommendations for active living throughout the lifecourse Children and young people should achieve a total of at least 60 minutes of at least moderate intensity physical activity each day. At least twice a week this should include activities to improve bone health (activities that produce high physical stresses on the bones), muscle strength and flexibility. For general health benefit, adults should achieve a total of at least 30 minutes a day of at least moderate intensity physical activity on 5 or more days of the week. The recommended levels of activity can be achieved either by doing all the daily activity in one session, or through several shorter bouts of activity of 10 minutes or more. The activity can be lifestyle activity* or structured exercise or sport, or a combination of these. More specific activity recommendations for adults are made for beneficial effects for individual diseases and conditions. All movement contributes to energy expenditure and is important for weight management. It is likely that for many people, 45-60 minutes of moderate intensity physical activity a day is necessary to prevent obesity. For bone health, activities that produce high physical stresses on the bones are necessary. The recommendations for adults are also appropriate for older adults. Older people should take particular care to keep moving and retain their mobility through daily activity. Additionally, specific activities that promote improved strength, co-ordination and balance are particularly beneficial for older people. (Source: At least five a day, Department of Health, 2004)

Origin - South Birmingham PCT Public Health Team March 2004

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2.

Health Equity Audit

This report fits into step 2 of the HEA cycle – Equity profile: identify the Gap (see Figure 1). The guidance is to:   

Use data to compare service provision with need, access, use & outcome Measures to include proxies for disadvantage, social class, wards in the bottom quintile, Black and Minority Ethnic groups, gender or other population group Focus on the third of population with poorest health outcomes

This report does not look at the effectiveness of the intervention, only whether the service can be described as being equitable given the population and prevalence of adverse outcomes. Figure 1: The Health Equity Cycle.

Source: http://www.dh.gov.uk/assetRoot/04/06/90/87/04069087.pdf

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Origin - South Birmingham PCT Public Health Team March 2004


3.

Methodology

There are three phases to this report: 1. Identify need a. Identify conditions diseases and conditions that are ameliorated by activity b. Identify the number of deaths that result from these diseases and conditions c. Investigate the relationship between mortality and demography d. Investigate the relationship between mortality and deprivation e. Investigate the relationship between mortality and ethnicity f. Estimate activity rates in the population by demography, ethnicity and deprivation 2. Identify Interventions/service provision a. Provision of facilities (both public and private) b. Membership of BCC centres c. Exercise on prescription 3. Identify Gap a. Access rates, b. Do services meet need considering demographic, ethnicity and deprivation factors

Origin - South Birmingham PCT Public Health Team March 2004

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4.

Phase 1: Identifying the need

4.1.

Mortality from diseases and conditions from diseases and conditions related to activity

The evidence on the conditions that can be ameliorated by activity have been recently and best summarised in the Department of Health’s report “At least five a week”. The table of evidence is included in Appendix A. A lack of physical exercise will not be the sole reason for all of these deaths. It is estimated that over 3,421 people a year die from these diseases across Birmingham, see table. Table 1: Number deaths occurring in Birmingham death rates from diseases and conditions that are ameliorated by activity, 2002. Disease

Men

Coronary heart disease Cerebrovascular Disease Essential (primary) hypertension

Women

Total

1084 385 3

817 586 8

1901 971 11

Depression

79

16

95

Falls Malignant neoplasm of colon

51 67

50 69

101 136

17 1686

9 1555

26 3241

Non-insulin-dependent diabetes mellitus Total Source: ONS2002

There is very poor data on prevalence of chronic conditions in the population. In the future more could be made of the data from primary care as information systems improve with the introduction of the new GMS contract. 4.2.

Variation in mortality by Sex

Figures 2 & 3 show the geographical variation in mortality from diseases and conditions ameliorated by activity at ward level. There is a twofold variation in the death rate across Birmingham for males, and a near four fold variation for females. The average male death rate is nearly twice that of females.

