Health and Wellbeing
Health and Wellbeing
Life Expectancy
Why is this important?
Life expectancy and healthy life expectancy are extremely important summary measures of overall population health. The Marmot Review, Fair Society, Healthy Lives, demonstrates clear and significant links between avoidable differences in health outcomes and deprivation, where people experiencing multiple deprivation not only living shorter lives, but spend a greater portion of their shorter lives with a disability or in poor health. As a Marmot city, Coventry has adopted and embedded the principles of Marmot, tackling the social conditions that can lead to health inequalities, and working to improve the areas in which people are born, grow, live, work and age.
What is the local picture? How does it compare?
There are health inequalities across Coventry whereby areas with higher levels of deprivation tend to have lower life expectancy. Hillfields is one of these areas. Life expectancy is a statistic giving a high-level picture of the health of Coventry residents and should be used with care in understanding likely life spans for people; excess deaths due to the COVID-19 pandemic will have had a negative impact on life expectancy statistics but this may not have a permanent impact. Whilst this data includes 2020 and the pandemic will have undoubtedly affected mortality statistics, life expectancy increases had already stalled before 2020.
Life expectancy (LE) in Hillfields for both males and females is lower than the rest of the city overall, the gap being particularly high for males living here. Healthy life expectancy (HLE) is also significantly lower than average here, on average people suffer poorer health earlier in their life than other places. In Hillfields this is particularly the case for females, HLE being substantially lower than that of Coventry and England as a whole.
Table: Life expectancy at birth 2016-2020 by MSOA, the most up to date figures available at local level
|
Area |
Life Expectancy (LE) at birth (years) (2016-20) |
|
|
Female |
Male |
|
|
Hillfields |
81.6 |
74.3 |
|
|
|
|
|
Coventry |
82.1 |
78.1 |
|
England |
83.2 |
79.5 |
Source: The Office for Health Improvement and Disparities 2022, Crown Copyright.
Health inequalities across the city mean that people in more deprived parts of the city, like Hillfields, not only live shorter lives, but also spend a greater proportion of their shorter lives in poor health. The gap between healthy life expectancy at birth (HLE) and life expectancy at birth (LE) is referred to as the ‘window of need’. While this gap in Coventry is bigger than that of England as a whole, for the people in the Hillfields area is even bigger, particularly so for females. In Hillfields, females spend 35% of their expected life span in poor health, a higher proportion than the 25% for females in Coventry or the 22% nationally. This window of need is wider for females than males, partly due to the longer life expectancy of women, which means they spend more of their lives in poor health.
Table: Life expectancy (LE) at birth & healthy life expectancy (HLE) at birth 2009-2013 by MSOA*.
|
Area |
Healthy life expectancy at birth (2009-2013) |
Life expectancy at birth (2009-2013) |
Window of need (2009-2013) |
|||
|
Female |
Male |
Female |
Male |
Female |
Male |
|
|
Hillfields |
52.1 |
54.6 |
80.5 |
75.7 |
28.4 |
21.1 |
|
|
|
|
|
|
|
|
|
Coventry |
61.8 |
61.2 |
82.1 |
77.9 |
20.3 |
16.7 |
|
England |
64.8 |
63.5 |
83.0 |
79.1 |
18.2 |
15.6 |
Source: The Office for Health Improvement and Disparities, Crown Copyright.
*The most up to date figures available at local level for healthy life expectancy, data for LE is presented for the same period to accurately calculate the ‘window of need’. The data for 2016-20 LE in the table above is the best to use to understand LE alone. This is the most up to date data at MSOA level, for more up to date information for Coventry City as a whole please see our Citywide profile
Premature mortality (deaths under 75) is significantly higher in Hillfields than in Coventry and the national average. The standardised mortality ratio (SMR), which adjusts for different age structures across populations, is 148.7 in Hillfields, compared to 116.9 in Coventry overall and 100 nationally. An SMR of 100 represents a mortality rate the same as the national average given the age structure of the population. This means Coventry's premature mortality is 16.9% above the national average, after the age structure of the population has been accounted for, and 48.7% higher the national average in Hillfields.
