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Introduction

Wales, covering an area of 20,780 square km, has seven diverse local health boards (LHBs).  LHB boundaries define areas whose geographical size ranges from under 500 square km, in the case of Cardiff and Vale University LHB, to over 6,000 square km in the case of Betsi Cadwaladr University LHB.

The more urban and post-industrial southern and eastern areas of Wales, which include Aneurin Bevan, Cardiff and Vale University, Cwm Taf and Abertawe Bro Morgannwg University LHBs make up 60 per cent of the population of Wales but just 17 per cent of the area of Wales.  In contrast, Powys Teaching, Betsi Cadwaladr University and Hywel Dda LHBs are dominated by more rural areas.

 

Interactive map of area			Health Maps Wales can be used to see the location of acute hospitals as well as LHB, local (or unitary) authority boundaries. Analyses are presented at small area level for a number of indicators including upper super output area (USOA), middle super output area (MSOA) & lower super output area (LSOA).
	Area size Square Kilometres, 2007	Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK			20,780 6,172 5,196 5,781 1,071 471 535 1,553 244,168

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Population

Mid Year Population Estimates

Population estimates are produced by the Office for National Statistics (ONS), and take into account births, deaths, and an estimate of migration between the last census and the middle of the current year. [1]

The population of Wales is estimated to have been 2.98 million in 2007. At Local Health Board (LHB) area level, populations range from 132 thousand in Powys LHB to 679 thousand in Betsi Cadwaladr University LHB.

Mid Year Population Estimates Thousands, 2007          (1.5 MB)

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University  LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK

2,980.0 678.5 132.0 375.2 499.4 445.0 289.4 560.5 60,975.0

References

1. National Statistics. Population estimates. A short guide to population estimates. London:ONS; 2004  Available at: http://www.statistics.gov.uk/downloads/theme_population/Short_Guide_revision_Nov_04_final.pdf [accessed 2nd Jun 2009]

Registered Populations

Around 3,119,700 individuals with a Welsh residence are registered with a general practice in Wales; a further 20,200 individuals with an English residence are also registered with Welsh practices. Further information and commentary is available at: http://www.wales.nhs.uk/sites3/page.cfm?orgid=568&pid=38713.

Population Density

Population density provides a measure of the number of people living in an area. It is calculated by dividing the population by the geographical area in square km. Population density is higher in urban areas, and lower in rural areas.

Wales, covering an area of 20,780 square km and with a population, in 2007 of approximately 2.98 million has a population density of 143 people per square km. National Parks cover 20 per cent of the land area.  At Local Health Board (LHB) area level population density ranges from just 25 persons per square km in the more rural and sparsely populated Powys Teaching LHB to over 900 persons per square km in Cardiff and Vale University LHB, primarily due to Wales’ capital city Cardiff.

Population Density Persons per square km,  2007

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK

143.4 109.9 25.4 64.9 466.3 944.8 540.8 360.9 251.0

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Projected population change

Population projections are based on assumptions; they indicate what may happen should recent trends in births, deaths and migration continue. [1]

Current projections see a rise in the older population (75 years and over) of Welsh residents from 252,000 (9 per cent of total population) in 2006 to 452,000 (14 per cent of total population) in 2031. The relative increase is higher in some more rural areas, such as Powys and lower in more urban areas, particularly Cardiff. The increase in the number of older people is likely to cause a rise in chronic conditions such as circulatory and respiratory diseases and cancers. Meeting the needs of these individuals will be a key challenge for the local health boards. In the current economic climate, the relative (and absolute) increase in economically dependent and, in some cases, care-dependent populations will pose particular challenges to communities.

		Number	% change
Population projections Projected increase/decrease in total population from 2006 to 2031          (668 KB)	Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK	330,000 75,900 23,100 63,600 79,000 101,400 19,500   50,200   10,500,000	(+11.1%) (+11.2%) (+17.6%) (+17.1%) (+15.9%) (+23.0%) (+6.7%) (+9.0%) (+17.4%)

References

1. Welsh Assembly Government. Local Authority Population Projections for Wales (2006-based): Summary Report. Cardiff: WAG; 2008.  Available at: http://new.wales.gov.uk/statsdocs/population/popproj08/popprojsum08e.pdf [accessed 19th May 2009]            

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Black and minority ethnic population

Every NHS organisation has a statutory duty to promote race equality. Not only may ethnicity reflect specific language and cultural needs but also health needs. People from black and minority ethnic (BME) backgrounds are more likely to come from low income families, suffer poorer living conditions and gain lower levels of educational qualifications compared to white populations. [1] In addition, certain BME groups have higher rates of some health conditions. For example, South Asian and Caribbean-descended populations have a substantially higher risk of diabetes; Bangladeshi-descended populations are more likely to avoid alcohol but to smoke. [2]

