logo

Overview

This report is a comprehensive review of health in the North East region and builds on the findings of the Health Profile for England (HPfE) 2021 (1).

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 Up 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 and antibiotic prescribing both continue to decrease.

Taken together, this data confirms 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 service recovery programmes with a resolute focus on secondary prevention called for in the NHS Core20Plus5 approach to reducing health inequalities. 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, this data confirms areas for system-wide prioritisation, mobilisation and action.

Introduction

This profile brings together data and knowledge to give a broad picture of health in the North East. The report provides a regional view of health and indicators broadly based on and presented in the Health Profile for England 2021 (HPfE) (1), first produced by Public Health England (PHE) in 2017.

As the first edition of Health Profile for the North East region, the report includes public health intelligence about prevalence, regional trends, local authority comparisons, and health inequalities. The interactive charts and interpretation are grouped into the following sections:

The North East edition is part of the suite of nine new regional profiles that have been produced following the content, format, and methods and definitions (2) published in the HPfE, with content altering slightly from the national report and per region 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 HPfE provides a wider view from international down to regional comparisons. The regional editions do not cover all of the inequalities 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.

Please note that we have provided direct web links to some of the sources, including sources available directly via OHID Fingertips profiles. The data outlined in the text was accurate as at 22 March 2022 unless otherwise stated.


Key findings

Regional health and wellbeing context

The health and wellbeing gap between the North East and the rest of England remains significant for many health indicators, including life expectancy which is closely related to area level deprivation and socioeconomic status. Within the North East the gap in life expectancy at birth between the least and most deprived areas is 12.2 years in males and 9.7 years in females. A third of the population live in areas of relative high deprivation (in the 20% of most deprived areas of England). Employment, as well as good quality and fair work that reduces in-work poverty, are major drivers of overall health and wellbeing. However, employment rates in the region continue to be lowest in the country, as is the median average for weekly earnings. The proportion of children both in relative and absolute low income families is highest in the country and increasing.


COVID-19 and life expectancy

As in the rest of the country, improvements in life expectancy stalled around 2011, followed by a downward trend in 2020 due to the excess mortality from COVID-19. COVID-19 deaths are linked to area level deprivation and also ethnicity. Deaths were higher in Asian and Asian British ethnic groups, the largest ethnic minority (non white) group in the region. Mortality from COVID-19 in black and black British groups was similarly high. Deaths related to COVID-19 were also more prevalent in more densely populated areas, and significantly higher in males. Inequalities in hospitalisation and deaths from COVID-19 are partly explained by COVID-19 vaccination rates, which are lowest in black African, other white, and in Pakistani ethnic groups and highest in white British ethnicity. Vaccination rates were lower in the most deprived areas and varied by occupation - uptake was highest in managerial and professional occupations and lowest in those who have never worked or in long term unemployment.

The North East ranks lowest for life expectancy compared to other regions, relative deprivation being associated closely with mortality rates. In 2020 life expectancy fell to 76.9 years in males and to 80.9 years in females - the region’s lowest level since 2003, although provisional data from 2021 suggests that life expectancy may have returned to pre-pandemic levels. People living in more affluent areas live longer than in deprived areas and the fall in life expectancy between 2019 and 2020 saw inequalities by deprivation widen in the North East in males, from 12.3 to 12.8 years. In females, however, the gap slightly narrowed overall, from 10.6 to 10.0 years.


Child health

Whilst over 127,000 (22.8%) children live in absolute low income families, some gains have been made in child health including in infant mortality which is significantly better than the England average. Many of the child development indicators such as school readiness have reached the national levels and trends were improving prior to the pandemic. Child obesity, however, is significantly higher than the England average for both Reception and Year 6 children. The most recent data suggest that the proportion of babies born with low birthweight and infant mortality rate have not changed significantly since the start of the pandemic. There has been progress in narrowing the gap between the region and the England average for the proportion of mothers smoking at the time of delivery, although the region remains significantly higher than the national average (13.3% compared to 9.6%). Directly comparable data on child obesity or child development are not available for the pandemic period but the latest evidence, in line with the rest of the country, suggests an increase in child obesity. Physical activity levels in children seem to have increased contrary to the national trend but the change is not statistically significant.


Health in adults

Healthy life expectancy measures the number of years spent in good health. In 2017 to 2019, healthy life expectancy was 59.4 years for males and 59.0 years for females, with no significant difference by sex. The top causes of morbidity or ill health were low back pain, diabetes mellitus and depression in males, and for females low back pain, headache and gynaecological diseases. Depression and anxiety were estimated to account for 5.4% and 2.9% of total morbidity respectively in the region in 2019. More recent Office for National Statistics (ONS) estimates indicate that 1 in 4 adults reported feeling high anxiety in the previous week, an increase since 2016/17. Impacts on population mental health are also evident in the rates of hospital admissions for self-harm which are highest in the North East compared to other regions. The diagnosis rate of dementia continues to be higher or the same as the England average in all but one local authority in the region. Whilst cancer screening among other health services have been disrupted during the pandemic, cancer screening coverage for breast, cervical and bowel cancers in 2021 was nevertheless significantly higher than the national average.


Risk factors associated with ill health

Tobacco, high blood pressure, and unhealthy diet along with high body mass index (or obesity), alcohol and drug use, and occupational risks are the leading risk factors for ill health and mortality from CVD, cancers, and respiratory disease. Prior to the pandemic there was an upward trend in obesity whereas smoking has been declining. The estimated smoking prevalence in 2020 was 13.6%. The proportion of adults classified as obese and overweight in 2020/21 was 69.7% and significantly worse than the England average. 15.9% of all age population registered with a GP in 2020 were diagnosed with high blood pressure, with a trend consistently above the England average. Diagnosed prevalence can, however, indicate a better diagnostics performance rather than overall prevalence. In 2019/20, 64.7% of adults were physically active, a rate significantly below the England average with wide variation in estimates by local authority. With many of the risk factors, England level data shows considerable disparities by wider determinants such as deprivation or occupation. For example, smoking among routine occupations, at 21.6% in 2020, is 8 percentage points higher than in the general population.


Wider determinants of health

A diverse range of social, economic and environmental factors influence people’s mental and physical health across the life course. Index of multiple deprivation is a composite measure that draws together many of those factors, including employment, education, housing and living environment. As discussed above, the North East has a large number of people living in one of the most deprived areas of England. A third of the population (33.1%) in the North East was estimated to be living in households that did not reach the minimum income standard in 2018/19. Moreover, around half of children (49.9%) in the region are estimated to be living in a household with income not meeting the minimum acceptable standards of living (based on what members of the public think is enough money to live on). 14.8% of households in the North East experienced fuel poverty in 2019, a measure which defines a household as fuel poor if it has income (after accounting for fuel costs) below a certain level and a low energy efficient home. On the other hand, the region is better than the England average for a number of areas including air pollution or deaths and serious injuries on roads, which are the lowest in the country. The population in the North East also has better access to parks and outdoor spaces compared to many other regions.


Health protection

Health protection issues include the prevention and control of all types of infectious diseases, and chemical and environmental threats to the health of the population. The profile briefly presents information on air pollution, sexually transmitted infections, tuberculosis (TB), vaccinations and AMR (antimicrobial resistance). This report only covers a small section of health protection indicators, responsibility of which is now under UKHSA’s (UK Health Security Agency) remit. COVID-19 is also part of infectious diseases but given its wider impact it is covered separately in the report. Modelled estimates by Defra suggest that 3.6% of mortality in 2019 was attributed to air pollution in the North East, a proportion which is lowest compared to other regions. The regional trend for the concentration of human-made fine particulate matter (PM2.5) levels has been changing from its highest level in 2014, at 7.5 per \(\mu\)g/\(m^{3}\) to its lowest in 2020, following a steep decline during the first year of the pandemic. TB incidence rate has seen a decline from its highest point in 2007 at 7.7 to its lowest level at 2.9 of new cases per 100,000 population in 2019. New sexually transmitted infections (STIs, excluding Chlamydia aged <25) diagnostic rate was 449 per 100,000 population, significantly lower than the England average of 619 in 2020. Whilst coverage for childhood vaccinations were also interrupted during the pandemic, flu vaccination coverage was considerably higher than previous years. Generally, vaccination coverage for the North East is higher than the England average for both childhood and flu vaccines. The regional trend between 2015 and 2020 shows that the rate of antibiotic prescribing in primary care has fallen every year, with the largest drop between 2019 and 2020 likely to be due to the pandemic and disruptions in access to health services.


Information about the interactive charts

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

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

Inequalities - how the indicator varies between different groups in the North East 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 level.

Sub-regional comparison - headline information on the indicator variation is presented at the Upper Tier Local Authority (UTLA) level. 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.

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 data methods and definitions (3)


Introduction to the North East

The North East of England population, the smallest population out of all regions, is around 2.68 million according to the 2020 ONS mid-year estimates (4).The population is expected to grow to around 2.77 million by 2043, an increase of 3.2%. The region’s over 65s age group is expected to grow from 1 in 5 in 2022 to 1 in 4 residents by 2043, a regional rise only equalled by the South West of England (5). These projections, however, are 2018 based estimates whilst we, at the time of writing, await the Census 2021 results. The longer term impact of Brexit on net migration and COVID-19 is also uncertain, but in 2020 the North East of England median age fell from 41.8 to 41.7 years, driven by increased numbers of deaths and increases in net international and internal migration (5).

The region includes five universities in the cities of Newcastle, Durham, Sunderland and Middlesbourgh. There is an extensive coastline running down the East side of the region, seven of the twelve local authorities in the region are located along this coastline. The Chief Medical Officers 2021 Annual report highlights and discusses the observed poorer health outcomes in coastal communities compared to other areas in England. The population distribution varies by local authority within the region. County Durham makes up over 20% of the region`s population with almost 500,000 inhabitants, while Hartlepool has the smallest population of all local authories in the region at just over 90,000.

The populations from ethnic minority groups (excluding white minorities) is estimated to be 4.2%, the North East being less diverse compared to other regions (6). Regardless, ethnic minority groups make up a sizeable population which includes people from black African, black Caribbean, Bangladeshi and Pakistani ethnic minority backgrounds. People from ethnic minority backgrounds are at a greater risk of worse health outcomes than the white British ethnic group. These outcomes may include a higher risk of death from COVID-19, or women from black ethnic groups often suffer worse maternal outcomes (7). Latest population estimates by ethnicity from ONS (2018) suggest that in the North East white British ethnicity makes up 93.6% of the population, followed by Asian (2.9%), white other (1.7%), mixed (0.9%) and black (0.9%) ethnic groups. ONS experimental statistics estimates suggest that lesbian, gay and bisexual population was 2.4% in 2019 1 (8).


COVID-19

Introduction

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


England had experienced two main waves of cases by the end of June 2021 (1). 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

In the North East, at the end of December 2021:

  • just over 588,000 confirmed cases of COVID-19 had been reported in the North East region (9)

  • the region’s highest 7-day average number of new cases was reported on the 31 December 2021, at 9,839 (Fig. 1a)

  • the three highest cumulative rates per 100,000 population were in Middlesbrough, Hartlepool, Stockton-on-Tees, and lowest in Northumberland, County Durham, and Darlington (Fig. 1c).

Evidence on disparities in COVID-19 cases and deaths has emerged throughout the pandemic. As in the rest of the country, in the North East, the cumulative age standardised case rates per 100,000 population in the region have significantly differed by age, sex and ethnicity (Fig. 1b):

  • case rates per 100,000 population were significantly higher in females (22,341) than males (20,407)

  • rates were significantly higher in age groups 0-24 and 25-49 (24,479 and 26,794 respectively)

  • lowest case rates were in mixed/multiple ethnic groups (16,032), but significantly higher in ‘any other ethnic group’ and in black and black British ethnic groups, respective rates of 23,400 and 23,131 per 100,000 population

  • unlike deaths and admissions involving COVID-19, by the end of 2021 deprivation did not appear to correlate with case rates. In fact, the least deprived areas had the highest rates per 100,000 population - highest in the second least deprived decile at 23,283, and lowest in the second most deprived decile at 20,706 per 100,000 population

  • case rates appear to be lowest in both areas with highest and lowest population density.

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

Source: UKHSA COVID-19 dashboard Date accessed: 23/02/2022 Note: Source data are updated daily and historic data may be revised. Download data


Deaths involving COVID-19

At the end of December 2021,

  • there were over 7,200 deaths registered with COVID-19 mentioned on the death certificate in the North East region (10)

  • the region’s highest 7-day average deaths were reported for 11 April 2020, with 65 deaths in total (Fig. 2a).

