Overview
This report is a comprehensive review of health in the South 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 South East. 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 South 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:
overview of the population of the region
COVID-19
mortality and life expectancy
child health
adult health
risk factors associated with ill health
the wider determinants of health
health protection issues
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.
Chart format
Charts in this report follow a standard format, with 3 sections for
each topic area:
Trends - overall data for the key indicator used in
South 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 South 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 - indicator data is usually
presented at the Upper Tier Local Authority (UTLA) level (counties and
unitary authorities) on a separate tab. In some cases, data is available
at Lower Tier Local Authority (LTLA) Level (districts and unitary
authorities). UTLAs/LTLAs affiliated with the government region are
shown unless stated otherwise. UTLA codes and boundaries are subject to
change after the data is released. For some figures in the report there
is no data for Buckinghamshire. This is because of the change from a
county council to a unitary authority and data for the time period
reported is not available for the new geography.
It is not always possible to use the same indicator for the trends,
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.
Main findings
The data in this report describes some of the important factors
affecting the health of the population of the South East, using data
that was available up to the end of January 2022. It also provides
examples of how the pandemic may have exacerbated some existing
inequalities.
1. Mortality was higher than previous years with some widening
inequalities
By the end of 2021, there had been over 19,000 deaths reported within
28 days of a positive test for COVID-19 in the South East. In 2020
COVID-19 had become the leading cause of death for males in the region
and the second largest cause of death among females after dementia and
Alzheimer’s disease.
Compared to the death rates in previous years, deaths from all causes
during the pandemic were 1.1 times higher in females and 1.12 times
higher in males. Deaths were higher than expected in all age groups over
25, associated with a significant reduction in life expectancy of 0.8
years for females and 0.9 years for males from 2019 to 2020. Excess
deaths were also particularly high in members of Asian, Mixed and Other
ethnic groups.
The impact on existing health inequalities in mortality and life
expectancy was still evident. The differences in life expectancy between
the most and least deprived in the region increased for males (by 0.9
years to a difference of 8.3 years), although for females the gap
decreased slightly (by 0.6 years to a difference of 5.8 years).
Whilst life expectancy improved overall for both females and males
between 2010 and 2019, healthy life expectancy fell, with people living
more years in poor health. This has implications for health services and
social care, as well as for lifelong health promotion.
2. Improvements in child health have been slowing down
In the South East, there has been a rise in the proportion of babies
born with low birthweight at full term since 2016. In 2020 there were 5
local authorities in the South East that had statistically significantly
higher proportions of low birthweight compared to the regional value:
Portsmouth, Reading, Slough, Southampton and Windsor and Maidenhead.
Infant mortality rates have been falling, but there was a rise between
2014-16 and 2017-19 although the trend is now downwards again. Child
development at the end of Reception has improved since 2012/13, although
the trend is now flat. Females have persistently higher levels of
development than males, and children eligible for free school meals have
persistently lower levels of achievement than the average. This gap is
not closing.
Across the South East, there have been no improvements in childhood
obesity rates, and it has been very difficult to measure these during
the pandemic. Seven local authorities had particularly high rates of
obesity in Reception and/or Year 6 in 2019/20: Kent, Medway, Milton
Keynes, Portsmouth, Reading, Slough and Southampton.
However, there have been some improvements in indicators of child
health. There has been a consistent fall in the rate of under 18
conceptions across the South East since 1998, although two local
authorities still have statistically significantly higher rates than
England: Medway and Portsmouth.
There has also been a fall in the rates of hospital admissions caused
by unintentional and deliberate injuries in children (0-14 years) across
the South East.
3. Mental health and wellbeing have deteriorated
The Annual Population Survey includes four self-reported measures of
wellbeing. Between 2019/20 and 2020/21, the proportions of people in the
South East reporting high anxiety, low happiness, low satisfaction and
low worthwhile all increased compared to the previous five years.
Across the South East, rates of hospital admissions for intentional
self-harm rose between 2010/11 and 2020/21 from 184.8 per 100,000 to
201.9 per 100,000, with a statistically significantly higher rate for
females (when compared with males). The rate for suicide also increased
between 2010-12 and 2018-20 from 9.3 per 100,000 to 10.1 per 100,000,
with a statistically significantly higher rate for males (when compared
with females).
4. Deaths from Dementia and Alzheimer’s disease have
increased
Dementia and Alzheimer’s disease remained the leading cause of death
in females in the South East, and the third largest in males. Deaths
from dementia and Alzheimer’s disease increased between 2019 and 2020
across most deprivation groups in the South East and contributed to the
widening gap in life expectancy in males.
5. Diabetes has become a major disease burden
The rate of years lived with disability (YLD) for diabetes was the
only disease to see a statistically significant increase between 1990
and 2019, increasing by 153.4%. In 2019 it was the fourth leading cause
of YLDs in the South East. For the reporting period January 2020 to
March 2021 (2020/21) approximately 40% of the estimated prevalence of
non-diabetic hyperglycaemia (NDH) was diagnosed. In the NHS South East
region in 2020/21, only 32.4% of those registered with NDH had been
offered a place on an NHS DPP course.
6. Diagnosis of cancers was affected over the pandemic
period
New cancer diagnoses declined over the early pandemic period, with a
reduction in the number of all new cancers diagnosed in the South East
from March 2020, which did not return to pre-pandemic levels until March
2021. By September 2021, monthly new diagnoses of prostate cancer had
still not returned to pre-pandemic levels. The reduction in new cancer
diagnoses may represent reductions in screening or delays in diagnosis
over the pandemic period and could be associated with cancers presenting
at more advanced stages.
7. Some important behavioural risk factors have not been
improving
In the South East, the percentage of adults overweight or obese
continued to rise from 59.7% in 2015/16 to 61.5% in 2019/20, with the
highest percentages in Medway, Portsmouth and Kent. It is not yet known
how adult obesity has been affected by the pandemic.
The prevalence of high blood pressure in the South East has shown
little change from 13.6% in 2015/16 to 14.1% in 2020/21. It is likely
that changes in access to health services over the pandemic period may
have prevented the diagnosis of more cases of hypertension and made it
more difficult to provide effective treatment. This is important, as
hypertension is associated with heart and kidney disease and strokes.
Across the South East, all Clinical Commissioning Groups saw a reduction
in the percentage of hypertension patients treated to target in 2020/21
compared to the previous year.
However, there is some good news; smoking rates in adults (18+) have
continued to fall in the South East from 15.9% in 2015 to 12.2% in 2019.
There is considerable variation between communities and rates are higher
in more deprived areas.
8. Employment rates have fallen over the pandemic
Good employment contributes to good health and wellbeing. The South
East has a history of high employment as a region, but in the first year
of the pandemic employment rates in people aged 16-64 fell from 79.6% in
2019/20 to 77.7% in 2020/21. Moreover, there have been persistent
differences in employment rates between males and females and between
local authorities. Restoring employment is an important aspect of
recovering from the pandemic and in reducing inequalities.
COVID-19
This section examines the direct impact of the COVID-19 pandemic on
health with analysis of COVID-19 cases, death rates involving COVID-19,
excess deaths during the pandemic and vaccination rates up to 31
December 2021. Hyperlinked data from the OHID COVID-19 dashboard is at
19 April 2022.
COVID-19 cases
Health Profile for England Highlights
England had experienced two 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. Whereas case rates in
regions in the south of England increased later, in December 2020 and
January 2021.
By the end of December 2021, 1,782,564
confirmed cases of COVID-19 had been reported in the South East.