Figures from the 2001 Census show that in Wales, the BME population is 2.1 per cent, compared to 7.9 per cent in the UK as a whole. BME populations have, in general, a younger age structure compared to white populations reflecting past immigration and fertility patterns. Progressive ageing of BME populations is anticipated in the future but will depend on fertility levels, mortality rates and future net migration. [3]

At the local health board area (LHB) level, figures vary from 0.9 per cent in Powys Teaching LHB to 6.7 per cent in Cardiff and Vale University LHB.

The effect of migration since the 2001 Census is more difficult to quantify. There is no single dataset that holds information on all immigrants and there are many different definitions and categories of ‘migrants’. The NPHS is currently working on some analyses of people registering with a General Practitioner in Wales, who have made no such registration previously in the UK and whose place of birth is outside of the UK. These analyses are more akin to incidence than prevalence, albeit with certain limitations, and indicate post 2001 census demographic and temporal trends, many of which may predate the more recent coverage of inward migration.

Data at MSOA level for Newport, Cardiff, Swansea and the Vale of Glamorgan can be found in their local authority specific documents at

[http://www.wales.nhs.uk/sites3/page.cfm?orgId=719&pid=22797]. Data for other local authority areas are not included due to the small number of people from a BME background living in these areas.

Black and Minority Ethnic Population % people who are non white, 2001

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK

2.1% 1.0% 0.9% 1.0% 1.6% 6.7% 1.1% 1.9% 7.9%

References

1. National Public Health Service for Wales [online], 2008. Black and Ethnic Minority Population. Available at: http://www.wales.nhs.uk/sites3/page.cfm?orgid=719&pid=23574 [accessed 20th May 2009]

2. Health and Social Care Information Centre [online], 2005. Health survey for England 2004: the health of minority ethnic groups – headline tables. Available at: http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles-related-surveys/health-survey-for-england/health-survey-for-england-2004-health-of-ethnic-minorities-headline-tables  [accessed 20th May 2009].

3. National Statistics [online], 2004., Focus on Ethnicity and Identity Age/Sex Distribution Non-White groups are younger. Available at: http://www.statistics.gov.uk/cci/nugget.asp?id=456 [accessed 19th May 2009].

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General fertility rate

General fertility rate (GFR) is a measure of current fertility levels and denotes the number of live births per 1,000 women aged 15-44. Although GFR takes account of the age and sex distribution of the population, it makes no allowance for different sized cohorts of women at childbearing ages.

The Wales general fertility rate of 59.4 is lower than the UK rate based on figures from 2007. However, rates are broadly similar across LHBs within Wales, where fertility (GFR) ranges from 57.4 in Hywel Dda LHB to 61.4 in Powys Teaching LHB.

General Fertility Rate Live births per 1,000 females (aged 15-44 yrs), 2007                 (694 KB)

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK

59.4 60.5 61.4 57.4 59.0 58.0 61.2 59.7 61.5

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Life expectancy

Life expectancy at birth in the UK has reached its highest level on record for both males and females. A newborn baby boy could expect to live 77.2 years and a newborn baby girl 81.5 years if mortality rates remain the same as they were in 2005–07. Females continue to live longer than males; however the gap is narrowing. Over the past 25 years the gap has narrowed from 6.0 years to 4.3 years. [1]

Life expectancy in Wales is slightly lower than the UK average. Variation within Wales ranges from 75.1 (males) and 79.9 (females) in Cwm Taf LHB to 78.6 (males) and 82.2 (females) in Powys Teaching LHB.

Life expectancy at birth Persons born between 2005-07

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK

Males (years) 76.8 77.2 78.6 77.1 76.3 76.9 75.1 76.7 77.2

Females (years) 81.2 81.5 82.2 82.0 80.7 81.6 79.9 80.9 81.5

References

1. Office for National Statistics (2009). Life Expectancy at birth. Available    http://www.statistics.gov.uk/CCI/nugget.asp?ID=168  [accessed 2nd Jun 2009]

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Welsh Index of Multiple Deprivation (WIMD)

Geographically based deprivation measures can be used to show inequalities in health and suggest areas likely to most need measures to improve health and manage ill-health. The Welsh Index of Multiple Deprivation 2008, is produced at a small area level called Lower Super Output Area (LSOA), and is derived from a broad range of factors.