There were wide inequalities in death rates involving COVID-19 (Fig 2b), the cumulative age-standardised mortality rates in the region were:

  • significantly higher in males than females, with the rate of 376.0 in males compared with females at 253.3 per 100,000 population

  • significantly higher in over 65 age groups onwards gradually increasing by age: 3.6 times higher in 75-84 age groups than in ages 65-74, and more than a threefold increase in ages 85+ compared to 65-74

  • in line with the national findings, death rates gradually increased with deprivation - the death rate in the most deprived decile was over three times higher than in the least deprived decile (a rate of 509.3 compared to 163.4 per 100,000)

  • significantly higher in Asian and Asian British ethnic groups, the largest non-white ethnic minority group in the region. Mortality in black and black British was similarly high, although the difference to the regional average is not statistically significant due to the relatively smaller number recorded in that ethnic group

  • deaths tended to be significantly higher in the more densely populated areas

  • age standardised cumulative death rates were highest in Middlesbrough, Sunderland, and South Tyneside local authorities, and lowest in Northumberland, Redcar and Cleveland, and Newcastle upon Tyne (Fig. 2c).


Inequalities in COVID-19 deaths rates in England

HPfE reported that inequalities in death rates from COVID-19 largely reflected inequalities in COVID-19 case rates (1). Deaths are also influenced by differences in survival following COVID-19 infection. During the first wave of the pandemic in England, people aged over 80 years were 70 times more likely to die from COVID-19 once infected, compared with those aged under 40 years (11). Survival was higher in females than males and, after controlling for age, deprivation and pre-existing health conditions, survival among many ethnic minority groups remained lower than the white group. The Bangladeshi ethnic group had the lowest survival and had nearly twice the odds of dying once diagnosed than the white ethnic group. The Pakistani, Chinese, and black other ethnic groups had 1.35 to 1.45 times the odds of dying once diagnosed and the Indian group 1.16 (12). The possible reasons for these differences and further interpretation of ethnic inequalities in COVID-19 mortality rates are discussed in Health Profile for England 2021.


Figure 2 – COVID-19 deaths

Figure 2a - 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 2b - 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 2c - Local Authority

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

Excess mortality during the COVID-19 pandemic

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 year`s mortality rates as a baseline. 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. Between 27 March 2020 and 31 December 2021, the cumulative all-cause deaths were (Fig 3b):

  • 1.13 times higher than expected in the region as a whole

  • 1.14 times higher in females and 1.12 times higher in males

  • higher than expected in all age groups apart from females under the age of 25, with the highest excess mortality in males aged 25-49

  • associated with deprivation in males, with each deprivation quintile there is a gradual increase in excess mortality

  • equally high in all three of the most deprived quintiles for females, a less pronounced gradient by deprivation than males

  • excess mortality is highest in black males and 1.35 times higher than expected

  • highest excess mortality rates were in Sunderland, Middlesbrough, County Durham and Redcar and Cleveland local authorities with higher than expected ratio of deaths at 1.15 and over.

Figure 3 – Excess deaths

Figure 3a - Trends

Source: OHID Excess mortality in England dashboard Date accessed: 07/02/2022 Download data

Figure 3b - Inequalities & UTLA

Source: OHID Excess mortality in English regions dashboard Date accessed: 07/02/2022 Download data

COVID-19 vaccinations

By the end of Dec 2021, 88.3% of the North East population aged 18 and over had received two vaccination doses. However, there is a wide variation in the COVID-19 vaccine uptake by (Fig 4b):

  • country of birth with just over 10 percentage point difference for those born in the UK compared to non-UK born residents

  • English language proficiency (people who report that their main language is not English and that they cannot speak English well or at all) with around 17 percentage point disparity: 88.6% in those whose main language is English compared to 72.0% in populations where English is not their main language

  • sex: 90% of females had received two doses compared to 86.3% of males

  • those who report having some level of disability - where day to day activities are limited - generally had a higher vaccination coverage

  • deprivation: most deprived areas had 80.8% uptake compared to 93.5% in the least deprived, a difference of nearly 13 percentage points

  • occupation: uptake in managerial and professional occupations 93.2%, gradually decreasing by socioeconomic status with those who have never worked or long term unemployed lowest at 70.3%

  • ethnicity: vaccination rates were lowest in black African (68.4%), other white (71.9%), and in Pakistani (74.7%) ethnic groups and highest in white British ethnicity (89.0%)

  • housing: uptake was highest in people who own their own house at 92.0% and lowest among those who are privately renting (78.6%) (after ‘not classified’ group at 74.2%)

  • religion: Christian groups had the highest two dose vaccination rate at 90.7% compared to Jewish groups with lowest proportion at 69.9%

  • area characteristics: rural populations appear to have higher proportion with two doses at 90.6% against urban populations at 87.7% but the difference is less pronounced than in other groups outlined above

  • local authority: rates for two doses ranged from 67.1% in Newcastle upon Tyne to 84.1% in Northumberland (Fig. 4c).

Figure 4 – COVID-19 Vaccinations

Figure 4a - 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 4b - 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 4c - Local Authority

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

Life expectancy and mortality

Introduction

This section examines trends and inequalities in all-cause mortality, mortality from leading causes of death and life expectancy. It presents data for the pre-pandemic period, and 2020 data where available.

Life expectancy

Life expectancy is an important summary measure of population health and mortality. Since 2010, improvements in life expectancy have stalled, and in some areas or groups declined. The North East ranks lowest for life expectancy compared to other regions. In 2020 the difference to the South West, the region with the highest life expectancy, in females was 2.9 years and in males 3.2 years, disparities of which are associated with levels of area deprivation (13).

Further analysis for the region shows (Fig. 5):

  • increases in life expectancy at birth stalled in the last decade after the trends, both in males and female, had been mostly rising year on year since 2001 (Fig. 5a)

  • life expectancy decreased during the first year of the pandemic: In 2020 life expectancy fell to 76.9 years in males and to 80.9 years in females - region’s lowest level since 2003 (Fig. 5a). Provisional data for 2021 however show an increase in life expectancy to pre-pandemic levels for both males and females (78.7 and 82.8 years respectively) (15)

  • people living in more affluent areas live longer than in deprived areas. The fall in life expectancy between 2019 and 2020 saw inequalities by deprivation widen in the North East in males (Fig. 5b): the life expectancy gap by deprivation 2 widened from 12.3 to 12.8 years (16). In females the gap slightly narrowed overall, from 10.6 to 10.0 years

  • local authority comparisons against the regional average (Fig. 5c) suggests life expectancy in 2020 was significantly lower in females in Middlesbrough (79.0 years) and County Durham (80.1 years). For males, the lowest life expectancy in the region was also in Middlesbrough (74.6%) followed by Hartlepool (75.1%) and Sunderland (75.6%). Northumberland and North Tyneside have a significantly better life expectancy both for males and females.

These estimates describe the average number of years a baby born in 2020, for example, would live if they experienced the age-specific mortality rates for 2020 throughout their life. Life expectancy at birth estimates are not projections or predictions of how long babies born in a given year can expect to live but an alternative way of summarising mortality rates for a given period. As mortality rates will change in the future, the figures are not a forecast of future life expectancy.

Figure 5 – Life expectancy

Figure 5a - Trends

Source: OHID Public Health Outcomes Framework Date accessed: 10/06/2022 Download data

Figure 5b - Inequalities

Source: OHID COVID-19 Health Inequalities Monitoring for England (CHIME) tool Date accessed: 02/03/2022 Note: SII = Slope Index of Inequality. See data and definitions document for more details. Download data

Figure 5c - Local Authority

Source: OHID public health profiles Date accessed: 02/03/2022 Download data

Child health

Introduction

Every child having a good start in life is the foundation for the future health and wellbeing of England’s population. The proportion of the North East children both in relative and absolute low income families is highest in the country, and increasing (17).

This section presents some key indicators of child health: Birthweight, infant mortality, early child development and child obesity. The data includes the pre-pandemic period and 2020/21, where available.

Low birthweight

Low birthweight (less than 2500 grams) is measured as a proportion of all live births only (excludes still births). In the North East (Fig. 9a):

  • prior to the pandemic the proportion of babies born at full term with a low birthweight has generally been increasing since 2009 with some exceptions year on year in the region

  • in 2020, the proportion of babies born with low birthweight (3.2%) remained higher than the England average

  • there was a wide variation by local authority in 2020, but only Middlesbrough showing a statistically significant difference to the regional average at 4.1%. The proportion was lowest in North Tyneside at 2.4% (Fig. 9b).


In England the last two decades have seen overall improvements in babies born with a low birthweight, infant deaths and child development (1). However, in the years leading up to the coronavirus pandemic improvements slowed down.

Levels of children born with low birthweight has been monitored monthly during the pandemic, but whilst some fluctuation in trends is in evidence regionally, there appears to be no significant increase in the North East and Yorkshire region (15).


Figure 9 – Low birthweight

Figure 9a - Trends

Source: OHID Public Health Outcomes Framework Date accessed: 31/03/2022 Download data

Figure 9b - Local Authority

Source: OHID Public Health Outcomes Framework Date accessed: 31/03/2022 Download data

Infant mortality

Infant mortality covers all deaths within the first year of life. The majority of these are neonatal deaths which occur during the first month and the main cause is related to prematurity and preterm birth, followed closely by congenital anomalies (18). The infant mortality rate in the North East region (Fig. 10a):

  • continues to be better than the England average, at 3.5 per 1,000 births in 2018-20

  • has seen improvements since 2001-03 but stalled around 2011-13

  • local authority comparisons show that the rates range from 2.1 in Hartlepool to 5.0 per 1,000 births in Darlington, but the differences are not statistically significant, which is often the case when describing small number of deaths and relatively small differences (Fig. 10b).

Figure 10 – Infant mortality

Figure 10a - Trends

Source: OHID Public Health Outcomes Framework Date accessed: 31/03/2022 Download data

Figure 10b - Local Authority

Source: OHID Public Health Outcomes Framework Date accessed: 31/03/2022 Download data

Child development

Starting primary school is a significant milestone in a child’s educational journey. Language and communication skills are fundamental to young people’s potential development and achievements later in life (19). Being able to express themselves, interact with peers and make themselves understood helps to build a child’s confidence and boost their self-esteem. Inadequate communication skills can lead to poorer adult outcomes in literacy, mental health and employment (20,21). A good level of development is defined as children achieving at least the expected level in the early learning goals in the prime areas of learning (personal, social and emotional development; physical development; and communication and language) and the early learning goals in the specific areas of mathematics and literacy.

In the academic year 2018/19 (Fig. 11) the proportion of children reaching a good level of development at the end of Reception year in the region was:

  • at the same level as England, the regional trend has risen at a faster rate since 2012, closing the gap between the North East and the rest of the country

  • fewer boys than girls achieved good level of development: 78.3% of girls and 65.7% of boys (Figure 11a). This was also the case for the England average

  • local authority comparisons (Fig. 11b) in 2018/19 indicated higher than regional average level of development in Northumberland and Stockton-on-Tees with significantly lower levels evident in Middlesbrough.

COVID-19 impact on child development

Due to the pandemic, data on child development at the end of Reception year was not reported for the academic year September 2019 to July 2020. In March 2020, Early Years settings were closed to most children, with only children from key workers and vulnerable families continuing to attend (around 7% of children aged 2 to 4) (22). Outside formal Early Years settings, young children may also have experienced a lack of social activities and interactions that would normally have helped to prepare them for the start of school, such as with grandparents and via play dates.

Although the full impact of the pandemic on early years development will not be known for some time, a study carried out by the Education Endowment Foundation (EEF) found that out of the schools in England surveyed, 76% reported that children who started school in the Autumn 2020 term needed more support than children in previous cohorts (23). Almost all surveyed schools indicated that they were concerned about pupils’ communication and language development (96%), personal, social and emotional development (91%) and levels of literacy (89%).

Figure 11 – Child development

Figure 11a - Trends

Source: OHID Child and Maternal Health Profile Date accessed: 31/03/2022 Download data

Figure 11b - Local Authority

Source: OHID Child and Maternal Health Profile Date accessed: 31/03/2022 Download data

Childhood obesity

Prevention and treatment of childhood obesity presents a significant public health challenge. Obesity in childhood can result in the early onset of cardio-metabolic, respiratory and musculoskeletal conditions, as well as adverse psycho-social outcomes and an increased risk of living with obesity and associated mortality and morbidity later in life (24).

Trends

The trend data for the North East is available until 2019/20 academic year, as the pandemic and school closures affected data collection in 2020/21. Although NHS Digital has provided regional estimates from the pandemic period, this is not shown in the charts (Fig.12a) because of the inconsistencies in reporting in 2020/21.