Hillfields ranks 10th out of 42 Coventry areas for premature mortality, with particularly high rates of premature deaths from cancer (124.4) and circulatory disease for the same age group (151.0). It is also the 8th highest for deaths considered preventable (174.3), In this instance, a ‘preventable’ death is one which is considered as avoidable through public health or primary interventions.
What else is happening? What else can be done?
A social gradient approach focusing on people’s prospects and opportunities, housing, and environment and lifestyle factors can help improve outcomes, and reduce inequality and reduce premature mortality. Themes that have been explored throughout this JSNA.
Health Protection
Why is this important
Health Protection is a term used to cover a set of activities within public health. It is defined as protecting individual, groups and populations from single cases of infectious disease, incidents and outbreaks, and non-infectious environmental hazards such as chemicals and radiation. Monitoring health protection coverage helps to identify possible drops in immunity before levels of disease rise.
Before the introduction of widespread immunisation and vaccinations, infectious and communicable diseases (that is, diseases that can spread from one person or living organism to another) were a major and widespread cause of death and permanent disability, especially among children.
To stop the spread of vaccine-preventable diseases and ensure herd immunity, it is important to maintain 95% vaccination coverage. Monitoring health protection coverage helps to identify possible drops in immunity before levels of disease rise. The Covid-19 pandemic has underlined the importance of health protection and vaccination. Data on Covid-19 for this area was not yet available at time of writing this profile.
What is the local picture? How does it compare?
The COVID-19 pandemic had a significant impact on Hillfields, with 3,432 recorded cases between March 2020 and May 2022. This is out of a total population of 13,442 from the 2021 Census, a case rate of 255.3 per 1,000 residents, similar to the overall city rate for this period of 324.8. On the face of it, this indicates that Hillfields had one of the lowest case rates of all Coventry areas, however we should be mindful when comparing the area’s case rate to other areas, these official cases do not represent all cases, not all people who had COVID-19 in this period will have taken a test or reported its result and some people were asymptomatic so were unaware they had the virus. Therefore, these figures do not count total prevalence, and it is difficult to conclude from differing case rates, it may be a result of different testing and reporting rates.
Many people suffer from ongoing symptoms, from ‘long COVID’; while we don’t know how many local residents suffer from this and if it higher or lower than average, the Office for National Statistics (ONS) estimates the prevalence of self-reported long COVID at 2.92% of all people living in private households in the UK in March 2023.
The number of people who died where COVID-19 was the underlying cause was relatively high amongst residents of Hillfields. Across the whole country, death rates associated with COVID-19 were higher in areas of higher deprivation and amongst many ethnic minority groups. Hillfields, a diverse area with relatively high levels of multiple deprivation, saw significantly higher than average COVID-19 mortality rates. In the three years 2020 to 2022, 21 residents died with the underlying cause being given as COVID-19, out of a total number of 184 deaths from all causes. We can compare mortality rates between areas using Standardised Mortality Ratios (SMRs), a measure used to compare the observed number of deaths in a specific population with the number of deaths that would be expected based on the age and sex-specific rates in a standard population. It helps to assess whether the mortality rate in a particular area or population is higher or lower than expected, after accounting for differences in age distributions of the population; this is important because death rates from COVID-19, and from all causes, are much higher in older people and some areas have older populations that others. The SMR for COVID-19 deaths spanning the period from 2020 to 2022 for Hillfields was 172.2. An SMR of 100 indicates a mortality rate the same as the England average after adjusting for the age profile of the population, the rate for Hillfields being over 100 means that death rates were 72% higher than the national average, after the age structure of the Hillfields population was adjusted for. This puts the COVID-19 death rate in Hillfields at much higher than the city average, one of the areas with the highest rates.