In Wales the majority of the deprived areas are found in the South Wales valleys, some parts of the North Wales coast and parts of Cardiff and Swansea. However, within less deprived areas there are often pockets of hidden deprivation.

Welsh Index of Multiple Deprivation (WIMD) % lower super output areas (LSOAs) in most deprived 5th of Wales, 2008            (2.5MB)

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB

20% 12% 4% 10% 27% 20% 39% 24%

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Disability and carers

People with a Physical/Sensory Disability

NHS bodies have duties under the Disability Discrimination Act 2005 to have due regard to the promotion of equality of opportunity, promotion of positive attitudes towards people with disability and encouraging participation of disabled persons in public life. [1] The original 1995 Act definition of disability is ‘a physical or mental impairment which has substantial and long-term adverse effects on [the] ability to carry out normal day to day activities’. [2]

Many people with physical and sensory impairments live completely independently, however disability can sometimes necessitate increased need for informal help and health care and long-term care needs and costs. [2] Although not an inevitable consequence of ageing, increasing age is commonly associated with increasing disability and loss of independence, with functional impairments such as loss of mobility, sight and hearing. [3]

The term physical/sensory disability covers visual, hearing and physical impairments; the Register of Physical/Sensory Disability is compiled from local authority registers of physically or sensory disabled people in Wales aged 18 years or over. These include people registered under Section 29 of the National Assistance Act 1948 who are normally resident in the local authority. Registration is voluntary and not all people with disabilities choose to register. The registers are therefore not a reliable guide to the prevalence of physical and sensory disability in the population. [4] The higher proportions of people registered could be reflective of the demographics of the local area, for example an older resident population. It could also be influenced by differences in local authority procedures and their capacity for registering people as having a physical/sensory disability.

Figures show that there are 81,823 people registered on the Register of Physical/Sensory Disability in Wales on 31st March 2008.

Physically/Sensory Disabled Persons Number of people on LA register of physically/sensory disabled persons, 2007-08

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB

81,823 26,799 7,867 9,344 11,094 6,416 4,700 15,603

References

1. Office of Public Sector Information. Disability Discrimination Act 2005. Available http://www.opsi.gov.uk/Acts/acts2005/ukpga_20050013_en_1 [accessed 26th May 2009]

2. Disability Discrimination Act 1995. Chapter 50. London :HMSO; 1995. Available at: http://www.opsi.gov.uk/acts/acts1995/ukpga_19950050_en_1 [accessed 3rd Jun 2009]

3. Welsh Assembly Government 2006. National Service Framework for Older People in Wales. Available http://www.wales.nhs.uk/sites3/documents/439/NSFforOlderPeopleInWalesEnglish.pdf [accessed 4th Jun 2009]

4. Local Government Data Unit http://dissemination.dataunitwales.gov.uk/webview/index.jsp?language=en  [accessed 28th May 2009]

Carers

Research shows that unpaid carers, that is, family, friends and neighbours provide around 70 per cent of care in the community. [1] Changes in marriage patterns, increases in single person households, lone parent families and mobility among family members are likely to reduce the availability of informal care. This is especially the case when older people become sick, disabled, frail or vulnerable. A decline in the number of informal carers is likely to increase the demand for statutory health and social services. As life expectancy increases there is a risk that carers may continue their caring roles for much longer periods. They may also be caring for people with multiple and increasingly complex needs. [1]

Local authorities record the number of carers (aged 16 and over) who provide or intend to provide a substantial amount of care on a regular basis for another individual aged 18 or over. This definition is taken from the Carers and Disabled Children Act 2000. [3] Once identified, carers may be offered an assessment to determine their need for services and payments in lieu of the provision of services to them. [2]

These figures relate to number of carers identified during a 12 month period. The number may not reflect the true extent of the caring role in the community as some people may not identify themselves to local authority services as a carer. The higher proportions of people identified as a carer could be reflective of the demographics of the local area, for example an older resident population. It could also be influenced by local authority procedures and their capacity to identify individuals as carers. 

Figures show that 9,262 people in Wales, aged 16 and over, were identified as carers between 1st April 2007 and 31st March 2008.