Trend data up until 2019/20 academic year for the North East shows (Fig 12a):

  • whilst trends in girls at reception age have been relatively stable since 2011, obesity levels saw a slightly steeper increase compared to previous years, by a 1 percentage point between 2018 and 2019

  • whereas for boys, the proportion decreased to its lowest level since 2012, to 10.8% in 2019/20, and for the first time obesity was lower than in girls at 11.3%

  • in Year 6 - trends have been steadily increasing for boys since 2012, up from 22.0% to 26.1% in 2019. The proportion of obesity in girls is lower than boys at 20.3%, a proportion that has remained at similar levels in the previous 10 years

  • regional trends for obesity at Reception age and in Year 6 continues to be above England average in both boys and girls.

COVID-19 impact on child obesity and physical activity

The latest findings during the 2020/21 academic year, reported by NHS Digital, suggest that obesity has increased across all regions in both Reception age children and children in Year 6 (25). A link between weight gain and out of school time in the school holidays has previously been demonstrated (26). Closure of schools, sporting and leisure facilities, park facilities and recreational areas, together with an increase in screen time over the pandemic period have led to an overall reduction in physical activity in children and young people (27), and confirmed by the latest Sport England survey estimates for the country (28). In the North East, however, physical activity levels in children saw a small but not statistically significant increase in 2020/21: from 46.2% from the previous year to 47.1% (29). In some other regions - namely the East of England, South East, South West and West Midlands - physical activity in children also dropped bringing the average to a small decrease in England overall from 44.9% to 44.6%. The UK Chief Medical Officers’ (CMOs’) definition and recommendation is that that children and young people (5-18 years) are physically active for an average of at least 60 minutes per day across the week (30). Data also suggests that the proportion of respondents snacking “more often” during the pandemic has increased most in younger age groups, possibly contributing to increased weight gain and obesity in children and young people (15).


Inequalities in physical activity and the pandemic

Recent survey results from Sport England suggest that in England, there has been a reduction in physical activity in boys, and an increase in girls during the pandemic in England (28). Whereas the differences by deprivation have widened.


Fewer children were measured as part of the National Child Measurement Programme (NCMP) in 2020/21 than in 2019/20, making direct comparisons between the two years unreliable. However, in the academic year 2020 to 2021, data reported by NHS Digital (25) suggests that:

  • 15% of children aged 4 to 5 (Reception year) in the region were obese

  • 29.1% of children in the North East aged 10 to 11 years (Year 6) were obese.

Data from the 2020/21 NCMP is not published at local authority level due to the inconsistent reporting, with the exception of a small number of LAs where data was collected for 75% or more children (31). From the North East, prevalence of obesity in 2020/21 was reported only for Darlington, Northumberland and South Tyneside. Increased prevalence of obesity can be seen in each of the these three local authorities for both Reception and Year 6 children.

The available evidence suggests that there has been an increase in childhood obesity, but local level and long term implications to childhood obesity due to the pandemic are still uncertain whilst we wait for NCMP results from the next few years.


Inequalities in child obesity

England level data from 2020/21 reported by NHS Digital suggest that between 2006/07 and 2020/21 the gap between obesity prevalence for children attending schools in the most and least deprived areas increased from 4.5 to 10.7 percentage points, with the steepest increase shown between the latest two academic years (32). NHS Digital reports that 2020/21 NCMP data show a gap of 11.3 percentage points for girls and 10.1 percentage points for boys between the least and most deprived areas of England. The latest deprivation gap in Year 6 overall is 16.6.%, but narrower in girls than boys: 14.7 percentage points for girls and 18.4 percentage points for boys. Obesity prevalence by ethnicity was highest for Black children at 22.5% in both reception and year 6 at 35.7%. It was lowest for Chinese children in reception (8.3%) and White (23.6%) and Chinese children in year 6 (24.3%) (33).


Figure 12 – Child obesity

Figure 12a - Trends

Source: OHID Child and Maternal Health Profile Date accessed: 31/03/2022 Download data

Figure 12b - Local Authority

Source: OHID Child and Maternal Health Profile Date accessed: 31/03/2022 Download data

Hospital admissions for injuries in children

Admissions caused by unintentional and deliberate injuries in children aged 0-14 have been decreasing in the last ten years with the latest year 2020/21 showing a further dip which is likely to have been affected by disruption to health services during the pandemic. The difference between England and the North East has narrowed, however, the region’s:

  • rate continues to be significantly higher than the England average, in 2020/21 at 100.4 per 10,000 children aged 0-14 compared to the England rate of 75.7. (Fig. 13a)

  • local authority comparison shows significantly higher than regional average rates in Newcastle upon Tyne (125.4), North Tyneside (121.7) and Northumberland (116.0) (Fig.13b)

Smoking at the time of delivery

Smoking is the most important modifiable risk factor in pregnancy associated with premature births, miscarriage, stillbirth, neonatal complications, low birth weight and sudden infant death syndrome (34). Smoking in early pregnancy in deprived areas of England was more than five times the least deprived in 2018/19 (35). In the North East there has been progress in narrowing the gap between the region and England:

  • smoking at the time of delivery has been steadily decreasing in the last ten years, from 21.1% in 2010/11 to 13.3% in 2020/21 - progress which has been more rapid than in England. However, the proportion of mothers smoking at the time of delivery, in the region, remains significantly higher than the England average at 9.6% (Fig. 14a)

  • local authority comparisons suggest that the prevalence ranges from 9.9% in North Tyneside to 15.5% in County Durham, the latter which together with Sunderland (15.1%) are significantly above the regional average (Fig. 14b)

Other indicators of child health

Previous Health Profile for England reports, prior to the pandemic, demonstrated inequalities in many other aspects of children’s health (36), including regional variations whereby:

  • five of the North East region’s local authorities were within the England’s highest 10 areas for obesity in early pregnancy in 2018 to 2019: Sunderland, Redcar and Cleveland, Northumberland, Middlesbrough and County Durham (37)

  • as in the rest of England, the rate of under 18s conceptions has been declining in the North East, over the past 20 years (38). The gap between the England average and the region narrowed in 2019, the rate however, remains significantly above the national average at 21.8 per 1,000 births compared to England rate of 15.7 in 2019.

Prior to the pandemic, in England smoking among teenagers had been reducing, while drug use had increased. The proportion of 15-year-olds who reported they were regular smokers decreased from 12% to 5% between 2010 and 2018 (39). Lifetime prevalence of drug use among school pupils aged 11 to 15 increased sharply between 2014 and 2016, even accounting for a methodological change, but then remained at 24% up to 2018 (40). This survey data is not available at regional level.

The Health Profile for England 2021 also concluded that the hospital admission rate for extraction of teeth due to dental decay in children reduced in 2020 and in children up to the age of 5 was half of that seen in previous years. This may indicate that more children are living with severe dental decay as a result.


Inequalities in child health

Health Profile for England 2021 reported wide inequalities across all indicators of child health. In 2019, in the most deprived areas, the proportion of term babies with a low birthweight, the infant mortality rate and the prevalence of obesity in children aged 4 to 5 and 10 to 11 years was more than double the least deprived (1). In 2018 to 2019, 23.4% of children aged 5 years had dental decay, and the prevalence was almost 4 times higher in most deprived areas than in the least deprived areas. For those indicators with data available by ethnicity (low birthweight, infant deaths, dental decay, obesity) inequalities by ethnic group are present.


Mental health in children and young people

Hospital admissions for self-harm in ages 10-24 in 2020/21 were the second highest in the country at 542.9 per 100,000 population after South West, a rate which equates to 2,575 admissions in that year (41). 3.2% of school pupils were identified with social, emotional and mental health needs, a proportion which is significantly higher than the England average. In 2019/20, the proportion of looked after children affected by poor emotional wellbeing was 39.0%, a measure which is identified in the child’s latest assessment as a cause for concern (42). The proportion was similar to the England average. The pandemic has had a profound effect on the life of young people, through isolation and interruptions to education. Some of these effects will be longer-term and data are not available to measure them yet. One national survey comparing aspects of mental health found that in 2020, one in six (16.0%) children aged 5 to 16 years were identified as having a probable mental disorder, increasing from one in nine (10.8%) in 2017. When compared with those unlikely to have a mental disorder, children and young people with a probable mental disorder were more likely to say that lockdown had made their life worse with 54.1% of 11 to 16 year olds, and 59.0% of 17 to 22 year olds stating this, compared with 39.2% and 37.3% respectively (43).

You can find out more about Child and Maternal Health from OHID Fingertips Public Health profiles.

Figure 13 – Injuries resulting in hospitalisation

Figure 13a - Trends

Source: OHID Public health profiles Date accessed: 31/03/2022 Download data

Figure 13b - Local Authority

Source: OHID Public health profiles Date accessed: 31/03/2022 Download data

Figure 14 – Smoking in pregnancy

Figure 14a - Trends

Source: OHID Public health profiles Date accessed: 31/03/2022 Download data

Figure 14b - Local Authority

Source: OHID Public health profiles Date accessed: 31/03/2022 Download data

Health in adults

Healthy ageing

As well as life expectancy (how long the population could expect to live), it is also important to consider the quality of life or length of time spent in good health. This is referred to as healthy life expectancy. Healthy life expectancy is not available for the years covering the pandemic yet; however, in the region, healthy life expectancy in 2017-19 (Fig.15):

  • for males, years lived in good health was 59.4 years, with the average years of life lived in poor health 18.6, this is worse than the England average of 63.2 years lived in good health

  • for females, years lived in good health was 59.0 years with the average years of life lived in poor health higher than males at 22.8 years. The England average years lived in good health for females is 63.5 years

Figure 15 – Healthy life expectancy

Figure 15a - Trends

Source: OHID Public Health Outcomes Framework Date accessed: 31/03/2022 Download data

Leading causes of morbidity

The Global Burden of Disease (GBD) study uses years lived with disability (YLDs) to attribute the burden of morbidity. YLDs is a measure of morbidity that combines the prevalence of each disease with a rating of the severity of its symptoms (excluding death itself), to give an overall measure of the loss of quality of life. Figure 16 identifies the most common causes of morbidity in 2019 according to GBD, as measured by age-standardised YLDs per 100,000 population. It also shows the change since 1990. Change over time needs to be interpreted with caution as this may reflect changes in methodology and categorisation. Overall, the top three leading causes of morbidity in the region in 2019 were low back pain, diabetes mellitus and depressive disorders. GP patient survey shows that long term musculoskeletal problems - which includes low back pain - overall are reported by 23.1% of people, a proportion which was highest in the North East compared to other regions in 2020 (44).

GBD 2019 study estimates that years lived with disability caused by diabetes has significantly increased since 1990. There were some differences by sex :

  • for males, the top three causes were: low back pain at 937.0 years lived in disability per 100,000 population, diabetes at 913.2 years and depressive disorders at 610.0 years. Diabetes was over 2.7 times higher in 2019 than three decades earlier

  • for females, the top three causes were: low back pain at 1305.7 years lived in disability per 100,000 population, headache disorders at 931.8 years and depressive disorders at 827.2 years. Diabetes was the fifth highest cause for years lived in disability after gynaecological disease.

These modelled estimates show very similar results for leading causes by local authority (Fig.16b ). Please note that GBD study 2021 will be published in 2022 but at the time writing data was not yet available to be included in this report.

Figure 16 – Leading causes of morbidity

Figure 16a

Source: Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Download data

Figure 16b - Local Authority

Source: Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Download data

Mental health and wellbeing

The GBD study estimates that mental health conditions, such as depression and anxiety, respectively account for 5.4% and 2.9% of total morbidity in the region (45). These estimates relate to 2019, and for all ages.

Figure 17a shows trends in wellbeing up to 2011/12 to 2020/21. These are Office for National Statistics (ONS) measures looking at levels of anxiety, low happiness, low life satisfaction and low worthwhile feelings.

In the region (Fig. 17):

  • 1 in 4 of the population reported feeling high anxiety in 2020/21, up from 1 in 5 in 2016/17

  • similarly, the proportion of the population reported feeling low happiness in 2019 has worsened since 2016/17, from 8.7% to 10.1% in 2020/21

  • 7.0% of the population reported feeling low satisfaction in 2020/21 and 5.6% reported low scores on their life feeling worthwhile

  • at local authority level, there is some variation but almost no statistically significant differences, apart from Redcar and Cleveland having a lower proportion of people with low happiness scores, whereas Darlington has higher than regional average level of people with high anxiety score.

These wellbeing measures have been monitored throughout the pandemic, and at the time of writing North East showed statistically significant increase in low life satisfaction (17.9%) and low self worth (17.6%) reported in Sept 2021 and compared to 2019 (46). The UCL COVID-19 Social Study provides estimates of regional average anxiety levels being high during the first lockdown, a trend that reduced once restrictions were lifted.

