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Overview

This report is a comprehensive review of health in the North West 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 for 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 risk factor contributing 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 West. The report provides a regional view of health and indicators presented in the Health Profile for England 2021 [1], first produced by Public Health England (PHE) in 2017.

As the first edition of Health Profile for North West 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:

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

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


Supporting Information

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

Headline - overall data for the key indicator used in North West, 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 North West, 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.


This report builds on the methodology used in the Health Profile for England 2021, with minor amendments to enable regional and sub-regional comparisons, and to account for methodological changes that have occurred since the publication of the Health Profile for England 2021. Further information on methods, data and definitions is available here

Key Findings

This report provides a comprehensive look at the state of health in the North West. The structure of the report follows that of the National Health Profile for England and looks to mirror the layout. Where key findings from the national report are relevant to the North West situation or where there is an absence of regional data England values are used but this is highlighted in the text and references.

Like in previous Health Profile for England reports, this update looks at a range of population health data, such as smoking and obesity, but it also provides an early summary of the impact of the COVID-19 pandemic on many aspects of health inequalities.

Health inequalities are avoidable, unfair and systematic differences in health between different groups of people. There are many kinds of health inequality, and many ways in which the term is used. This means that when we talk about ‘health inequality’, it is useful to be clear on which measure is unequally distributed, and between which people.

Here we look at 5 important points the report makes about how the nation’s health has been affected directly and indirectly by the pandemic.

Mortality was higher than previous years

In 2020, COVID-19 was the leading underlying cause of death among males, replacing heart disease, and the second largest cause of death among females after dementia and Alzheimer’s disease. By the end of December 2021, 23,865 deaths had been registered with COVID-19 mentioned on the death certificate among residents in the North West.

Between 21 March 2020 and 31 December 2021, deaths were 1.16 times higher than expected across England, based on data for the previous 5 years.

Deaths were higher than expected in all age groups over 25 years but were particularly high in those who live in deprived areas (1.20 times higher for men and 1.19 for women) and in the Black population (1.74 times higher for men and 1.55 for women), reflecting the disproportionate impact of the pandemic on these groups.

Dementia deaths increased, and diagnoses declined

Dementia and Alzheimer’s disease remained the leading cause of death in North West in females and the third largest in males.

In 2021, there were around 5,500 fewer people aged 65 and over with a diagnosis of dementia compared with the previous year. Although increased mortality among people with dementia during the pandemic may be a factor, this is also likely due to reduced access to services where diagnosis takes place.

Health services were not used as much

During the pandemic, hospital admissions, A&E attendances and the number of GP consultations were all down, particularly in the first wave of the pandemic.

Surveys show that half of people with a worsening health condition between May 2020 and January 2021 did not seek treatment, most commonly because they did not want to put pressure on the NHS or were concerned about catching COVID-19.

This has meant that new diagnoses for some diseases this year were considerably down compared with previous years. This includes cancer, for which there were 18% less diagnoses between April and December 2020 than in the same months in 2019, a larger reduction than seen nationally.

This reduced contact with health services may mean that preventative treatment has been missed but could also lead to long-term health complications and an increase in deaths in the future, meaning that we can still expect to see the impact of COVID-19 in years to come.

Children’s development may have suffered

Children’s education has been severely disrupted during the pandemic. From 23 March 2020 until June 2020, most schools in England were closed to children other than those with parents who were key workers or who were classed as vulnerable.

While the full impact of the pandemic on child health and development is still not known and will not be known for some time, initial studies suggest that children who started school in the Autumn 2020 term needed additional support when compared with children in previous academic years and that learning has suffered to some degree for most pupils and year groups, particularly primary and more disadvantaged students.

Almost all schools have indicated that they are concerned about young pupils’ communication and language development, personal, social and emotional development and levels of literacy as children were not experiencing the social interactions that they usually would, such as play dates and interacting with grandparents.

Increased alcohol consumption among heavy drinkers likely drove a rise in alcoholic liver deaths

There has been an unprecedented increase in alcohol-specific deaths (deaths which were caused by alcohol use), mainly due to increased alcoholic liver disease mortality. In 2020, alcohol-specific deaths increased by 20% compared with 2019. Although alcohol-specific mortality rates have been increasing in recent years, this represented a significant acceleration in the upward trend.

A recent PHE report monitoring alcohol consumption and harms during the pandemic noted that the increase in alcoholic liver disease mortality was “likely to be due to increased consumption among an already at-risk group of heavy drinkers”.

Increased mortality has impacted on life expectancy

The high number of deaths due to COVID-19 caused life expectancy in England to fall in 2020, by 1.5 years for males to 77 years and 1.2 years for females to 81 years. This is the lowest life expectancy since 2009 for males and 2008 for females.

