Rural Health Norfolk

Rural Health profile for Norfolk Local Authority

Action with Communities in Rural England (ACRE) Rural evidence project
October 2012

Finding your way around this rural health profile 2

This rural health profile brings together quantitative data on rural health issues for your area, to help you with the evidence you need to strengthen and influence local health services.
The profile is structured around the five themes shown below, alongside links to the more detailed subsections under each theme.

Data tables 30
Background sections Introduction 3 Details of the indicators 34
Geographies used in this report 35
Introduction 4
Mental health 9
Overall Wellbeing 5
Health & wellbeing Cancers, cardiovascular and respiratory
Life expectancy & mortality 6
Health 10
Disability 7-8

Introduction 11
Births and deaths 15
Population Age and Gender 12-13
Population groups with specific needs 16
Ethnicity 14

Introduction 17
Education 21-22
Social place & wellbeing Community wellbeing, economy and income 18-19
Housing 23
Environment, accessibility and transport 20

Introduction 24
Lifestyles & health improvement
Lifestyle behaviours 25-26

Introduction 27
Service use
Use of health services 28-29

This report was commissioned by Action with Communities in Rural England (ACRE) and the Rural Community Action Network (RCAN) from Oxford Consultants for Social Inclusion (OCSI), www.ocsi.co.uk / 01273 810 270.
ACRE would like to thank DEFRA for their support and provision of Ordnance Survey data and licensing, OS license number 100022861. ©ACRE/ RCAN/ OCSI 2012.
This report, or any part, may be reproduced in any format or medium, provided that is reproduced accurately and not used in a misleading context. The source must be identified and the title of the publication specified with the copyright status acknowledged.

Rural Health for Norfolk, © ACRE, RCAN, OCSI 2012.

Introduction 3

The importance of robust local evidence on rural health issues How we have created this rural health profile
The shift in how local health programmes are commissioned and delivered raises This report covers the Local Authority of Norfolk, in the area served by Norfolk Rural
challenges and opportunities for rural health services. With new roles for Health and Community Council. Appendix A shows all data for the local area compared against
Wellbeing Boards, Clinical Commissioning Groups and local council public health England (and rural and urban comparisons), while Appendix B shows details of the
teams, it is more important than ever that Rural Community Action Network members indicators.
can evidence the importance of rural health issues. This rural health profile provides
To create this profile, OCSI have collected and aggregated health datasets for all rural
robust data to help underpin effective planning, prioritisation and commissioning
and urban areas in England. To do this, we have used the Countryside Agency and
decisions for rural health services.
Office for National Statistics (ONS) definitions of rural areas which were created in 2004
How this profile is intended to help you (see Appendix C for details). New definitions for rural areas are due to be published early
2013 based on Census 2011 data; once these are released, this and the other reports
This profile brings together quantitative data on rural health issues for your area, to help from the Rural Evidence programme will be updated to match the new definitions.
you with the evidence you need to strengthen and influence local health services. Each
You can access this and the other area profiles through the Rural Evidence website,
of the sections shows data for rural areas in Norfolk, comparing with other areas (local
www.rural-evidence.org.uk (you will need a login from ACRE to access the reports).
authority and national averages), and with trends over time where data is available.

The information is organised under the five themes shown on the previous index page, About the Rural Evidence programme and other available support
and is intended to help you discuss questions like:
Although there is a great deal of ‘hard’ data available for rural areas, villages, hamlets
 Where are we now? and smaller towns, this information has not been brought together into an accessible
 What change has taken place in the past? resource to support organisations working in rural England. The Rural Evidence
 What are the strengths (and weaknesses) in our community? programme is developing a series of profile reports, for each of the rural communities in
 What changes would we like to see in future, and what needs to be done? England. So far, reports have covered: parish and settlement profiles, the rural economy,
access to services, rural deprivation, rural daytime populations, and rural health.
Of course, we cannot show all the data for all the issues that you might be interested in,
so in each section we have highlighted more detailed information that may be available, The reports are available through Rural Community Action Network members, but the full
such as data held by local organisations and/ or published in public health reports. range and background information can be viewed at www.rural-evidence.org.uk. Help is
also available from the ACRE team on using the evidence effectively to influence
The report has been designed so that you can work through each of the sections, or decisions about policies and services, as well as via case studies and resources on the
jump straight to the most useful parts using the index on page 2. More detailed data website.
tables for Norfolk are in Appendix A, with details on the sources of the data in Appendix
B. The Rural Evidence programme is a collaboration between ACRE, RCAN members and
Oxford Consultants for Social Inclusion (OCSI).