Self harm

Emergency admissions for self-harm per 100,000 population are the highest in the North East compared to other regions in 2020/21 (47). Figure 18 shows that trends in emergency hospital admissions for self-harm in 2020/21:

  • continue to be higher than the England average after a drop between 2014/15 and 2016/17

  • the latest available data shows the rate at 273.9 per 100,000 and significantly worse than the England average rate of 181.2

  • local authority comparison by sex shows the highest rates tend to be in females, and rates for girls and women are highest in North Tyneside, Northumberland and Darlington ranking highest (Fig. 18b)

  • for males emergency admissions for self-harm are highest in North Tyneside, Northumberland and Gateshead.

Suicide

Conversely to self-harm where the rates are higher in females, the regional average rate for suicides in 2018-20 was four times lower in females with the rate of 5.0 per 100,000 population compared to 20.2 in males (48, 49).

As for overall trends and local authority comparison:

  • the average regional suicide rates, for those aged 10 and over, increased (Fig. 18a), with a significant rise from 10.8 per 100,000 since 2015-17 to a rate of 12.4 in 2018-20

  • at local authority level, Redcar and Cleveland had the highest rates of suicide both in males and females.

Figure 17 – Mental health and wellbeing

Figure 17a - Trends
<b>Source:</b> <a href = 'https://fingertips.phe.org.uk/public-health-outcomes-framework#page/0/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000004/yrr/1/cid/4/tbm/1' target = '_blank'> OHID Public Health Outcomes Framework </a> <b>Date accessed:</b> 31/03/2022 <a href = 'https://fingertips.phe.org.uk/static-reports/health-profile-for-england/Data/North_East_017a_mental_health_and_wellbeing.csv' target = '_blank'><b>Download data</b></a>

Source: OHID Public Health Outcomes Framework Date accessed: 31/03/2022 Download data

Figure 17b - Local Authority
<b>Source:</b> <a href = 'https://fingertips.phe.org.uk/public-health-outcomes-framework#page/0/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000004/yrr/1/cid/4/tbm/1' target = '_blank'> OHID Public Health Outcomes Framework </a> <b>Date accessed:</b> 31/03/2022 <a href = 'https://fingertips.phe.org.uk/static-reports/health-profile-for-england/Data/North_East_017b_mental_health_and_wellbeing.csv' target = '_blank'><b>Download data</b></a>

Source: OHID Public Health Outcomes Framework Date accessed: 31/03/2022 Download data

Figure 18 – Suicide and Self-harm

Figure 18a - Trends
Figure 18b - Local Authority

Source: OHID Public health profiles , Suicide Prevention Profile Date accessed: 31/03/2022 Download data

Dementia and Alzheimer’s disease

As evident earlier in the report, dementia and Alzheimer’s disease is one of the leading causes of death, and a significant cause of ill health in the region. In 2021, the region’s estimated dementia diagnosis rate was 66.2% in the population aged 65 and over, a proportion that represents nearly 22,000 registered patients with dementia diagnosis (50). The rate is within the 66.7% national target set out in the prime minister’s challenge in 2013 for dementia - although slightly below, the difference is not statistically significant (51). The diagnosis rates are compared to the prevalence estimated by the Cognitive Function and Ageing Study II.

The diagnosis rate in the region decreased from 75.2% in 2019 with the biggest drop in 2021, which is likely to be due to the pandemic and disruption in health services. In 2021, however, only Northumberland had a rate significantly below the target, at 60.7%.

Referrals to memory clinics from primary care practitioners reduced in April 2020. Referral numbers remained flat until June 2021 but by November 2021 there was evidence that referrals were returning to pre-pandemic levels (15).

Cancer

Cancers are a significant cause of ill health and mortality in the country and the region. World Health Organisation (WHO) estimates that between 30% to 50% of cancers are preventable by implementing existing evidence-based prevention strategies, avoiding risk factors, and through supporting people to live healthier lives, including: stopping smoking, losing weight, eating healthily, taking more exercise and reducing sun exposure (52). Strategies to improve early diagnosis and detection along with appropriate treatment are key factors for higher survival rates from cancer. April 2020 at the start of the pandemic saw the lowest level of cancer diagnosis at 1,000.5 new cancer cases diagnosed compared to 1,592.0 at the same month in the previous year, April 2019, when comparing the monthly trends in new cancer diagnoses for all sites combined (Fig 19a). This is likely to have been impacted by health services disruption discussed briefly in the next chapter. Cancer screening coverage for breast, cervical and bowel cancers in 2021 were however significantly better the national average (53). The four most commonly diagnosed cancer sites are a lung, breast, colorectal and prostate cancers, with lung cancer consistently highest out of all four cancers (Fig 19a).

Figure 19 – Cancer incidence

Figure 19a - Trends

Source: National Cancer Registration & Analysis Service Date accessed: 07/02/2022 Note: Data based on Cancer Alliance 2020 geographies. See data and definitions document for more details on mapping alliances to Government Office Regions. Download data

Health service contact during the pandemic

The reduced admissions, GP consultations, A&E attendances and health seeking behaviour observed during the pandemic may also represent missed opportunities to provide secondary prevention treatment to patients to reduce risk factors, such as blood pressure and cholesterol control, and may also result in an increase in long term health complications.

Data on admissions to hospital during the pandemic for causes other than COVID-19 can help to understand the potential broader impacts of the pandemic on future health. In the North East:

  • the estimated hospital admissions from all causes dropped by 26.3% in the first quarter of 2020/21 compared to 2018/2019 baseline. This was however reversed by the first quarter of 2021/22, and over pre-pandemic levels by 4.7% (15)

  • Outpatient attendances in the first quarter of 2020/2021 reduced by 46.7% and were still below the baseline by 9.8% a year later - in the first quarter of 2021/22 (15).

Risk factors associated with ill health

Introduction

Risk factors play an important role in determining whether a person becomes ill, at what age, and the associated effect on quality of life. The Global Burden of Disease (GBD) study divides risk factors into 3 main groups: behavioural, metabolic, and environmental and occupational (45). These are underpinned by the broader social and economic risk and protective factors that shape people’s lives such as education, income, work and social capital. These wider determinants are discussed in the next section of this report. At the time of writing GBD 2019 results for regions and local authorities were available but an update is due during the first half of 2022. This section focuses on behavioural and metabolic risk factors in adults. It examines the contribution that these risk factors make to morbidity and mortality, using GBD data. Trends and inequalities in some of the risk factors making the largest contribution are examined.

Leading risk factors

Figure 20a and 20b show the leading risk factors making the largest contribution to morbidity and mortality in the region:

  • the risk factors making biggest contribution to mortality in the North East were tobacco, high blood pressure, high blood glucose and diet

  • these also make a significant contribution to morbidity along with high body mass index (or obesity), alcohol, drug use and occupational risks. Although calculated independently, these risk factors are connected and individuals often have more than one risk factor

  • the leading risk factors contribute to main causes of deaths: CVD, cancers, diabetes, and tobacco being a specifically high risk to chronic respiratory diseases.


HPfE 2021 reported inequalities in risk factor prevalence contributing to inequalities in ill health and mortality (1). For example, inequality in smoking prevalence by deprivation is a large determinant of the inequalities in mortality and life expectancy. In 2019, smoking prevalence remained much higher than average in some groups, for example, people in manual occupations (23.2%), people with a long term mental health condition (25.8%), deprived areas (16.9%), and the mixed ethnic group (19.5%). The prevalence of ‘increasing or higher risk’ drinking was greatest in the highest household income group at 34.8%. The prevalence of obesity in adults was higher in the more deprived areas, and there were wide inequalities in the proportion of adults meeting recommended level of physical activity and fruit and vegetable consumption. Health Survey for England evidence suggest that prevalence of multiple risk factors is higher in men, the white ethnic groups, lowest income households, most deprived areas, and people with long term health conditions (54).


Smoking

In the last decades smoking prevalence has continued to decrease and the gap between the North East and the England average has narrowed slightly, by 0.4 percentage points between 2015 and 2019 (Fig. 21a).

The latest data for 2020 is not directly comparable due to methodological changes caused by the pandemic, (hence not included in the trend chart 21a) but the latest data shows:

  • smoking prevalence in 2020 estimated at 13.6%, a proportion which is highest out of all the other regions and significantly higher than the England average of 12.1% (55)

  • smoking prevalence was highest in Hartlepool at 15.9% and lowest in Stockton-on-Tees at 10.8.% (56).

There is a wide variation in smoking by:

Recent methodological changes mean that current prevalence from the Annual Population Survey (APS) cannot be reliably compared to previous years, but according to previous surveys in the last two decades smoking rates have been decreasing. Other data sources suggest that this trend continues. There is also evidence of an increase in the rates of people attempting to quit smoking during the pandemic (15). Although the rates have fluctuated, quit rates remained consistently higher than in 2019. Analysis of Opinion and Lifestyle Survey suggests that across all regions the latest smoking prevalence is lower compared with 2019, London being the only exception, although the differences between 2019 baseline and the 4 week period ending 10 October 2021 are not statistically significant.

Alcohol

Increasing and high risk drinking is defined as drinking more than 14 units per week. In 2019 the prevalence of ‘increasing or higher risk drinking’, was highest in North East (28.7%) followed by the North West (26.9%) and the East Midlands the lowest (18.7%) (1). Health Survey for England latest estimates for local authorities in 2015-18 suggested a wide range between the highest proportion of adults drinking over the recommended limit at 33.8% in South Tyneside to the lowest at 14.1% in Hartlepool (54).

Both alcohol specific and alcohol related mortality are higher in the region compared to the England average, with the former showing an increasing trend. Alcohol specific mortality measures deaths that are wholly caused by alcohol consumption. Whereas alcohol related deaths include a wider range of alcohol-related conditions, a fraction of which are attributed to alcohol.

In the North East in 2020:

  • the number of deaths related to alcohol in the region was 1,304, which represents a rate of 49.0 per 100,000 population (59). The mortality rates range from highest in Hartlepool at 60.2 to lowest in Northumberland at 37.3 per 100,000 population

  • the number of alcohol specific deaths in the region was 522, which represents a rate of 20.0 per 100,000 population and significantly higher than the England average, and highest in South Tyneside at 25.4 and lowest in Gateshead at 13.1 per 100,000 population (60).

There are significant differences by sex, for example, alcohol specific mortality in 2018-2020 was nearly twice as high in males than females (11.0 and 21.3 per 100,000 population respectively) (61)

Increasing the number of individuals in treatment is part of Government’s strategy to support recovery from addiction. It also aligns with reducing re-offending as some offending behaviour is closely linked to dependent alcohol use. The proportion (30.7%) of adults in treatment for alcohol dependence successfully completing structured treatment was lowest in the country in 2020, with no significant change in trend in the last five years (62). Successful completion of treatment also means that the individuals did not re-present to treatment within 6 months of completion.


HPfE 2021 reported differences in drinking patterns by age and income. ‘Increasing or higher risk’ drinking was highest in the 55 to 64 age group, with the lowest rates among younger age groups, under 25s, as well as those aged 75 or over. Prevalence of ‘increasing or higher risk’ drinking was greatest in the highest household income group but greater harm, such as hospital admissions for alcohol-related conditions in 2018 to 2019, were more than double that in the least deprived areas, the gap has only slightly narrowed since 2010/2011 (1). Suggested explanations for this inverse relationship between consumption and harms, often referred to as the ‘alcohol harm paradox’, include interactions with other behaviours such as smoking, poor diet and exercise, among the reasons why alcohol-related harms are greater in more deprived areas (63).


Drug use

Pre-pandemic survey-based estimates for recent drug use in England vary year-on-year (64). 9.4% of people aged 16 to 59 reported using any drug in the last year in 2019 to 2020. Rate of deaths due to drug-misuse continue to be highest among those born in the 1970s (65). Regional differences are significant - North East had the highest rate of deaths due to drug misuse and London the lowest (9.9 and 3.5 deaths per 100,000 respectively in 2018-20) (66). In the North East region there were 731 deaths during 2018-20 due to drug misuse, and the rate per 100,000 population has been increasing faster than the England rate (67). Local authority comparison shows that all but one local authority had higher than national average rates of deaths from drug misuse, six of which are in the highest ten in the country. The proportion of individuals in treatment successfully completing structured drug treatment for both non opiate and opiate dependence in 2020 was lower than the national average. The proportion for non opiate users, however, has seen a recent improvement since 2018, and the gap between the region and England is narrowing (68).

