Lancashire's growing health divide laid bare - and why one medic thinks business can help bridge it

Employers across Lancashire are being urged to get more involved in efforts to improve the county’s health and wellbeing.

The call comes from Lancashire’s director of public health in response to statistics showing the scale of the gap between overall life expectancy in the region and the number of years residents can expect to be well.

Dr. Sakthi Karunanithi, Lancashire's director of public health

Dr. Sakthi Karunanithi, Lancashire's director of public health

Dr. Sakthi Karunanithi has just published a report in which he claims the county has been “adding years to our lives, but not necessarily life to our years”.

On average, both men and women in Lancashire will spend their final 17 years of life in poor health. That means the typical resident will have become ill several years before they even reach the official retirement age.

According to Dr. Karunanithi, employers should bear some of the burden in helping to prevent that deterioration – even if it is not for entirely altruistic reasons.

“We’re seeing people becoming iller earlier – and that is really going to have an impact on the economy if we don’t do something about it now.

“It’s soon going to be too late for businesses to realise that the health of the workforce is going to have an impact on their bottom line – if not directly, via the health of their own employees, then through people in work becoming carers for their loved ones.

“There’s so much businesses can do [to improve health] that makes a difference to their bottom line and productivity – there is a need to do everything we can to make our workplaces healthy,” he explains.

Dr. Karunanithi says that employers need to transform their “organisational culture” and consider all aspects of the lives of their staff both inside and outside the workplace. He wants to partner with businesses to develop a wholesale “Lancashire offer” for workforce health – so that standards are the same across the county.

Public Health England suggests various ways in which employers can make a difference – including by providing access to occupational health services and encouraging healthy practices amongst their staff.

But for Dr Karunanithi, businesses are just one section of society with which the NHS needs to forge “novel new partnerships” in order to truly tackle the underlying causes of ill health.

His comments come in response to figures showing some measures of health inequality between Lancashire and the rest of England – and within different parts of the county itself – are widening.

The gap in life expectancy for women between the most and least deprived areas of Lancashire increased to a little over eight years between 2015 and 2017, while for men it stood at more than ten years.

Meanwhile, statistics show that the disparity in healthy life expectancy between the most affluent and most impoverished parts of the county was more than 15 years during the last decade.

“That is very closely linked to housing, income and access to good quality jobs and education,” Dr. Karunanithi says.

“Just providing a service for people who smoke, drink or are overweight isn’t going to be enough.”

His report, “Investing in our Health and Wellbeing”, suggests that Lancashire needs to target local areas on a relatively small scale in order to make a real difference to the complex factors which interact with each other to create the conditions for poor health.

There should be investment in the “assets and strengths of specific communities” – while citizens should be engaged to take action for themselves and the places where they live, the reports says.

Challenged on the wisdom of such a devolved approach, Dr. Karunanithi denies that the agenda is one of absolving the NHS of responsibility for good health and attempting to place the burden – and the blame – elsewhere.

“The NHS is there predominantly for when people fall ill. But even the NHS is finding it very difficult to cater for the rising demands [on it] because of ill health.

“Our clinical services account for only 20 percent of determining health and wellbeing for any one of us. The rest is determined by how good a start we have [as] children, our education and access to good quality employment and disposable income, housing and transport.

“Obviously there are also some key things like smoking, alcohol and obesity – all of which are on the rise and we need to do something collectively [about].”

Lancashire County Council’s cabinet member for health, Shaun Turner, adds that the benefits of a co-ordinated approach to improving the region’s health would be felt by all those who need to work together to make it happen – as well as the individuals themselves.

But he acknowledges that a focus on the role of employers is only relevant for people with a job.

“If you live in poverty, you’re much more likely to be iller – work is the answer to that and instigating a decent economy, because you’re wealthier if you’ve got your health.

“A workless person would save the system £12,000 [if they moved into work]. That would be shared between ourselves, the NHS and government – so let’s get people back into work, give them some self-belief, some money in their pocket and their health,” County Cllr Turner said.

But that aspiration stands in the shadow of the harsh facts about life in some parts of Lancashire today.

Almost a quarter of the nearly 800 smaller locality areas into which the county is divided are in the 20 percent most deprived across England – a measure which has deteriorated since 2015. Preston, Hyndburn, Pendle and – lowest of all – Burnley all fall into that category as whole districts.