4

Origin - South Birmingham PCT Public Health Team March 2004


as h

w oo d

H ea th Ki ng S ' s oh N o or N to H ec n an he ds lls w or t O h Sh sc ar ott S pa d E rk nd br o B i ok Fo lles l Ki x H ey ng o st llie an s Se din lly g O M ak o La sel e Sm dyw y a l oo lH d Ki ea ng th sb u Ya ry r S dle pa y rk S hil he l Er ldo di n ng to Ac oc W e n k' ole s G y r H od ee n Lo ge ng H i br ll id ge P e A st rr on Br y B an ar dw r H oo ar d Ed bor gb ne a S to Bo sto ck ur n Su lan nv tt d ille on G r N ee ew n H Q al ui l nt S S a o ut nd n to w e n V ll N es or e y t Su H hfi tt a on ll eld G Fo re en B ar ur tle Oa k y G s re en

W

Standardised Rate per 100,000 Population

Ki ng 's N Fo or x ton H ol lie Sp S s a r oh kb o r N ook S ec m h al ell lH s W ea L as a hw dy th oo wo d od H Er ea di th Sh ngt ar on d En d H Ast od o H ge n an ds Hil w l or Ya th Ed rd Ac g ley b St ock as oc 's ton kl G an re e d G n re Ki Mo en ng se st le an y d Sp in a g B rkh ou i rn ll v Ba W ille rt e l e ol e y G y r S a ee nd n w S e el ly ll O a O k Pe sc rr ott y B B arr ill es Sh ley e H ldo ar n S bo ut to Q rne n ui Fo nt u r on Br O an ak dw s S ut Kin oo to gs d n b N ur ew y N H or al Lo thf l n ie Su gb ld tt ri d on ge H Ves al l G ey re en

Standardised Rate per 100,000 Population

Figure 2: Directly age standardised death rates from diseases that are diseases and conditions that are ameliorated by activity, for males aged over 30 years by ward, 2002 across Birmingham Directly Standardised Mortality Rates from diseases and conditions that are ameliorated by activity by ward across Birmingham, aged over 30, Males,

800

700

600

500

400

300

200

100

0

Source: ONS 2002/3

Figure 3: Directly age standardised death rates from diseases that are diseases and conditions that are ameliorated by activity, for females aged over 30 years by ward, 2002 across Birmingham Directly Standardised Mortality Rates from diseases and conditions that are ameliorated by activity by ward across Birmingham, aged over 30, Females,

450

400

350

300

250

200

150

100

50

0

Primary Care Trust

Source: ONS 2002/3

Origin - South Birmingham PCT Public Health Team March 2004

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4.3.

Variation in mortality by deprivation

There is a strong relationship between local deprivation and deaths from are diseases and conditions that are ameliorated by activity. The more deprived the community the higher the death rates (see Figure 4). Figure 4: SMR for deaths from diseases that are diseases and conditions that are ameliorated by activity plotted against the Index of Multiple Deprivation 2000 across Birmingham by the four PCTs 200 180 160

SMR

140 120 100 0

20

40

60

80

100

80 60 Affluent

IMD East

HoB

North

Deprived South

Linear fit

Source: ONS 2002/3 Standardised to England

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Origin - South Birmingham PCT Public Health Team March 2004


4.4.

Variation in mortality by deprivation

There is no data on the ethnic breakdown of those who die. The only detail available is their country of birth. This shows that deaths from diseases and conditions that are ameliorated by activity is highest amongst those of Caribbean, Irish or European birth (Table 2). Table 2:

Death rates per 10,000 from diseases and conditions that are ameliorated by activity by country of birth across Birmingham

Africa Bangladesh Caribbean China Europe India Ireland Middle east North America Pakistan South America South Asia UK Birmingham Source: ONS 2002/3

Pop Deaths 13611 25 10784 20 19534 109 1411 1 7558 52 23197 87 28911 252 5229 5 1553 7 41724 113 545 2 5897 9 810208 2541 970162 3223

Rate 18.4 18.5 55.8 7.1 68.8 37.5 87.2 9.6 45.1 27.1 36.7 15.3 31.4 33.2

LL 11.2 10.4 45.4 0.0 50.2 29.6 76.4 1.2 11.8 22.1 0.0 5.3 30.1 32.1

UL 25.6sig low 26.7sig low 66.2sig high 21.0sig low 87.4sig high 45.4 97.9sig high 17.9sig low 78.4 32.1sig low 87.5 25.2sig low 32.6sig low 34.4

Origin - South Birmingham PCT Public Health Team March 2004

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5.

