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Overview

This report is a comprehensive review of health in the East Midlands and builds on the findings of the Health Profile for England.

This report includes a set of important health-related topics based on the Health Profile of England. It highlights the universal impact of COVID-19 as well as presenting inequalities between the least and most deprived areas, and variation in health behaviours seen in each region in England. As we move into the post pandemic and recovery phase there are emerging opportunities to sustainably tackle the historical and emerging challenges through the Levelling Up1 and soon to be published Disparities White Papers. Action will be supported via greater integration between the NHS and social care enabled by the development of Integrated Care Systems.

The data in this report provides evidence of the impact of COVID-19 on life expectancy, increasing risk factors in our population and the impact on the determinants of health which will have an enduring and long-term impact on the health of our population.

Healthy life expectancy at birth had started to decrease or level off in most regions before the pandemic. This represents an increasing number of years lived in poor health, resulting in a reduced ability to work, a reduced sense of wellbeing and an increased need to access services.

In all regions obesity was the largest contributor to morbidity. Smoking and diabetes were the second and third largest contributors although their placing varied in different regions.

In many areas we have seen a widening of inequalities between the most and least deprived areas. The harms to health are not uniform, data in this report tells a compelling story about widening health inequalities and variations in health behaviours.

There are also areas of improvement, the proportion of mothers smoking at the time of delivery continues to decline and antibiotic prescribing continues to decrease.

Taken together, these data confirm that we are now observing the direct and indirect impacts of the COVID-19 pandemic on all parts of society, with many chronic health conditions worsening and most historically disadvantaged areas being further so. This has resulted in greater health need and widening health inequalities in all parts of the nation. The findings reinforce the need for targeted increases of clinical and preventive services recovery programmes with a resolute focus on secondary prevention called for in the NHS Core20Plus5 initiative. As we have learned throughout the pandemic the nature and scale of the challenges cannot be met by any single agency. We must harness the full potential of our newly transformed public health and health care systems, guided by the new national strategies and frameworks, working closely with our partners in place, and engaging and mobilising local communities. Ultimately, these data confirm areas for system-wide prioritisation, mobilisation and action.


Introduction

The Regional Health Profile for England 2021: East Midlands report provides a comprehensive look at the state of the region’s health. It presents a range of population health data, such as smoking and obesity as well as providing an early summary of the impact of the COVID-19 pandemic on many aspects of health and health inequalities. The report provides a regional view of health and indicators presented in the Health Profile for England 2021, first produced by Public Health England (PHE) in 2017.The purpose of this regional report is to provide an overarching summary of the health of the population of the East Midlands for key public health stakeholders. The key stakeholders for this report are the Office for Health Improvement and Disparities, UK Health Security Agency and NHS England and Improvement. The report will also be of interest and importance to the wider public health system. The report gives a clear and consistent description of the health challenges facing the population and is a useful background document to support public health organisations working together to improve population health. It will be used to support and inform regional public health strategy and priority setting.

As the first edition of the Health Profile for the East Midlands region, the report includes public health intelligence about prevalence, regional trends, local authority comparisons, and health inequalities. The interactive charts and interpretation are grouped by these key themes:

The East Midlands edition is part of a set of nine new regional profiles that have been produced following the content, format, and methods and definitions published in the Health Profile for England. Content differs from the national report and between regions depending on the availability of regional level data and indicators. For example, the regional reports provide local authority comparisons benchmarked mostly against regional averages, whereas the Health Profile for England provides a wider view from international to regional comparisons. The regional editions do not include all the inequality breakdowns available in the England report, as some of the sub-national breakdowns are not available. Some references to the national level inequalities data, however, have been presented here for important context about how health outcomes and risks vary by ethnicity, age, sex and socioeconomic status and area deprivation.


Note on the format of the report

Charts in this report follow a standard format, with three sections for each topic area where data is available:

Headline - overall data for the key indicator used in the East Midlands, usually as a trend over several years. Regions are defined as government regions. Where this is not possible, other geographical region definitions are used as indicated in the supporting information.

Inequalities - how the indicator varies between different groups in the East Midlands, by protected characteristics such as age, sex and ethnicity or categories of socioeconomic deprivation where possible. Some inequalities information presented at national level in the Health Profile for England 2021 is not available at regional and sub-regional levels.

