JSNA Summary East Sussex
December 2022
The Joint Strategic Needs Assessment (JSNA) is a resource containing a wide range of local and national information to inform plans and decisions to improve people's health and wellbeing and reduce health inequalities. The 2018/19 Director of Public Health's annual report provided a profile of health and wellbeing in East Sussex.
This summary will update and present some of the main findings from the annual report, based on the 11 key points identified describing our health today and what it means for the future:
Understanding our population
The population of East Sussex was estimated to be 558,852 in mid-2020, 6% more people than in 2010. Internal migration from within the UK is the main driver for the rising population in the county. East Sussex has a much older population profile than the country as a whole, and compared to England, has a significantly lower population who are non-White British/Northern Irish.
East Sussex is the 5th most deprived of the 26 county councils, although deprivation varies significantly within the county, with Hastings being the 17th most deprived of the 317 local authorities nationally, and Wealden being the 65th least deprived.
Giving children the best start in life
What happens during pregnancy and the first few years of life may have an effect on health and wellbeing outcomes in later life. Although children and young people in East Sussex report increasingly healthier behaviours, we see some clear differences in outcomes, such as hospital admissions for alcohol, significantly higher in Hastings.
Challenges in emotional health and wellbeing remain and the level of need for child and adolescent mental health services are high. Educational achievement is variable across the county and exclusion from school is above the England average.
Enabling children to achieve their full potential and be physically and emotionally healthy provides the cornerstone for a healthy, productive childhood and adulthood.
Supporting our ageing population
The over 65s now represent over a quarter of the county's population and are projected to make up nearly a third of all people by 2030. The fast growth will be seen in the 85 and over group. This ageing population is placing additional pressures on social care and the NHS, as well as on families, and our workplaces. Those aged 85 and over are the largest users of health and social services.
Talking about mental health
1 in 4 of us will experience mental ill-health at some point in our lives, with mental illnesses constituting the largest single burden of disease nationally. Mental illness also has a considerable economic cost to our health and care system, and also to individuals, families and communities.
In East Sussex, the GP recorded prevalence of severe mental illness; depression and dementia are all higher than England.
Mental health is a lifetime issue, requiring a joined up approach across the lifespan. We need to promote good mental health for all and the importance of early intervention, particularly in childhood and the teenage years, both to prevent mental illness from developing and to mitigate its effects when it does.
Being dementia friendly
Dementia is the leading cause of death for women in the county and has risen to the second leading cause for men, with an additional 4,700 people projected to have dementia by 2035. It is important that we build dementia-friendly communities, where people are aware of and understand dementia and where people with dementia can live in the way they want to and in the community they choose.
Ensuring equitable opportunity for secure income and housing
Good health is about much more than just good health care services, for example: a good education, a good job, and a safe place to live. Having enough money for daily living is one of the biggest determinants of health outcomes. At its most basic, access to safe and secure housing is a key determinant of health. Across the county there are increasing numbers of people who do not have access to housing or whose housing is temporary.
Poor housing impacts on both physical and mental health and wellbeing and is estimated to cost the NHS over £1 billion annually. Poor and unsafe housing can occur in all forms of home ownership and occupancy, but in general the private rented sector has the highest rates of poorer housing.
Reducing the differences in how long we live
Since 2001/03 life expectancy has been increasing in the county, however in the most recent years it appears to be stabilising. A girl born in East Sussex today can expect to live to 84, and a boy to 80. However, while healthy life expectancy has increased for males from 62 to 63 between 2009/11 and 2018-20, for females it has fallen from 66 to 63 years.
Those living in our most deprived communities have the lowest life expectancy and can expect to live fewer years in good health. There is a 15 year gap between those who have the highest life expectancy and those who have the lowest. There is a 19 year gap between those with the longest healthy life expectancy and those who have the shortest.
To increase the number of years we live in good health and reduce inequalities we must look beyond just the absence of disease and include the conditions and influences that create good health and wellbeing.
Ensuring integrated initiatives to beat obesity
Along with smoking, obesity is among the leading risk factors for poor health. It is associated with a range of conditions, including cardiovascular disease, musculoskeletal conditions, respiratory disease, diabetes and many cancers.
The NHS spends over £6 billion each year on treating overweight and diabetes related ill health. Obesity is a complex problem with a large number of different but often interlinked causes. No single measure is likely to be effective on its own in tackling obesity. To have a significant impact on obesity everybody needs to get involved.
Understanding increasingly complex patterns of illness
Much of the demand for health and social care in the future will be driven by the increasingly complex management of people with multiple long term conditions and those who are becoming progressively more frail. Multi-morbidity is often thought of as a condition that affects only older people.
However, the risk of exposure to unhealthy lifestyle factors in early life is relatively high in more deprived areas and multi-morbidity is known to develop at least 10-15 years earlier. By 2028 it is estimated that there will be an additional 22,000 people with two or more conditions in East Sussex.
Alongside this increase, there will be an additional 5,500 people who will be moderately or severely frail in the county. These changes pose major challenges to our health and care systems and highlight the need to invest in and strengthen timely prevention activities and early identification.
Having a shared understanding of demand for services
The demand for services, both health and social care, continues to increase: This is, in part, due to our aging population, as well as some of the inbuilt inefficiencies within our systems. Despite knowing a large amount about hospital activity, we know very little about what happens at a population level in other settings and sectors.
Better information and shared data are needed to understand how people move between services and organisations, and identifying how and when an individual’s level of need changes. Making a shift towards population health management requires collaboration across a range of sectors and winder communities – between local authorities, the NHS, the third sector and patients and the public themselves working together as a system.
Building on our strong communities
Many of the communities in East Sussex already have a secure identity with 7 in 10 people reporting they have a strong sense of belonging and more than 8 in 10 satisfied with their local area. People are engaged and willing to support each other with half of those responding to our community survey reporting they have volunteered in the past year.
The growing demands, in the context of and aging population, increasing prevalence of long term conditions and multi-morbidity, highlight the importance of focusing on prevention and early intervention. However, we also need to concentrate our efforts on improving and sustaining good health and positive wellbeing. In order to achieve this we must empower individuals and local communities by involving them in designing and delivering the services they use.
This asset based approach involves building and mobilising the skills and knowledge of individuals, and the connections and resources within communities and organisations. By taking a strengths and assets approach we have a better chance of making a positive impact on the health and wellbeing of our population. Promoting independence and developing a sustainable health and care system requires us to value everyone’s contributions.