Physical activity

In 2020 to 2021, 63.5% of adults were physically active in the North East, a measure which means undertaking at least the recommended level of 150 minutes of moderate intensity physical activity or equivalent per week (69). In the region:

  • the rate of physical activity is significantly worse compared to the England average of 65.9%

  • there is variation by local authority where the lowest activity levels are found in Hartlepool at 51.3% and the highest in Northumberland 70.1% (70).

England level findings from mid-May 2020 to mid-May 2021 by Sport England Active Lives survey confirms wide inequalities in physical activity in adults. Compared to general population at 60.9%, the proportion of physical activity was lower for: people who are routine/semi routine jobs and those who are long term unemployed or have never worked (52%); living with a disability or long term health condition (45%); and Asian (48%) and black (52%) ethnic groups (71).

Obesity

Long term trends show an increase in adult obesity in England, although with some fluctuation year to year (1). In 2019/20, obesity prevalence was highest in the North East (34.0%) and lowest in London (23.4%) (1). In the North East region the latest data shows that (Fig. 21a):

  • the proportion of adults classified as obese and overweight increased between 2015/16 to 2020/21 from 66.8% to 69.7%

  • the prevalence of 69.7% was significantly worse compared to the England average of 63.5% in 2020/21

  • there is some variation by local authority, ranging from lowest in North Tyneside (65.9%) to highest in Stockton-on-Tees (75.8%). (Fig. 21b).

As with other risk factors, there are inequalities in adult obesity prevalence by age, sex and deprivation. The HPfE report outlined evidence by age groups and in 2019 adult obesity was lowest in those aged under 25 with a gradual increase by age group up to ages 65-75 after which prevalence decreases (1). This pattern was seen for both males and females. Obesity prevalence was lowest in the least deprived areas and highest in the most deprived, with a clear gradient evident both in females and males (72).

The long term 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 and a widening of inequalities.

Diet

The proportion of the population meeting the recommended ‘5-a-day’ on a ‘usual day’ was 53.7%, and lower than the England average of 55.4% in 2019/2020 (73). HPfE 2021 reported wide inequalities at England level: the recommended 5-a-day is lower for people who were unemployed (45.2%), living with a disability (52.1%), working in routine and manual occupations (45.8%), Asian (47.2%), black (45.7%), or living in the most deprived areas (45.7%) (1).


COVID-19 impact on risk factors

HPfE 2021 reported that the prevalence of ‘increasing and higher risk’ drinkers went up in April 2020 and remained above pre-pandemic levels until June 2021 (1). There has also been a reduction in physical activity levels particularly in black and Asian groups and lower socioeconomic groups. The number of people trying to quit smoking during the pandemic has increased with over a third of smokers attempting to quit in the 3 months up to June 2021.

High blood pressure

The diagnosed prevalence of high blood pressure (hypertension) in the region in 2020:

  • was 15.9% of the all-age population registered with GPs, with relatively small changes since 2015 prevalence at 15.6%, and consistently higher than the England average (13.9% in 2020) (Fig. 21a)

  • the proportions by local authority range from highest in Northumberland (17.8%) to lowest in Newcastle upon Tyne (12.0%) but this variation can also be related to better diagnosis rates that can vary by GP surgery and geographical areas. (Fig. 21b).

These figures include adults with blood pressure higher than 140/90 mmHg, and those with blood pressure below this limit who report taking medication to lower their blood pressure. It should also be noted that diagnosed prevalence indicate a better diagnostics performance rather than overall prevalence. Also, these prevalence figures are not age standardised so will be influenced by the age of the population making direct area comparisons difficult.

Blood glucose

Increased blood glucose levels may lead to diabetes and can increase the risk of heart disease and stroke, kidney disease, vision and nerve problems. A blood glucose level that is above normal but not in the diabetic range is referred to as Non-diabetic hyperglycaemia (NDH). Whilst we have no prevalence estimates available for the region overall, the CCG (clinical commissioning group) level estimates from the National Diabetes Audit for 2020/21 suggest that prevalence in the North East ranges from 4.2% to 8.1% for patients aged 17 and over registered at the general practice - the equivalent figures for England, from lowest to highest are 1.7% to 9.6% respectively (74).

Figure 20 – Leading risk factors

Figure 20a - Morbidity

Source: Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Download data

Figure 20b - Mortality

Source: Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Download data

Figure 21 – Risk factors

Figure 21a - Trends
Figure 21b - Local Authority
<b>Source:</b> <a href = 'https://fingertips.phe.org.uk/covid19#page/1/gid/1938133364/pat/15/par/E92000001/ati/6/are/E12000001/yrr/1/cid/4/tbm/1/page-options/car-do-0' target = '_blank'> Wider Impacts of COVID-19 on Health: Wellbeing and behavioural risk factors </a>, <a href = 'https://fingertips.phe.org.uk/covid19#page/3/gid/1938133361/pat/15/ati/6/are/E12000004/iid/219/age/1/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0' target = '_blank'> Wider Impacts of COVID-19 on Health: Hypertension QOF </a> <b>Date accessed:</b> 31/03/2022 <a href = 'https://fingertips.phe.org.uk/static-reports/health-profile-for-england/Data/North_East_021b_risk_factors.csv' target = '_blank'><b>Download data</b></a>

Source: Wider Impacts of COVID-19 on Health: Wellbeing and behavioural risk factors , Wider Impacts of COVID-19 on Health: Hypertension QOF Date accessed: 31/03/2022 Download data

Wider determinants of health

Introduction

The wider determinants of health are a diverse range of social, economic and environmental factors which influence people’s mental and physical health across the life course. Inequalities in these factors are an important driver of the inequalities in risk factors and health outcomes presented earlier in this report.

This section presents some key indicators for a range of wider determinants of health relating area deprivation, to the built and natural environment, education, and employment and income.

Area deprivation in the North East

The Index of Multiple Deprivation 2019 is a relative measure of deprivation measured across seven distinct domains: Income; health and disability; employment; education, skills and training; barriers to housing and services; crime; and living environment (75). Area deprivation is closely link to risk factors and health outcomes. In the North East:

  • around a third of residents (34%) live in geographical areas that are classified as being in 20% the most deprived areas of England. But there are big differences by local authority. For example, in Middlesbrough over half of the population live in the most deprived quintile of the country, compared to a fifth in Northumberland (76)

  • the more deprived areas tend to have a lower proportion of the population aged 65 and over

  • Middlesbrough and Hartlepool are in the 10 most deprived local authorities in the country when comparing overall deprivation scores (77). Seven out of the North East 12 local authorities are within the 25% local authorities with highest deprivation score overall.

Employment

Employment, as well as good quality and fair work that reduces in-work poverty, and the focus of government’s levelling up agenda, are major drivers of overall health and wellbeing (78). Good employment improves health and wellbeing across people’s lives, boosting quality of life and protecting against social exclusion.

Rates of employment in the North East continue to be lowest out of all regions, according to the labour force quarterly statistics by ONS, with the latest period available until Dec 2021 (15).

Annual figures show that the region’s employment rates (Fig. 22a):

  • have historically been lower for females compared to males, but increasing from 60.9% since 2011/12 to 69.6% in 2020/21

  • employment increased for males, from 69.4.0% in 2011/12 to 72.9% in 2020/21

  • vary by local authority across the region (Fig. 22b): Middlesbrough, Hartlepool and South Tyneside had significantly lower employment rates than the regional average in 2020/21 whereas Stockton-on-Tees, Gateshead and North Tyneside had significantly higher employment rates than the regional average.

Interpretation of trends should be undertaken with caution due to the likelihood that the impact of the pandemic has not yet been fully reflected in the available data (15). All face to face interviews were suspended affecting interviews from March 2020 due to the pandemic, a change in survey methodology which increases the potential for a non-response bias. ‘Furlough’ scheme has not been previously defined or measured and may have led to apparent contradictions or unexpected trends.


HPfE 2021 outlined evidence that he COVID-19 pandemic has had a substantial impact on employment patterns and opportunities (1). There is evidence that the economic impacts of the pandemic affected young people disproportionately. At the end of January 2021, the take up rate of eligible employees that made a claim to HMRC under the furlough scheme was highest in those aged under 18 (34.5%) and those aged 18 to 24 (21.1%). There has also been a decline in the number of 16 and 17 years olds in employment, from 22.5% in the 3 month period March to May 2020, to 13.9% in the comparable period in 2021. In November 2020 the arts, entertainment and recreation industry and the accommodation and food service industry had the highest percentage of employees on furlough leave at 33.6% and 21.9% respectively. These are industries with a high proportion of the workforce who are relatively young.


Figure 22 – Employment

Figure 22a - Trends

Source: OHID Public health profiles Date accessed: 31/03/2022 Download data

Figure 22b - UTLA

Source: OHID Public health profiles Date accessed: 31/03/2022 Download data

Income

Many physical and mental health outcomes improve incrementally as income rises (79,80). Income is related to life expectancy, disability free life expectancy, and self-reported health (80). The relationship operates through a variety of mechanisms. Financial resources determine the extent to which a person can both invest in goods and services which improve health and purchase goods and services which are bad for health. Low income can also prevent active participation in social life and day to day activities, affecting feelings of self-worth and status. It can also influence health through feelings of shame, low self-worth and exclusion (81). The average weekly median earning in the North East in 2021 was 451 GBP, and significantly lower than the England average of 496 GBP (82).

The Minimum Income Standard (MIS) is defined as not having enough income to afford a ‘minimum acceptable standard of living’, based on what members of the public think is enough money to live on. In 2018/19 (Fig. 23a) a third of the population (33.1% ) in the North East lived in households that did not reach the minimum income standard, a second highest proportion in the country after Yorkshire and the Humber at 33.8%, according to the analysis by Joseph Rowntree Foundation (79).

Child poverty and children in low income families

Around half of children (49.9%) in the region are estimated living in a household with income not meeting the minimum acceptable standards of living (Fig. 23a). Another measure from Loughborough University looks at child poverty rates after housing costs (Fig. 23b) and local authority comparison shows that the highest estimated rates are in Newcastle upon Tyne (41%), Middlesbrough (39%), Sunderland (38%), Hartlepool (38%) and South Tyneside (38%).

Another income measure looks at the proportion of children in absolute and relative low income families. The proportion of children in both absolute and relative low income families in 2019/20 was highest in the North East compared to other regions, and for both measures the trend has increased since 2015/16 (83,84). Moreover, the proportion of children living in low income families was significantly higher than England in all the region’s local authorities. The number of children in absolute low income families is estimated at 108,746 which makes up 22.8% of children aged 16 and under in 2019/20 (83). The proportion living in relative low income families is 26.8%, which equates to an estimated 127,830 children in the region (84).

Figure 23 – Minimum income standard

Figure 23a - Trends

Source: Joseph Rowntree Foundation Households below a Minimum Income Standard: 2008/09 - 2018/19 Date accessed: 31/03/2022 Download data

Figure 23b - Local Authority

Source: After housing cost childer poverty rate estimates, Loughborough University 2019-20 Date accessed: 31/03/2022 Download data

The built and natural environment

As described in 2021 HPfE, the quality of the built and natural environment affect our physical and mental health and wellbeing (1). Poor air quality, housing standards or access to green spaces are risk factors for health, particularly for older people, children, disabled people and individuals with long term illnesses.

Homelessness and temporary accommodation

Homelessness and the use of temporary accommodation remain at high levels in England (85). In 2020/21, 0.4 per 1,000 of households in the North East were in temporary accommodation, which is significantly lower than the England average of 4 per 1,000 (85). Although there was a slight increase in the rate from 0.3 per 1,000 households in the previous year, the North East rate remains lowest in the country. During 2021, 14,730 households were either homeless or at risk of homelessness in 2020/21 (86). The rate of 12.5 per 1,000 households was significantly higher than the England average but the rate decreased from the previous year (87). The measure for homelessness is the rate of households owed a prevention or relief duty under the Homelessness Reduction Act. Prevention duties include any activities aimed at preventing a household threatened with homelessness within 56 days from becoming homeless. Relief duties are owed to households that are already homeless and require help to secure settled accommodation.

Fuel poverty

14.8% of households in the North East experienced fuel poverty in 2019, a proportion which is estimated to represent over 176,000 households (88). This measure defines a household as fuel poor if it has income (after accounting for fuel costs) below a certain level and a low energy efficient home. Fuel poverty in the region in 2019 was higher than the England average of 13.4%, although statistical significance is not calculated. A study on cold-attributable winter deaths by temperature level demonstrates the majority of deaths (97% in the North East example) in an average winter occurred at temperatures above the alert threshold temperature of 2\(^\circ\) (89). Children living in a cold home may also find it more difficult to study or do homework which affects educational and long term work opportunities. The proportion of households experiencing fuel poverty is likely to increase as the cost of energy increases.