Sub-regional comparison - headline information on the indicator variation is presented at the Upper Tier Local Authority (UTLA) level - referred to as ‘local authorities’ in the narrative. UTLAs affiliated with the government region are shown unless stated otherwise. UTLA codes and boundaries are subject to change pending the data released. It is not always possible to use the same indicator for the headline, inequalities and sub-regional comparisons within each topic area.

Note on date formats - where more than one calendar year is used to calculate a measure, then a hyphen is used to show which years are included i.e. 2019-2020 for a two-year average. Where the data used covers a financial year or an academic year, a slash is used to indicate which years are covered i.e. 2019/20 indicates that the data covers April 1 2019 to March 31 2020. When describing change over time, the preposition ‘to’ is used.

Note on statistical significance - point estimates for lower geographies are compared to a national, regional or benchmark value. Where confidence intervals do not overlap with the reference point estimate, the difference is statistically significantly different. This is described as significantly higher or lower in the narrative. Where confidence intervals do overlap, the point estimates are described as similar. Where two time points or categories are compared for the same geographical area, statistical significance is based on overlapping confidence intervals around each point estimate and described in the same way as above.

Further information is available from the Health Profile for England data methods and definitions but please note that not all England level indicators have been used in this report.


Key findings

The East Midlands is home to a diverse population. When compared to England, deprivation appears to be lower in the region overall, but this masks the wide inequalities within the region. Inequalities exist in all places across the East Midlands whether they are urban, industrial, rural, or coastal communities. The city areas of Leicester, Nottingham and Derby are significantly more deprived than average with 1 in 5 people living in an area classed as income deprived and more than 1 in 4 children living in poverty.

Through mechanisms related to this socioeconomic deprivation, these populations experience poorer housing and working conditions, fuel poverty and reduced access to goods and services that improve health. In the industrial towns of the counties there has been a decline in the local jobs market also leading to socioeconomic disadvantage. Intersectionality describes how these multiple forms of disadvantage interact with individual characteristics such as gender, ethnicity, and age, resulting in the health inequalities presented throughout this report.

Many other factors impact on population health and wellbeing, such as age, sex and ethnicity. It is important to note that Leicester, Nottingham and Derby have significant proportions of their populations from ethnic minority groups.

Nationally, the evidence shows that the COVID-19 pandemic has exacerbated existing inequalities in both risk factors and outcomes. During the first year of the pandemic, the employment rate decreased in the region overall, worsening the socioeconomic drivers of health outcomes already experienced by the most deprived areas.

Across the East Midlands, there has been an increase in risk factors for ill health. This is particularly evident in the measures of self-reported wellbeing which show concerning trends over the pandemic, with significant percentage point increases in self-reported anxiety, low happiness, and satisfaction among the region’s population. The East Midlands has significantly higher rates of hypertension, obesity and smoking than the England average. Trends in obesity rates in the East Midlands show that this has been increasing in recent years in both adults and children. The impact of the pandemic on adult obesity levels is not known but given the changes in other risk factors presented (diet, physical activity and alcohol), it is possible we will see an increase in prevalence and a widening of inequalities. Smoking remains the risk factor most associated with lower life expectancy and healthy life expectancy. Overall smoking prevalence in the East Midlands continues to decline but remains higher than the England average. Inequalities in smoking prevalence among those in routine and manual occupations and those with a long-term mental health condition persist. There has also been an increase in the rate of deaths from alcohol-specific conditions, which were particularly high in 2020.

Added to these increasing risk factors for ill health is the impact of the pandemic on the use of health services. This may have influenced health outcomes across the life course. There were significant reductions in outpatient and inpatient admissions to hospital during the pandemic. Whilst emergency hospital admissions have returned to pre-pandemic levels, outpatients and elective admissions are still below average levels. Of particular concern is a reduction in new cancer patients entering treatment, over 8,000 lower for the Midlands (East and West combined) during the time period analysed compared to pre-pandemic levels. It will not be known for some time how this will affect health outcomes.

The direct and indirect impact of COVID-19 has resulted in a decline in overall life expectancy across the region. There were over 13,000 deaths registered with COVID-19 mentioned on the death certificate by the end of 2021. Because of this, COVID-19 became the leading cause of death for men in the region and the second largest cause of death among females after dementia and Alzheimer’s disease.