Health and wellbeing: Introduction 4
Health is defined by the World Health Organisation as “a state of physical, mental and What other data may be available?
social wellbeing and not only the absence of disease and disability”. In other words, it is
important to understand public health in a broader sense than just measures of mortality As with all analysis in this report, we have used data published for all small areas
(deaths), morbidity (illnesses) or disability. across the country, aggregated to local rural areas. Additional detailed local datasets
may be available from organisations such as the local authority, while some useful
In this report, we therefore look at a wide set of physical, mental and social wellbeing
data is published nationally only for larger geographies (so cannot be broken-down for
indicators. We start in this section by looking at the traditional indicators of health and
local rural areas). Other relevant data includes:
wellbeing, such as life expectancy and mortality, disability, mental health and mortality
rates due to common causes. Later sections go on to look at the local population (p12),  Morbidity data: prevalence of non-fatal (possibly recurrent) health conditions
social place & wellbeing (p19), healthy lifestyles and behaviours (p26) and service use may be available from PCTs for local areas
(p29).  Data on maternity related health outcomes, including infant mortality, still births
and low birth weight are collected by the ONS at Local Authority level
The table below shows the indicators we explore in this introductory health and
wellbeing section. http://www.statistics.gov.uk/hub/population/births-and-fertility/live-births-and-
stillbirths/
Theme Indicators
 Prevalence of mental health issues, including dementia, and numbers of people
Overall wellbeing People with a limiting long-term illness, Indices of Deprivation
with learning disabilities are collected by the Projecting Adult Needs and
Health domain
Services information system (PANSI) for upper tier Local Authorities
Life expectancy and Healthy life expectancy, Total life expectancy, Standardised
http://www.pansi.org.uk/
mortality mortality ratios, Indices of Deprivation Years of Potential Life
 A range of sexual health indicators are collected and published by the Health
Lost
Protection Agency at Local Authority level
Disability Disability free life expectancy at birth, Attendance Allowance http://www.data4nr.net/resources/health--disability/1469/
claimants, Disability Living Allowance claimants, Indices of  Office for National Statistics: Measuring National Well-being – Health publication
Deprivation Comparative Illness and Disability Ratio, http://www.ons.gov.uk/ons/rel/wellbeing/measuring-national-well-
Mental health Incapacity Benefit claimants for mental health reasons, being/health/index.html
Indices of Deprivation Mood and Anxiety Disorder indicator
Cancers, cardiovascular Standardised mortality ratios for cancer, coronary heart
& respiratory health disease, stroke, circulatory disease and respiratory disease


Health & wellbeing: Overall wellbeing 5

People in rural areas with a People (0-64) in rural areas Are there health deprived
We start by looking at indicators of overall wellbeing, including people with limiting long- limiting long-term illness with a limiting long-term rural areas locally?
term illness, and local levels of health deprivation. (2001) illness

What information is shown here? 82,380 38,155 No
Based on the ID 2010 Health
19.3% in rural areas (Norfolk= 11.4% in rural areas (Norfolk=
domain, no rural areas are in the
The data highlight boxes display the number of people in Norfolk who have a limiting 19.4%) 11.8%)
most deprived 20% in England
long term illness, for all people and for people aged 0-64. The Indices of Deprivation
Health domain shows the number of LSOA’s in the most deprived 20% on this measure.
The domain measures morbidity, disability and premature mortality but not aspects of F ig 2. People with health problems
behaviour or environment that may be predictive of future health deprivation.
8.7
9.5
Figure 1 shows the share of people with a limiting long term illness who are living in People in not good health
9.1
9.0
urban and rural areas in Norfolk. Figure 2 shows the proportion of all people with poor
11.4
health in rural and urban areas in Norfolk. 12.3
People with a limiting long-term illness (0-64)
11.8
11