Only Ribble Valley sits in the 20 percent most affluent parts of England – and the statistics about the smaller localities which achieve that accolade are also heading in the wrong direction, down from 18.8 percent in 2015 to 18.3 percent today.

The county’s clinical commissioning groups (CCGs), which are responsible for securing health services for the population, currently spend 16 percent of their budgets on the two percent of people who represent their most complex patients.

Overall, Lancashire is ranked as the most disadvantaged of the 26 county council areas in England.

But Dr. Karunanithi still senses a cause for optimism after witnessing the effects of a pilot initiative last year which focused on identifying and addressing health and wellbeing needs at a hyper-local level. Chorley and Fleetwood were both used as test beds for the concept, known as “total neighbourhoods”

“With advances in technology and analytics, people are starting to work together better than we perhaps used to do.

“We’re seeing a recognition that whatever we have done [to date] hasn’t taken us far enough to make an impact, so this is all about using intelligence and information to make better decisions.

“It does fill me with hope that colleagues and various sectors are coming together to make a positive difference.”

GETTING BUSINESS ON BOARD

According to the North and Western Lancashire Chamber of Commerce, employers are increasingly aware of their role in improving the health of the people they rely on to run their business.

“Increasing productivity is crucial for businesses across Lancashire to remain competitive – and reducing time, and money, lost to sickness is an important part of achieving this,” says Geoff Mason, the organisation’s policy manager.

“There is more interest than ever in the training courses run by the Chamber that cover these areas, especially those [relating to] stress and mental wellbeing. Our ‘Get Active’ series of events…aim to encourage both physical exercise and team building.

“Looking at new companies joining the Chamber’s membership, it would seem this is a growing sector. Several wellbeing practitioners have set up and are engaging with companies. This is positive news not only for the workforce, but also for productivity and the local economy,” he adds.

Amongst those fulfilling the demand for workplace wellness initiatives is Chorley-based Helen Kimber, who finds that her services as a nutritionist, personal trainer and yoga expert are now being called on by companies as well individuals.

“Your most important asset as a business is the people who work for you,” says Helen, whose Hero Lifestyle firm will shortly deliver a course on helping women going through the menopause to a non-ministerial government department.

“If you treat them well, you’ll reap the rewards – and treating them well doesn’t necessarily mean in monetary value, but maybe getting people in to talk to them about health and do some work with them.

“I find that people are quite welcoming – as long as you’re not preaching to them.

“If, as an employee, you are knowledgeable about [health], you can make more decisions for yourself about how to live. You might also have more resilience – so that when life does throw something at you, you can perhaps cope with it better.”

HOW CAN BUSINESSES BOOST LANCASHIRE’S HEALTH?

Public Health England has given business the basics about how it can better look after its staff:

***Encourage healthy behaviours such as taking regular breaks, physical activity and eating well.

***Promote uptake of health risk reduction programmes on issues such as obesity and smoking.

***Provide access to occupational health services and other strategic support for staff – and ensure they are aware it exists..

***Consider reasonable adjustments such as flexible working.

***Train managers in how to talk to colleagues about physical and mental health.

IN NUMBERS

Life expectancy at birth in Lancashire – Men: 78.6 years (England average 79.6); Women: 82.2 years (England average 83.1)

Healthy life expectancy at birth in Lancashire – Men: 61.1 years (England average 63.4); Women: 64.5 years (England average 63.8)

Source: Lancashire director of public health, for the period 2015-2017

DEPRIVATION RANKINGS

Every local authority area in the country is ranked according to its "relative level" of deprivation. The calculation is based on 39 indicators which take into account not only poverty - a lack of financial means - but also whether residents are deprived of other types of resources.

This is how Lancashire fared in the 2019 indices of multiple deprivation. Each council area is ranked out of 317, where 1 is the most deprived in England and 317 the least.

Blackpool - 1

Burnley - 8

Blackburn with Darwen - 9

Hyndburn - 16

Pendle - 33

Preston - 45

Lancaster - 89

Rossendale - 92

Wyre - 129

West Lancashire - 155

Chorley - 177

Fylde - 195

South Ribble - 204

Ribble Valley - 283