Estimates of activity prevalence rates

There are neither estimates nor measures of how much activity Birmingham’s population is undertaking at ward, PCT or City level. Therefore this report has had to estimate the levels of activity from the national Health Survey for England. This is a high quality annual survey of the state of the national’s health based on a sizeable (20,000) sample of the population. This survey based on interviews and measurements undertaken by nurses provides the height and weight of each person interviewed. The strength of the survey design is that the sample has been drawn from the whole population and calculated to produce reliable prevalence data with reduced biases that can occur when undertaking opportunistic surveying. The 1999 HSE was used here as it had a boosted sample to produce more reliable estimates for the ethnic populations. Vital when working with Birmingham’s population, which is the second most ethnically diverse population in England. So what we lose in terms of contemporary data we gain in the understanding of the prevalence levels by ethnicity. Even with this enhanced survey measurements were not available for every ethnic group. Black Africans are poorly represented. However there was enough data for Indian, Pakistani, Bangladeshi, Black Caribbean and Chinese populations. The remaining ethnic groups were aggregated into an “other” group. The aggregated ethnic groups had very different activity patterns. The Bangladeshi population were the least activity, whilst the Black Caribbean and White populations were the most activity (Figure 5) Figure 5: The number of times a person undertakes 30 minutes of activity in a week by ethnic group (HSE 1999). 100% 90% 80% 70% 60% 50% 40% 30% 20% 10%

To ta l G ra nd

W hi te

ta ni Pa kis

O th er

In di an

ne se Ch i

be an ca r ib

ac k Bl

Ba ng l

ad es hi

0%

None

8

Less than 1

1 or 2 a week

3 or 4 a week

5 or more a week

Origin - South Birmingham PCT Public Health Team March 2004


Unfortunately, it is not possible to build into the model a good measure of deprivation. The HSE records income and social class. The Census records Social Economic Status, which does not map on to social class. The only measure that is directly comparable between the HSE and the Census is economic activity. Economic activity does provide some marker of income deprivation as it provides numbers unemployed, permanently sick, those looking after families, and employed in part time jobs. This classification does however omit the wide pay differentials for those in employment and reduces the age categories to just two (16-24 and over 25). The resulting estimates, given in table 3, therefore take into account differences in sex, ethnicity, economic activity and to a lesser degree age for the City and between PCTs. Table 3: Prevalence (%) of people not achieving 5 sessions of 30 minutes per week, by economic activity, ethnic group, sex, and age.