The region’s highest 7-day rolling case rate by specimen date occurred
in the week ending 31 December 2021 at 1,591.8
cases per 100,000 population. Figure 1a shows the daily case
numbers and the 7-day rolling average case numbers. The highest number
of daily cases was on 29 December 2021 at 31,302.
COVID-19 affected some groups in the South East more than others, and
this can be illustrated by variations in the cumulative confirmed case
rates (cases confirmed by at least one positive test). It is important
to note that testing strategies have also varied across different groups
e.g. there was increased testing of NHS and care home staff, NHS
patients and care home residents, and students and teachers in schools.
Such differential testing may have contributed to the variations in
recorded case rates between groups of people and between places. Figure
1b shows cumulative case rates for the period March 2020 to December
2021 for different population groups, as summarised below.
Age: recorded case rates were statistically
significantly higher compared to the South East rate (18,820.5 per
100,000) in the 25-49 year age group (23,570.5 per 100,000) and the 0-24
year age group (23,155.0 per 100,000).
Deprivation: while there were differences by
deprivation decile, there did not seem to be a clear pattern in recorded
case rates. Recorded case rates were highest in the least deprived
decile (decile 10) at 19,327.5 per 100,000 population, and lowest in the
next least deprived decile (decile 9) at 18,618.1 per 100,000
population. The most deprived decile (decile 1) had a similar rate to
the South East regional value.
Ethnicity: recorded case rates were statistically
significantly higher when compared to the South East rate (18,820.5 per
100,000) for the ‘Any other’ ethnic group (23,599.8 per 100,000),
‘black/black British’ (22,863.1 per 100,000) and ‘Asian/Asian British’
(21,376.4 per 100,000).
Population density: while there were differences in
recorded case rates by population density, the pattern was not clear.
Recorded case rates were lowest in the most densely populated decile at
17,779.6 per 100,000 and next lowest in the least densely populated
decile at 18,099.7 per 100,000. Recorded case rates were higher than the
South East regional value (18,820.5 per 100,000) in population density
deciles 4-9.
Sex: recorded case rates were statistically
significantly higher in females (19,564.5 per 100,000) than males
(17,984.2 per 100,000).
Figure 1c shows cumulative case rates and 7-day average case rates by
UTLA at the end of December 2021. The cumulative case rate was highest
in Slough at 22,521.5 per 100,000 population (crude rate) and Milton
Keynes had the highest 7-day average case rate at 2,011.1 per 100,000
population (crude rate). It should be noted that comparison of cases by
local authority at a point in time could be misleading because of the
factors (such as testing in an area) that can affect case rates.
Deaths involving COVID-19
By the end of December 2021, 19,315
deaths had been reported within 28 days of being identified as a
COVID-19 case (by a positive test) in the South East.
Figure 2a shows the daily and the 7-day average number of deaths
where COVID-19 was mentioned on the death certificate. The highest
number of daily deaths was 294 on 19 January 2021.
Health Profile for England Highlights
Inequalities in death rates from COVID-19 largely reflect
inequalities in COVID-19 case rates. However, they 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 [2]. 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 poorest
chance of survival and had 1.88 times 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 [3].
In the South East, there are wide inequalities in death rates
involving COVID-19 between March 2020 to December 2021, as shown in
Figure 2b.
Age: cumulative mortality rates were by far the
highest in people aged 85 years or older (4106.3 per 100,000). They were
also statistically significantly higher than the rate for all people in
the South East (239.5 per 100,000) for those aged 75-84 years (1,145.8
per 100,000) and those aged 65-74 years (356.1 per 100,000).
Deprivation: cumulative age-standardised mortality
rates were highest in the most deprived deprivation decile at 379.3 per
100,000 population and decreased across the deciles to the lowest rate
of 165.7 per 100,000 population in the least deprived decile.
Ethnicity: cumulative age-standardised mortality
rates were statistically significantly higher when compared to the rate
for the South East (239.5 per 100,000) in the ‘Any other ethnic group’
(421.8 per 100,00), ‘Asian/Asian British’ (419.3 per 100,000), and
‘black/black British’ (339.5 per 100,000) ethnic groups.
Population density: cumulative age-standardised
mortality rates were highest in the most densely populated areas at
334.3 per 100,000 population, and lowest in the least populated areas at
188.7 per 100,000 population.
Sex: cumulative age-standardised COVID-19 mortality
rates were statistically significantly higher for males (307.2 per
100,000) than females (186.9 per 100,000).
Figure 2c shows the highest cumulative age-standardised COVID-19
mortality rate was in Slough at 466.0 per 100,000 population.
Oxfordshire had the lowest rate at 169.6 per 100,000 population.
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 years, had the pandemic not occurred. These figures account for
inequalities prior to the pandemic and therefore reflect the
disproportionate direct and indirect impact of the pandemic on different
groups.
Figure 3a displays the weekly number of excess deaths in the South
East from 27 March 2020 to 31 December. The weekly numbers are variable,
but peak excess deaths of around 1,500 were seen in mid to late April
2020. For the period March 2020 to June 2020 there were typically less
deaths than expected.
Health Profile for England Highlights
Nationally, there was an association between deprivation and excess
mortality, with an excess mortality ratio of 1.17 in the most deprived
areas and 1.13 in the least deprived areas. As with the regional
figures, this considers any existing inequality in mortality by
deprivation. So, greater excess mortality in deprived areas is an
indication that COVID-19 has exacerbated existing inequalities by
deprivation. Further analysis has shown that among black and Asian
groups excess mortality in those aged under 75 did not vary by
deprivation and was high across all deprivation groups. This indicates
that the excess mortality in those aged under 75 in the black and Asian
groups cannot be explained by deprivation and other factors play a role
[4].
Figure 3b shows that between 27 March 2020 and 31 December 2021 the
cumulative excess mortality ratio for the South East was 1.105. This
means that there were 1.105 times more deaths in this period than
expected. There was variation across different groups as summarised
below.
Age: cumulative mortality was higher than expected
in age groups over 25, with the highest excess mortality ratio in the
50-64 age group, for both males and females.
Deprivation: for females in the South East, there
was a general increase in the excess mortality ratio as deprivation
decreased, with a ratio of 1.03 in the most deprived and 1.12 in the
least deprived quintiles. For males there was little apparent
relationship between cumulative excess mortality and deprivation
quintile, with the ratio ranging from 1.1 in the most deprived and least
deprived quintile, and 1.13 in quintiles 2-4.
Ethnicity: cumulative excess mortality ratios were
highest for people recorded as ‘Other ethnicity’ at 1.82 and 1.59 for
females and males respectively. This compares to 1.09 times higher for
‘white’ females and 1.11 times higher for ‘white’ males. Males from
‘Asian’ and ‘Mixed’ ethnic groups had cumulative excess mortality ratios
of 1.31 and 1.19 respectively.
Sex: the cumulative excess mortality ratio was 1.1
for females and 1.12 for males.
UTLA: the cumulative excess mortality ratio for
UTLAs in the South East was highest in Slough at 1.22.
COVID-19 vaccinations
In the South East region, by the end of December 2021, 83.0%
(7,218,227) of people aged 12+ years had received 1 dose of COVID-19
vaccine, 76.7% (6,669,786) had received 2 doses and 57.6%
(5,005,580) had received 3 doses.
Figure 4b shows that there was variation in the percentage of people
aged 18+ receiving their 2 doses of COVID-19 vaccine across different
population groups.
Country of birth: 2 doses of COVID-19 vaccine had
been received by 90% of people aged 18+ born in the UK compared to 81.4%
of those born elsewhere.
Deprivation: 2 doses of COVID-19 vaccine had been
received by 92.7% of people aged 18+ in the least deprived quintile
compared to 82.8% in the most deprived.