19.3
19.5
F ig 1. People with a limiting long-term illness All people with limiting long-term illness
19.4
Rural 17.9
Urban
53% of all people with a
limiting long term illness 0 5 10 15 20 25
live in rural areas Rural Urban All Norfolk England

52% of all people In rural Norfolk a lower % of 0-64 year olds have a limiting long term illness than in
47% of all people live in rural areas urban areas
with a limiting long 46.6 47.5
term illness live in 52.5 53.4
urban areas Sources: Census 2001, Indices of Deprivation 2010

48% of all people
live in urban areas


Health & wellbeing: Life expectancy and mortality 6
Healthy life Healthy life Total life expectancy Total life expectancy
The expected and actual life outcomes of people in the local area are important expectancy for expectancy for males for females in rural for males in rural
indicators to take into account by health commissioners and providers looking to both females in rural areas in rural areas areas areas

improve services and tackle health inequalities. 75 years 72 years 82 years 78 years
What information is shown here? 73 years in urban areas 70 years in urban areas 82 years in urban areas 77 years in urban areas
and 74 years in Norfolk and 71 years in Norfolk and 82 years in Norfolk and 77 years in Norfolk
The data highlights show life expectancy and healthy life expectancy for females and as a whole as a whole as a whole as a whole

males in Norfolk from 1999-2003 (this is the most recent data published nationally for
small areas, local health agencies may hold more up-to-date data for small areas).
F ig 3. Healthy Life Expectancy
Figure 3 shows healthy life expectancy from birth for females, males and both sexes for 75.1 73.5 74.4 71.8 69.5 70.7 73.4 71.5 72.5
80
rural and urban Norfolk. Figure 4 shows the standardised mortality ratio for all causes

Age in years
70
60
and all ages for urban and rural Norfolk. This indicator highlights the ratio of observed to 50
40
expected deaths (given the age profile of the population)1. 30
20
10
0

Females Males Both
Rural Urban All Norfolk
Healthy life expectancy is higher in rural Norfolk compared with urban areas

F ig 4. Standardised Mortality ratio (all causes and ages) Source: ONS life expectancy estimates at ward level (1999-2003). Population weighted aggregation from ward

120 98.3 101.6 to rural urban areas.
90.7 94.2
100
80
60
Ratio

40
20
0

Rural Urban All Norfolk England

The standardised mortality ratio is lower in rural Norfolk compared to urban areas

Sources: ONS (2005-2009). Population weighted aggregation from SOA to rural urban areas.

1 A mortality ratio of 100 indicates an area has a mortality rate consistent with the age profile of the area, a mortality rate of more/ less than 100 indicates that the mortality rate is higher/ lower than expected given the overall age
profile of the area. Note a mortality rate of 100 does not equal the national average mortality rate (it represents the average mortality rate for an area with that age profile).


Health & wellbeing: Disability (a) 7

Older people with social care People with a disability (Disability
Understanding the level of disability in the local area can help ensure both needs (Attendance Allowance) Living Allowance)
sufficient provision of (and equity of access to) health care, and also that the
right support mechanisms are in place to prevent further inequalities as a
16,380 20,430
15% of older people claim
result of disability, e.g. in education, employment, housing, service use and Attendance Allowance in rural
5% of people claim Disability Living
Allowance in rural areas and 5%
so on. In addition, due to the distance people can live from services, mobility areas and 17% claim in urban
claim in urban areas
areas
and isolation are key concerns for public health providers in rural areas; this
becomes even more the case when considering disability as a factor.
F ig 5. Disability Free Life Expectancy F ig 6. Indices of Deprivation: People receiving
What information is shown here? 70 64
66 65
65 63
63
66 64 health benefits (age standardised score)
61
120 113.2 112.5

Indices of Deprivation measure (higher is more deprived)
There is a limited amount of data available at small area levels on the types 60
101.3
of disabilities in rural areas, but the proportion of people claiming disability 100
50 91.0
related benefits provides an overview of levels of disability in the area.