Coventry delivered hundreds of thousands of COVID-19 vaccines that protected many from severe illness or death and protected the health service. However, many remain unvaccinated, and vaccination rates are much lower than the city average in Hillfields. There is a strong link with deprivation with increasingly lower rates of vaccine coverage in areas of higher deprivation, and ethnic minority groups have lower rates in Coventry; so, Coventry’s rates are lower than the national average and Hillfields, an area of higher deprivation with an ethnically diverse population, has relatively low COVID-19 vaccination rates compared to the city average. By December 2023, 7,565 Hillfields residents had received their 1st dose of the COVID-19 vaccine, an uptake of 46.1% of residents aged 12+, lower than Coventry at 68.1%. 6,549 have received their 2nd dose, an uptake of 39.9% lower than Coventry at 63.3%. These uptake rates may be underreported due to the population data used by the NHS, but still Hillfields’ uptake rate is lower than the Coventry and national average. Vaccination rates are higher amongst older groups, although still lower than the Coventry average in Hillfields amongst older people; for local residents aged 65+ the coverage in the area is 79.5% for dose 1 compared to 93.1% for Coventry and 78.0% for dose 2 compared to 92.4% for Coventry.
The pandemic had many impacts, not all directly on residents’ physical health. The restrictions due to the pandemic and the lockdowns, may have had an impact on different aspects of health, not least mental health. The ONS conduct an annual survey where they ask people about their personal wellbeing, it indicates increased levels of anxiety amongst Coventry’s population during the pandemic. The % who gave a score indicating high levels of anxiety increased from 20.6% in 2019/20 to 26.9% in 2020/21. Responses to questions in the Coventry Household Survey 2022 give indications as to the impact that the COVID-19 pandemic had on people's lives, people were asked how worried they were about the impact of COVID-19 on their financial situation, their diet, their mental health, their physical health, and their feeling of loneliness; on a scale of 0-10, those scoring 7 or higher are classed as ‘worried’ in the statistics quoted below. Overall, considering margins of error due to sample sizes, the proportion of Hillfields residents who were worried about the impacts was higher than the city average.
63% said they were worried about the impact the pandemic had on their financial situation (Coventry average 40%), 36% said they were worried about the impact the pandemic had on their diet (Coventry 22%), 44% said they were worried about the impact on their physical health (Coventry 31%), 45% said they were worried about the impact the on their mental health (Coventry 38%), and 39% said they were worried about the impact on their feelings of loneliness (Coventry 28%).
As is the case for Coventry overall, uptake rates in Hillfields are below the 95% threshold for several different childhood vaccinations. There is no data specifically for vaccination rates within Hillfields itself, as the uptakes are based on individual GP practices and there are no dedicated GP practices located specifically within the boundary used for Hillfields area. As such, it is difficult to quantify the actual vaccination coverage for the area specifically. However, we can infer that residents of the area will use GP practices located in neighbouring areas; uptake rates vary across these practices, with some seeing lower uptake rates than the Coventry average across a range of childhood vaccinations at 12 months, 24 months and 5 years, and others seeing higher than average update rates. As such it is difficult to get an overall picture of uptake for children living in Hillfields, indications are that overall uptake is not significantly different from the Coventry average, but importantly lower than the 95% threshold. The range of uptake rate for local practices are:
- DTaP/IPV/Hib for one-year olds (a vaccination offered to babies to protect them against five serious childhood diseases) range between 82.5% and 98.0%, compared to the overall city’s uptake rate of 90.3% and national rate 91.8%.
- The rotavirus vaccine uptake (which protects against gastroenteritis) range between 76.2% and 91.8%, compared to 88.5% for the city overall and national rate 89.9%.
- MMR for 2-year-olds ranges between 81.9% and 97.9% compared to the overall city’s uptake rate of 88.5% and national rate 89.2%.
- MMR first dose for 5-year-olds, range between 86.4% to 98.2% compared to the overall city’s uptake rate of 92.9% and the national rate 93.4%.
- The rates for the second MMR dose for 5-year-old are considerably lower than the first dose, ranging between 69.7% to 92.1%, compared to the overall city’s rate 84.6% and national rate 85.7%.
Vaccination rates for key cohorts of people eligible to receive the annual seasonal flu vaccine was lower than the national average across Coventry in 2022/23 and indications are that uptake rates are lower still particularly amongst the older cohort in Hillfields, residents aged 65 years and over. For local GP practices uptake rates vary, but uptake amongst patients aged 65+ at all practices was lower than the Coventry average of 78.1% (England average 82.8%).
What else is happening? What else can be done?