Disability status: there was no clear pattern by
disability status.
English language proficiency: 2 doses of COVID-19
vaccine had been received by 89.7% of those whose main language was
English compared to 75.4% of those whose is main language is not
English.
Ethnicity: receipt of 2 doses of COVID-19 vaccine
was lowest among people in the ‘black Caribbean’ ethnic group at 68.8%,
whereas the highest uptake was 90.7% in the ‘white British’ group.
Household tenure: receipt of 2 doses of COVID-19
vaccine was highest in people who owned their property at 92.3% and
lowest in those who did not own their property at 80% and 81% for those
in social and private rented properties.
Religion: receipt of 2 doses of COVID-19 vaccine was
lowest in people of Muslim faith at 76.3%. Uptake in people of
Christian, Hindu and Jewish faiths was around 91%.
Rural and urban populations: 2 doses of COVID-19
vaccine had been received by 88.3% of people in urban areas compared to
91.5% of people in rural areas.
Sex: 2 doses of COVID-19 vaccine had been received
by 90.2% of females compared to 87.6% of males.
Socio-economic classification: receipt of 2 doses of
COVID-19 vaccine was generally higher in people with high
social-economic status, with the lowest uptake in those with the status
‘never worked and long-term unemployed’ at 72.2%.
Figure 4c shows that by the end of December 2021, 64.4% of people in
Slough had received second dose vaccinations compared to 82.8% of people
in Hampshire second dose vaccinations.
Life expectancy and mortality
This section examines trends and inequalities in life expectancy,
all-cause mortality, and mortality from leading causes of death. It
presents data for the pre-pandemic period, and 2020 data where it is
available.
Life expectancy
Figure 5a shows that trends in life expectancy at birth from 2001 to
2020 have increased for both females and males in the South East.
However, compared to 2019, life expectancy fell in 2020 by 0.8 years for
females to 83.7 years and by 0.9 years for males to 80.1 years.
All deprivation deciles across the South East saw a fall in life
expectancy between 2019 and 2020, as shown in Figure 5b. The slope index
of inequality (SII) 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 an
area and summarises this into a single number, assuming a linear
relationship between the indicator and deprivation. The higher the value
of the SII, the greater the inequality within an area.
Within the South East, the SII for life expectancy for females
decreased from 6.4 years in 2019 to 5.8 in 2020, suggesting a decrease
in the inequality in life expectancy by 0.6 years. However, for males
the SII increased from 7.4 years to 8.3 from 2019 to 2020, suggesting an
increase in the inequality in life expectancy of 0.9 years.
Figure 5c shows life expectancy at birth figures for 2020 by local
authority for both females and males. Female life expectancy was significantly
lower when compared to England for Medway (81.9 years), and
Reading (81.1 years). Male life expectancy was significantly
lower when compared to England for Southampton (77.6 years),
Reading (77.5 years), Medway (77.3 years) and Slough (77.1 years).
Breakdown of trends in life expectancy by age or cause of death
The change in life expectancy between 2019 and 2020 has been
attributed largely to COVID-19, accounting for a reduction of 0.82 year
in females and 1.03 years in males in the South East. By age, deaths
among those aged 50 and over had a negative effect on life expectancy
for both females and males. In previous years, improvements in mortality
among most of these age groups had been contributing to an increase in
life expectancy (Figure 6a). However, between 2019 and 2020, the
greatest contributions to falling life expectancy were from females aged
80-89 (0.29 years) and males aged 70-79 (0.27 years).
Figure 6b shows that for females in 2020, the 70-79 age group
contributed the largest number of years (1.73) to the difference in life
expectancy between people in the most and least deprived deprivation
deciles. Chronic lower respiratory disease and ‘other’ diseases were the
largest causes of the difference in life expectancy between deprivation
groups, contributing 0.81 years and 0.76 years respectively. COVID-19
contributed 0.57 years.
For males in 2020 the 70-79 age group also contributed the largest
number of years (2.21) to the difference in life expectancy between
people in the most and least deprived deprivation deciles. Chronic lower
respiratory disease (0.89 years), COVID-19 (0.95 years), heart disease
(0.95 years) and ‘other’ diseases (0.87 years) were the largest
contributors to the difference in life expectancy between the most and
least deprived groups.
Trends in mortality and leading causes of death
Figure 7a shows trends in age-standardised mortality rates for all
ages and those aged under 75 for females and males in the South East
from 2001 to 2020. Rates for both generally decreased over these 20
years. However, between 2019 and 2020 there have been some changes.
For females the all-age mortality rate increased from 730.0 per
100,000 in 2019 to 806.7 in 2020. The mortality rate for those aged
under 75 years increased from 228.6 per 100,000 in 2019 to 241.0 in
2020. For males the all-age mortality rate increased from 988.5 per
100,000 population in 2019 to 1,106.0 in 2020. The mortality rate for
those aged under 75 years increased from 344.4 per 100,000 in 2019 to
379.7 in 2020.
Between 2019 and 2021, the mortality rate for people aged under 75
years increased each year for all deprivation groups. The increase
between 2020 and 2021 was only statistically significant for deprivation
deciles 2 and 4 (Figure 7b).
Figure 7c shows the mortality rate for those aged under 75 years by
local authority in the South East between 2019 and 2020. Mortality rates
increased for most local authorities, although this was only
statistically significant for a few (for females: Buckinghamshire, for
males Buckinghamshire, Kent, and Surrey). Interestingly, Portsmouth and
Windsor and Maidenhead had a non-statistically significant decrease in
their mortality rates.
Figure 8a shows that for females in 2020 the leading cause of death
for all ages and those aged 80 and over was dementia and Alzheimer’s
disease. In those aged 20-34, ‘suicide and injury/poisoning of
undetermined intent’ was the leading cause of death. For males in 2020,
the leading cause of death for all ages was COVID-19. In those aged 80
and over it was dementia and Alzheimer’s disease. For people aged 20-34
and 35-49, ‘suicide and injury/poisoning of undetermined intent’ was the
leading cause of death.
Age-standardised morality rates for cancer, circulatory disease and
respiratory disease show a clear pattern when viewed by deprivation
decile (Figure 8b). More deprived areas have higher mortality rates.
However, there is no such pattern for dementia and Alzheimer’s
disease.
Child health
Every child having a good start in life is the foundation for future
health and wellbeing. This section presents some important indicators of
child health including low birthweight, infant mortality, early child
development and child obesity.
Health Profile for England Highlights
In England the last two decades have seen overall improvements in
babies born with a low
birthweight, infant deaths and child development. However, in
the years leading up to the coronavirus pandemic, improvements had
slowed down.
Low birthweight
Low birthweight is associated with an increased
risk of infant mortality, developmental problems in childhood
and poorer health in later life [5-6].
Figure 9a shows the proportion of babies born at full term with a low
birthweight (less than 2,500 grams) between 2006 and 2020 for the South
East. There has been a marked increase between 2016 and 2020. While this
remains statistically significantly better than England, the overall
trend is statistically significantly worsening.
As shown in Figure 9b, in 2020 there were 5 local authorities in the
South East that had statistically significantly higher proportions of
low birthweight compared to the regional value (2.6%). These were Slough
(4.3%), Windsor and Maidenhead (3.8%), Southampton (3.8%), Portsmouth
(3.5%) and Reading (3.4%).