Active travel and access to green spaces

Greener environment is better for health, preventing illness, but also aids recovery from illness and managing poor health. Greenspace can help to bind communities together, reduce loneliness, and mitigate the negative effects of air pollution, excessive noise, heat and flooding. In the North East:

  • the average distance to the nearest park or public garden is 827.3 metres, which is the third shortest distance after London and North West, according to a survey from April 2021. North East also has the highest proportion of people with access to private outdoor space (15)

  • in 2019/20, 13.2% of adults walked and 1.8% cycled to work at last least three days a week, proportions for both form of active travel were third lowest compared to other regions (90,91). London is the only region with significantly better rates than the England average

  • Newcastle upon Tyne had a significantly higher proportion of people walking for travel at least three days per week at 23.6% and the local authority ranks highest also for cycling for travel at least three days per week (92,93).

Education

Educational attainment is strongly linked with health behaviours and outcomes. Higher educational qualifications and more years in education is linked to lower risk of: Long term diseases; self reported poor health; and mental health conditions such as depression or anxiety (94). Education provides knowledge and capabilities that contribute to mental, physical, and social wellbeing. Educational qualifications are also a determinant of an individual’s labour market position, which in turn influences income, housing and other material resources associated with health.

In the North East in 2020:

  • the proportion of 16-17 year olds not in education, employment or training (NEET) or whose activity is not known was 5.7%, which represents 3,100 children aged 16-17, and at similar level to England (5.5%) (95). The proportion has decreased since 2018, from 6.5%

  • the proportion of 16-17 year old NEETs varied by local authority, with significantly higher proportions in Newcastle upon Tyne (7.1%) and County Durham (6.5%) compared to the regional average.

Health protection

Introduction

Health protection issues include the prevention and control of infectious diseases, as well as chemical, environmental and radiological threats to the health of the population.

Over the past century, there has been a considerable reduction in the number of deaths from infectious diseases linked to vaccine protection, improvements in living conditions, water and sanitation, as well as effective treatments for infections. However, the COVID-19 pandemic has demonstrated how threats from new infectious diseases can emerge and will continue to do so as a result of a whole range of global factors. The COVID-19 pandemic is not over, and there remains the potential threat from other pathogens such as pandemic influenza.

There are also a range of environmental threats such as air pollution, climate change and flooding. Climate change is a major risk to health both nationally and globally. It affects all aspects of our everyday life and our environment, including the places we live, the air we breathe, as well as our access to food and water (96). Climate change also increases the likelihood of extreme weather events such as flooding and heat waves (97).

It is not possible to cover all health protection issues in this report. This section presents a selection of key health protection topics on air pollution, sexually transmitted infections, tuberculosis (TB), vaccinations and vaccine preventable infections, and antimicrobial resistance (AMR).

Infectious diseases

In England, prior to the pandemic the incidence of many infectious diseases such as TB had been declining, but disproportionately impacted more deprived or inclusion health groups (such as the homeless, substance misusers and refugees/asylum seekers) (1). In 2019, the incidence of TB was higher in people born outside of the UK, particularly those of Indian, Pakistani or black African ethnicity, than in people born inside the UK. It was also higher in the most deprived than the least deprived areas and more than a fifth of UK born cases had a known social risk factor such as homelessness or drug use. Preventable bacterial sexually transmitted infections (STIs) such as gonorrhoea and syphilis have been increasing prior to the pandemic.

Impact of the pandemic on infectious diseases

The 2021 HPfE reported that the level of testing for or detection of some infectious diseases, such as TB and STIs, decreased during the pandemic which may reflect a real decrease in incidence due to social distancing measures, reduction in access to testing or a reluctance to be tested (1). The prevalence of several infectious diseases such as seasonal influenza and norovirus has been reduced in the last 2 years of the pandemic, possibly a beneficial side-effect of public health measures against COVID-19 with reduced exposure (98). However, there are likely to have been negative impacts and risks of late diagnosis due to changes in health seeking behaviours during the pandemic period. Childhood vaccinations were interrupted during the pandemic and there has been a reduction in MMR (measles, mumps, rubella) vaccine coverage.

Flu vaccination coverage has been sustained and was considerably higher than previous years. Flu vaccine uptake in England from 1 September 2020 to 28 February 2021 was 80.9% for patients aged 65 years and over compared with 72.4% in 2019 to 2020.

Air pollution

Air pollution is a significant public health issue, long term exposure can contribute to cardiovascular and respiratory conditions and shorten lives. Some estimates suggest that long term exposure to the air pollution mixture in the UK has an annual effect equivalent to 28,000 to 36,000 deaths (99). Modelled estimates at sub-national level by Defra suggest that 3.6% of mortality in 2019 was attributed to air pollution in the North East, a proportion which is lowest compared to other regions, and has remained at similar levels since 2015 (100).

As described in the HPfE 2021, the highest exposures were generally in busy, urban environments, often with high levels of deprivation, contributing to health inequalities.

Data for the levels of PM2.5 from 2011 to 2020 shows (Fig. 24a):

  • the regional trend has been changing from its highest level in 2014, at 7.5 per \(\mu\)g/\(m^{3}\) to its lowest in 2020, following a steep decline during the first year of the pandemic

  • in 2020, the levels of man-made fine particulate matter was 4.8 per cubic metre (\(\mu\)g/\(m^{3}\)), for England the mean concentration was 6.9 \(\mu\)g/\(m^{3}\)

  • within region, the levels range from highest in Middlesbrough with 5.4 per \(\mu\)g/\(m^{3}\) to lowest in Northumberland at 4.1 per \(\mu\)g/\(m^{3}\) (Fig. 24b).


HPfE 2021 highlights that the highest air pollution exposures have been in deprived urban environments therefore contributing to health inequalities. During the pandemic, up to July 2021, there were fewer vehicles on the roads, which had a favourable impact on air pollution levels. Social restrictions implemented during the pandemic meant that there were fewer vehicles on the roads, as people were asked to stay at home, which had a favourable impact on air pollution levels. Motor vehicle use fell dramatically during the first (March 2020) and third (January 2021) national lockdowns in England, but by the end of July 2021 were similar to previous years (1).


Figure 24 – Air quality

Figure 24a - Trends

Source: OHID Wider Determinants of Health Date accessed: 31/03/2022 Download data

Figure 24b - UTLA

Source: OHID Wider Determinants of Health Date accessed: 31/03/2022 Download data

Sexually transmitted infections

According to the HPfE 2021, the epidemiology of sexually transmitted infections (STIs) has changed markedly over the last two decades, reflecting changes in demographics, individual behaviours, surveillance techniques, diagnostics and treatments (1). There has been a continued decline in the rate of new HIV diagnoses due to a combination of testing, pre-exposure prophylaxis, rapid linkage to treatment and support for those diagnosed with HIV to attain viral suppression. The country has also seen a decline in the rate of genital warts following the introduction of the HPV vaccination programme.

New STI diagnosis rate (excluding Chlamydia aged <25) was 449 per 100,000 population, significantly lower than the England average of 619 in 2020 (101). The England average is influenced by London, which has a significantly higher rate compared to other regions, at 1,391. The North East region has the highest percentage late HIV diagnosis outside of London, at 39.8% of all diagnoses. Late diagnosis is the most important predictor of morbidity and mortality among those with HIV infection.

Further analysis for the North East region highlights (Fig. 25a):

  • a sharp decline in the detection rates in 2020: the diagnostic rates per 100,000 for Chlamydia (aged 25+), Gonorrhoea and Syphilis had been increasing in the region, as well as in England, between 2012 and 2019. Only the diagnostic rate for Genital warts has been decreasing since 2012.

  • diagnostic rates per 100,000 in the region in 2020 were 120.0 for Chlamydia (aged 25+), 58.8 for Gonorrhoea, 43.9 for Genital warts and 8.5 for Syphilis, all of which are lower than England.

There is wide regional variation in the diagnostic rates of STI in the North East. Chlamydia (aged 25+) diagnosis are most common followed by Gonorrhoea, Genital warts and Syphilis. In 2020:

  • the local authority with the highest chlamydia diagnostic (aged 25+) rate per 100,000 in the region was Middlesbrough (186.2), the lowest was Northumberland (80.8)

  • the local authority with the highest diagnostic gonorrhoea rate per 100,000 in the region was Newcastle upon Tyne (83.4), the lowest was Northumberland (a diagnostic rate of 26.9 per 100,000)

  • the local authority with the highest genital warts rate per 100,000 in the region was again Newcastle upon Tyne (63.6), the lowest was Stockton on Tees (25.8)

  • whereas for Syphilis, Stockton-on-Tees had the highest Syphilis rate per 100,000 (40.5), the lowest was North Tyneside (1.0).


HPfE 2021 reported that the measures taken to control the COVID-19 pandemic resulted in a drop in the number of people accessing services. Reduced demand for these services during this time may have been influenced by compliance with social distancing measures and changes in risk perception and behaviour, but may also indicate undetected infections. The full impact on infection transmission and long term health outcomes will take time to emerge and evaluate (1).


Figure 25 – Sexually transmitted infections

Figure 25a - Trends

Source: Sexual and Reproductive Health Profiles Date accessed: 31/03/2022 Download data

Figure 25b - Local Authority

Source: Sexual and Reproductive Health Profiles Date accessed: 31/03/2022 Download data

Tuberculosis

The number of new cases of tuberculosis (TB) have fallen dramatically in England over the last century.

More recently, in the North East (Fig 26a):

  • TB incidence rate has seen a decline from its highest point in 2007 at 7.7 to its lowest level in 2019 at 2.9 (new cases per 100,000 population)

  • the incidence rate in 2020 was 3.1, a crude rate which is significantly lower than the England average of 7.3 per 100,000 population.


HPfE 2021 reported that the rates of TB are higher in people born outside of the UK, particularly those of Indian, Pakistani or black African ethnicity, than in people born inside the UK. It was also higher in the most deprived than the least deprived areas and more than a fifth of UK born cases have a known social risk factor such as homelessness (1).


Figure 26 – Tuberculosis

Figure 26a - Trends

Source: OHID TB Strategy Monitoring Indicators Date accessed: 31/03/2022 Download data

Vaccines and vaccine preventable infections

The HPfE 2021 cites evidence of flu vaccine uptake rates in winter 2020 to 2021 in England which have been higher than in previous years due to increased efforts to reach as many people as possible and increased awareness due to the pandemic (1).

The latest vaccine uptake data for the region in 2020/21 (aggregated from all known lower geography values) show all but Human papillomavirus (HPV) vaccines either reaching or better than their respective benchmark or goal set, including childhood vaccination coverage (102):

  • influenza vaccine uptake in GP registered patients aged 65 and over was 83.7%, and significantly better than the England average of 80.9%

  • influenza vaccine uptake in ‘at risk’ populations was also better than England (56.6% v 53.0%). However, this leaves 47.4% of eligible individuals at increased risk of morbidity and mortality from flu, who did not receive or refused a vaccination. However, because of social distancing measures introduced for the COVID-19 pandemic influenza-like illness was much lower in 2020 to 2021 than in other seasons (103)

  • 92.5% of children aged 5 had received the two MMR doses, highest rate out of all regions and trend remaining at similar level during the latest 5 years (104)

  • local authority comparison shows that for the same period the vaccination coverage for the two MMR doses aged 5 ranges from lowest in Middlesbrough (84.7%) to highest in County Durham (96.4%) (105).

Antimicrobial resistance

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antibiotics and other antimicrobial medicines. This makes infections harder and more costly to treat. It also increases the risk of the infectious disease spreading, and leading to more severe illness and death. In England, antibiotic-resistant bloodstream infections rose by an estimated 32% between 2015 and 2019 (106).

AMR occurs naturally over time, but can also be caused by the misuse and overuse of antimicrobials (107).

There is some variation in prescribing rates with higher prescribing levels in the two most deprived areas in 2020 but no clear gradient (1). Antibiotic prescribing in primary care is often measured in STAR-PU, which are weighted units to allow comparisons adjusting for the age and sex of the population.

Figure 27a shows the trend in the rate of antibiotic prescribing in primary care in the North East and England between 2015 and 2020:

  • In 2020, the indirectly standardised antibiotic prescribing ratio is 0.9 in the region compared to 0.8 for England

  • The regional trend between 2015 and 2020 shows that the rate of antibiotic prescribing in primary care has fallen every year in the region, and in England, with the largest drop between 2019 and 2020

  • The local authority variation (Fig 27b) ranges from highest in Northumberland to lowest Stockton-on-Tees (indirectly standardised ratio of 1.0 to 0.7)

  • The ratio is significantly higher than the regional average in Northumberland, Sunderland, North and South Tyneside, and Newcastle upon Tyne .