Age in years
40 80
Figure 5 shows disability free life expectancy at birth (1999-2003) for rural
and urban areas in Norfolk. 30
60
Figure 6 shows The Indices of Deprivation 2010 Comparative Illness and 20
Disability Ratio. This is an age and sex standardised measure of the number 40
10
of people receiving health related benefits (Disability Living Allowance,
20
Severe Disablement Allowance, Incapacity Benefit, Attendance Allowance 0
and the disability premium of Income Support) 2. Rural Urban All Norfolk
0
Figures 7-10 (on the following page) show people receiving Disability Living
Allowance (a benefit payable to people who become disabled before the age
of 65) and Attendance Allowance (for people aged 65+ with social care
Male Female Total
needs). Figures 7 and 8 show the change in the proportion of people claiming
these benefits from 2002-2011 in rural and urban Norfolk and figures 9 and
10 compare the age breakdowns of these people.
Sources: DWP (Feb-12), ONS (1999-2003), Indices of Deprivation 2010.

2 Data is standardised by calculating the numbers receiving health benefits by five year age-sex band, divided by the total population by five year age-sex band (note shrinkage is applied so the score is not a rate out of 100, but
a relative score, with higher scores indicating a higher level of illness and disability).


Health & wellbeing: Disability (b) 8
F ig 7 People with a disability (receiving Disability Living Allowance) F ig 9. Age breakdown of people claiming Disability Living Allowance
6.0 46.4
50

(% of Disability Living Allowance claimants by
43.4 43.8
45 40.2 42.0 38.4
37.2
5.0 40 32.7
35
30
% receiving DLA

4.0 25 20.9 19.4
17.8 17.8
20

age band)
3.0 15
10
5
2.0
0

1.0 Rural Urban All Norfolk England

0.0

Aged under 24 Aged 25-59 Aged 60+

In rural Norfolk a lower proportion of Disability Living Allowance claimants are aged under 16 and a
higher proportion are aged 65+ compared with local urban areas

F ig 8. Older people with social care needs (receiving Attendance Allowance) F ig 10. Age breakdown of people claiming Attendance Allowance
20 60

% of Attendance Allowance claimants by age
48.7 47.0 47.9
% receiving Attendance Allowance

50 45.3
40.2 41.4 40.7 41.9
15 40

30

10 20 11.1 11.7 11.4 12.8

band
10

5 0
Increase following change
in definition of pensionable age Rural Urban All Norfolk England
(excluding females aged 60-64)
0

Aged 65-74 Aged 75-84 Aged 85+

Rural Urban All Norfolk England A higher proportion of Attendance Allowance claimants are aged 85 and over in rural Norfolk
compared with urban areas

Source: DWP (Feb-12). Population weighted aggregation from SOA to rural urban areas.


Health & wellbeing: Mental health 9
The far-reaching impact of mental health issues costs the NHS an estimated £77 billion a F ig 11. Indices of Deprivation 2010 mood and anxiety
Number claiming Incapacity lev els score (higher = more deprived)
year. However, recent research has suggested that 75% of people suffering mental health Benefit for Mental Health
problems go untreated 3. Mental health issues can affect people to varying degrees, and reasons in rural areas 1.00
0.80 0.50
have a range of possible causes; as a result, mental health relates in some way to most of
the indicators highlighted in this report.
3,760 0.60
0.40
0.24
0.36

0.20
1.4% of people in rural areas, 0.00
Studies on rural inequalities have shown that mental health is a major component affecting compared with 2.1% in urban -0.20
-0.01
areas -0.40
wellbeing in rural areas, for example showing that suicide rates amongst farmers are -0.60
-0.80
particularly high. With certain groups more vulnerable to mental health problems, and the -1.00
high levels of untreated mental health issues, it is important to ensure that adequate mental Rural Urban All Norfolk England

health services and support are available to people living in rural areas.