Health Profile for England Highlights
The Health Profile for England examines inequalities
in low birth weight at a national level. In 2018, the proportion
of babies born at full term with a low birthweight in the most deprived
areas was more than double the proportion in the least deprived areas,
as measured by the Relative Index of Inequality (RII). The relative
index of inequality is a summary measure of inequality. It measures the
relative difference between the most and least deprived areas and is
presented as a ratio. For low birthweight the RII is 2.2, meaning that
the level in the most deprived areas is 2.2 times higher than the least
deprived. The analysis for April 2020 to March 2021 suggested that these
inequalities have remained throughout the pandemic [7].
There are well-established inequalities by ethnic group in low
birthweight [8]. During April 2016 to March 2020 and April 2020 to March
2021, low birthweight was highest among Asian and black groups and
lowest in the white group [7].
Infant mortality
Infant mortality includes 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 [9]. Nationally, the rate of
infant mortality increases
as deprivation increases.
Figure 10a presents trends in infant mortality rates for the South
East from 2001-03 until 2018-20, as three-year rolling averages to make
it easier to see the overall trend. It shows that the rate of infant
mortality fell from 4.3 per 1,000 live births to 3.5. However, there has
been an increase from 2014-16 to 2017-19, with a slight downturn in
2018-20.
As shown in Figure 10b, in 2018-20 Oxfordshire (1.9 per 1,000) is the
only local authority in the South East which has a statistically
significantly lower infant mortality rate than the regional value (3.5
per 1,000). All other local authorities in the South East had rates that
were not statistically different from the regional value.
Child development
Starting primary school is a significant milestone in a child’s
educational journey. Language and communication skills are fundamental
to a child and young person’s potential development and achievements
later in life [10]. Being able to express themselves, interact with
peers and make themselves understood helps to build a child’s confidence
and boost their self-esteem [11]. Inadequate communication skills can
lead to poorer adult outcomes in literacy, mental health, and employment
[12].
Figure 11a shows that the percentage of children achieving a good
level of development at the end of Reception year has generally
increased from 2012/13 to 2018/19 and remains above the England average,
for both males and females. However, the percentage for males is
consistently lower than for females. In 2018/19 the respective figures
were 68.5% and 81.0%. The percentages for children eligible for free
school meals were even lower at 48.2% for males and 63.3% for females,
and this attainment gap has not narrowed.
As shown in Figure 11b there were 7 local authorities with
statistically significantly lower percentages (for all children) than
the regional value (74.6%) in 2018/19. These were Reading (69.2%),
Portsmouth (69.4%), Southampton (71.1%), Brighton and Hove (71.5%), Isle
of Wight (71.5%), West Sussex (71.9%) and Oxfordshire (73.5%). Again,
there is much lower attainment by children eligible for free school
meals.
Health Profile for England Highlights
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) [13]. 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 friends.
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. 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%) [14].
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
[15].
Figure 12a shows the prevalence of obesity in both males and females
for Reception year and Year 6 children from 2006/07 to 2019/20. In the
South East prevalence of obesity has increased for both sexes in both
age groups. In 2019/20 8.6% of Reception year females were obese,
compared with 9.2% of Reception year males. For Year 6 females the
prevalence of obesity in 2019/20 was 15.7% compared to 19.8% of Year 6
males.
The variation in childhood obesity across local authorities in the
South East is shown in Figure 12b for 2019/20. For Reception year
children, Slough (11.9%), Medway (11.6%), Portsmouth (11.0%) and Kent
(10.4%) had statistically significantly higher percentages of obesity
than the regional value (8.9%). For Year 6 children Slough (24.9%),
Southampton (23.8%), Medway (22.2%), Portsmouth (22.1%), Reading
(21.4%), Kent (19.9%) and Milton Keynes (19.8%) had statistically
significantly higher percentages of obesity than the regional value
(17.8%).
The latest findings from the National Child Measurement Programme
(NCMP) shows the prevalence of obesity (including severe obesity) had
statistically significantly increased from 8.9% in Reception year in
2019/20 to 12.6% in 2020/21 [16]. For Year 6, the corresponding figures
were 17.8% and 20.9%, also a statistically significant increase.
Health Profile for England Highlights
The Health Profile for England examined inequalities in child obesity
at England level. In both age categories (Reception and Year 6),
children in more deprived areas were more likely to be obese. In 2019/20
the percentage of obese children in Reception was 6.0% in the least
deprived decile compared to 13.3% in the most deprived decile. For Year
6 children the percentage of obese children was 11.9% in the least
deprived decile compared to 27.5% in the most deprived decile.
The HPfE also highlighted inequalities by ethnic group. In 2019/20,
the black African ethnic group had the highest prevalence of obesity in
both Reception (15.9%) and Year 6 children (30.5%) - statistically
significantly higher than the England percentages (9.9% and 21.0%
respectively). Although, there were other ethnic groups similarly
high.
A link between weight gain and out of school time in the school
holidays has previously been demonstrated [17]. The closure of schools,
sporting and leisure facilities, park facilities and recreational areas,
together with an increase in screen time over the pandemic period, led
to a reduction in physical activity in children and young people [18]
Recent evidence from Sport England suggested that in England, there has
been a reduction in physical activity in boys, and an increase in
physical activity for girls during the pandemic in England [19].
Other indicators related to child health
The
Health Profile for England 2019 demonstrated inequalities in
many other aspects related to children’s health, prior to the pandemic.
This section looks at some of these indicators for the South East.
Health Profile for England Highlights
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. 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
level up to 2018 at 24% [20]. This survey data is not available at
regional level.
Dental decay
In the South East, 17.6% of children aged 5 years old had experience
of visually obvious dental decay in 2018/19. Proportions were
statistically significantly higher in Slough (37.9%) and Reading (30.6%)
than England (23.4%). Note that there were 5 local authorities for which
no data was available for this indicator.
Injuries resulting in hospitalisation
Figure 13a shows the trend for hospital admissions for unintentional
and deliberate injuries in children (aged 0-14 years) between 2010/11
and 2020/21. For the South East the crude rate has reduced from 111.1
per 10,000 in 2010/11 to 73.2 per 10,000 in 2020/21, which is lower than
the rate for England (75.7 per 10,000).
There is wide variation across the South East for this indicator in
2020/21, as shown in Figure 13b. Isle of Wight (129.8 per 10,000), West
Sussex (101.3 per 10,000) and East Sussex (99.8 per 10,000) had
statistically significantly higher rates than the region as a whole
(73.2 per 10,000).
Smoking in early pregnancy
Smoking in pregnancy has well known detrimental
effects for the growth and development of the baby and health of
the mother. Smoking during pregnancy increases the risk of premature
births, miscarriage, stillbirth and perinatal deaths, complications in
pregnancy, low birthweight and the child developing other conditions in
later life. In 2018/19 there was significant variation in the
proportion of mothers smoking in early pregnancy for local
authorities in the South East. Isle of Wight (18.9%), Medway (16.9%),
East Sussex (15.2%), and Kent (14.1%) had statistically significantly
higher proportions than England (12.8%).
Smoking at the time of delivery
Figure 14a shows the trend in the proportion of mothers smoking at
the time of delivery. In the South East the proportion has reduced from
11.9% in 2010/11 to 9.0% in 2020/21. However, Figure 14b shows that in
2020/21 there was significant variation in smoking at the time of
delivery across local authorities in the South East. 7 local authorities
were significantly worse when compared to the regional proportion,
whereas 11 local authorities had significantly better proportions of
smokers, and 1 local authority was not significantly different when
compared to the regional proportion.
Health in adults
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 described as “healthy life
expectancy”. Information on healthy life expectancy is not yet available
for the years covering the pandemic.
