Brighton's top doctor warns of serious city health problems

Alcohol-related illnesses, rising adult Obesity, high numbers of sexually transmitted infections and high death rates for all cancers are some of the worrying issues affecting the city.

The city's director of public health Tom Scanlon has pinpointed areas of concern alongside issues where improvements have been made in his annual report.

Last month The Argus revealed the first part of Dr Scanlon's report, in which he revealed the extent of the city's drinking problem.

His main concerns are the impact of alcohol and binge drinking on young people and adults.

He is also concerned about the choices people are making leading to high rates of reported sexually transmitted infections.

Dr Scanlon warned that people needed to take a good look at their attitudes and behaviours and decide whether they were willing to make some changes to help improve their long-term health.

Drug misuse

Brighton and Hove has the dubious title of drugs death capital of Britain, with 44 drugrelated deaths reported in 2008, giving it a rate of 22.73 per 100,000 of the population.

Based on reports by the Coroner, the National Programme on Substance Abuse Deaths suggests the number of drug-related deaths has been falling but the Office of National Statistics, which assesses the data differently, says there has been little change.

Heroin is the drug most frequently implicated in drugrelated deaths.

Dr Scanlon said: "Substance misuse has been a persistent problem in Brighton and Hove for some time.

"All drug-related deaths should be investigated to better understand the circumstances surrounding each death."

Sexual health

Cases of chlamydia, genital warts, herpes, syphilis and gonorrhoea have been rising in recent years although there was a slight reduction last year.

However, there were still more than 4,000 reported cases of sexually transmitted infections recorded in 2009.

A large number of cases, including HIV, may also have gone undetected, making infection rates higher.

There were a reported 1,306 people with HIV infection in the city in 2008.

Some groups are more at risk of STIs than others -- these include teenagers and young adults and the lesbian, gay, bisexual and transgender community.

Dr Scanlon said Brighton had a long history of risk-taking sexual activity but the public health message did not seem to be getting through.

He said: "This may be due to the particular characteristics of our population, which contains many groups at greater risk.

"The high prevalence of alcohol consumption in the city is also an important factor.

We could react and invest considerable public money in public health messages.

"There is an evidence base on how best to present these messages but our recent track record suggests that while these might be heard, they may not necessarily be listened to.

"We need a long and hard think about the issue of sexual health, about the related health and social costs, about the links to behaviour and the important role played by alcohol consumption."

Obesity

There is an upward trend of obesity in adults with all the potential health implications -- coronary heart disease, diabetes and cancers.

However, the city may be on the verge of reducing obesity in children.

Recent figures show that in the 2008-09 academic year, 16% of Year 6 pupils were obese, a slight reduction on the year before.

Children's centres in the more deprived areas of Moulsecoomb, Bevendean and Coldean had higher levels of obese and overweight children than the centres in Preston Park and Knoll and Stanford.

A survey found the eating habits and levels of activity in both children and adults are beginning to improve but the figures, according to Dr Scanlon, are still "depressingly low", with only 15% of residents taking the recommended minimum level of 30 minutes exercise a day.

A focus on healthy eating has been introduced in the city but only 34% of youngsters in primary schools, and 21% in secondary schools are eating school meals.

Dr Scanlon said: "In a relatively short space of time we have moved from a state of under-nutrition through the excessive consumption of the wrong foods.

"Obesity is more pronounced in the more deprived parts of the city.

Any strategy has to be able to target these groups.

"The scale of the task should not be underestimated."

Teenage pregnancy

The under-18s conception rate is 36 per 1,000 according to the latest statistics available, a drop of more than a quarter since 1998.

However, the abortion rate in teenage pregnancies has risen from 48% to 63%, well above the national average of 50%.

Repeat abortions in under-19s in the city stand at 15.2% compared with a national average of 11%.

Cancer

There are about 650 deaths per year from all cancers in Brighton and Hove, of which about 310 are in people under 75.

There are about 79 lung cancer deaths per year in men and 50 in women.

The mortality rate for "all cancers" in people aged under 75 is higher in Brighton and Hove than in England.

Cancer death rates in the city had been increasing in the past few years although there has now been a slight decline.

Dr Scanlon said: "There have been some worrying local trends in cancer in recent years though there has been a return to improvement.

"The recent rise in mortality was examined in detail and it was not possible to pin this down to any one or few cancers." Life expectancy MEN in the city have a life expectancy of 75 years, while for women it is 81.

However, Brighton and Hove has the second worst male life expectancy among 15 comparable cities, including Bristol, Portsmouth and Leicester.

For men and women combined, Stanford, Withdean and Brunswick have the highest life expectancies at 82, 84 and 85 respectively.

Queen's Park, Westbourne and East Brighton wards have the lowest life expectancies at 76, 76 and 77.

Dr Scanlon said: "What is clear is there is a strong and persistent link between deprivation and ill health.

This was true in 1900 and is true today." Alcohol There are 53,000 hazardous drinkers in the city -- just over 24% of the population aged 16 or above.

An estimated 40,181 people binge drink.

People in the Hanover, Elm Grove, Moulsecoomb, Hollingbury and Stanmer areas have the highest rates of drinking in the city.

Just over half of those who attend the accident and emergency department at the Royal Sussex County Hospital because of alcohol and assault are from Brighton and Hove.

Recorded alcohol-related hospital admissions rose from 855 per 100,000 in 2003-04 to 1,870 per 100,000 in 2008-09.

An estimated 17 residents have needed a liver transplant for alcohol-related illnesses during the past ten years.

The city also has a high level of male deaths from chronic liver disease.

Dr Scanlon said: "Excessive alcohol consumption does not stop with acute intoxication in younger people but continues throughout people's lives.

"Put simply, it is not overstating the case to say that in Brighton and Hove an awful lot of people die or fall ill as a result of alcohol consumption, while the lives of many others are disrupted and in some cases ruined."

Infectious diseases

Last year was an unusual year for infectious disease outbreaks in Brighton and Hove.

For the first time in 40 years there was a pandemic flu outbreak -- on this occasion swine flu, which led to the death of a young girl in the city.

There was also a measles outbreak, with more than 100 people believed to have been infected.

Twelve children were ill enough to be admitted to hospital and some needed intensive care.

Two stayed in hospital for more than ten days.

The spread was blamed on the historically low uptake of the measles, mumps and rubella vaccine, which has subsequently improved with a take up rate of about 82%.

However, this is still not enough to protect the wider community as a whole, as at least 90% of a population needs to be vaccinated to offer the protection needed.

Dr Scanlon said: "Vaccination levels are improving.

"However, it is more than unfortunate that it seems to have taken the outbreak of a serious disease, and the admission of several ill children to hospital to convince some parents of the merits of vaccination."

Smoking

Smoking as a habit is on the decrease as are the diseases most associated with it.

There have been great efforts to reach the quit smoking targets in Brighton and Hove in recent years -- mostly with success.

But this will be increasingly difficult because the group of smokers who remain are likely to be the most resistant to quitting.