Employed fulltime

age

Male

16-25

70.0

40.0

75.0

71.0

56.3

64.9

50.4

56.1

over 25

72.4

60.4

77.3

65.4

74.6

63.2

65.2

65.8

Female 16-25 Employed part Male time

Male

Male

55.2

81.3

72.7

27.8

56.4

54.1

57.4

70.1

61.5

52.8

65.2

63.5

62.4

16-25

78.6

85.7

80.0

87.5

83.3

83.3

63.4

74.2

over 25

78.3

68.4

81.3

80.4

60.0

68.2

76.6

75.6

66.7

57.1

100.0

80.0

62.5

80.0

85.3

77.6

over 25

73.9

70.3

82.6

82.0

64.3

91.9

72.1

74.1

16-25

93.9

50.0

0.0

100.0

100.0

90.3

82.8

89.6

over 25

89.3

82.5

95.6

88.9

77.8

87.3

80.7

85.0

90.6

80.0

0.0

100.0

100.0

91.1

74.3

87.6

over 25

95.2

77.0

94.2

90.0

83.3

86.7

80.0

85.3

16-25

75.0

0.0

0.0

100.0

0.0

75.0

66.7

75.0 71.1

over 25

100.0

85.7

66.7

100.0

60.0

0.0

100.0

0.0

50.0

100.0

66.7

66.7

40.0

50.0

100.0

75.0

100.0

60.0

73.9

68.1

100.0

0.0

100.0

0.0

0.0

0.0

100.0

77.8

over 25

100.0

100.0

100.0

100.0

85.7

100.0

97.5

98.2

100.0

50.0

0.0

100.0

0.0

100.0

100.0

84.6

100.0

96.9

100.0

100.0

100.0

100.0

93.5

95.7

over 25

95.0

96.6

88.0

92.5

100.0

95.2

89.5

90.5

Female over 25

92.3

94.8

84.4

95.2

76.9

89.3

90.4

90.6

100.0

0.0

0.0

0.0

0.0

62.5

44.4

52.2 60.8

Male

16-25 over 25

Female 16-25 over 25 Male

16-25 over 25

Female 16-25 over 25 Unemployed

50.0

over 25

Self employed Male

Student

66.7 100.0

16-25

Female 16-25 Retired

Overall

47.3

over 25

Male

white

70.5

Female 16-25 Perm sick

Pakistani

77.2

Female 16-25 Other

Other

over 25

Female 16-25 Looking after family

Black Bangladeshi Caribbean Chinese Indian

sex

Male

31.0

75.6

63.2

42.9

85.2

56.4

0.0

0.0

75.0

0.0

66.7

20.0

47.6

40.0

38.5

83.3

70.8

36.4

69.2

54.8

59.3 65.1

76.8

58.1

76.2

68.8

66.7

65.1

56.7

100.0

33.3

66.7

80.0

60.0

0.0

66.7

61.4

71.8

65.5

67.9

75.0

59.4

73.3

72.2

71.2

66.7

58.3

92.3

40.0

100.0

100.0

57.1

64.0

16-25

100.0

100.0

0.0

0.0

100.0

100.0

71.4

85.7

over 25

100.0

66.7

100.0

100.0

100.0

100.0

73.3

82.1

66.7

0.0

0.0

100.0

0.0

100.0

50.0

60.0

100.0

20.0

0.0

100.0

100.0

100.0

94.4

86.8

83.5

67.4

81.1

75.4

65.4

78.6

72.9

74.2

Female 16-25 over 25 Grand Total

53.8 100.0

Source: HSE 1999

Origin - South Birmingham PCT Public Health Team March 2004

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Applying these prevalence rates to the census population it is possible to create an estimate of the total number of not undertaking exercise across Birmingham, the resident population of the PCTs and the wards or other areas by ethnic group and economic activity and sex. This analysis estimates the population of Birmingham aged over 16 who are not meeting the exercise target to be 491,177. Table 4: The estimated number not meeting the exercise target for age sex ethnicity and economic activity in Birmingham from the 1999 HSE estimates and 2001 Census resident population. sex student