Healthy ageing
Figure 15a shows that in the South East healthy life expectancy for
females, decreased by 1.2 years from 67 years in 2010-12 to 65.8 years
in 2017-19. The average years of life lived in poor health for females
in 2017-19 was 18.5 years. For males, healthy life expectancy decreased
slightly by 0.2 years from 65.5 years in 2010-12 to 65.3 years in
2017-19. The average years of life lived in poor health for males in
2017-19 was 15.5 years.
Leading causes of morbidity
The Global Burden of Disease (GBD) study estimates the number of
years lived with disability (YLDs) as a way of describing 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 16a identifies the most common causes of morbidity in the
South East for 1990 and 2019 according to GBD (as measured by
age-standardised YLDs per 100,000 population). The top 3 leading causes
of morbidity in the South East in 2019 were low back pain, depressive
disorders, and headache disorders. For females, the top 3 were low back
pain, headache disorders, and gynaecological diseases. For males, the
top 3 were low back pain, diabetes mellitus, and depressive
disorders.
Change between years should be interpreted with caution as it may
reflect changes in methodology and categorisation. For both males and
females, diabetes mellitus is the only cause to have a statistically
significant change in its morbidity rate. The rate of YLDs increased by
153.4% between 1990 and 2019 and became the fourth leading cause of YLDs
for all persons. In 2020/21 for the NHS South East region 495,137
people were on the diabetes register, accounting for 6.5% of the
GP practice list size.
Mental health and wellbeing
According to the Global Burden of Disease study, mental health
conditions such as depression and anxiety accounted for 14.6% of total
morbidity (years lived with disability) in the South East in 2019
[22].
Figure 17a shows trends in self-reported wellbeing from 2011/12 to
2020/21, measured by four different indicators: anxiety, low happiness,
low satisfaction and low worthwhile feelings. Comparing the years
2019/20 with 2020/21 can suggest how the COVID-19 pandemic was affecting
wellbeing. In the South East, all four of these indicators deteriorated
between 2019/20 and 2020/21. Between 2019/20 and 2020/21, the proportion
of the population reporting high anxiety rose from 22.0% to 23.6%. The
proportion of the population reporting feeling low happiness rose from
7.9% to 8.7%. The proportion of the population reporting feeling low
satisfaction rose from 4.3% to 5.9%, and the proportion of the
population reporting feeling low self-worth rose from 3.2% to 4.3%.
Variation in these self-reported wellbeing measures across the local
authorities in the South East is shown in Figure 17b. Many local
authorities are missing data due to small sample sizes. For the high
anxiety indicator, there were 3 local authorities which had
statistically significantly higher percentages than the regional value
(23.6%). These were Brighton and Hove (30.8%), Windsor and Maidenhead
(28.6%) and Milton Keynes (28.4%).
Self-harm and suicide
Figure 18a shows that the rate of emergency hospital admissions for
intentional self-harm in the South East increased from 184.8 per 100,000
in 2010/11 to 201.9 in 2020/21. The rate for suicide has also increased
from 9.3 per 100,000 in 2010-12 to 10.1 in 2018-20.
In the South East in 2020/21 the rate
of emergency hospital admissions for intentional self-harm was
statistically significantly higher for females (275.1 per 100,000) than
for males (131.3 per 100,000). In contrast, the rate
of suicide in the South East in 2018-20 was statistically
significantly higher for males (15.3 per 100,000) than for females (5.2
per 100,000).
Figure 18b shows that Southampton (372.9 per 100,000) has a
statistically significantly higher rate of emergency hospitals
admissions for self-harm in 2020/21 than any other upper tier local
authority in the South East. Whilst there is variation in the suicide
rate across local authorities, there are no statistically significant
differences, due to small numbers and hence large confidence intervals.
However, females have statistically significantly lower rates of suicide
than men for all local authorities except Portsmouth and Reading (where
the data is available for both sexes).
Cancer
According to the Global Burden of
Disease study, cancers accounted for 2.03% of total morbidity
(years lived with disability) in the South East in 2019 and (as
discussed earlier in the report) are a leading cause of death.
Figure 19a shows that the trend in new cancer diagnoses for all sites
combined and the four main cancers (breast, prostate, colorectal and
lung) declined in March 2020. Cancer diagnoses began to increase again
as the COVID-19 pandemic progressed. The total number of new cancer
diagnoses in April and May 2020 were around a third lower than in the
earlier months of 2020.
By September 2021, monthly new breast and colorectal cancer diagnoses
were higher than in January and February 2020, before the pandemic.
Monthly new lung cancer diagnoses were similar and new monthly prostate
cancer diagnoses were lower in September 2021 than in January and
February 2020.
Cancer screening coverage fell during the pandemic in the South East
for breast and cervical screening programmes. Breast
cancer screening coverage statistically significantly decreased
from 75.3% of eligible women (aged 53-70) screened in 2019 to 68.0% in
2021. Cervical
cancer screening coverage for women aged 25 to 49 years also saw
a statistically significant decrease from 71.4% in 2019 to 69.5% in
2021. Similarly, for women aged 50
to 64 years cervical screening coverage statistically
significantly decreased from 76.4% of eligible women screened in 2019 to
74.8% in 2021. Conversely, bowel
cancer screening coverage statistically significantly increased
from 62.2% in 2019 to 68.0% in 2021.
Health Profile for England Highlights
There were reductions in new cancer diagnoses across all referral
routes, but those following referral from screening showed the greatest
reduction. From April to December 2020 the number of cases diagnosed
following screening was less than half that in the equivalent period in
2019. Screening is a vital tool in early diagnosis of cancer, but the
availability of screening programmes was reduced during 2020 [23].
Risk factors associated with ill health
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.
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
later in 2022. This section focuses on behavioural and metabolic risk
factors in adults.
Health Profile for England Highlights
Inequalities in risk factor prevalence contribute to inequalities in
ill health and mortality. For example, inequality in smoking prevalence
by deprivation is a large determinant of the inequalities in mortality
and life expectancy. In 2019, smoking prevalence in England was 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 national prevalence of obesity in adults was higher in the most
deprived than least deprived areas, and there were wide inequalities in
the proportion of adults meeting the recommended level of physical
activity and fruit and vegetable consumption. Health Survey for England
evidence suggested that prevalence of multiple risk factors is higher in
men, the white ethnic group, lowest income households, most deprived
areas, and people with long term health conditions [24].
Figure 20a shows that the risk factors making the largest
contribution to morbidity in the South East are high body mass index,
high fasting plasma glucose, tobacco, and alcohol use. Whereas the risk
factors making the biggest contribution to mortality (Figure 20b) in the
South East are tobacco, high blood pressure, diet, and high fasting
plasma glucose. Please note that the disease burdens attributable to
specific risks are independently calculated for each risk factor. Risk
factors attributed to YLDs or deaths cannot be summed together.
Obesity
Figure 21a shows that in the South East, the percentage of adults
overweight or obese increased from 59.7% in 2015/16 to 62.4% in 2020/21,
but remains
statistically significantly lower than England (63.5%).
Figure 21b shows that there was some variation by local authority in
2020/21, with the highest percentage of overweight or obese people in
Medway (69.4%). This is statistically significantly higher than the
South East percentage (62.4%). Other local authorities with a
statistically significantly higher percentage than the South East were
Milton Keynes (69.3%) and East Sussex (64.9%). The lowest percentage was
in Windsor and Maidenhead (57%), statistically significantly lower than
the South East percentage.
Health Profile for England Highlights
As with other risk factors, there are inequalities in adult obesity
prevalence by age, sex and deprivation. HPfE reported that, in 2019,
obesity was lowest in those aged under 25 with a gradual increase by age
group up to ages 65-75, after which prevalence decreases. 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
clearer gradient for females than males.
