The main health and wellbeing challenges in Devon are:
- An ageing population which is also growing faster than the national average increasing future demand for health and care services
- New towns such as Cranbrook and new housing developments in existing towns with a young population structure very different to the rest of Devon, and a different set of challenges relating to health-related behaviours, child health and sexual health. Community development and preventive approaches will be vital in these areas
- Increasing financial pressures affecting local authorities, Clinical Commissioning Groups and other agencies requiring changes to traditional patterns of service provision to ensure health and care services remain affordable
- A configuration of local authority and health organisations more complex than most other counties, with two-tier local authorities, and Clinical Commissioning Groups crossing local authority boundaries. This creates extra challenges in terms of the continuity of services, planning and effective partnership working
- A sparse and predominantly rural population, creating additional challenges around access to health and care services and the need for sophisticated models of home-based care, outreach and work to reduce social isolation. The effective utilisation of local resources, voluntary / community organisations and community assets will be critical
- Patterns of deprivation marked by isolated pockets and hidden need within communities and higher levels of rural deprivation, with groups experiencing health inequalities likely to be geographically dispersed. This creates additional challenges when addressing health inequalities and targeting services to those most in need
- A disparity between the quality of indoor and outdoor environments in Devon. According to the Indices of Deprivation 2015 over half the Devon population (54.55%) live in areas in the most deprived 20% in England for the quality of the indoor environment (decent homes standard and central heating), with no areas in the most deprived 20% in England for the quality of the outdoor environment (air quality and road traffic accidents affecting pedestrians and cyclists). Housing has a direct impact on health with poor housing leading to an increased risk of cardiovascular and respiratory disease, as well as anxiety and depression
- Average earnings below the national average and house prices and cost of living above the national average contribute to a number of issues including food poverty, homelessness, mental health and wellbeing, and fuel poverty
- The need for a focus on prevention at all stages of the life course aimed at improving health in later life for all, as well as narrowing the 10 to 15 year gap in health status between those living in the most deprived and least deprived areas. This will be critical to addressing the demographic and financial pressures that local organisations are facing
- The need for a focus on mental health and wellbeing throughout the life course with a particular emphasis on groups and geographic areas where outcomes are comparatively poor and socio-economic deprivation, and an understanding of the relationship between mental and physical health
- High levels of social isolation resulting in loneliness, which whilst most common on the older population, is evident in younger age groups, minority groups and people who are geographically isolated. This has an immediate impact on mental health and wellbeing and a long-term impact on general health
- Improvements in relation to health-related behaviours in younger age groups are not mirrored in older age groups, and considerable variations exist by sex, deprivation and other social and economic factors. These changing patterns of smoking, excess weight, physical activity, diet, alcohol, drug use and other behaviours should directly inform the planning of future interventions
- The growing number of people with long-term conditions, sensory impairment, dementia, cancer and other health problems. This requires a particular focus on those living with multiple health conditions, as traditionally health systems have been largely configured for individual diseases rather than multi-morbidity
- Growing levels of severe frailty in the population. Whilst frailty increases with age, signs of mild frailty can appear in people in the 20s and 30s, and more severe frailty in people in their 40s, 50s and 60s, with an earlier onset in more deprived areas. The detection of the early stages of frailty (known as pre-frailty) is important as the progression from pre-frailty to severe frailty typically takes 10 to 20 years, providing a window of opportunity to slow or ameliorate this progression. The detection of frailty in primary and community care, the early identification and treatment of disease, prevention, and the targeting of groups who are likely to be most affected are vital
- The Devon population is diverse in its needs and inequality can take many forms, resulting in differing health and care needs to which health and care commissioners need to respond.