age

Looking after home/family

681

506

1957

1741

3210

9794

18614

Female

106 980

193 344

170 2211

674 1544

0 2680

1423 13611

2643 21979

46

457

244

100

936

380

1667

3830

Male

16 to 24

217

195

45

656

498

1419

7570

10599

25 and over

540

3548

401

4760

2923

4351

68479

85002

16 to 24

176

276

24

682

216

595

6757

8726

25 and over

164

2967

251

3014

1704

932

40147

49179

Male

16 to 24

117

155

2

150

145

407

788

1764

Female

25 and over 16 to 24

655 79

343 145

40 9

469 200

275 176

1035 428

4473 2392

7291 3428

25 and over

119

1847

96

1950

917

1017

31456

37402

Male

16 to 24

15

2

0

13

27

55

118

229

180

162

11

203

204

804

2088

3651

25 and over 16 to 24

461

561

2509

2285

6457

209

2357

1782

8835

19202

35224

70

0

0

88

0

476

872

1505

25 and over 16 to 24

331 268

456 0

67 6

710 0

681 192

1869 1307

3855 1093

7969 2866

25 and over

394

457

101

1021

982

2501

6320

11775

17

0

0

0

0

0

613

630

355

1190

27

1192

694

2219

17180

22857

Male

16 to 24 25 and over 16 to 24

23

21

0

32

0

160

446

682

272

1098

31

1328

623

1730

14004

19086

Male

16 to 24

0

0

0

0

0

0

0

0

Female

25 and over 16 to 24

391 0

2018 0

140 0

1010 0

583 0

1630 0

26301 0

32072 0

25 and over

210

2427

170

1335

408

1209

37424

43183

30

0

0

0

0

138

316

484

246

224

129

1571

365

2892

11204

16632

Male

16 to 24 16 to 24 25 and over

10

0

881

Female

Female

Grand Total

162

16 to 24

25 and over

Unemployed

478 1958

Male

25 and over

Self Employed

Overall

77 608

Female Retired

White

726

25 and over

Permanently sick or disabled

Pakistani

16 to 24

Female Other

Other

25 and over 16 to 24

Female Employee - Part Time

Indian

Male

25 and over Employee - Full Time

Black Bangladeshi Caribbean Chinese

3

0

0

9

0

35

40

86

11

102

92

594

118

224

3387

4526

Male

16 to 24

186

534

0

0

677

1516

2586

5499

Female

25 and over 16 to 24

590 95

1147 0

52 0

1102 224

1346 0

2471 768

8865 965

15574 2052

25 and over

135

177

0

687

713

715

5255

7682

9782

22757

3189

30255

21704

50514

352976

491177

Origin - South Birmingham PCT Public Health Team March 2004


These estimates can be used to investigate differences by sex, age and ethnic group. The Bangladeshi and Pakistani populations are likely to have the highest proportion of people failing to meet the 5 a week target, whereas the Black Caribbean are most likely to have the lowest proportion failing to meet the target (Figure 6). When considering the two age groups available, the younger age group are more activity with fewer failing to reach the target (Figure 7).

al l ve r

te O

w hi

is ta ni Pa k

ot he r

n In di a

ne se C hi

ca rib

ac k bl

Ba n

be an

90 80 70 60 50 40 30 20 10 0 gl ad es hi

Prevalence (%)

Figure 6: The percentage of the population estimated not to be achieving the 5 a week target by Ethnic Group and sex across Birmingham based the HSE1999 estimates and 2001 Census resident population.

Male

Female

16-25

ve ra ll O

w hi te

an i Pa ki st

ot he r

In di an

C hi ne se

90 80 70 60 50 40 30 20 10 0

Ba ng la de bl sh ac i k ca rib be an

Prevalence (%)

Figure 7: The percentage of the population estimated not to be achieving the 5 a week target by Ethnic Group and sex across Birmingham based the HSE1999 estimates and 2001 Census resident population

over 25

Origin - South Birmingham PCT Public Health Team March 2004

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6.

Interventions

6.1.

Local authority provision

Birmingham City Council (BCC) is the largest leisure provider in the city with X sites across the city (Figure 8). There are other private providers however there is no single source of these facilities, nor information on how many people use them.

Figure 8: A map of BCC leisure facilities and wards

12

Origin - South Birmingham PCT Public Health Team March 2004


6.2.

Exercise on prescription

In Birmingham there has been an Exercise on Prescription Scheme since 1994 and over 9,000 people have been referred by their GP. The scheme is for people aged between 15 and 74 who have got some of the risk factors which can lead to coronary heart disease. This includes being overweight, smoking, high cholesterol, family history of heart disease, high blood pressure or a very stressful lifestyle. Other people are referred to prevent osteoporosis, to improve mobility, to help control diabetes or to help treat depression to name but a few.

6.2.1.

The service

If a GP or Practice Nurse feels that you are a patient is suitable person to be referred onto the Exercise on Prescription Scheme they will complete a Prescription Card and arrange an appointment with the most local Health and Fitness Advisor. The initial consultation at the Leisure Centre with the Health and Fitness Advisor will last up to an hour and involves an explanation of the scheme, a talk about any relevant medical conditions, your current physical activity levels, the activities on offer locally, a tour of the Leisure Centre and devising an exercise plan. At their next session referrals have the option of having a fitness appraisal; a set of measurements such as height, weight, body composition and fitness before starting an exercise programme. There are lots of activities to choose from - there's something for everyone. Once a referral has started their exercise programme they will see their Health and Fitness Advisor for support and guidance during the next 12 weeks. At this point they will meet again to discuss progress, complete another fitness appraisal if appropriate and compare results and discuss future exercise participation. A report is then sent to the GP surgery. The Exercise on Prescription Scheme operates at the following sites:             

Cocks Moors Woods Leisure Centre Sparkhill Pool and Fitness Centre Kingstanding Leisure Centre Newtown Pool and Fitness Centre Shard End Community Centre and Sports Hall Saltley Community Leisure Centre Northfield Pool and Fitness Centre Fox Hollies Leisure Centre Wyndley Leisure Centre Stechford Cascades Handsworth Leisure Centre Erdington Pool & Turkish Suite Castle Vale Community Leisure Centre

Origin - South Birmingham PCT Public Health Team March 2004

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7.

Access Rates

7.1.