The impact of the pandemic on adult obesity levels is not known but
given the changes in other risk factors presented (diet, physical
activity, and alcohol) it is possible we will see an increase and a
widening of inequalities.
Blood glucose
Increased blood glucose levels may lead to diabetes and can increase
the risk of heart disease, 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).
Analysis
from 2015 estimated that there were approximately 810,000 people
across the NHS South East region with NDH. For the reporting period
January 2020 to March 2021 (2020/21) 332,925 patients had been
diagnosed, which accounted for approximately 40% of the estimated
prevalence [25]. The diagnosed
prevalence increased across all CCGs in the region between
2017/18 and 2020/21. In 2020/21 the prevalence (as a percentage of the
GP Practice list size for patients aged 17+) ranged from 2.2% in
Berkshire West CCG to 7.3% in West Sussex CCG.
The NHS Diabetes Prevention Programme (NHS DPP) delivers
evidence-based behavioural interventions that can prevent or delay the
onset of Type 2 diabetes in adults who have been identified as having
NDA. In the NHS South East region in 2020/21, 32.4% of those registered
with NDH had been offered a place on an NHS DPP course [25]. This
percentage increased across all CCGs in the region from 2017/18 to
2020/21. In 2020/21 values
ranged from 20.9% in Kent and Medway CCG to 45.2% in East Sussex
CCG.
Smoking
Figure 21a includes a chart which shows estimates of adult (aged 18+)
smoking prevalence from the Annual Population Survey (APS) for the
period 2015 to 2019. Over this period there was a reduction in smoking
prevalence in the South East from 15.9% in 2015 to 12.2% in 2019. For
every year shown in the chart the prevalence for the South East has
been
statistically significantly lower than the prevalence for
England (the prevalence for England in 2019 was 13.9%).
Figure 21b includes a chart showing the variation in prevalence of
adult smoking for local authorities in the South East in 2019. There
were 6 local authorities that had a statistically significantly higher
prevalence of smoking when compared to the South East prevalence.
Smoking prevalence was highest in Brighton and Hove (17.5%) and lowest
in Wokingham (8.4%).
Smoking prevalence remains much higher than average in some
socio-economic groups. In the South East in 2019, the prevalence in
routine
and manual occupations (for those aged 18 to 64 years) was
23.7%, statistically significantly higher than the prevalence for the
general working age population (14.3%).
Data from the GP Patient Survey (GPPS) shows that smoking prevalence
is also higher in adults (18+) with a long
term mental health condition. In 2019/20 the prevalence for the
South East was 24.9% compared to 13.1%
in the general adult population.
Health Profile for England Highlights
There is early evidence that the pandemic may have had a positive
impact on enabling some people to quit or reduce smoking. Data from the
UCL smoking tool kit, reported in the WICH tool, shows that over a third
of smokers attempted to quit in the 3 months up to June 2021.
Over-the-counter nicotine replacement therapy (NRT) and e-cigarettes are
still the most commonly used aids for quitting. However, during the
pandemic there has been a reduction in their use, which suggests an
increase in people trying to quit unaided [7].
Alcohol
‘Increasing or higher risk drinking’ is defined as drinking more than
14 units per week, but up to 35 units for women and up to 50 units for
men. In 2019 the Health Survey for England showed that the prevalence
of ‘increasing or higher risk drinkers’ in the South East was
19% and the proportion of ‘higher risk drinkers’ (more than 35 units for
women or more than 50 units for men per week) was 5%.
Health Survey for England estimates of the percentage of adults
drinking over 14 units of alcohol a week for local authorities
for the period 2015-18 vary from 7.9% (Slough) to 40.7% (Brighton and
Hove and the Isle of Wight). Brighton and Hove and the Isle of Wight
have statistically significantly higher percentages compared to the
South East value (22.9%).
The number of deaths
related to alcohol in the region was 3,132 in 2020, which
represents a directly standardised rate of 33.9 per 100,000 population -
statistically significantly lower than England.
Health Profile for England Highlights
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. Also, that there were differences in drinking
patterns by age and income. ‘Increasing or higher risk’ drinking was
highest in the 55 to 64 age group. The lowest rates were 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. However, the rate of hospital
admissions for alcohol-related conditions, in 2018 to 2019, in the most
deprived groups was more than double that in the least deprived areas.
The gap has changed little since 2010/2011 [26]. This inverse
relationship between consumption and harms is often referred to as the
‘alcohol harm paradox’. Attempts to understand this have suggested
interactions with other behaviours such as smoking, poor diet and
exercise, among the reasons why alcohol-related harms are greater in
more deprived areas [27].
High blood pressure
Figure 21a shows that the prevalence of high blood pressure
(hypertension) in the South East has shown little change between 2015/16
(13.6%) and 2020/21 (14.1%). There was some variation by local authority
for 2020/21, as shown in Figure 21b. The highest prevalence of
hypertension was for the Isle of Wight at 18% and the lowest for
Brighton and Hove at 9.6%. However, this indicator only includes
diagnosed prevalence. The Public Health England (PHE) CVD
Prevention Packs show the percentage of the estimated
hypertension prevalence which has been diagnosed. In 2019/20 this ranged
from 53.2% in Brighton and Hove CCG to 72.6% in Fareham and Gosport CCG.
At a NHS
South East regional level the corresponding percentage was
65.0%, with an estimated 308,420 patients needed to be diagnosed to meet
the national ambition of 80% detection.
Once diagnosed, it is important that a patient’s blood pressure is
managed. Again, there was variation
in management across the region, ranging from 64.4% of
hypertension patients treated to target in Surrey Heath CCG to 71.5% in
South Eastern Hampshire CCG in 2019/20. For the
region the corresponding percentage was 68.8%, with an estimated
150,560 patients needed to be treated to target to meet the national
ambition of 80%.
COVID-19 had an impact on the management of hypertension patients.
According to CVD Prevent data, the percentage of hypertension patients
managed to target in 2020/21 ranged from 41.0% in East Sussex CCG to
54.0% in Oxfordshire CCG [28]. All CCGs saw a fall compared to the
previous year. For the region the corresponding percentage for 2020/21
was 45.8%. This drop is only partly due to a change in the health status
of patients, as there is also a known drop in the percentage of patients
who have had a blood pressure reading recorded during the pandemic
period.
Diet
The proportion of the population eating the recommended
‘5-a-day’ portions of fruit or vegetables on a ‘usual day’ in the South
East was 58.3%, statistically significantly higher than the
England value of 55.4% in 2019/2020. There was some variation
by local authority where the highest percentage of the
population eating the recommended 5 a day was in Brighton and Hove at
65.3%. The populations with the lowest percentages were in Slough and
Portsmouth at 49.7%. This was statistically significantly lower than the
England and South East percentages.
Health Profile for England Highlights
HPfE 2021 reported wide inequalities in the proportion of people
eating the recommended 5-a-day. It was 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%).
Drug use
Health Profile for England Highlights
Pre-pandemic survey-based estimates for recent drug use in England
vary year on year. 9.4% of people aged 16 to 59 reported using any drug
in the last year in 2019 to 2020 [29].
In the South East region, the rate of death due to drug misuse was
4.0 per 100,000 and was statistically significantly lower than the rate
for England (5.0 per 100,000). Looking at the rate
of death due to drug misuse for 2018-20 by local authority,
Brighton and Hove (10.9 per 100,000) and Portsmouth (8.0 per 100,000)
had statistically significantly higher rates than England.
