logo

Introduction

The Health Profile for England (HPfE) was first produced by Public Health England (PHE) in 2017. It brings together PHE data and knowledge with information from other sources to give a broad picture of the health of people in England today. The report has been updated annually, with content and format altering slightly each year.

The 2021 edition of the HPfE provides a comprehensive snapshot of the nation’s health and updates many indicators presented in previous reports. It also contains a summary of the impact of the coronavirus (COVID-19) pandemic on many aspects of health.

During the pandemic, PHE has been publishing information on its impacts on health in a series of tools and outputs including the COVID-19 dashboard (1), the COVID-19 Health Inequalities Monitoring for England tool (CHIME) (2), the Wider Impacts of COVID-19 on Health (WICH) monitoring tool (3) and the weekly Excess Mortality in England reports (4). The information and insight gained from these tools are used, with other sources, as a basis for discussion of the impact of the pandemic on wider health outcomes and health inequalities.

In addition, the report makes comparisons with health in a selection of other countries (see Box 1 for selection) where possible. Much of the information is presented in a standard chart format (see Box 1) and key points emerging from these charts are discussed.

This report is divided into the following sections:

Summary points are included at the beginning of each section, followed by detailed analysis and charts.

The data and evidence in the report are provided to support policy makers and practitioners, to inform health improvement activities and support a reduction in health inequalities in their policy areas.


Box 1

Charts in this report follow a standard format, with 3 sections for each topic area:

Trends - overall headline data for the key indicator used in England, usually as a trend over several years.

Inequalities - how the indicator varies between different groups in England, by protected characteristics such as age, sex and ethnicity or categories of socioeconomic deprivation where possible. Other breakdowns for specific indicators are also included where available and relevant.

International comparison - the closest available indicator for the topic area, for 9 selected countries including the UK. This includes all countries in the Group of Seven (G7) - the USA, Canada, Japan, France, Italy, Germany and the UK - as well as the 2 other European Union (EU) nations with a population greater than 35 million - Spain and Poland. Where possible, a breakdown within the UK is included, but this is not available for many indicators

It is not always possible to use the same indicator for the headline, inequalities and international comparisons within each topic area.


The data behind each chart is available to download here.

Further information on methods, data and definitions is available here

COVID-19

Introduction

This section examines the direct impact of the COVID-19 pandemic on health. Prior to the COVID-19 pandemic, the 1918 flu pandemic was the most significant and accounted for around 150,000 deaths in England and Wales (5). The 2009 swine flu pandemic was mild by comparison and caused fewer than 700 deaths across the whole of the UK (6).

This section presents data on COVID-19 case and vaccination rates up until the end of June 2021 and death rates involving COVID-19 up until the end of May 2021. It also presents information on excess deaths during the pandemic up until 2 July 2021.

Summary 1 - COVID-19 cases

At the end of June 2021, 4,174,318 confirmed cases of COVID-19 had been reported in England. COVID-19 has impacted some groups more than others and at the end of June 2021, cumulative confirmed case rates in England were higher in females than males, highest in the North West region followed by London and the North East, higher in more deprived than less deprived areas, and highest in the Asian ethnic group. The UK’s highest 7-day average in early January 2021 (881 per million population) was the largest per head of population seen at any time in the countries presented. These differences between groups and countries were influenced by testing availability and policy, particularly early in the pandemic.

Summary 2 - deaths involving COVID-19

At the end of June 2021, 132,053 deaths among England residents had been registered with COVID-19 mentioned on the death certificate. Wide inequalities in death rates involving COVID-19 have been seen. At the end of May 2021, the cumulative age-standardised mortality rate was highest in London followed by the North West region. The rate in the most deprived areas in England was 2.4 times the rate in the least deprived, the rate in males was 1.6 times that of females, the rate in those aged 85 years and over was 3.2 times those aged 75 to 84 years and the rates in Black and Asian groups were more than double the rate in the White group.

