Appendix 2
Our Healthier Nation White Paper - Glossary and References
Glossary and Technical Notes
National Targets - to reduce mortality from: cancer; coronary
heart disease and stroke and related conditions; suicide; and to reduce
the rate of fatal and serious injury from accidents.
Target year: 2010 for all four targets.
Baseline year:
Mortality targets: the average of the European age standardised
rates for the three years 1995, 1996 and 1997.
Serious injury from accidents target: the hospital admission
rates for the year 1995/96.
Sources of data:
Mortality targets: Office for National Statistics (ONS) mortality
statistics from death registrations. Mortality rates are age standardised
to allow for changes in the age structure of the population (using the
European standard population as defined by the World Health Organisation).
Serious injury target: Hospital Episode Statistics.
Definitions:
Cancer - all malignant neoplasms - ICD-9 codes 140-208 inclusive.
Age group: under 75.
Target reduction by year 2010 - at least one fifth (20%).
Coronary heart disease and stroke and related conditions -
includes all circulatory diseases - International Classification of
Diseases ICD-9 codes 390-459 inclusive.
Age group: under 75.
Target reduction by year 2010 - at least two fifths (40%).
Accidents - mortality from accidents and adverse effects -
ICD-9 codes E800-E949 inclusive
Age group: all ages
Target reduction by year 2010 - at least one fifth (20%).
- serious accidental injury relating to hospital admissions defined
by ICD-10 codes as below
Age group: all ages
Target reduction by year 2010 - at least one tenth (10%).
The injury must be sufficiently serious to require a hospital stay
of four days or more
Accident morbidity
- Primary diagnosis must indicate an injury, ie is in range S00 through
T98X
- External cause code must be in one of the following ranges:
- V01 - V99 Transport accidents
- W00 - X59 Other external causes of accidental injury (mostly
falls)
- Y40 - Y8 Complications of medical and surgical care
- Length of stay must exceed 3 days.
As some records with a primary diagnosis indicating an injury do not
contain a valid external cause code, these codes will be scaled out
in proportion to the records with a valid cause code before applying
the second rule above. Coding of external cause is consistently improving
and this correction will decrease in importance as coding approaches
100%.
Suicide - suicide and undetermined injury - ICD-9 codes E950-E959
plus E980-E989 minus E988.8
Age group: all ages.
Target reduction by year 2010 - at least one fifth (20%).
International Classification of Diseases
The World Health Organisation maintains a statistical classification
of diseases, injuries and causes of death, which is internationally
recognised and used. Currently, the ninth revision of this classification
(ICD-9) is used in England for differentiating causes of death, but
the tenth revision (ICD-10) is used for classifying hospital episodes.
Suicide and undetermined injury
Official suicides are those in which the coroner or official recorder
has decided there is clear evidence that the injury was self-inflicted
and the deceased intended to kill himself. Unofficial suicides or open
verdicts are those where there may be doubt about the deceased's intentions.
Research studies show that most open verdicts are in fact suicides.
For the purposes of comparisons with other countries, the figures quoted
are for official suicides, but for the purpose of measuring overall
suicides in England, official suicides and open verdicts are combined.
Social class
The Registrar General's Social Class groupings used in this document
are as follows:
|
Social class grouping |
Example occupations |
| I |
Professional |
Doctors, engineers |
| II |
Managerial/technical |
Managers, teachers |
| IIIN |
Non-manual skilled |
Clerks, cashiers |
| IIIM |
Manual skilled |
Carpenters, van drivers |
| IV |
Partly skilled |
Warehousemen, security guards |
| V |
Unskilled |
Labourers |
It should be noted that the proportion of the working population falling
into these groups changes over time, and comparisons of social class
groupings over time should therefore be interpreted with caution.
Chapter Two
Fig no. Description
2.1 A major decline in death
from all infectious diseases in the 20th Century
Derived from: Office for National Statistics. Charlton
J, Murphy M, eds. The Health of Adult Britain:
1841-1994. London: The Stationery Office, 1997.
Additional data to 1997 from series DH2 nos 22,23,24.
London: The Stationery Office, 1997, 1998, 1998.
2.2 Major improvements in expectation
of life after centuries of early death
Office for National Statistics. Drever F, Whitehead
M, eds. Health Inequalities. London: The
Stationery Office, 1997.
2.3 Major fall in infant deaths
in the 20th century
Office for National Statistics. Mortality Statistics:
Childhood, infant and perinatal (series DH1
no. 19 (1841-1985) and DH3). London: The Stationery Office,
DH1 - 1989, and DH3 - 1990-1998.
2.4 Age at death at the start
and end of the 20th century
1900 The Registrar General. Sixty-Third Annual Report
of the Registrar General of Births, Deaths and Marriages
in England, 1900. London: HMSO, 1902.
1997 Office for National Statistics. Mortality Statistics
Cause, England and Wales 1997 (DH2 no.24).
London: The Stationery Office, 1998.