What information is shown here?
F ig 12. People receiving Incapacity Benefits (IB) for mental Decrease from 2009 as IB no
Figure 11 shows the Indices of Deprivation measure for mood and anxiety disorders, for
health reasons longer provided to new claimants
rural and urban areas in Norfolk. This is composite measure using a number of mental

% receiving IB (code 'mental')
4
health measures4 combined into an overall score, with a higher positive score indicating
higher levels of mood and anxiety disorders and a lower negative score indicating low 3

levels of mood and anxiety disorders. Figure 12 shows the change in the proportion of 2
people claiming Incapacity Benefit (IB) for mental health reasons from 1999-2011 for rural
and urban areas in Norfolk. From November 2009 IB was no longer provided for new 1

claimants; people who are out of work for mental health reasons were now eligible for
0
Employment Support Allowance5.

The % claiming IB for mental health reasons is lower in rural Norfolk than in urban areas

Sources: DWP (Feb-12), Indices of Deprivation 2010. Population weighted aggregation from SOA to rural
urban areas.

3 Centre for Performance, Mental Health Policy Group, 2012, “How mental illness loses out in the NHS” (Available Online: http://bit.ly/Q0Lwbn )
4 Prescribing data for 2005 from NHS Prescription Services, hospital episode data for 2006-07 and 2007-08 from the NHS Information Centre, suicide mortality data for 2004-2008 from the ONS and health benefits data for 2008
from the DWP
5 Figures on the number of people receiving Employment Support Allowance due to mental health reasons are not published for rural areas and cannot be reported here.


Health & wellbeing: Cancers, cardiovascular & respiratory health 10
Mortality rates are an immediate and direct measure of the levels of health in local F ig 13. Standardised Mortality Ratio (select causes)

areas, and a key indicator of the need for particular local services and support. The 120

types of illnesses people suffer are affected by a variety of lifestyle and physical factors, 100
and because of this are likely to vary between different communities. For example,
cancer and asthma outcomes have been highlighted as poor in some rural areas. 80

Ratio
60
What information is shown here?
40
There is a limited amount of material available to form a rural health analysis. Morbidity
20
measures (prevalence and incidence rates) for select illnesses are likely to be the most
useful indicators of rural health outcomes; but the data is relatively incomplete at small 0
area levels and so not assessable for rural areas. This is for a number of reasons but Cancer Coronary Heart Circulatory Disease Respiratory Disease Stroke

includes confidentiality and the worry that anonymity may not be preserved due to the Disease

sparsity of many rural communities. Rural Urban All Norfolk England

Mortality rates can be used as proxy indicators of health status amongst rural
populations; however it is important to recognise that mortality rates are influenced by Sources: ONS Standardised Mortality Ratios (2005-2009), ONS 2010. Population weighted aggregation from

the age profile of the population in rural areas. MSOA to rural urban areas.

Figure 13 shows the standardised mortality ratio for five select causes, for rural and
urban Norfolk. The standardised mortality ratio measures the level of observed deaths
for each condition against ‘expected’ deaths for each condition (‘expected’ deaths’ are
the level of deaths that would be expected in an area given the area’s age profile)6.

6 A mortality ratio of 100 indicates an area has a mortality rate consistent with the age profile of the area, a mortality rate of more/less than 100 indicates that the mortality rate is higher/lower than expected given the overall age
profile of the area. Note a mortality rate of 100 does not equal the national average mortality rate (it represents the average mortality rate for an area with that age profile).