Summary 3 - excess mortality

Excess mortality is a measure of how much higher all-cause mortality was in the pandemic period than would have been expected, based on previous years, had the pandemic not occurred. Between 21 March 2020 and 2 July 2021, all-cause deaths in England were 1.14 times higher than expected and this rose to 1.23 times higher in London. They were higher than expected in all age groups over 25. In deprived areas deaths were 1.17 times higher than expected. Deaths in the Black and Asian groups were close to 1.50 times higher than expected, compared with 1.12 times higher in the White group. These figures account for inequalities prior to the pandemic and therefore reflect the disproportionate direct and indirect impact of the pandemic on Black and Asian groups and deprived areas.

Summary 4 - COVID-19 vaccinations

At the end of June 2021, 92.0% of those aged 50 and over had received both doses of the COVID-19 vaccine. There was variation in uptake, from 94.9% in the least deprived areas to 86.8% in the most deprived areas, from more than 90.0% in the White British and Indian ethnic groups to less than 70.0% in the Black African and Black Caribbean groups, from 93.4% in those born in the UK to 81.8% in those born outside of the UK and from over 90.0% in most regions to 84.7% in London. However, among the countries presented, the UK and USA had the highest rates of second dose vaccinations.

Detailed analysis and charts

COVID-19 cases

The first two cases of COVID-19 were detected in England on 30 January 2020 and the first death within 28 days of a positive test occurred on 2 March 2020. At the end of June 2021, 4,174,318 confirmed cases of COVID-19 had been reported in England (1).

England had experienced 2 main waves of cases by the end of June 2021. The first wave took place in spring 2020 and the second from autumn 2020 to spring 2021. The timing of the second wave varied throughout the country and cases in regions in the north of England were relatively high in October and November 2020, while in regions in the south of England case rates increased later in December 2020 and January 2021.

Based on the specimen date (the date the sample was taken), Figure 1a shows daily cases peaked in England at 72,510 on 29 December 2020, during the second wave of the pandemic. However, case numbers in the first wave were significantly underestimated by limited testing availability.

In England, inequalities in COVID-19 case rates emerged early on in the pandemic and persisted into the second wave (2, 7). The inequality breakdowns presented in Figure 1b show that, at the end of June 2021, cumulative age-standardised case rates were higher in females than males, highest in the North West region followed by London and the North East, higher in more deprived than less deprived areas, and highest in the Asian ethnic group particularly the Pakistani and Bangladeshi groups.

Although the cumulative case rate at the end of June 2021 was highest for those aged 85 and over, the second highest rate was for those aged 25 to 49 years and the lowest rate was for those aged 65 to 74 years. These age patterns have changed throughout the pandemic as they been influenced by testing policies and capacity as well as vaccination policy and uptake through the second wave. In June 2021 the highest case rates were in the 0 to 24 age group, many of whom were not eligible for vaccination, followed by people aged 25 to 49 who became eligible later in the vaccination rollout program (2).

In terms of international comparisons, Figure 1c shows that the timing of peaks in case rates per million population varied considerably between the countries presented. The data in Figure 1c are based on the date positive cases were reported, not the date the sample was taken, and 7-day averages are used as not all countries report cases every day. Comparisons of case rates between countries should be treated with caution as, although influenced by factors such as differences in population mixing, sociodemographic profiles and measures to control the virus, they are also influenced by differences in testing availability and case definitions between countries.

Nevertheless, the UK’s peak in early January 2021 (a 7-day average of 881 per million population) was the largest per head of population seen at any time in the 9 countries presented. At the end of June 2021, however, the USA had the highest cumulative case rate, followed by France, Spain, Poland, the UK and Italy.

Figure 1 - COVID-19 cases

Figure 1a - Trends

Source: PHE COVID-19 dashboard Date accessed: 05/08/2021 Note: Source data are updated daily and historic data may be revised. Download data

Figure 1b - Inequalities

Source: PHE COVID-19 Health Inequalities Monitoring for England (CHIME) tool Date accessed: 18/08/2021 Note: Source data are updated monthly and historic data may be revised. Download data

Figure 1c - International