Birmingham City Council Leisure Card holders

The council’s Sport and Leisure department kindly provided data from their leisure card membership system on those people who have registered on this system. These data included people who held two types of cards available: (i) the standard card - free to all for collection of Points that accumulate to give discounts, and (ii) the Passport to Leisure card that costs £4 a year and is available to those over 60, full time students, those looking after child, carers or those in receipt of certain benefits. With this card a person pays reduced rates on activities at all centres. The Leisure service made data available on all card holders and which leisure centre they had registered with. They could not provide data on Passport to Leisure separately, nor the activities undertaken.

7.1.1.

Uptake by demography

There are two peaks in membership applications: the first in the 15-24 age group; and the second at retirement age, 60-64 for females and 65-69 for males. Overall females had higher membership rates (Figure 9). Figure 9: Age sex specific rates of BCC Leisure card holders, rate per 1,000 population.

600.0

Rate per 1,000 populaiton

500.0

400.0

300.0

200.0

100.0

0.0 0-4 5-9 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+ 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 Males

14

Females

Origin - South Birmingham PCT Public Health Team March 2004


7.1.2.

Geographical uptake

There is a six fold difference in the uptake of BCC Leisure Cards across the City, ranging from a low of 6.7% in Ladywood to a high of 37.1% in Oscott; the average is 18.6% (Figure 10). Figure 10: Percentage of the population who have Leisure Cards by ward

Birmingham Oscott Selly Oak Kingsbury Moseley Perry Barr Brandwood Sutton Vesey Sutton Four Shard End Kingstanding Fox Hollies Billesley Hall Green Acock's Green Stockland Green Sparkbrook Northfield Bournville Sheldon Aston Weoley Yardley Quinton Sutton New Hall Sandwell Harborne Erdington Soho Hodge Hill Small Heath King's Norton Edgbaston Longbridge Washwood Bartley Green Nechells Handsworth Sparkhill Ladywood 0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

% of population

Origin - South Birmingham PCT Public Health Team March 2004

15


7.1.3.

Uptake by BME groups

Of those members whose ethnicity is recorded 74.1% of them classify themselves as white (compared to 70.4% of the population of Birmingham. For those from Black and Minority Ethnic groups the Bangladeshi, Indian and Pakistani populations were all less likely to have a Leisure card.

Figure 11: The comparison between the relative composition of the Leisure point members compared to the population of Birmingham, by Black and Minority Ethnic group.

12.0 10.0

%

8.0 6.0 4.0 2.0

Members

16

M

Population

Origin - South Birmingham PCT Public Health Team March 2004

ta ni

O th er

Pa kis

ixe d

R

ac e

In di an

ne se Ch i

Ca rib be an Ba ng la de sh Bl i ac k Af ric an Bl ac k O th er

BA

As ia n

O th er

0.0


7.1.4.

Uptake and Deprivation

There is a strong negative relationship between membership and deprivation. The most deprived communities have the lowest rates of membership. Figure 12: Relationship between Leisure Card Membership and deprivation, with wards identified by PCT

rate per 1,000 population

400

300

200

100

0 0

10

20

30

40

Affluent

50

60

70

Deprivation HoB

North

South

80

90

Deprived East

Linear fit

Origin - South Birmingham PCT Public Health Team March 2004

17


7.2.

Exercise on Prescription

7.2.1.

Data quality

The purpose of data collection for exercise services is not centred on population analysis. The main function is to provide the information required for the contract monitoring. This has serious implications for the completeness of recording of the data items that are used in population analysis namely age, sex, ethnicity, socio-economic data and residency. Nor is information routinely collected on reason for referral. 7.2.2.

Variation by sex

The service is predominantly accessed by females, the ratio being 2:1 (Table 6). Table 6: Exercise on Prescription: Usage by sex, by PCT 2003.

East Male Female

33.5 66.5 100.0

Overall

7.2.3.

HoB

South 28.0 72.0 100.0

North

Birmingham 34.4 33.9 65.6 66.1 100.0 100.0

39.0 61.0 100.0

Variation by Age

The largest percentage of people on the scheme is in the 35-54 (43.4%), however this is also the widest age group spanning 20 years (Table 7). It is in fact the 55-64 age group that is enrolled more than any other age group. Table 7: Exercise on Prescription: Usage by Age, by PCT 2003.

