Wednesday, 6 March 2013

Census 2011 : Disability, Carers & Health

People waddling on single crutches, mobility scooters and ex-miners, steelworkers and
factory workers shifted from the dole. That's the stereotypical image of vast swathes of Wales.
But it looks as if - despite relatively high numbers of long-term sick,
and "headlines of doom" - it's starting to change.

(Pic : South Wales Argus)

My next look at the 2011 census data focuses on the nation's health – in particular those with what are recorded as "long term limiting illnesses".

The most immediate concern with regard these numbers will be social security – which isn't devolved. This still has a massive impact on Cardiff Bay, as it affects policy and priorities in areas such as health, education, social care – all of which are devolved. It even impacts things like improving accessibility and participation in the arts.

Disability in modern Wales

A limiting illness is defined as a disease or disability that : "limits a person's daily activities and what they can do."

In the 2011 census, people were able to describe themselves as having a limiting illness that affects them "a lot", "a little", or no limiting illnesses. Long term limiting illness means all those ticking "a lot" and "a little". In the 2001 census it appears as though you couldn't note the severity.

First, let's look at the percentage population with a limiting illness. In 2011, an average 23% of the population in every Welsh local authority described themselves as having some sort of limiting disability. A slight majority of those described it as affecting them "a lot".

% of the population recording a "long term
limiting illness"
in 2011
(Click to enlarge)

The South Wales Valleys, Swansea and Carmarthenshire all have above-average levels of disabled people. We all knew that. There aren't any shocks here.

The highest percentages are in the Heads of the Valleys authorities – Blaenau Gwent (27.2%) Caerphilly (25.4%) and Merthyr Tydfil (26.9%). Alongside these, Bridgend (24.2%), Carmarthenshire (25.4%), and Rhondda Cynon Taf (25.9%) all have above average populations with disabilities.The local authority with the highest disabled population was Neath Port Talbot (28%).

In north Wales, only Conwy stands out in particular (24.3%). Rural Wales (with the exception of Carmarthenshire) generally has lower percentages of disabled people than urban/industrial Wales. Gwynedd stands at 20.5% for example, Vale of Glamorgan at 20.3% and both Powys and Ceredigion at around 21%.

Cardiff had the lowest percentage of disabled people overall (18%), closely followed by Flintshire (19.5%). Newport (20.8%) and Monmouthshire (20.2%) also had below average disabled populations.

Next it's worth looking at how this changed since 2001. Here's where the surprises creep up.

Change in the % population with a "long
term limiting illness"
(Click to enlarge)

The local authorities with the sharpest falls in disabled people compared to 2001 are generally those with the highest recorded populations of disabled people.

Merthyr Tydfil experienced the sharpest fall in the disabled population - by 3.1%. They are some way ahead of Neath Port Talbot (1.4% fall), Rhondda Cynon Taf (1.3% fall) and Blaenau Gwent (1.1% fall).

It's actually the relatively "healthier" local authorities that are experiencing rises in the numbers of disabled. Monmouthshire saw the sharpest rise at 1.1%, while Powys (1%), Conwy (0.8%) and Anglesey (0.7%) bucked the general trend of a fall in the "sick population".

The average fall per local authority was just 0.4%. However, the fact that the largest falls have been in areas often associated with high levels of disability, might indicate that perceived stereotypes associated with the Valleys are beginning to turn around – and rather quickly.

Unpaid Care

In the census, people were also able to say if they were providing unpaid care to someone in the household, as well as how many hours a week. A majority of people saying yes – 57% - did so for fewer than 19 hours per week. However, 28% of unpaid carers were doing so for 50 hours a week or more.

The most extraordinary thing about unpaid care across Wales is that it's fairly uniform. It averages around 12.2% per local authority, with little variation. Levels of unpaid care were, however, noticeably lower in Cardiff, (10.2%) Newport (11.4%) and Gwynedd (10.3%).

