Wider determinants of health

3 Wider determinants of health A variety of factors, both social and environmental, impact on an individual s health. This chapter considers how these wider determinants of health are at work in Southwark. Deprivation and income There is known to be a strong and life-long association between deprivation and poorer health. To measure the degree of deprivation in a given population the Department of Environment, Transport and the Regions (DETR), calculates a score called an Index of Multiple Deprivation (IMD). Seven components are factored into the IMD score: values for Income, Employment, Health deprivation and Disability, Education skills and training, Housing, Geographical access to services, and Living environment (these individual components are called domains and each have individual scales). At the lowest level IMD scores are calculated for geographical areas containing about 1,500 people termed Lower layer Super Output Area (LSOA) of which there are 165 in Southwark. There are 33 local authority districts in London and 354 local authority districts in England. For any IMD, or domain scale, rank 1 indicates that the LSOA or district is the most deprived thus larger rank scores are an indication of decreasing deprivation. Table 3.1 Southwark indices of deprivation 2007 Southwark rank order within national scores, out of 354 IMD Income scale Employment scale Southwark rank order within London scores, out of 33 IMD score Income scale Employment scale 26 18 22 9 7 2 Source: Office of Deputy Prime Minister, 2004 In the most recent IMD (2007, using 2005 data) Southwark borough ranked 26 against 354 local authority districts within England, and ranked 9 within London s 33 boroughs. Four years earlier Southwark was ranked 17 nationally; and 6 within London. Therefore on this measure, on London and national rankings, Southwark is showing an improvement. Figure 3.1 plots the IMD scores at LSOA level for Southwark. It can be seen that wards in the south of the borough (College, Village and Dulwich), and some along the Thames (Riverside ward and Surrey Docks), are the least deprived. East Walworth, Camberwell Green, Peckham, Livesey and Rotherhithe wards have more deprivation with LSOAs bordering Peckham High Street and the Old Kent Road amongst the most deprived. 11

Figure 3.1 Index of Multiple Deprivation deciles, LSOA, Southwark, 2007 Source: Office of the Deputy Prime Minister, 2006 after a map produced by Southwark Analytical Hub December 2007 The health and disability deprivation map of Southwark (Figure 3.2) shows that the areas with the highest levels of deprivation occur in the East Walworth, Nunhead, South Bermondsey and Rotherhithe wards. Areas with low levels of deprivation occur in the south of the borough, in parts of the Riverside, Surrey Docks and Chaucer wards in the north. Figure 3.2 Index of Health & Disability Deprivation deciles, LSOA, Southwark, 2007 Source: Office of the Deputy Prime Minister, 2006 after a map produced by Southwark Analytical Hub December 2007 12

Table 3.2 shows that all but two of Southwark s 21 wards improved their IMD score in the four years between IMD2004 and IMD2007. Ward scores for East Walworth and Newington worsened. The same five wards East Walworth, Livesey, Camberwell Green, Peckham and Nunhead remained as the most deprived in both studies. Table 3.2 IMD2007 & IMD2004, ward scores & rankings, Southwark IMD2007 IMD2004 IMD2007/ 04 Ward score rank Ward score rank differ in rank Most deprived East Walworth 43.57 1 42.08 5 4 Livesey 42.28 2 46.18 1 1 Camberwell Green 41.80 3 45.39 2 1 Peckham 40.36 4 44.81 3 1 Nunhead 40.82 5 44.06 4 1 The Lane 38.14 6 38.16 8 2 South Bermondsey 37.57 7 38.95 7 0 Newington 37.92 8 37.88 10 2 Faraday 36.86 9 39.28 6 3 Brunswick Park 35.22 10 38.10 9 1 Rotherhithe 33.71 11 35.42 12 1 Grange 33.05 12 36.74 11 1 Cathedrals 32.30 13 32.33 14 1 Chaucer 29.59 14 33.46 13 1 Riverside 27.27 15 31.24 15 0 College 27.79 16 28.03 18 2 South Camberwell 27.52 17 30.01 16 1 Peckham Rye 26.88 18 28.51 17 1 Surrey Docks 22.99 19 25.82 19 0 East Dulwich 22.84 20 24.32 20 0 Village 16.97 21 18.11 21 0 Least deprived 13