2.5 Selected causes of death
at the start, middle and end of this century
1900 The Registrar General. Sixty-Third Annual Report
of the Registrar General of Births, Deaths and Marriages
in England, 1900. London: HMSO, 1902.
1950 Office for National Statistics. Charlton J, Murphy M,
eds. The Health of Adult Britain: 1841-1994.
London: The Stationery Office, 1997.
1997 Office for National Statistics. Mortality Statistics
Cause, England and Wales, 1997 (DH2 no.24).
London: The Stationery Office, 1998.
2.6 Deaths before age 75 years
in England annually: a major contribution from the four
priority areas
Based on : Department of Health. Public Health Common
Data Set, 1998.
(Derived from Office for National Statistics data).
London: London School of Hygiene and Tropical Medicine,
1998.
2.7 Unhealthy years at the end
of life
Bone M R, Bebbington A C, Jagger C, Morgan K, Nicolaas
G. Health Expectancy and Its Uses. London: HMSO,
1995.
Chapter Three
Fig no. Description
3.1 Heart disease among public
sector workers: higher rates associated with lack of control
over job
Bosma H, Marmot M, Hemingway H, Nicholson A, Brunner
E, Stansfield S.
Low job control and risk of coronary heart disease in
Whitehall II (prospective cohort) study. British
Medical Journal 1997; 314: 558-565.
Chapter Four
Fig. no. Description
4.1 Death and disadvantage: excess
death rates amongst men in non-professional classes
Office for National Statistics. Drever F, Whitehead
M, eds. Health Inequalities. London: The
Stationery Office, 1997.
4.2 The widening mortality gap
between social classes
Office for National Statistics, Decennial Supplements,
indexed by Department of Health Statistics Division 2.
4.3 Asthmatics are two to three
times more likely to live in damp properties
Williamson I J, Martin C J, McGill G, Monie R D H, Fennerty
A G. Damp Housing and asthma: a case-control
study. Thorax, 1997; 52: 229-234.
Chapter Five
Fig. no. Description
5.1 Change in annual death rates:
some improving, some worsening
Analysed by Department of Health, Statistics Division
2, from Office for National Statistics data.
5.2 Death rates from all cancers
- England in the middle of the Western Europe rankings
World Health Organisation, Copenhagen. Health For All
indicators database (EU) England data analysed by
Department of Health, Statistics Division 2 from Office
for National Statistics data (ICD-9 140-208)
5.3 Death rates from breast cancer:
UK amongst the worst in Western Europe
World Health Organisation, Copenhagen. Health For All
indicators database (EU) England data analysed by
Department of Health, Statistics Division 2, from Office
for National Statistics data. (ICD-9 174)
5.4 Death rates from cervical
cancer: English women amongst worst in Western Europe
World Health Organisation, Copenhagen. Health For All
indicators database (EU) England data analysed by
Department of Health, Statistics Division 2, from Office
for National Statistics data. (ICD-9 180)
5.5 Cancer survival: England
and Wales generally lag behind Europe and USA
Office for National Statistics. Cancer Survival Trends
in England and Wales
1971-1995. Deprivation and NHS Region. London:
The Stationery Office, 1999.
(Includes data from Eurocare II (EU) and Seer (USA))
5.6 Survival is better in affluent
than in deprived areas
Office for National Statistics. Cancer Survival Trends
in England and Wales 1971-1995. Deprivation
and NHS Region. London: The Stationery Office, 1999.
5.7 Some spectacular breakthroughs:
five year survival rates for acute lymphoblastic leukaemia
in children.
Cancer Research Campaign Factsheet 23.2 1995 and Office
for National Statistics. Cancer Survival
Trends in England and Wales 1971-1995. Deprivation and
NHS Region. London: The Stationery Office, 1999.
5.8 Ways of beating cancer: examples
of how everyone can play their part
Chapter Six
Fig no. Description
6.1 Death rates from circulatory
disease: UK amongst highest in Western Europe
World Health Organisation, Copenhagen. Health For All
indicators database (EU). (ICD-9 390-459)
6.2 Death rates from stroke:
English women one of the worst records in Western Europe
World Health Organisation, Copenhagen. Health For All
indicators database (EU) England data analysed by
Department of Health, Statistics Division 2, from Office
for National Statistics data. (ICD-9 430-438)
6.3 Levels of smoking have fallen
more quickly in professional classes
Office for National Statistics. Series General Household
Survey (1972-1996).
London: The Stationery Office 1974-1998.
6.4 Obesity in women: higher
levels amongst manual social groups
Social and Community Planning Research (SCPR), Department
of Epidemiology and Public Health. Prescott-Clarke
P, Primatesta P eds. Health Survey for England
1996. London: The Stationery Office, 1998.
6.5 Well under half of people
with high blood pressure are treated successfully
Social and Community Planning Research (SCPR), Department
of Epidemiology and Public Health. Prescott-Clarke
P, Primatesta P eds. 1991-96 data from Health
Survey for England 1996. London: The Stationery Office, 1998.