East 0 – 16 17 – 24 25 – 34 35 – 54 55 – 64 65 – 74 Overall

18

HoB 1.4 2.2 9.4 44.0 24.5 18.4 100.0

South 1.0 5.3 14.6 47.8 17.0 14.3 100.0

0.3 3.9 8.6 41.6 26.6 19.0 100.0

North 0.7 1.6 6.6 40.0 26.6 24.5 100.0

Birmingham 0.8 3.6 10.1 43.4 23.4 18.7 100.0

Origin - South Birmingham PCT Public Health Team March 2004


7.2.4.

Variation by ethnic group

The ethnicity profiles of those referred to the scheme were compared to those of the PCTs resident population at the time of the 2001 Census. This found that East has poor access rates for its Black and Minority ethnic groups and South was not much better especially for the Black groups. Heart of Birmingham were referring many more Asians but not Blacks, whilst North again was referring fewer Blacks. Table 8: Exercise on Prescription (EoP): Usage by sex, by PCT 2003 compared to ethnic population recorded in 2001 Census. East EoP White – UK

HoB

Census EoP

South

Census EoP

North

Census EoP

Birmingham

Census EoP

Census

71.9

18.8

72.9

82.8

58.7

Irish

4.7

2.6

3.0

4.2

3.4

Other

1.1

1.0

1.1

0.5

White overall Black – Caribbean

77.7

90.7

22.4

29.1

77.0

84.4

87.5

0.9 90.7

63.1

71.6

4.3

2.6

27.0

10.7

6.7

2.4

5.2

2.6

12.1

4.7

African

0.0

0.2

2.4

1.3

0.2

0.5

0.0

0.2

0.8

0.6

British

1.4

0.3

5.2

1.3

2.3

0.3

1.2

0.3

2.8

0.6

Asian - Indian

3.6

2.8

12.6

13.1

5.5

3.9

3.8

2.8

6.9

6.0

Pakistani

8.3

0.8

22.0

29.2

5.6

3.3

0.2

0.8

9.7

9.4

Bangladeshi

0.0

0.2

2.1

7.0

0.9

0.4

0.0

0.2

0.9

2.1

Kashmiri

0.7

0.7

0.3

0.0

0.4

British

2.2

2.2

0.2

0.9

1.2

Other

1.1

Not disclosed

0.7

0.9

0.3

0.0

0.5

100.0

100.0

100.0

100.0

100.0

Overall

0.6

2.6

3.0

1.2

1.4

1.2

Origin - South Birmingham PCT Public Health Team March 2004

0.6

1.6

1.6

19


7.2.5.

Variation by Deprivation

The scheme does not report the postcode of the client and therefore it is not possible to report whether there are any socio-economic variations in the prescribing of scheme. It is highly likely that there are such inequities in the scheme. This assumption is based on the analysis of referrals to the scheme by South Birmingham PCT GPs compared to list deprivation. This analysis (see Figure 13) shows that despite a slight relationship between increased referrals and deprivation it is not consistent.

Figure 13: Exercise on prescription referral rate by Practice against estimated practice deprivation, 2003 SBPCT.

1.6

Referral rate per 100 patients on list

1.4 1.2 1 0.8 0.6 0.4 0.2 0 20

25 Affluent

20

30

35

40

Deprivation

Origin - South Birmingham PCT Public Health Team March 2004

45 Deprived

50


8.

Observations 

Leisure Care uptake is inversely related to deprivation. If this reflects usage then it seems that the more deprived communities do not access City Council leisure facilities. Membership is low in the Indian, Pakistani and Bangladeshi populations

Exercise on prescription is used predominantly of females. There are very different referral patterns across the four PCTs and our Black populations are not being referred as much as the White and Asian population.

Exercise on prescription is not used by all GPs.

9.

Recommendations %%%%%%%%%%%%%  Data collection needs to be overhauled to be useful for health equity audit evaluation in particular the data needs to be stored electronically to enable cross tabulation of the data items and additional fields for practice and postcode of residence added. 

The exercise estimates need to be validated either against the forthcoming lifestyle survey or from data recorded in primary care.

Origin - South Birmingham PCT Public Health Team March 2004

21


Appendix Appendix A Level and strength of evidence for a relationship between physical activity and contemporary chronic conditions (Source: At least five a week, Department of Health, 2004)

22

Origin - South Birmingham PCT Public Health Team March 2004


Exercise_across_Birmingham_A_Health_Equity_Audit_2004