The most deprived areas in Southwark Figure 3.3 plots (purple) IMD values for LSOAs that are within the ten percent most deprived in England. They are located in East Walworth, Camberwell Green, Peckham, Rotherhithe, South Bermondsey, Livesey, and The Lane and Nunhead wards. Figure 3.3 Index of Multiple Deprivation, LSOAs within most deprived decile, Southwark, 2007 Figure 3.4 plots the IMD rank order differences between the IMD2004 and the IMD2007. Areas that are shaded blue have reduced deprivation levels. Many areas show reduced deprivation during this period, an area of the Grange ward having the most improvement. Areas that are shaded purple represent a slight increase in deprivation and include parts of the Cathedrals ward in the north, Newington, South Bermondsey and Brunswick Park wards in the centre of the borough and in the Peckham Rye and College wards in the south. 14

Figure 3.4 Index of Multiple Deprivation 2004 to 2007, change in overall rank deprivation deciles Source: after map produced by Southwark Analytical Hub, December 2007 Figure 3.5 plots the health deprivation and disability domain rank order differences between the IMD2004 and the IMD2007. As with Figure 3.4 areas that are shaded blue report reduced deprivation and are widely dispersed across the borough, areas in Peckham, Chaucer and South Bermondsey showed the most improvement. More parts of the borough are coloured purple with worsening health and disability deprivation, an area in the Riverside ward, in the north of the borough, experienced the greatest deterioration. Figure 3.5 Index of Health Deprivation and Disability 2004 to 2007, change in overall rank deprivation deciles Source: after map produced by Southwark Analytical Hub, December 2007 15

Income and Benefits There is a positive relationship between income and health, generally the wealthier you are the better your health. In 2007 on average, full time working men in Southwark earned 576 per week, less than the London average ( 596), by contrast women in Southwark earned 27 more than the London average of 506. Southwark s employment rate is below that of England, in 2005/06 two-thirds of Southwark s working age population were employed compared to around three quarters for England. Table 3.3 Employment rate 1997/98 to 2005/06 1997/8 1998/9 1999/00 2000/1 2001/2 2002/3 2003/4 2004/5 2005/6 Southwark 60.6 62.7 65.9 61.6 64.4 64.1 63.8 64.3 63.2 England 73.3 74.1 74.4 75.2 75.1 75.0 75.0 74.8 74.4 Source: Department for Work and Pensions, Annual Local Area Labour Force Survey (ALALFS) Annual Population Survey (APS) employment rates, 1997/98 to 2005/06 The number of people in Southwark with no qualifications has increased from one third in 2001/02 to 36.5 percent in 2004/05. For England over the same period it fell slightly. Table 3.4 Employment rates of those with no qualifications 2001/02 to 2005/06 2001/02 2002/03 2003/04 2004/05 Southwark 33.3 29.7 37.6 36.5 England 52.0 50.6 50.1 50.1 Source: Department for Work and Pensions, PSA Floor Targets In May 2007, just over 32,000 Southwark working-age residents claimed one or more Department for Work and Pensions (DWP) benefits. Incapacity Benefits made up the largest proportion of this total, followed by Lone Parents and Jobseekers Allowance (JSA). As a proportion of the resident working age population, 16.9 percent of the Southwark working age population claimed one or more benefits, several percent above the average rates for London and Great Britain. Table 3.5 Working-age benefit claimants, percentage of working age population, May 2007 Southwark total Southwark (%) London (%) Great Britain (%) JSA 7,180 3.8 2.9 2.3 Incapacity Benefits 13,610 7.1 6.1 7.2 Lone Parents 7,500 3.9 3.2 2.1 Carers 1,250 0.7 0.7 1.0 Others on income related benefits 1,270 0.7 0.6 0.5 Disabled 1,190 0.6 0.7 0.9 Bereaved 280 0.1 0.2 0.3 All claimants 32,270 16.9 14.4 14.2 Source: DWP benefit claimants working age client group JSA is payable to people under pensionable age who are available for, and actively seeking at least 40 hours work a week. The latest, October 2007 figures, show almost 7,000 JSA claimants in Southwark (Table 3.6). Southwark had a higher proportion of JSA claimants compared to London and Great Britain. 16