The pandemic has exacerbated existing inequalities in life expectancy by deprivation to the largest we have seen in two decades, which is as far back as our data goes. The gap between the most and least deprived areas in the North West in 2020 was 12.5 years for males, 1.3 years larger than in 2019, and 10.8 years for females, 0.9 years larger than in 2019.


Introduction to the North West

The North West is a geographically diverse area with stunning coastline, national parks and areas of outstanding natural beauty. The urban centres are concentrated around the cities of Liverpool and Manchester. Geographically the North West is the 6th largest of the 9 regions, however it has the 3rd highest regional population.The North West is often considered three subregions with their own unique cultures. To the north are Lancashire and Cumbria, to the south and east is Greater Manchester, and to the south and west are Cheshire and Merseyside.

There are 2 national parks within the North West, the Lake District and Peak District which crosses the border into the Midlands, 3 World Heritage sites and 3 areas of outstanding natural beauty.

The region is home to 7,341,200 residents, and the population is growing. Overall the population within the region experience worse than national average outcomes, such as lower life expectancy, higher levels of poverty and deprivation. However, there is significant variation within the region.

Life expectancy for females in the North West is 81.7 years and for men 77.9 years (2018-20), below England’s average life expectancy for (83.1 years , and 79.4 years respectively).From birth, men living in the North West can expect to live 60.2 years disability free and for women the figure is 59.1 years (2018-20).

The elderly population within the North West (18.7% are aged 65 and over) are mostly concentrated in the rural county areas with the larger urban areas of Manchester, Liverpool, Preston and Lancaster having younger populations.


COVID-19

Introduction


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

This section examines the direct impact of the COVID-19 pandemic on health with analysis of COVID-19 cases, vaccination rates, death rates involving COVID-19 and excess deaths during the pandemic up until 31st December 2021. COVID-19 impacted the North West severely. As of 31 December 2021, the North West had the highest cumulative COVID-19 case rate of all 9 regions in England and the highest total number of deaths. The impact of COVID-19 is ongoing and it is likely that the elective healthcare backlog, educational impact and wider indirect consequences of the pandemic will take some time to quantify and address.


COVID-19 cases

By 31 December 2021, 1,743,857 confirmed cases of COVID-19 had been reported in the North West. The region’s highest 7-day average case rate occurred in December 2021 at 2,470.4 cases per 100,000 population. The impact of COVID-19 was not equally distributed, and some groups have been more affected than others. The data is influenced by testing strategies and not everyone has access to the same level of testing throughout the pandemic. In the early stages of the pandemic testing was limited to healthcare and care home settings. Regular testing was required in some high-risk settings, education, care and healthcare establishments although universal testing was available, many people would only get tested if they had symptoms or were identified as a contact of an individual who had tested positive. The increased testing in NHS, care home and student populations may have detected more cases in those groups leading to an overrepresentation of these groups in the data.

Sex: recorded COVID-19 cases were statistically significantly higher in females (23,788 per 100,000) than males (21,459 per 100,000 population).

Age: recorded COVID-19 cases were statistically significantly higher in the 0-24 years (24,538 per 100,000) and 25-49 years (22,299 per 100,000 population) age groups.

Deprivation: the relationship between COVID-19 cases and deprivation isn’t linear although statistically significantly higher rates are more prominent in the more deprived deciles (decile 1 being the most deprived and decile 10 being the least deprived). Deprivation deciles 3, 4 and 6 through to 10 have cases rate statistically significantly higher than the North West average. Deprivation decile 5 is the only decile that has a statistically significantly lower case rate than the regional average. Deprivation decile 9 has the highest case rate: 23,461 per 100,000.

Ethnicity: COVID-19 case data is available for broad ethnic groups. The other ethnic group category had the highest case rate (27,526 per 100,000) and was 1 of 3 categories with rates statistically significantly higher than the regional average (22,676 per 100,000), Asian/Asian British (23,323 per 100,000) and Black/Black British (27,076 per 100,000) were the other 2.

Population density decile: COVID-19 case rates were statistically significantly higher in deciles 3-9. In deciles 1 (the most densely populated) and 10 (the least densely populated) rates were significantly lower than the regional average. Low rates in the most densely populated areas are unexpected and are potentially caused by lower uptake of testing in those areas, more investigation is required to better understand the cause.

Local authority: Figure 1c shows that the local authority with the highest COVID-19 case rates in the North West was Knowsley at 27,103 per 100,000 population, significantly higher than regional average. As at the end of December 2021, Knowsley had the highest 7-day rolling rate at 2,875 per 100,000 population

Figure 1 - COVID-19 cases

Figure 1a - Trends

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

Figure 1b - Inequalities

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

Figure 1c - Local Authority