The impact on existing inequalities in mortality and life expectancy is evident. The difference in life expectancy between the most and least deprived areas in the region increased for both males (by 1.2 years to 9.7 years difference) and females (0.9 years to 8.5 years difference).

Healthy life expectancy is decreasing in the East Midlands for both males and females, and in 2017-2019 was 62.2 years for males and 61.9 years for females. Healthy life expectancy is a key metric for understanding overall health, but we cannot yet see the impact of the Covid pandemic on this metric. It is important to note that healthy life expectancy was declining prior to the pandemic, with women expecting to live for 21 years with poor health and men 17.4 years. The increase in the number of years that people will live with poor health reduces their ability to work, reduces their sense of wellbeing, and increases their need to access services.


Introduction to the East Midlands

The East Midlands is made up of ten local authorities: Derby, Derbyshire, Leicester, Leicestershire, Lincolnshire, North Northamptonshire, West Northamptonshire, Nottingham, Nottinghamshire, and Rutland. In April 2021, North Northamptonshire and West Northamptonshire were formed when Northamptonshire County Council split was transformed into two new unitary authorities. Because this change is comparatively recent, there are sections throughout the report where data is presented at the Northamptonshire level as opposed to North and West Northamptonshire separately.

Based on population estimates from mid-2020, the East Midlands has a population of 4.9 million people, equating to 9% of the England population. The population of the East Midlands continues to grow and is expected to increase to 5.5 million people by 2043, an increase of 11% from 2022. However, the East Midlands population is ageing. In 2022, it was estimated that 992,583 people (20%) in the East Midlands were aged 65 and over. By 2043, this is projected to increase to just under 1.4 million people, resulting in 25% of the population being aged 65 and over.

In the East Midlands, 34% of the population live in rural areas, whereas 66% live in urban areas, and 18% of the East Midlands population live in the most deprived quintile. In 2019/20, 18% of children lived in relative low income families. In the 2021 Annual Population Survey (APS), 420,200 people in the East Midlands were from ethnic minorities, equating to 11% of the East Midlands population.

The city areas have higher than average proportions of the population that are from ethnic minorities; Leicester (49%), Nottingham (24%) and Derby (17%). These areas are also the most deprived local authorities in the region, with around 20% of people living in an area classed as income deprived. In 2019/20, the proportion of children living in relative low income in these areas was as high as 31% in Leicester, 27% in Nottingham and 24% in Derby. There are also other pockets of deprivation in the industrial towns of the county areas and coastal Lincolnshire. These inequalities in wider determinants are reflected in the inequalities in health outcomes seen across the region.


COVID-19

Introduction

This section examines the direct impact of the COVID-19 pandemic on health with analysis of COVID-19 cases, death rates involving COVID-19, excess deaths, and vaccination rates during the pandemic up until 31 December 2021.


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.


COVID-19 cases

The data in figure 1 shows that:

  • at the end of December 2021, 1,020,990 confirmed cases of COVID-19 had been reported in the East Midlands
  • the region’s highest 7-day average case rate occurred in the week ending on 31 December 2021 at 14,696 cases per 100,000 population that week

Cumulative case rates presented may be lower than actual case rates due to the limited community testing in the earlier phases of the pandemic. COVID-19 has impacted some groups more than others and the cumulative confirmed case rates in the region were:

  • by sex, higher in females than males at 21,308 and 19,315 per 100,000 population respectively
  • by age, highest in people aged 25 to 49 at 25,671 per 100,000 population
  • by deprivation, highest in deprivation decile 9 at 21,210 per 100,000 population
  • by ethnicity, highest in the black/black British ethnic group at 23,058 per 100,000 population
  • by population density, highest in the 5th density decile at 21,330 per 100,000 population
  • by local authority, highest in Leicester at 23,702 per 100,000 population. At the end of December 2021, Derbyshire had the highest 7-day rolling rate at 2,059 per 100,000 population


Figure 1 - COVID-19 cases

Figure 1a - Trends

Source: UKHSA COVID-19 dashboard Date accessed: 02/03/2022 Note: Source data are updated daily and historic data may be revised. Download data

Figure 1b - Inequalities

Source: OHID COVID-19 Health Inequalities Monitoring for England (CHIME) tool Date accessed: 23/02/2022 Note: Source data are updated monthly and historic data may be revised. Download data

Figure 1c - Local Authority