Low physical activity
The definition of being physically active is taking at least the
recommended 150 minutes of moderate intensity physical activity or
equivalent per week. In 2019/20, 69.5% of adults (aged 19+) were physically
active in the South East, statistically significantly higher
than the England proportion of 66.4%. There was variation by local
authority, but Slough (56%) was the only local authority in the South
East where the proportion of physically active adults (aged 19+) was
statistically significantly lower than the proportion for England.
In contrast, adults (19+) doing less than 30 minutes of moderate
intensity physical activity or equivalent per week are classified as
physical inactive. In 2019/20, 20.1% of adults (19+) in the South East
were physically inactive, statistically
significantly lower than the England percentage of 22.9%. The
percentage of the population (19+) physically inactive in Slough
(32.3%), Southampton (28%), Milton Keynes (25.1%) and Kent (21.6%) was
statistically significantly higher than the South East value.
Health Profile for England Highlights
As with children, England level findings in 2020/21 from Sport
England uncover wide inequalities in physical activity in adults [30].
The proportion of adults who were physically active within each
demographic breakdown was lowest for the following: people who have
routine/semi routine jobs/those who are long-term unemployed or have
never worked (52%); people living with a disability or long-term health
condition (45%); Asian (50%); female (60%); and 75+ years old (39%).
Wider determinants of health
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 [31]. Inequalities in these
factors are important drivers of the inequalities in risk factors and
health outcomes presented earlier in this report.
This section presents some important indicators for a range of wider
determinants of health, including the built and natural environment,
education, employment and income, and communities and social
capital.
The built and natural environment
The quality of the built and natural environment, such as quality of
and access to green spaces and fuel poverty, affects health. The
contribution of air quality is discussed in the section on health
protection.
Fuel poverty: Fuel poverty is now measured by the
new Low Income Low Energy Efficiency (LILEE) statistic [32]. A household
is defined as fuel poor if it has income (after accounting for fuel
costs) below a certain level and a low energy efficient home. According
to this measure in 2019 the South East had the lowest proportion
of fuel poverty (7.5%) of all the regions in England - the proportion
for England was 13.4%. The proportion
for local authorities in the South East ranged from 4.7% in
Wokingham to 10.7% in Portsmouth and Southampton.
Natural environment: Living in a greener environment
can promote and protect good health, aid recovery from illness and help
with 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 [33].
In 2018 to 2019, 71% of adults in the South East spent time outdoors
in the natural environment every week, higher than the England value of
65% [34]. Of those visiting the outdoors in their leisure time less than
once a month, 28% reported they didn’t spend more time outdoors because
of being too busy at work.
According to data from the Woodland Trust, in 2020 15.6%
of the South East population had accessible woodland of at least
2 hectares within 500 metres of where they live. There was statistically
significant variation across local authorities in the region, with
values ranging from 3.8% in Portsmouth to 56.2% in Southampton.
Education
Educational attainment is strongly linked with health behaviours and
outcomes. Better-educated individuals are less likely to suffer from
long term diseases, to report themselves in poor health, or to suffer
from mental health conditions such as depression or anxiety [35].
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.
GCSE results (attainment 8)
Attainment 8 measures pupils’ results in 8 GCSE-level qualifications
at state-funded mainstream schools. Due to changes in the way GCSE
grades were awarded during the COVID-19 pandemic it is not appropriate
to compare attainment data from previous years for the purpose of
measuring changes in student performance. The average ‘Attainment
8 score’ for pupils in the South East was 52.1 out of 90.0 in
the 2020/21 academic year, statistically significantly higher than the
score for England (50.9 out of 90.0). At local authority level there was
some variation, with the mean score ranging from 46.3 in Portsmouth to
60.4 for Wokingham.
A difference
in sexes was apparent with an average score for females in the
South East of 55.1 and for males a score of 49.4 in 2020/21 academic
year. The data also shows that the average Attainment 8 score for pupils
in the 2020/21 academic year also varied by ethnic group. Pupils from
the Chinese ethnic group had the highest average Attainment 8 score out
of all ethnic groups (69.6) and white pupils had the lowest score
(51.3). The largest differences in sexes was present in black pupils
where the difference in scores between boys and girls was 8.0. The
smallest differences in sexes was present in Chinese pupils, a
difference of 4.0.
Not in education, employment, training, or whose activity was
not known (NEET)
In 2020, 6.4% of 16-17-year olds in the South East were not in education,
employment, training or whose activity was not known (NEET).
This is statistically significantly worse than the England value of
5.5%, but has not changed from 2019. A statistically
significant difference between sexes was also observed, with
5.7% of female and 7.1% of male 16-17 year olds NEET. There was significant
variance between local authorities in the South East in 2020.
Surrey (9.5%), Medway (7.9%), West Sussex (7.7%) Southampton (7.6%) Kent
(7.5%) and Buckinghamshire (7.0%) all had statistically significantly
higher proportions than England (5.5%).
Employment
Good employment improves health and wellbeing across people’s lives,
boosting quality of life and protecting against social exclusion [36].
In the South East in the period 2011/12 to 2019/20 the percentage
of people (aged 16 to 64 years) in employment grew from 74.6% in
2011/12 to 79.6% in 2019/20. In 2020/21 (within the first year of the
COVID-19 pandemic), there was a statistically significant reduction in
the percentage of people in employment to 77.7%. The South East still
has statistically significantly higher employment than England
(75.1%).
Figure 22a shows that there are persistent differences in employment
between females and males in the South East. The percentage of females
(aged 16-64 years) in employment in 2020/21 was 74.3%, compared to 81.1%
for males.
Figure 22b shows that in 2020/21 there was also inequality in
employment by local authority in the South East. West Berkshire (82.5%),
Reading (81.9%) and Surrey (80.1%) had statistically significantly
higher percentages of people in employment than the South East
percentage (77.7%). Slough (68.0%) and the Isle of Wight (71.9%) had
statistically significantly lower percentages when compared to the South
East.
Health Profile for England Highlights
HPfE 2021 outlined evidence that the COVID-19 pandemic has had a
substantial impact on employment patterns and opportunities. 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 was also a decline in the number of 16 and 17 year 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 [7].
Income
Many physical and mental health outcomes improve incrementally as
income rises [37-38]. Income is related to life expectancy,
disability-free life expectancy and self-reported health [38-39]. The
relationship operates through a variety of mechanisms. Financial
resources determine the extent to which a person can 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 [40]. It can also influence health through feelings of shame,
low self-worth, and exclusion [41].
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 [42]. Figure
23a shows the trend for the percentage of individuals not reaching the
MIS in the South East. In 2018/19, 25% of the population of the South
East did not reach the MIS, higher than in 2008/09 (20.8%). For the
period 2016/17-2018/19 the average
number of people not reaching the MIS was 2,147,000 in the South
East. For children in the South East the percentage who did not reach
the MIS in 2018/19 was 31.8% - higher than the percentage for people of
all ages. Different estimates of child poverty for 2019-20 by lower tier
local authority are shown in Figure 23b. There is variation across the
region, ranging from 12% to 34% of children living in poverty (after
housing costs).
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. Over the past century, there has been a
considerable reduction in the number of deaths from infectious diseases.
However, the COVID-19 pandemic has demonstrated how threats from new
infectious diseases can emerge.
Environmental threats include factors such as air pollution, climate
change and flooding. Climate change is a 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 [43].
It is not possible to cover all health protection issues in this
report. This section presents specific information on air pollution,
sexually transmitted infections, tuberculosis (TB), vaccinations and
vaccine preventable infections, and antimicrobial resistance (AMR).
Air pollution
Air pollution can contribute to cardiovascular and respiratory
conditions and shorten lives. It is estimated that long-term exposure to
air pollution in the UK has an annual effect equivalent to 28,000 to
36,000 deaths [44].