Ensuring communities understand and trust public health messages, and that they are accessible and culturally appropriate is vital. Coventry has a very diverse and active voluntary and community sector with many small and well-connected groups, it is also blessed with many community leaders and “go to” people in local neighbourhoods. During the pandemic the Community Resilience Team created Community Messengers who consisted of existing faith, voluntary and community networks in the city. The number of messengers has now grown to 320. The messengers perform two main functions: -
- they help to disseminate into their community the “stay safe” messages.
- they collect and feedback community intelligence which is then used to influence a number of things such as improving our communication materials, focusing our interventions and deploying our local
teams of COVID-19 advisors.
Young people were included through a partnership with The Positive Youth Foundation, a charity that supports young people in the Coventry area (and who chair the Coventry Youth Partnership), and a series of focus groups held with young people and the council’s communications team helped the development of
specific messaging for young people, including several videos.
Community members now have a platform and a chance to participate directly in shaping how the council and communities engage with each other. This helps to facilitate a community-led response to communications and messaging surrounding several topics.
There is increasing recognition of the key role that places and communities play in our health. Community groups are best placed to address health challenges, because they are trusted and have the networks understanding and legitimacy to do so. Health and care providers need to shift to an ‘enabling’ leadership style, supporting communities to maintain their health and well being by pooling engagement resources and helping to build capacity by sharing skills and facilities with the communities we serve. The One Coventry Plan is designed to work with our communities to ensure that they are able to address their health needs and to reduce inequalities.
Since 2021, Coventry was successfully awarded funding to deliver the Healthy Communities Together (HCT) programme. This programme is funded by the National Lottery and aims to support local areas to develop effective and sustainable partnerships between the voluntary and community sector, the NHS and local authorities to improve health and wellbeing, reduce health inequalities and empower communities.
A community-informed and culturally competent approach to healthcare is essential to increasing screening and vaccination rates. Asylum seekers and refugees typically have worse health than the wider migrant and UK-born population. During migration they are vulnerable to environmental threats – e.g., trafficking, and sexual exploitation – and may have experienced gender-based violence – e.g., torture, sexual violence, FGM, and conflict - that lead to health problems. They, and other newly arrived communities, can also spend long periods of their journey with limited access to healthcare which presents challenges in the form of poorly-managed long-term conditions – e.g., diabetes, and hypertension – and untreated communicable diseases such as TB, HIV and STIs. Newly arrived communities are at increased risk of poor mental health too potentially suffering with anxiety, PTSD, and depression. Therefore, newly arrived communities need healthcare on arrival and information and guidance about the NHS, what services are available, and about their health care rights. The impact of language and cultural barriers cannot be understated so services should be culturally appropriate, and trauma informed.
Building on existing health and wellbeing infrastructures having a collaborative partnership approach, bringing together residents’ experience and partners’ skills and assets, should be taken to strengthen health and wellbeing in communities. An example of this is Vaccinating Coventry – a partnership group with membership from a range of council teams with a focus on improving vaccine uptake inequality across the city. While vaccine uptake across Coventry and Warwickshire has been good, early in the vaccination programme data started to reveal areas of Coventry with much lower uptake, particularly among minority ethnic groups and those living in more deprived areas. The work of the group is linked tightly with wider COVID-19 prevention inequality work, focused upon access to testing, understanding of and adherence to national guidelines.
Demand and access
Why is this important?
The demand for health and care services is expected to increase as the city’s population grows and ages. To manage this growth there is a need to shift the emphasis to proactive and preventative care. This means ensuring people have better general health regardless of where they live, requiring fewer visits to hospital and shorter stays if they need inpatient care; and remodelling urgent and emergency and planned care so that it can cater to the expected increase in demand.
What is the local picture? How does it compare?
Hillfields has relatively good access to health services, with most residents being able to reach a GP and a pharmacy within a few minutes. All residents in the area can access a GP within a 15-minute walk of their home, this access is important because car ownership rates are low in this area. For many parts of Hillfields walking time is less than 15 minutes to a GP, but access is slightly less good for people living in the northern parts of the area, from where it is estimated it should take around 15 minutes. Despite there being no main GP practice within the Hillfields area itself, there is a single branch of the Sky Blue Medical Group located in the Harnall Lane Medical Centre, and a number of other practices nearby. The biggest coverage is in the western area of Hillfields which comes from the City of Coventry Health Centre on Stoney Stanton Road, several practices are located there. There are more practices in other locations nearby, including in Lower Stoke & Gosford Park, and Stoke Heath. With one pharmacy located in a fairly central position within the area and others around the edge of the area, the longest journey time by foot to a pharmacy for all residents of Hillfields is estimated to be less than 10 minutes.