Table 3.6 JSA claimants, percentage of working age population, Oct 2007 Southwark total Southwark (%) London (%) Great Britain (%) Males 4,865 4.8 3.6 2.9 Females 2,102 2.3 1.8 1.2 All people 6,967 3.6 2.7 2.1 Source: ONS claimant count with rates and proportions Housing Poor housing environments contribute to both mental and physical ill health through poor amenities, shared facilities and overcrowding, inadequate heating or energy inefficiency. In 2001, more than half of Southwark s residents lived in rented accommodation, much higher than that for England (19%) and London (26%). Conversely, a smaller proportion will own a home (31%) compared to England (69%) and London (57%), Table 3.7. Table 3.7 Household tenure, percentages, 2001 own own with own rented rented rented rented outright mortgage shared from social reg. private/ from or loan ownership council landlord agency other Southwark 9.7 20.3 1.4 42.3 11.2 12.5 2.6 London 22.1 33.5 1.0 17.1 9.1 14.3 2.9 England 29.2 38.9 0.7 13.2 6.1 8.8 3.2 Source: ONS, Census 2001 Southwark s 105,806 households differ to those across England and Wales. In 2001, more Southwark households were occupied by one person (37% Southwark; 30% England and Wales), many fewer were occupied by married couples (20% Southwark; 36% England and Wales), and there were more lone parents. Table 3.8 Household composition, 2001 Southwark E&W E&W rank London rank % average % /out of 376 /out of 33 One person households 37.3 30.0 14 10 Married couple households 19.9 36.5 368 25 Cohabiting couple households 9.6 8.3 37 3 Lone parent households: with dependent children 10.0 6.5 9 6 with non-dependent children only 3.9 3.1 17 6 All other households 19.2 15.6 24 8 Source: ONS, Census 2001 Social housing in Southwark has improved over recent years, in 2006 the percentage of non-decent housing was 37 percent (2006 data), Figure 3.6. Figure 3.6 Social sector non-decent housing in Southwark, percentage of Local Authority & Registered Social Landlord property, 2003/06 Source: PSA Floor Targets, Local Authority Profiles, Southwark, August 2007 17

Education Education level influences employment opportunities and income. These have been shown to impact on housing, community participation and many other determinants of health. Higher levels of educational achievement are associated with improved health and wellbeing in later life. In 2007 there were a total of 36,100 pupils in Southwark s 91 schools, Table 3.9. Table 3.9 Southwark schools, 2007 Type of establishment Schools Pupils Nursery 5 518 Primary 71 22,540 Secondary (maintained) 10 8,333 Academies + CTC 5 4,711 Total 91 36,102 Source: Southwark Education, School Census January 2007 In 2005/06 at least 30% of pupils in all Southwark schools achieved five or more GCSE grades A* C in 2005/06, a higher rate than England (Figure 3.7). However, there is still some way to go to improve grades at Key Stage 3 to reach targets in English, Maths and Science. Figure 3.7 Southwark educational achievements, 2002/03 to 2005/06 Source: PSA Floor Targets Local Authority Profiles, Southwark, August 2007. Compared to the rest of the Great Britain more Southwark residents have higher qualifications (36.5%). Table 3.10 also shows there are more people in the borough with no qualifications a third more than both the London and Great Britain average. 18

Table 3.10 Southwark qualifications Jan 2006 to Dec 2006 Southwark numbers Southwark (%) London (%) Great Britain (%) NVQ 4 equivalent and above 59,600 36.5 34.6 27.4 NVQ 3 or equivalent 78,100 47.7 47.9 45.3 NVQ 2 or equivalent 97,300 59.5 60.9 63.8 NVQ 1 or equivalent 112,300 68.7 70.7 77.7 Other qualifications 17,400 10.7 15.3 8.5 No qualifications 33,500 20.5 13.9 13.8 Notes NVQ 4 equivalent and above: HND, Degree and Higher Degree level qualifications or equivalent NVQ 3 equivalent: NVQ 2 equivalent: NVQ 1 equivalent: 2 or more A levels, advanced GNVQ, NVQ 3, 2 or more higher or advanced higher national qualification (Scotland) or equivalent 5 or more GCSEs at grades A-C, intermediate GNVQ, NVQ 2, intermediate 2 national qualification (Scotland) or equivalent Source: ONS Annual Population Survey, 2006 fewer than 5 GCSEs at grades A-C, foundation GNVQ, NVQ 1, intermediate 1 national qualification (Scotland) or equivalent Other qualifications includes foreign qualifications and some professional qualifications Demographics and wider determinants of health summary l Southwark has a young, ethnically diverse and growing population. Such variations have implications for health and social care throughout the borough. For example, increasing population places pressure on health resources and people from different backgrounds/ cultures have different health needs. It is important to understand the make up of the local population and to gather accurate population data, in order to plan effectively to provide the appropriate level of health services. 19