% of the population providing some sort
of unpaid care in 2011
(Click to enlarge)

Levels of unpaid care are, unsurprisingly, generally higher in areas with higher numbers of people with limiting illnesses – Neath Port Talbot records the highest of both. Even relatively "healthy" local authorities like the Vale of Glamorgan recorded around the average.

This could, therefore, be closely linked to demographics, with "older" areas being just as reliant on full time care as "less healthy" local authorities. I'll look at demography another time, so I'll come back to this then.

Some care is provided by local authority social services. This could mean that people with similar levels of need are treated the same by local authorities. That would result in roughly the same number of people "falling through the net" in each local authority. This could be because those people are judged to have specific conditions that wouldn't qualify for care, or there's an even spread of people with conditions that require constant care at home.

But it's worth highlighting that it works out that, in 2011, just over 100,000 people in Wales were providing more than 50 hours a week of unpaid care.

The healthy population

There's little point in going into too much detail here, as it's effectively just a mirror of the disabled figures. This just confirms that healthiest populations appear to be in rural Wales – as well as Cardiff & Flintshire – while the south Wales valleys lag.

% of the population without a "long term
limiting illness"
in 2011
(Click to enlarge)

It's worth underlining that, contrary to popular belief, the vast bulk of people in every Welsh local authority considered themselves "healthy".

The EnglandandWales "healthy population" was 81%. In Wales alone, the local authority average was lower at just under 77%. So although there's a difference in healthy populations between England and Wales, the difference perhaps isn't as massive as commonly believed.

Also, as noted further up, Wales is marginally "healthier" now that it was in 2001.

Are the Valleys getting healthier? Why? & How?

The youngest men who would've experienced working in Welsh deep
coal mines will now probably be in their 50s. Have excess deaths amongst
older cohorts reduced the numbers of long-term sick overall?
(Pic : BBC Wales)
The falls is disabled people in the Valleys should be welcomed, and are quite dramatic, although there's not much of a change Wales-wide. It's worth looking in detail at some of the reasons why this could've happened.

The pessimist in me suspects that people with ongoing illnesses associated with heavy industry have died in greater numbers since 2001. A similar argument to that I put forward with regard drops in Welsh-speakers in some parts of Wales.

It could well be that the census doesn't accurately record health, perhaps with good reason, as it would lead to claims of "snooping". It's unclear what conditions would be classed as "limiting". What about mental illnesses? As I know all too well you can function on the outside, but inside you can be absolutely crippled – and it does affect your day-to-day life.

What about cancers? They're limiting, but not long-term if you receive treatment. Diabetics can live a normal life, but it's still a long-term disease. The Welsh Government's own annual health surveys are probably a more accurate reflection of disability in Wales than this census, if I'm honest. Though there have been concerns raised there too by Mick Antoniw AM (Lab, Pontypridd). I'll come back to that another time.

Have improvements in things like diabetes
management lengthened "healthy life expectancy"?
(Pic : Cwm Taf NHS Trust)

Improved health screening and management of long-term illnesses could be another possible reason. The Welsh Government have introduced things like bowel cancer screening for the over 50s. Diseases like diabetes and cancer might be better managed now, even if there are still long waiting times and waiting lists for such things. Better management of diseases like arthritis might be extending "healthy life expectancy" by reducing pain experienced, making people feel healthier.

The optimist in me points to things like investment in local leisure centres and sport. All local authorities that experienced a fall in limited illnesses have invested in such things greatly since 2001. Merthyr opened a new leisure centre a few years ago, for example. Swansea has a new replacement for its famous leisure centre, Port Talbot will get a replacement for the Afan Lido in the future and a new sports centre is under construction in Ebbw Vale.

Related to this, you've seen an expansion of private gyms basing themselves in cheap industrial units. Also, there's been an explosion of "alternative"/"trendy" forms of exercise like zumba, roller derby and various pool-based exercises.
Could things like that have contributed to falls in long-term illnesses?