Map: Locations of GP practices around the area of Hillfields, with walking distances highlighted
Data source: Shape Place, Department of Health & Social Care
Map: Locations of pharmacies around the area of Hillfields, with walking distances highlighted
Data source: Shape Place, Department of Health & Social Care
Overall, satisfaction with the GP practices in the areas nearby Hillfields is relatively good compared with the city as a whole and nationally. Using the latest GP survey data, 71% of the users of the above GP practices would rate their experience as good or very good. This is on par with the rest of Coventry and England (both 71%), although overall satisfaction has dropped since 2019, with GPs local to Hillfields, as it has across all Coventry GPs and nationwide; from 78% in local practices and 81% across all Coventry practices in 2019.
It is very much the same story when it comes to obtaining appointments via telephone and the actual wait for them. 60% of GP users in the area responded that it was easy or very easy to obtain an appointment and 58% were satisfied or very satisfied with the waiting times of their appointments. This is on par with the rest of Coventry but above the results for England, where only 50% of respondents said it was easy or very easy to obtain an appointment and 53% were satisfied or very satisfied with the waiting times.
What else is happening? What else can be done?
A social gradient approach focusing on people’s prospects and opportunities, housing and environment and lifestyle factors can help improve outcomes, reduce inequality and reducing premature mortality.
The citywide JSNA identified that a culturally competent approach that recognises and makes best use of the assets of the city’s diverse communities is essential. This includes working with local community and religious groups to encourage take-up of vaccination, diagnosis and screening programmes
As part of the Adult Social Care Service, the council are working more closely with other organisations to improve the outcomes for adults. The Improving Lives programme is a partnership programme, led by Coventry and Warwickshire Integrated Care System, bringing together University Hospital Coventry and Warwickshire, Coventry and Warwickshire Partnership Trust and the Council to work as one service. It aims to enhance patient experiences, prevent hospital admissions, and improve hospital discharge processes. The program focuses on effective care through three sub-programs: Interfaces, Hospital Processes at UHCW, and One Coventry Integrated Team. Its key goals are to promote independent living and simplify care delivery through partner collaboration.
Working together in partnership is vital to delivering services to residents. The Working Together Group; an alliance of CWPT, VSCE, and Primary Care in Coventry and Warwickshire, aims to strengthen partnership working within the voluntary, community, faith and not for profit social enterprise sector.
Healthcare pressures, particularly in rapidly growing areas, are a concern to residents in the area. As populations increase, local health services often struggle to keep up with rising demand. This leads to longer wait times, reduced access to primary care, and overburdened facilities, which disproportionately affects vulnerable groups such as the elderly, low-income families, and people with chronic health conditions. Addressing these pressures requires a multifaceted approach, including investment in healthcare infrastructure, hiring more medical professionals, and improving access to preventive care, especially in areas experiencing rapid population growth.
Lifestyles
Why is this important?
Individual behaviours, such as eating enough fruits and vegetables, smoking, alcohol consumption, and physical activity can affect health. These lifestyle behaviours are strongly influenced by the environment in which people live. For example, people living in a ‘food desert’, with limited access to affordable and healthy food, are more likely to eat unhealthily; an unsafe environment is likely to discourage people from walking or cycling; and social and cultural influences, including friendship groups, advertising and media, play an important role in determining people’s lifestyles.
These lifestyle risk factors – poor diet, physical inactivity, excessive alcohol consumption and smoking – are all linked to ill health and premature death. Having a combination of the risk factors contributes to greater ill health. People facing poorer social circumstances are more at risk of having multiple risk factors, exacerbating avoidable differences in health.
What is the local picture? How does it compare?