Population: Introduction 11
A detailed understanding of the local population is important information for rural health What other data may be available?
services, as population size and structure is a major driver of health need and demand.
This information also sets a benchmark against which other data can be compared, Additional detailed local datasets may be available from organisations such as the
helping to identify inequalities and modelling service requirements. local authority, while some useful data is published nationally only for larger
geographies (so cannot be broken-down for local rural areas). Other relevant data
This section looks at the following key issues:
includes:
Theme Indicators
 More detailed breakdowns of population sizes by age and gender are published
Age and gender Total population, population by five year age band, population by
by government: www.data4nr.net/resources/527
broad age band
 Population projections data by age and gender to 2033 are available at Local
Ethnicity Population in non-white ethnic groups, population by broad ethnic
Authority level: www.data4nr.net/resources/797
group
 GPs hold information on number of people registered with GP practices that
Births and deaths Number of live births, crude death rate
can be used to inform local measures of population and migration
Groups with People providing unpaid care, single pensioner households, full time
specific needs students and school children, lone parents, households with no car or
 Data on births by ethnicity of baby and age / country of birth of mother are also
van, households with multiple needs published at Local Authority level, www.data4nr.net/resources/436.
 Data on pupil ethnicity at Local Authority level, www.data4nr.net/resources/247.
 Data on pupils with English as an Additional Language are published for upper-
tier Local Authority level, see www.data4nr.net/resources/249.
 There is a range of more detailed birth data at Local Authority level including
birth rates by age of mother www.data4nr.net/resources/1429
 There is a range of communities of interest data for larger geographies,
including: Children on the child protection register
(www.data4nr.net/resources/528), children with statements of Special
Educational Needs (www.data4nr.net/resources/250), Gypsies and Travellers
(www.data4nr.net/resources/250), homeless people
(www.data4nr.net/resources/1334), looked-after children and those leaving care
(www.data4nr.net/resources/512), migrant workers
(www.data4nr.net/resources/1111), refugees and asylum seekers
(www.data4nr.net/resources/375), teenage parents
(www.data4nr.net/resources/803), NEETs
(www.data4nr.net/resources/1020)


Population: Age and gender (a) 12
How many people How many people are How many people are Dependency ratio
Information on the age and gender of the local population can help commissioners and live in rural areas aged 0-15 in rural aged 65+ in rural areas (in rural areas)
providers target services to those areas and communities most in need of such locally? (2010) areas locally? (2010) locally? (2010) 2010

services. 452,545 74,010 131,055 82.86
52% of people in
What information is shown here? Norfolk; 49.2% male;
16.4% (Urban average = 29.0% (Urban average = Urban average =
16.9%) 21.1%) 61.26
50.8% female
The information on the right shows the number of people living in rural Norfolk (2010). The dependency ratio is an age-population ratio
Also shown is the breakdown of the population by sex and age and the dependency of those typically not in the labour force (the
ratio (the ratio of non-working age to working age population). dependent part) and those typically in the labor
force. For example, the population aged 0-15 or
Figure 14 shows the proportion of the population living in rural and urban areas. Figure over 65 expressed as a ratio of the working age
15 shows a population pyramid comparing the proportion of males and females in rural population
Norfolk by five year age band. Figure 16 shows how the proportion of the population is F ig 14. People living in rural and urban areas
changing over time in rural and urban areas in Norfolk. Figure 17 shows the age
breakdown of the population in rural and urban Norfolk. Figure 18 shows the projected
future change in population between 2012 and 2035 across Norfolk against national and Urban Rural
48% of all 52% of all
regional comparators. people live people live
in urban in rural
areas areas

47.5
52.5

Sources: ONS Mid Year Estimates (2010)


Population: Age and gender (b) 13
F ig 15. Population estimates by 5 year age band F ig 17. Population by age
85pl 2.5 1.1
Females 2.9 1.9 Males 100%
80-84
75-79 4.2 3.1 90% 19.6
21.1 25.2
70-74 4.3 3.6 29.0
80%
65-69 4.0 3.7
60-64 4.0 4.1 70%
55-59 4.5 4.7 60%
50-54 5.9 5.8
50% 61.8
45-49 5.6 5.8 62.0 58.2
5.6 6.0 40% 54.7
40-44
35-39 6.6 7.1 30%
30-34 7.2 8.1
20%
25-29 7.7 8.2
20-24 8.6 8.7 10% 16.4 16.9 16.6 18.7
15-19 5.3 5.6 0%
10-14 5.3 5.8
5-9 5.2 5.4 Rural Urban All Norfolk England
0-4 5.0 5.4

10 8 6 4 2 0 2 4 6 8 10 Aged 0-15 Working age Aged 65+

% of total population in each age band In rural Norfolk there is a lower proportion of 0-15 year olds compared with urban areas, and a
higher proportion of people aged 65+