Figure 24a shows the trend in the level of air pollution from
man-made fine particulate matter for the South East. The trend between
2011 and 2020 has been variable, with a peak during 2016. In 2020, the
level of air pollution from man-made fine particulate matter was
7.4\(\mu\)g/m3 in the South East
compared to 6.9\(\mu\)g/m3 for
England.
There is limited variation in modelled levels of mean fine
particulate matter air pollution across the local authorities in the
South East (Figure 24b). In 2020 values ranged from 6.6\(\mu\)/m3 in Isle of Wight to 8.9\(\mu\)g/m3 in Medway.
Health Profile for England Highlights
HPfE 2021 highlighted that the highest air pollution exposures have
been in deprived urban environments, contributing to health
inequalities. Social restrictions implemented during the pandemic meant
that there were fewer vehicles on the roads, 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 was similar to
previous years [7].
Sexually transmitted infections
Health Profile for England Highlights
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. There has been a continued decline in the
rate of new HIV diagnoses [45] due to a combination of testing,
pre-exposure prophylaxis, rapid linkage to treatment and support for
those diagnosed with HIV to attain viral suppression. There has also
been a decline in the rate of genital warts following the introduction
of the HPV vaccination programme [46].
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. This may also indicate undetected
infections. The full impact on infection transmission and long-term
health outcomes will take time to emerge and evaluate [47].
Chlamydia:
Figure 25a includes a chart showing the trend in diagnostic rates for
chlamydia (aged 25+) between 2012 and 2020. Diagnostic tests are used to
establish the presence of disease. In the South East rates rose from
108.1 per 100,000 in 2012 to 176.2 per 100,000 in 2019; before declining
in 2020 to 128.5 per 100,000. Values in the South East were consistently
lower than England, but mirror the national trend.
Figure 25b includes a chart showing the variation in chlamydia
diagnostic rates for local authorities in the South East for 2020. The
local authority with the highest chlamydia (aged 25+) diagnostic rate
per 100,000 in the South East was Portsmouth (371.5 per 100,000) and the
lowest was Oxfordshire (64.8 per 100,000).
The chlamydia detection rate is obtained from opportunistic screening
(National Chlamydia Screening Programme) among under 25-year olds. The
detection rate is a measure of chlamydia control activity, aimed at
reducing the incidence of infection and interrupting transmission. The
goal local authorities should be working to is 2,300 per 100,000
population aged 15 to 24.
The trend in detection
rates for Chlamydia (aged 15-24) for the South East has been
less clear compared to diagnostic rates for chlamydia (aged 25+). In
2012, the detection rate for Chlamydia (aged 15-24) was 1,617 per
100,000 rising to 1,673 per 100,000 by 2014. The rate then decreased in
2015 and 2016 before rising again to 1,773 per 100,000 in 2019.
Similarly, the detection rate fell in 2020 to 1,222 per 100,000. In
2020, the only UTLA in the South
East with a detection rate above the goal was Portsmouth (2,323
per 100,000).
Gonorrhoea:
Figure 25a includes a chart showing the diagnostic rates for
gonorrhoea in the South East between 2012 and 2020. Rates of gonorrhoea
rose from 25.4 per 100,000 in 2012 to 73.8 per 100,000 in 2019; before
declining to 53.5 per 100,000 in 2020. Values in the South East were
consistently lower than England, but mirror the national trend.
Figure 25b includes a chart showing that in 2020 the local authority
with the highest gonorrhoea diagnostic rate per 100,000 in the South
East was Brighton and Hove (187.8 per 100,000). The lowest was the Isle
of Wight (9.8 per 100,000).
Genital warts:
Figure 25a includes a chart that shows the diagnostic rates for
genital warts between 2012 and 2020. In the South East the rate declined
from 129.9 per 100,000 in 2012 to 46.9 per 100,000 in 2020. This mirrors
the England trend.
Figure 25b includes a chart that shows that in 2020 the local
authority with the highest genital warts diagnostic rate per 100,000 in
the South East was Brighton and Hove (94.9 per 100,000). The lowest was
Milton Keynes (24.8 per 100,000).
Syphilis:
Figure 25a includes a chart showing that in the South East the
diagnostic rate for syphilis increased from 2.9 per 100,000 in 2012 to
9.2 per 100,000 in 2019; before declining to 8.5 per 100,000 in 2020.
Values in the South East were consistently lower than England, but
approximately mirror the national trend.
Figure 25b includes a chart that shows that in 2020 the local
authority with the highest syphilis diagnostic rate in the South East
was Brighton and Hove (60.0 per 100,000), and the lowest was West
Berkshire (3.2 per 100,000).
Tuberculosis
Figure 26a shows the trend in TB incidence (new cases per 100,000
population) between 2000 and 2020. In the South East, following an
increasing trend in the earlier years of the time period, there has been
a steady decline in the TB incidence rate since 2011. This mostly
mirrors the trend seen for England. In 2020, the incidence rate was 5.1
per 100,000 in the South East compared to 7.3 per 100,000 for
England.
Health Profile for England Highlights
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
or drug use.
Vaccines and vaccine preventable infections
As a result of effective vaccination programmes the incidence of many
diseases has reduced significantly over time and the importance of
vaccination in controlling infectious diseases is highlighted by the
COVID-19 pandemic.
Flu
vaccine uptake in those aged 65 and over, in the South East,
increased significantly in 2020/21 to 81.8%. This was the first year
since 2010/11 that the national target of 75% was reached. Whilst there
was variation
across local authorities in the South East in 2020/21 Slough was
the only one not to meet the target.
Advice from the Joint Committee on Vaccination and Immunisation
(JCVI) on routine childhood immunisations stated that children should
continue to receive vaccinations according to the national schedule
during the COVID-19 pandemic [PHE statement from JCVI]. Measles is a
highly infectious disease which can only be controlled by vaccination.
Population
vaccination coverage of MMR (one dose received by their 2nd
birthday) in the South East was 92.3% in 2020/21, this is statistically
significantly higher than England (90.3%). Similarly to England, there
was a small but statistically significant drop between 2019/20 (92.7%)
and 2020/21.
People who have not received 2 doses of the MMR (measles, mumps,
rubella) vaccine are at risk of developing measles. In 2020/21 only
89.5% of the South East children
received their second dose by age 5, this is statistically
significantly higher than England (86.6%). Despite this being a
statistically significant increase from the previous year (89.1%), this
remains below the target of 95% or more. No local authorities in the
South East met the target of 95%, the highest was in West Berkshire at
94.1% and the lowest in Surrey at 84.3%.
Antimicrobial resistance
Antibiotic-resistant bloodstream infections rose by an estimated 32%
between 2015 and 2019 in England [48]. Figure 27a shows the trend in
antibiotic prescribing in primary care in the South East between 2015
and 2020. The chart shows antibiotic prescribing as an indirectly
standardised ratio per STAR-PU (STAR-PUs are weighted units to allow
comparisons adjusting for the age and sex of the population) and gives
an estimation of prescribing rates compared to expected values given the
demographics of a population. Antibiotic prescribing in primary care in
the South East has fallen every year in line with the trend observed for
England - with the largest drop between 2019 and 2020. In 2020, the
indirectly standardised antibiotic prescribing ratio was 0.70 in the
South East compared with 0.75 for England.
Figure 27b shows the variation in primary care antibiotic prescribing
for the local authorities in the South East for 2020. Eleven local
authorities are statistically significantly higher when compared to the
regional ratio. Seven local authorities are statistically significantly
lower, and 1 local authority is not statistically significantly
different when compared to the regional ratio.