Data for Health Survey for England 1997 published
on Internet website: www.doh.gov.uk/stats/hstab97/intro.htm
6.6 Unequal risk of heart disease
death at different employment levels in the public sector:
even after allowing for risk factors
Marmot M, Shipley M J, Rose G. Inequalities in death
- specific explanations of a general pattern? The
Lancet 1984; 1; 1003-1006.
6.7 Differing rates of coronary
bypass operations and angioplasties
Department of Health, Hospital Episode Statistics data,
calculated by Statistics Division 2. Figures are
provisional, no adjustments have been made for shortfalls in
data (i.e. the data are ungrossed).
6.8 Ways of beating coronary
heart disease and stroke: examples of how everyone can
play their part
Chapter Seven
Fig no. Description
7.1 Deaths from motor vehicle
traffic accidents: England performs comparatively well
World Health Organisation, Copenhagen. Health For All
indicators database (EU) England data analysed by
Department of Health Statistics Division 2, from Office
for National Statistics data. (ICD-9 E810-E819)
7.2 Death rates from all accidents
in children
England data analysed by Department of Health, Statistics
Division 2, from Office for National Statistics
data.
7.3 Child pedestrian deaths:
England one of the worst records in Europe
International Road Traffic and Accident database (OECD)
via Department of the Environment, Transport and the Regions.
From website - www.bast.de/indexeng.htm
7.4 Accidents kill proportionately
more children as they grow up
Analysed by Department of Health, Statistics Division
2, from Office for National Statistics data
7.5 Deaths from accidental falls
in older people are not reducing
Analysed by Department of Health, Statistics Division
2, from Office for National Statistics data.
7.6 Childhood accident deaths
involving head injury occur close to home
Derived from Sharples P M, Storey A, Aynsley-Green A,
Eyre J A. British Medical Journal 1990; 301:
1193-7.
7.7 Traffic calming can cut pedestrian
road accidents
Birmingham City Council via Birmingham Health Authority.
7.8 Ways of beating accidental
injury: examples of how everyone can play their part
Chapter Eight
Fig no. Description
8.1 Death rates from suicide:
England one of the best records in European Union
World Health Organisation, Copenhagen. Health For All
indicators database (EU) England data analysed by
Department of Health, Statistics Division 2, from Office
for National Statistics data. (ICD-9 E950-E959).
8.2 Ways of beating mental health
problems: examples of how everyone can play their
part
Chapter Nine
Fig no. Description
9.1 Live births to teenage
women in Europe: UK has the highest rate in Western Europe
Eurostat and United Nations Demographic Yearbook 1996,
via Social Exclusion Unit.
9.2 Underage pregnancies: a map
of inequalities
Based on: Department of Health. Public Health Common
Data Set, 1998. (Derived from Office for
National Statistics data). London: London School of Hygiene
and Tropical Medicine, 1998.
9.3 Percentage of young males
and females who have taken illicit drugs
Ramsay M, Spiller J, Drug Misuse Declared in 1996:
Latest Results from the British Crime Survey.
Home Office Research Study no 172. London: Home Office,
1997.
9.4 Some of the most common
adverse health effects of heavy alcohol consumption
Department of Health. Based on Sensible drinking.
The report of an inter- departmental working
group. Department of Health, 1995
9.5 The rising trend of reports
of food poisoning
Public Health Laboratory Service, website - www.phls.co.uk/facts/foodt1.ht
9.6 Vaccination conquers disease:
the trend for diphtheria
Derived from: Office for National Statistics. Charlton
J, Murphy M, eds. The Health of Adult Britain:
1841-1994. London: The Stationery Office, 1997. Additional
data to 1997: Public Health Laboratory Service, website - www.phls.co.uk/facts/dip.htm
9.7 An old adversary returning:
the recent rise in tuberculosis
Public Health Laboratory Service, website - www.phls.co.uk/facts/tube-toi.htm
9.8 Women in some ethnic groups
have a low uptake of potentially life-saving cervical
cancer smears
Health Education Authority. Kai Rudat ed. of MORI Health
Research Unit. Black and Minority Ethnic Groups
in England. Health and Lifestyles. Great Britain: BPC
Wheatons Ltd; 1994.
9.9 Relative mortality from coronary
heart disease by ethnic origin
Wild S, McKeigue P: British Medical Journal 314,
(7082) 1997: 705-710, from Office for National
Statistics data.
9.10 High rates of suicide amongst
young women born in the Indian sub-continent and living
in this country
Soni Raleigh V. Suicide patterns and trends in people
of Indian Subcontinent and Caribbean origin in England
and Wales. Ethnicity and Health, 1996:1(1): 55-63.
Chapter Eleven
Fig no. Description
11.1 Cancers: how the strategy
will save lives
11.2 Circulatory disease: how
the strategy will save lives
11.3 Accidental injury: how
the strategy will save lives
11.4 Suicide: how the strategy
will save lives
Estimates by Department of Health Economics and Operational
Research Division, based on mortality data from
Office for National Statistics.
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