F ig 16. Percentage change in total population from 2001-2010 F ig 18. Projected population change 2012-2035
12%
70% 62.8%

% change in population 2012-2035
56.3%
Change over time from 2001 (% change)

60% 54.0%
10%
50%

8% 40%
30% 21%
18% 17%
6% 20% 13.0% 10.9%
10.4%
10%
4% 0%
Total Aged 0-15 Aged 65+
2%
Norfolk East of England England

0%
Norfolk is projected to grow more slowly compared with the regional average, and faster
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 compared with the national average
Rural Urban All Norfolk

Sources: ONS population estimates (2010), ONS 2010-based population projections


Population: Ethnicity 14

People of White British People from Black or Minority Overseas migrants* in rural areas
There is evidence that people from ethnically diverse backgrounds – particularly ethnicity in rural areas Ethnic groups in rural areas (as % of working age population)
patients with low English language proficiency – can receive poorer quality services (2001) (2001) (2011-12)

compared to others, and are more likely to experience adverse events in their journey
415,020 12,935 1,820
through the health system.
97.0% (Urban average =
3.0% (Urban average = 4.7%) 0.6% (Urban average = 1.5%)
95.3%)
Ethnicity can also influence exposure to particular risks or health behaviours that impact
on health, e.g. chewing betel liquid and paan among some Asian men, is strongly *Based on the number of people
from overseas registering locally for
associated with mouth cancer. Some genetic conditions are more strongly associated a National Insurance number
with particular ethnic groups e.g. diabetes among south Asian men. These factors will
impact on how best to design health services for specific populations, whilst also aiming F ig 19. Population by ethnic group
5 4.6
to reduce any inequalities in health outcomes and service access.
4.5
3.9
What information is shown here? 4
3.5

The data tables and Figure 19 on the right show the proportion of people by ethnic 3 2.5
2.3

(%)
group in rural and urban Norfolk. 2.5 2.1
2
1.3
The data table on the far right shows the total number of people from areas locally 1.5
0.8 0.9
registering for a National Insurance number. This is a measure of the level of overseas 1
0.4
0.6 0.5
0.3
migration into the local area; recently published by DWP to small area. 0.5 0.2 0.1 0.2

0

Rural Urban England
White non-British Mixed Asian Black Other

The % of BME groups is lower in rural areas compared with urban areas

Source: Census 2001. DWP (2011-12) population weighted aggregation from ward to rural urban areas.


Population: Births and deaths 15

Number of births in Number of deaths in
What information is shown here? rural areas (2010) rural areas (2010)

Figures on the number of birth and deaths in the local area are collected by the Office
for National Statistics (ONS). The most recent year that data was collected at small 4,150 5,130
51.3% male; 48.7% female 49.5% male; 50.5% female
area level is 2010. The data highlight tables (below) show the number of births and
deaths in rural areas in Norfolk in 2010. Figure 20 shows the percentage of births to
people living in rural areas. Figure 21 shows the percentage of deaths occurring in F ig 20. Births
45 % of all
rural and urban areas. Figure 22 compares the crude death rate (per 100,000 Urban Rural
births occur in
population) in rural and urban areas in Norfolk. 55 % of all rural areas
births occur in
Source: ONS 2010. Population weighted aggregation from MSOA to rural urban areas.
urban areas 52% of all
people
44.7 live in rural
47.5
52.5
48% of all people 55.3 areas

live in urban
areas

F ig 22. Crude death rate F ig 21. Deaths
1,400 Urban Rural 57 % of all
1143.7 1128.6
deaths occur in
Deaths (rate per 100,000)

1,200 1029.1 1060.3
984.7 43 % of all
903.0 903.5
1,000 859.6 rural areas
deaths
800
occur in 52% of all people
600
urban live in rural areas
400
areas 42.9
200
0 47.5
52.5
Male Female 48% of all 57.1
Rural Urban All Norfolk England people live

Male death rates are higher in rural areas compared with urban areas in urban
areas
Female death rates are higher in rural areas compared with urban areas


Rural Health Norfolk

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