It should be noted however that the 2020 primary care antibiotic prescribing data is likely to have been heavily impacted by the disruption to primary care services during the pandemic.

Figure 27 – Antibiotic prescribing

Figure 27a - Trends

Source: OHID Public health profiles Date accessed: 31/03/2022 Download data

Figure 27b - Local Authority

Source: OHID Public health profiles Date accessed: 31/03/2022 Download data

Conclusion

Similar to the Health profile for England, the 2021 profile for the North East has provided a comprehensive snapshot of the region’s health, including impacts of COVID-19 up until December 2021. The report has aimed to highlight some of the key aspects of population health and well-being, and health inequalities where data has been available at regional and local authority level.

The report has highlighted how the direct impact of COVID-19 pandemic has disproportionally affected people from ethnic minority groups, people living in deprived areas or from different socio-economic groups, older people and those with pre-existing health conditions. The report has also outlined the area level disparities and inequalities with other risk factors and chronic conditions in existence prior to the pandemic, conditions of which are closely related to wider determinants of health such as area level deprivation, low incomes, or other social and environmental factors.

Data on the long term aspects of health during the pandemic are not yet available but will be added to the Wider Impacts of COVID-19 on Health (WICH) monitoring tool (15) where possible and summarised in future Health Profile for England and regional profiles. Inequalities in health are monitored via various OHID public health profiles and tools (108). Continued monitoring of the indirect impacts of the pandemic by OHID on the nation’s health as well as health inequalities will remain a priority.

References

  1. Public Health England. Health profile for England 2021 [4 April 2022]. Available from: https://fingertips.phe.org.uk/static-reports/health-profile-for-england/hpfe_report.html; 2021

  2. Public Health England. Definitions, methods and data [4 April 2022]. Available from: https://fingertips.phe.org.uk/static-reports/health-profile-for-england/definitions.html; 2021

  3. Office for Health Improvement and Disparities. Definitions, methods and data regional. Available from: https://fingertips.phe.org.uk/static-reports/health-profile-for-england/definitions-regional.html; 2022

  4. Office for National Statistics. Census Output Area population estimates - North East, England (supporting information) 2020 [March 2022] Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/datasets/censusoutputareaestimatesinthenortheastregionofengland; 2021

  5. Office for National Statistics. Population estimates for the UK, England and Wales, Scotland and Northern Ireland: mid-2020 [March 2022]. available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/annualmidyearpopulationestimates/mid2020; 2021

  6. Office for National Statistics. Regional ethnic diversit 2020 [March 2022]. Available from: https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/regional-ethnic-diversity/latest; 2020

  7. Public Health England. Maternity high impact area: Reducing the inequality of outcomes for women from Black, Asian and Minority Ethnic (BAME) communities and their babies [March 2022] Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/942480/Maternity_high_impact_area_6_Reducing_the_inequality_of_outcomes_for_women_from_Black__Asian_and_Minority_Ethnic__BAME__communities_and_their_babies.pdf; 2020

  8. Office for National Statistics. Sexual orientation in the UK. [1 April 2022] https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/sexuality/bulletins/sexualidentityuk/2019#uk-countries-and-english-regions; 2019. Office for National Statistics. Office for National Statistics. Sex and gender identity [March 2022] Available from: https://www.ons.gov.uk/census/censustransformationprogramme/questiondevelopment/genderidentity; 2021

  9. UK Health Security Agency. COVID-19 dashboard: North East region cases [31 March 2022] Available from: https://coronavirus.data.gov.uk/details/cases?areaType=region&areaName=North%20East; 2022

  10. UK Health Security Agency. COVID-19 dashboard: North East region deaths [31 March 2022] Available from: https://coronavirus.data.gov.uk/details/deaths?areaType=region&areaName=North%20East; 2022

  11. Public Health England. Disparities in the risk and outcomes from COVID-19 [March 2022] Available from: https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes; 2020.

  12. Public Health England. COVID-19: pre-existing health conditions and ethnicity [March 2022] Available from: https://www.gov.uk/government/publications/covid-19-pre-existing-health-conditions-and-ethnicity; 2020.

  13. Office for Health Improvement and Disparities. Public Health Outcomes Framework. Inequality in life expectancy and birth (male and female) [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000049/pat/15/par/E92000001/ati/6/are/E12000004/iid/90366/age/1/sex/2/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  14. UK Health Security Agency. Why have increases in life expectancy slowed down in England? [March 2022] Available from: https://ukhsa.blog.gov.uk/2018/12/11/why-have-increases-in-life-expectancy-slowed-down-in-england/; 2018

  15. Office for Health Improvement and Disparities. Wider impacts of COVID-19 on health monitoring (WICH) tool [31 March 2022]. Available from: https://www.gov.uk/government/statistics/wider-impacts-of-covid-19-on-health-monitoring-tool.

  16. Baker A, Fellows C. Life Expectancy in England in 2020 [31 August 2021]. Available from: https://publichealthmatters.blog.gov.uk/2021/03/31/life-expectancy-in-england-in-2020/; 2021

  17. Office for Health Improvement and Disparities. Public Health Outcomes Framework. Children in low income families (relative and absolute low income families) [31 March 2022]. Available from: https://fingertips.phe.org.uk/public-health-outcomes-framework#page/3/gid/1000041/pat/15/par/E92000001/ati/6/are/E12000001/iid/93701/age/169/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  18. Office for National Statistics. Child and infant mortality in England and Wales: 2019. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/childhoodinfantandperinatalmortalityinenglandandwales/2019

  19. Royal College of Speech and Language Therapists. The links between speech, language and communication needs and social disadvantage. https://www.rcslt.org/wp-content/uploads/media/Project/RCSLT/rcslt-social-disadvantage-factsheet.pdf; nd.

  20. Jeffreys B. Lockdowns hurt child speech and language skills - report. Available from: https://www.bbc.co.uk/news/education-5688903; 2021

  21. Public Health England, UCL Institute of Health Equity (IHE). Local action on health inequalities. Improving health literacy to reduce health inequalities. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/460710/4b_Health_Literacy-Briefing.pdf; 2015.

  22. Pascal C BT, Cullinane C, Holt-White E,. COVID-19 and Social Mobility. Impact Brief #4: Early Years. Available from: https://www.suttontrust.com/wp-content/uploads/2020/06/Early-Years-Impact-Brief.pdf; 2020.

  23. Bowyer-Crane C BS, Compton S, Nielsen D, D’Apice K, Tracey L,. The impact of Covid-19 on School Starters: Interim briefing 1, Parent and school concerns about children starting school. Available from: https://educationendowmentfoundation.org.uk/public/files/Impact_of_Covid19_on_School_Starters_-_Interim_Briefing_1_-_April_2021_-_Final.pdf; 2021.

  24. Ells et al. Interventions for treating children and adolescents with overweight and obesity: an overview of Cochrane reviews. Int J Obes (Lond). 42(11):1823-33. Available from: https://pubmed.ncbi.nlm.nih.gov/30301964/; 2018

  25. NHS Digital. National Child Measurement Programme 2020 to 20212. [31 March 2022] Available from: https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year/region; 2021

  26. Franckle R, Adler R, Davison K. Accelerated weight gain among children during summer versus school year and related racial/ethnic disparities: a systematic review. Prev Chronic Dis. 2014;11:E101.

  27. Atmakur-Javdekar Sruthi Being active in play environments: The key to children’s health and wellbeing: British Educational Research Association [31 March 2022]. Available from: https://www.bera.ac.uk/blog/being-active-in-play-environments-the-key-to-childrens-health-and-wellbeing; 2021

  28. Sport England. Coronavirus challenges: Importance of physical activity and sport in children. Available from: https://www.sportengland.org/news/coronavirus-challenges-highlight-importance-physical-activity-and-sport-children; 2021

  29. Office for Health Improvement and Disparities. Public Health Outcomes Framework. Percentage of physically active children [31 March 2022]. Available from: https://fingertips.phe.org.uk/search/physically#page/4/gid/1/pat/15/par/E92000001/ati/6/are/E12000001/iid/93570/age/246/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0_tre-ao-1

  30. DHSC. Physical activity guidelines. https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report; 2020

  31. Office for Health Improvement and Disparities. National Child Measurement Programme data by local authority 2020 to 2021 academic year. [31 March 2022]. Available from: https://www.gov.uk/government/statistics/national-child-measurement-programme-ncmp-data-for-the-2020-to-2021-academic-year-by-local-authority

  32. NHS Digital. National Child Measurement Programme, England 2020/21 School Year: Deprivation gap for obesity [31 March 2022] Available from: https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year/deprivation#deprivation-gap-for-obesity-reception

  33. NHS Digital. National Child Measurement Programme, England 2020/21 School Year: Deprivation gap for obesity [31 March 2022] Available from: https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year/ethnicity

  34. Office for Health Improvement and Disparities. Smoking and tobacco: applying All Our Health. [30 March 2022] https://www.gov.uk/government/publications/smoking-and-tobacco-applying-all-our-health/smoking-and-tobacco-applying-all-our-health

  35. Office for Health Improvement and Disparities. Public Health Outcomes Framework: Smoking in early pregnancy. [30 March 2022]. Available from: https://fingertips.phe.org.uk/search/smoking%20in%20early%20pregnancy#page/7/gid/1/pat/15/par/E92000001/ati/6/are/E12000001/iid/93579/age/-1/sex/2/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0_ine-yo-1:2018:-1:-1_ine-pt-0_ine-ct-44; 2018/2019

  36. Public Health England. Health Profile for England 2019: 9 key points from our 2019 update [31 August 2021]. Available from: https://publichealthengland.exposure.co/health-profile-for-england-2019; 2019

  37. Office for Health Improvement and Disparities. Public Health Profiles: Child and maternal health, Obesity in Early Pregnancy [31 March 2022]. Available from: https://fingertips.phe.org.uk/child-health-profiles#page/3/gid/1938133222/pat/15/par/E92000001/ati/402/are/E09000002/iid/93584/age/-1/sex/2/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  38. Office for Health Improvement and Disparities. Public Health Profiles: Child and maternal health, under 18s conception rate [31 March 2022]. Available from: https://fingertips.phe.org.uk/search/conception#page/3/gid/1/pat/6/par/E12000001/ati/402/are/E06000047/iid/20401/age/173/sex/2/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  39. Office for Health Improvement and Disparities. Local Tobacco Control Profiles: Smoking prevalence age 15 years - regular smokers (SDD survey) [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/tobacco-control/data#page/11/gid/1938132900/pat/6/par/E12000001/ati/302/are/E06000047/iid/91183/age/44/sex/4/cid/4/tbm/1/page-options/car-do-0_ine-yo-1:2018:-1:-1_ine-ct-39_eng-vo-1

  40. NHS Digital. Smoking, Drinking and Drug Use among Young People in England 2018. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2018; 2019.

  41. Office for Health Improvement and Disparities. Public Health Profiles: Child Health Profiles [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/child-health-profiles/data#page/3/gid/1938133238/pat/15/par/E92000001/ati/6/are/E12000001/iid/92315/age/246/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  42. Office for Health Improvement and Disparities. Public Health Profiles: Mental Health and Wellbeing JSNA [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile-group/mental-health/profile/mh-jsna/data#page/3/gid/1938132923/pat/6/par/E12000001/ati/202/are/E06000047/iid/90813/age/305/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  43. NHS Digital. Mental Health of Children and Young People in England: Wave 1 follow up to the 2017 survey. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up; 2020.