Carers Number of carers (aged 16 and over) identified during a 12 month period, 2007-08

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB

9,262 1,825 327 673 3,229 463 765 1,980

 

References

1. Welsh Assembly Government 2007. Carers’ Strategy for Wales Action Plan 2007. Available http://wales.gov.uk/dhss/publications/socialcare/carers/carers_strategy-e.pdf?lang=en [accessed 26th May 2009]

2. Local Government Data Unit 2009. Available http://dissemination.dataunitwales.gov.uk/webview/index.jsp?language=en [accessed 2nd June 2009]

3. Office of Public Sector Information 2009. Carers and Disabled Children Act 2000. Available http://www.opsi.gov.uk/acts/acts2000/ukpga_20000016_en_1 [accessed 2nd June 2009]

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Older people living alone

Living arrangements are important because older people living alone may place a greater demand on personal social services compared to older people with other living arrangements.[1] Greater financial independence, improvements in health and attitudes towards living in communal establishments contribute to the increasing proportion of older people living independently.[2] This is particularly important in the context of recent population trends such as the increase in the proportion of older divorced people. Such trends are closely linked with an increasing need for care facilities outside the family.[2]

Figures from the 2001 Census report that in Wales 43 per cent of older people live alone compared to 43.7 per cent in the UK as a whole. However, within Wales figures vary from 41.3 per cent in Cardiff and Vale University LHB to 44.5 per cent in Cwm Taf LHB.

Older people living alone % people aged 75 and over living alone, 2001

Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff and Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK

43.0% 43.2% 42.4% 41.9% 43.1% 41.3% 44.5% 44.2% 43.7%

References

1. National Public Health Service for Wales (2006) Health Needs Assessment 2006: Older People. Cardiff; NPHS. Available http://www.wales.nhs.uk/sites3/page.cfm?orgId=719&pid=22801 [accessed 14th May 2009]

2. Tomassini, C. (2005) Chapter 2: Family and living arrangements. In: National Statistics, ed. Focus on older people. London: National Statistics pp.11-20. Available http://www.statistics.gov.uk/downloads/theme_compendia/foop05/Olderpeople2005.pdf  [accessed 14th May 2009]

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Deaths

Whilst death is an inevitability of life, examining deaths occurring before they might reasonably be expected can demonstrate inequalities in health outcomes. Often these deaths occur for largely preventable reasons, [1] for example as the result of tobacco smoking. Higher rates of death are often associated with deprivation. [2]  

Figures for 2007 show the mortality rate in people less than 75 years old in Wales to be higher than the rate for the UK as a whole. There is substantial variation within Wales, with only 255.8 per 100,000 in Powys Teaching LHB and 413.9 per 100,000 in Cwm Taf LHB. In Wales as a whole the rate has fallen every year from 1999 to 2006. From 2006 to 2007 an increase is apparent. Similar increases from 2006 to 2007 can be seen in all three south east LHBs (Cwm Taf, Cardiff & Vale University and Aneurin Bevan) but not in any of the others.

Notes: All causes of death are included here, which may include deaths which could not have been preventable. The analysis uses the method of direct age standardisation, based on the widely used European standard population. The rates produced by this method are not only adjusted to take account of varying local population structures but are directly comparable with each other, be that between years or between areas. Survival until age 75 has been used for calculation of premature mortality, [3] and under 75 European age standardised death rates for certain conditions are used for Welsh Health Gain targets.

 

		Rate	95% confidence interval
Deaths under the age of 75 Age standardised mortality rate per 100,000 resident population and 95% confidence intervals, 2007             (441 KB)	Wales   Betsi Cadwaladr University LHB   Powys Teaching LHB   Hywel Dda LHB   Abertawe Bro Morgannwg University LHB   Cardiff & Vale University LHB   Cwm Taf LHB   Aneurin Bevan LHB UK	332.1 310.1 255.8 297.3 344.9 336.7 413.9 349.7 307.1	(325.9 – 338.5) (297.7 – 322.8) (230.9 – 282.6) (281.3 – 314.0) (329.4 – 361.0) (319.3 – 354.7) (391.5 – 437.3) (334.9 – 364.9) (305.8 – 308.5)

References

1. Wheller L, Baker A, Griffiths C & Rooney C (2007) Trends in avoidable mortality in England and Wales 1993-2005. Health Statistics Quarterly, 34. ONS: London. Available at http://www.statistics.gov.uk/articles/hsq/HS34Q-Mortality.pdf

2. Uren Z & Fitzpatrick J (2001) Analysis of mortality by deprivation and cause of death. Geographical Variations in Health – Decennial Supplement DS16. ONS: London. Available at

http://www.statistics.gov.uk/downloads/theme_health/DS16/DS16_cap11.pdf 

3. Wheller L, Baker A & Griffiths C (2006) Trends in premature mortality in England and Wales 1950-2004. Health Statistics Quarterly, 31. ONS: London. Available at http://www.statistics.gov.uk/articles/hsq/HSQ31premature_mortality.pdf