Another possibly good thing is improvements to the physical environment in the Valleys. There've been various land reclamation schemes on old mine workings and steelworks, water quality in Valleys rivers has improved dramatically and there's been an expansion of forestry land. Greenprint in action, perhaps?

Improved education/awareness about unhealthy lifestyles
has probably also contributed - especially in the young. However, that doesn't explain the worries about things like obesity. I'll come back to that later.

I think it's probably a mixture of both the pessimistic and optimistic viewpoints.

What else can we draw from this?

Economic link with disability – Look at the "healthiest population" map again. The areas with the healthiest populations almost exactly match the East Wales NUTS 2 region – where productivity (GVA) is significantly higher than the rest of Wales. The two arguably most productive parts of Wales – Cardiff and Flintshire – have the healthiest populations. Maybe if there was more focus on tackling this problem, we could overcome some of our economic problems too.

Neath Port Talbot has the highest rate of limiting illnesses at 28%
of the population. It also has one of the poorest records with
regard air pollution. Are the two linked?
(Pic : South Wales Evening Post)

Link between environment and poor health – Coming back to one of the points above. Take a look at the areas with the highest numbers of limiting illnesses. Clearly we're still living with a legacy of heavy industry, but the figures have improved in areas that have lost them, and remain high in areas that retain heavy industry (NPT, Pembrokeshire, Carmarthenshire), things like nuclear power plants (Anglesey) or large factories (Bridgend, RCT). I don't think it's a coincidence that the local authority with the highest levels of ill health – Neath Port Talbot - is also the area with one of the poorest records on industrial air pollution.

Wales is going to be hit disproportionately harder by cuts to the disabled – This has already been highlighted by the likes of the Bevan Foundation, Institute for Fiscal Studies and various campaign groups. It was also subject to a debate in the Senedd today. With a higher disabled population, cuts to things like accessibility and things like work fitness assessments will be, or are being, felt harder in Wales. However....

Wales isn't that unhealthy compared to the rest of the UK - Wales clearly does have a "sicker" population than the rest of the UK, but perhaps this is exaggerated. The difference is only 4% overall, dragged upwards by smaller pockets of extreme figures. The gap has closed....slightly.

Despite warnings about unhealthy lifestyles, it appears
as though large numbers of overweight and obese people in
Wales considered themselves healthy in 2011.
(Pic : NHS Wales)

False alarm on obesity and unhealthy lifestyles?
- Factoring in the numbers of people listed as overweight and obese (50-60% of the population), as well as things like smoking and alcohol consumption, it appears as though a fair chunk of people who are obese considered themselves healthy in 2011.
Maybe you really can be fat and "feel healthy" overall, or maybe we're all just a bunch of fibbers. Remember what I noted about the census perhaps being inaccurate on health.

The Assembly under-represents disabled groups – A lot of the discussion recently has been about gender balance, and I mentioned ethnic representation last time around. However, the biggest single group in Wales not currently represented in the Senedd (aside from [openly] LGBTs and people under 30) are the disabled. Some AMs will have ongoing long-term health problems, but nothing that limits their day-to-day activities the same way as a quarter of the Welsh population experience. I think it's time the Welsh Government seriously consider Lindsay Whittle AM's (Plaid, South Wales East) proposal for a Disabled Person's Commissioner.


  1. It's heartening to know we're not that "worse" (appreciate that's a loaded term) than the UK average. Certainly it's not as bad as I guessed.

    There's also a clear link between economic activity and health. The most ill areas are the ones that were most dedicated to heavy industry. Perversely, i'm "pleased" to see that borne out because we know it's not a "lifestyle choice" but that we're seeing a legacy from industrial disease.

    If all of the counties could move towards Cardiff/Flintshire levels of well-being, we'd become a healthier nation than the UK. Now that's a prize that's within reach.

  2. Thanks, Anon.

    I agree with you re. "legacy of industry". My only concern is that people with ill health as a result of industry are going to be replaced with ill people as a result of increasing age. I'm not sure how all of Wales could reach Cardiff levels of well being though. It's a complicated situation.