  44. Office for Health Improvement and Disparities. Public Health Profiles: GP Profiles [31 March 2022]. Available from: https://fingertips.phe.org.uk/public-health-outcomes-framework#page/3/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000001/iid/93377/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  45. Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study 2019 (GBD 2019) Results. [31 March 2022]. Available from: http://ihmeuw.org/5p04; 2019

  46. Office for Health Improvement and Disparities. Wider impacts of COVID-19 on health monitoring (WICH) tool [28 February 2022]. Available from: https://www.gov.uk/government/statistics/wider-impacts-of-covid-19-on-health-monitoring-tool

  47. Office for Health Improvement and Disparities. Public Health Profiles: Public Health Outcomes Framework. [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000004/iid/21001/age/1/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  48. Office for Health Improvement and Disparities. Public Health Profiles: Suicide Prevention Profile [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile-group/mental-health/profile/suicide/data#page/3/gid/1938132828/pat/6/par/E12000001/ati/202/are/E06000047/iid/41001/age/285/sex/2/cat/-1/ctp/-1/yrr/3/cid/4/tbm/1/page-options/car-do-0

  49. Office for Health Improvement and Disparities. Public Health Profiles: Suicide Prevention Profile [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile-group/mental-health/profile/suicide/data#page/3/gid/1938132828/pat/6/par/E12000001/ati/202/are/E06000047/iid/41001/age/285/sex/1/cat/-1/ctp/-1/yrr/3/cid/4/tbm/1/page-options/car-do-0

  50. Office for Health Improvement and Disparities. Public Health Profiles: Dementia Profile [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile-group/mental-health/profile/dementia/data#page/3/gid/1938133052/pat/6/par/E12000001/ati/302/are/E06000047/iid/92949/age/27/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  51. NHS England. New plans to improve dementia diagnosis rates. Available from: https://www.england.nhs.uk/2013/05/dementia-targets/; 2013

  52. World Health Organisation. Fact Sheets. Cancer. [31 March 2022] Available from: https://www.who.int/news-room/fact-sheets/detail/cancer; 2021

  53. Office for Health Improvement and Disparities. Public Health Profiles: Public Health Outcomes Framework, Cancer screening coverage [31 March 2022]. Available from: https://fingertips.phe.org.uk/search/cancer%20screening#page/1/gid/1/pat/15/ati/6/are/E12000001/iid/22001/age/225/sex/2/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  54. NHS Digital. Health Survey for England 2017. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2017; 2018

  55. Office for Health Improvement and Disparities. Public Health Profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000001/iid/93798/age/168/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  56. Office for Health Improvement and Disparities. Public Health Profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000001/iid/93798/age/168/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  57. Office for Health Improvement and Disparities. Public Health Profiles: Local Tobacco Control Profiles [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/tobacco-control/data#page/3/gid/1938132885/pat/6/par/E12000001/ati/302/are/E06000047/iid/93802/age/183/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  58. Office for Health Improvement and Disparities. Public Health Profiles: Local Tobacco Control Profiles [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/tobacco-control/data#page/3/gid/1938132900/pat/6/par/E12000001/ati/302/iid/93454/age/168/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  59. Office for Health Improvement and Disparities. Public Health Profiles: Local Alcohol Profiles for England [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/local-alcohol-profiles/data#page/3/gid/1938132984/pat/6/par/E12000001/ati/402/iid/93763/age/1/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  60. Office for Health Improvement and Disparities. Public Health Profiles: Local Alcohol Profiles for England [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/local-alcohol-profiles/data#page/3/gid/1938132984/pat/6/par/E12000001/ati/402/are/E06000047/iid/91380/age/1/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  61. Office for Health Improvement and Disparities. Public Health Profiles: Local Alcohol Profiles for England [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/local-alcohol-profiles/data#page/3/gid/1938132832/pat/6/par/E12000001/ati/402/are/E06000047/iid/91380/age/1/sex/2/cat/-1/ctp/-1/yrr/3/cid/4/tbm/1/page-options/car-do-0

  62. Office for Health Improvement and Disparities. Public Health Profiles: Local Alcohol Profiles for England [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/local-alcohol-profiles/data#page/6/gid/1938132895/pat/15/par/E92000001/ati/6/are/E12000004/iid/92447/age/168/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  63. Bellis MA, Hughes K, Nicholls J, Sheron N, Gilmore I, Jones L. The alcohol harm paradox: using a national survey to explore how alcohol may disproportionately impact health in deprived individuals. BMC Public Health.16(1):111; 2016

  64. Office for National Statistics. Drug misuse in England and Wales: year ending March 2020. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingmarch2020; 2020

  65. Office for National Statistics. Deaths related to drug poisoning in England and Wales: 2020 registrations. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2020; 2021

  66. Office for Health Improvement and Disparities. Public Health Profiles: Mortality [31 March 2022]. Available from: https://fingertips.phe.org.uk/mortality-profile#page/3/gid/1938133058/pat/15/par/E92000001/ati/6/are/E12000004/iid/92432/age/1/sex/4/cat/-1/ctp/-1/yrr/3/cid/4/tbm/1

  67. Office for Health Improvement and Disparities. Public Health Profiles: Mortality profile [31 March 2022]. Available from: https://fingertips.phe.org.uk/mortality-profile#page/3/gid/1938133058/ati/402/iid/92432/age/1/sex/4/cat/-1/ctp/-1/yrr/3/cid/4/tbm/1/page-options/car-do-0

  68. Office for Health Improvement and Disparities. Public Health Profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/4/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000001/iid/90245/age/168/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  69. Office for Health Improvement and Disparities. Public Health Profiles: Physical Activity [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/physical-activity/data#page/3/gid/1938132899/pat/15/par/E92000001/ati/6/are/E12000004/iid/93014/age/298/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  70. Office for Health Improvement and Disparities. Public Health Profiles: Physical Activity [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/physical-activity/data#page/3/gid/1938132899/pat/6/par/E12000001/ati/402/iid/93014/age/298/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  71. Sport England. Active Lives. Available from: https://www.sportengland.org/know-your-audience/data/active-lives; 2021.

  72. Office for Health Improvement and Disparities. Public Health Profiles: Obesity profile [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/national-child-measurement-programme/data#page/3/gid/1938133219/pat/15/par/E92000001/ati/6/are/E12000004/iid/93077/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  73. Office for Health Improvement and Disparities. Public Health Outcomes Framework. Proportion of the population meeting the recommended ‘5-a-day’ on a ‘usual day’ (adults) [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/7/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000004/iid/93077/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0_ine-yo-1:2019:-1:-1_ine-pt-0_ine-ct-27

  74. NHS Digital. National Diabetes Audit: Non-Diabetic Hyperglycaemia, 2020-21, Diabetes Prevention Programme. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/diabetes-prevention-programme-2020-21-underlying-data; 2021

  75. MHCLG Open data: English Indices of Deprivation 2019 - LSOA Level. and ONS mid year population 2019 by age. Available from: https://opendatacommunities.org/data/societal-wellbeing/imd2019/indices; 2019

  76. Ministry of Housing and Communities: Index of Multiple Deprivation 2019: File 7: all ranks, deciles and scores for the indices of deprivation, and population denominators. Available from: https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019; 2019

  77. Office for Health Improvement and Disparities. Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1938132983/pat/15/ati/402/are/E06000047/iid/93553/age/1/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  78. Health Foundation. Health Equity in England: The Marmot Review 10 Years On. [28 February 2022]. Available from: https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on; 2020

  79. Joseph Rowntree Foundation. How Does Money Influence Health. Available from: https://www.jrf.org.uk/report/how-does-money-influence-health; 2014

  80. The Marmot Review. Fair Society, Healthy Lives. Available from: https://www.parliament.uk/globalassets/documents/fair-society-healthy-lives-full-report.pdf; 2010

  81. Davillas A JA, Benzeval M,. ISER Working Paper: The income-health gradient: Evidence from self-reported health and biomarkers using longitudinal data on income. Institute for Social and Economic Research: University of Essex. Available from: https://www.iser.essex.ac.uk/research/publications/working-papers/iser/2017-03; 2017

  82. Office for Health Improvement and Disparities. Public health profiles: Wider determinants [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/wider-determinants/data#page/3/gid/1938133045/pat/15/par/E92000001/ati/6/are/E12000001/iid/93351/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  83. Office for Health Improvement and Disparities. Public health profiles: Wider determinants [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/child-health-profiles/data#page/3/gid/1938133228/pat/15/par/E92000001/ati/6/are/E12000001/iid/93701/age/169/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  84. Office for Health Improvement and Disparities. Public health profiles: Wider determinants [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/child-health-profiles/data#page/3/gid/1938133228/pat/15/par/E92000001/ati/6/are/E12000001/iid/93700/age/169/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  85. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/search/homelessness#page/3/gid/1/pat/6/par/E12000001/ati/402/are/E06000047/iid/93735/age/-1/sex/-1/cat/-1/ctp/-1/yrr/1/cid/4/tbm/11

  86. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. https://fingertips.phe.org.uk/public-health-outcomes-framework#page/3/gid/1000041/pat/15/par/E92000001/ati/6/are/E12000001/iid/93736/age/-1/sex/-1/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  87. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. https://fingertips.phe.org.uk/public-health-outcomes-framework#page/4/gid/1000041/pat/15/par/E92000001/ati/6/are/E12000001/iid/93736/age/-1/sex/-1/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  88. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. https://fingertips.phe.org.uk/search/93759#page/3/gid/1/pat/6/par/E12000001/ati/402/are/E06000047/iid/93759/age/-1/sex/-1/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  89. Public Health England. Cold weather plan for England: making the case why long term strategic planning for cold weather is essential to health and wellbeing. Available from: https://www.gov.uk/government/publications/cold-weather-plan-cwp-for-england; 2017.

  90. Office for Health Improvement and Disparities. Public health profiles: Physical Activity [31 March 2022]. Available from: https://fingertips.phe.org.uk/physical-activity#page/3/gid/1938132899/pat/15/par/E92000001/ati/6/are/E12000001/iid/93439/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  91. Office for Health Improvement and Disparities. Public health profiles: Physical Activity [31 March 2022]. Available from: https://fingertips.phe.org.uk/search/93440#page/3/gid/1/pat/6/par/E12000001/ati/402/are/E06000047/iid/93440/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  92. Office for Health Improvement and Disparities. Public health profiles: Physical Activity [31 March 2022]. Available from: https://fingertips.phe.org.uk/physical-activity#page/3/gid/1938132899/pat/6/par/E12000001/ati/402/are/E06000047/iid/93439/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  93. Office for Health Improvement and Disparities. Public health profiles: Physical Activity [31 March 2022]. Available from: https://fingertips.phe.org.uk/physical-activity#page/3/gid/1938132899/pat/6/par/E12000001/ati/402/are/E06000047/iid/93440/age/164/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  94. Cutler DM L-MA. Working Paper 12352: Education and Health: Evaluating Theories and Evidence. Available from: https://www.nber.org/papers/w12352; 2006.

  95. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000041/pat/15/par/E92000001/ati/6/are/E12000001/iid/93203/age/174/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  96. Landeg O. The Climate Change Act: 10 years on. Available from: https://publichealthmatters.blog.gov.uk/2018/11/26/the-climate-change-act-10-years-on/; 2018

  97. Public Health England. Climate change: health effects in the UK. Available from: https://www.gov.uk/government/publications/climate-change-health-effects-in-the-uk; 2021

  98. Public Health England. Surveillance of influenza and other seasonal respiratory viruses in the UK Winter 2020 to 2021. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/995284/Surveillance_of_influenza_and_other_seasonal_respiratory_viruses_in_the_UK_2020_to_2021-1.pdf; 2021

  99. Committee on the Medical Effect of Air Pollutants. COMEAP: Associations of long term average concentrations of nitrogen dioxide with mortality. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/734799/COMEAP_NO2_Report.pdf; 2018

  100. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/public-health-outcomes-framework#page/4/gid/1000043/pat/15/par/E92000001/ati/6/are/E12000001/iid/30101/age/230/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0

  101. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000043/pat/15/par/E92000001/ati/6/are/E12000001/iid/91306/age/182/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/0

  102. Office for Health Improvement and Disparities. Public health profiles: Health Protection [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/health-protection/data#page/1

  103. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000043/pat/15/par/E92000001/ati/6/are/E12000001/iid/30315/age/226/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1

  104. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000043/pat/15/par/E92000001/ati/6/are/E12000001/iid/30311/age/34/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/0/page-options/car-do-0

  105. Office for Health Improvement and Disparities. Public health profiles: Public Health Outcomes Framework [31 March 2022]. Available from: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000043/pat/6/par/E12000001/ati/402/are/E06000047/iid/30311/age/34/sex/4/cat/-1/ctp/-1/yrr/1/cid/1/tbm/0/page-options/car-do-0

  106. Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR). report 2019 to 2020. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/936199/ESPAUR_Report_2019-20.pdf; 2020.

  107. WHO. Antimicrobial resistance (who.int). Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance; 2021

  108. Office for Health Improvement and Disparities. Inequality Tools. Available from: https://fingertips.phe.org.uk/profile/inequality-tools; 2022

Footnotes

  1. At the time of writing Census 2021 estimates were yet to be released, a release of which will include information about gender identity, added as voluntary question for the first time (8).↩︎

  2. Life expectancy gap by deprivation is measured by the slope index of inequality (SII) (16). This is a measure of the social gradient in an indicator and shows how much a health outcome varies with deprivation. It takes account of inequalities across the whole range of deprivation within England and summarises this into a single number. The measure assumes a linear relationship between the indicator and deprivation. The higher the value of the SII, the greater the inequality within an area.↩︎