The number of residents that smoke in Hillfields is lower than the city average. In the Household Survey 2022, 5% said they currently smoke cigarettes; lower than the city’s rate of 11%. 4% said they used e-cigarettes compared to 7% for the city overall.
The importance of eating healthy food remains well recognised by most residents, but there are indications that some aspects of diet are poorer in this area overall, although it is a mixed picture. According to the latest 2022 Household Survey data, 98% of respondents from Hillfields agreed that it is important to eat healthily. However, the proportion of households in Hillfields eating five portions of fruit and vegetables per day is lower than the city average (11% vs 21% for Coventry)
A smaller number of households reported eating takeaways at least once a week (14%) compared to the city average (24%). In terms of cooking at home, only 52% of Hillfields respondents indicated that they have everything in the kitchen to cook a meal, lower than the Coventry average of 81%.
Alcohol consumption in Hillfields appears to be lower than the city average, however hospital admissions for alcohol related conditions is significantly worse compared to the city overall. Responding to the Coventry Household Survey 2022 only 9% from Hillfields said they drink alcohol more than once a week and compared to the city average of 25%. Of those that do drink alcohol, 11% said they drink more than 2-3 units of alcohol on two or more days in a typical week, compared to 24% of respondents from the whole city.
Alcohol is causing disproportionate harm to health in Hillfields. The number of hospital admissions amongst Hillfields residents between 2016/17 and 2020/21 for causes that can be attributed to alcohol use (‘broad definition’) gives a Standardised Admission Ratio (SAR) of 159.2, meaning it is 59.2% higher than the national average, this is higher than the Coventry SAR of 134.9. The SAR for admissions due to conditions that are ‘narrowly’ alcohol attributable, a more specific subset of health conditions and diseases that are directly and primarily caused by alcohol consumption, is 133.7, similar to the rate for Coventry overall of 132.8.
Table: Rates of admissions to hospital due to alcohol related conditions (defined in two ways, broadly and narrowly due to alcohol) by place of residence, 2016/17 to 2020/21
|
Hospital admission rates – alcohol related |
Hospital Standardised Admission Ratios (SARs) |
||
|
Hillfields |
Coventry |
England |
|
|
Hospital admissions for alcohol attributable conditions (Broad definition) |
159.2 |
134.9 |
100.0 |
|
Hospital admissions for alcohol attributable conditions (Narrow definition) |
133.7 |
132.8 |
100.0 |
Source: Hospital Episode Statistics (HES) NHS Digital
Physical activity levels in Hillfields are significantly below average. According to the 2022 Coventry Household Survey, 30% of Hillfields residents engage in no everyday activity (e.g., active travel or gardening), compared to 11% citywide. Additionally, 50% of Hillfields residents do not participate in any recreational activity (such as recreational walking or cycling), significantly higher than the city average of 24%.
Using the latest National Child Measurement Programme (NCMP) data for the 3 years covering 2019/20 to 2021/22, childhood obesity rates amongst Hillfields children aged 4-5 and 10-11 are higher than average. 12.0% of reception-aged children (4-5 years) in the area are classed as obese. There is also an increasing trend in the number of Year 6 children aged 10-11 years, with the latest data showing that 28.7% of children in this age group were measured as obese. These figures are slightly higher than the Coventry city averages, with 10.8% of reception and 24.8% of Year 6 children classed as obese across the city. This suggests that the area rate of obesity increases in line with that of the city between the ages of 5 and 11.
What else is happening? What else can be done?
Services in the area work well together to provide support and projects for vulnerable groups. Coventry Citizen’s Advice deliver projects to support people affected by Cancer. The Macmillan project delivers essential benefits advice services to people affected by cancer through a new model of integrated support, the Major Trauma project supports those in hospital who have suffered major trauma and the TB/HIV project is directed at individuals who have TB/HIV.
To address health inequalities and establish an environment that promotes and preserves good health, it is important to acknowledge that lifestyle factors are rooted in socioeconomic conditions. Hillfields has an abundance of groups working in the area to provide support to residents. It is important to continue to address access to affordable; lowering risky behaviours by changing social norms and connecting people to peer support groups, such as encouraging them to use health check services, sexual health check services, stop smoking services and improving their access to drop-in sessions for psychological therapy and child clinics in the neighbourhood.