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Overview

This report is a comprehensive review of health in the Yorkshire and Humber 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 Yorkshire and the Humber. 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 the Yorkshire and Humber 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:

This Yorkshire and Humber edition is part of the suite of nine new regional profiles that have been produced following the content, format, and methods and definitions (2) published in the HPfE, with content altering slightly from the national report and per region depending on the availability of regional level data and indicators. For example, the regional reports provide local authority comparisons benchmarked mostly against regional averages, whereas the HPfE provides a wider view from international down to regional comparisons. The regional editions do not cover all of the inequalities breakdowns available in the England report, as some of the sub-national breakdowns are not available. Some references to the national level inequalities data, however, have been presented here for important context about how health outcomes and risks vary by ethnicity, age, sex and socioeconomic status and area deprivation.

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

Key findings

Regional health and wellbeing context

Many health and wellbeing indicators, including life expectancy are closely related to area level deprivation and socioeconomic status. The Yorkshire and Humber region has a lower life expectancy than England, this gap has been increasing over time. Regional trends also mask inequalities that exist within the region. Within Yorkshire and the Humber the gap in life expectancy at birth between the least and most deprived areas is 11.2 years in males and 9.5 years in females. Around a fifth of the population of Yorkshire and the Humber live in the most deprived decile, the more deprived areas tend to have lower proportion of older age groups, for example, 13% of population in the most deprived areas are aged 65+ compared to 25% in the least deprived decile. Six of the Yorkshire and Humber local authorities are within the 25% of local authorities with highest deprivation score overall.

COVID-19 and life expectancy

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

Yorkshire and the Humber ranks third lowest for life expectancy compared with other regions, relative deprivation being associated closely with mortality rates. In 2020 life expectancy fell to 77.6 years in males and to 81.7 years in females - the region’s lowest level since early 2000s, although provisional data from 2021 show this trend may have returned to pre-pandemic levels. People living in less deprived areas live longer than those in deprived areas. The fall in life expectancy between 2019 and 2020 saw inequalities by deprivation widen in Yorkshire and the Humber in males from 10.6 to 11.2 years. In females the gap also increased, from 8.5 to 9.5 years.

Child health

Whilst around 220,000 (20.9%) children live in absolute low income families, some gains have been made in child health including admissions for unintentional injuries and child development where the gap between England and the region has either narrowed or the regional average has been improving similar to the England trends.

The most recent data suggests that the proportion of babies born with low birthweight as well as infant mortality rate, have not changed significantly since the start of the pandemic. However, the region’s infant mortality rate in 2018-20 was significantly higher than the England average. Directly comparable data on child obesity or child development are not available for the pandemic period, but the latest evidence suggest an increase in child obesity similar to the rest of the country. Child obesity has been increasing and is significantly higher than the England average for both Reception and Year 6 children. Physical activity levels in children seem to have increased contrary to the most recent national trend but the change is not statistically significant.

Health in adults

Healthy life expectancy measures the number of years spent in good health. In 2017 to 2019, healthy life expectancy was 61.2 years for males and 61.9 years for females, with no significant difference by sex. The top causes of morbidity (ill health) were low back pain, depression and diabetes mellitus in males, and for females low back pain, headache and gynaecological diseases. Recent Office for National Statistics (ONS) estimates indicate that 1 in 4 adults reported feeling high anxiety in the previous week, an increase since 2016/17. According to the Global Burden of Disease study, in 2019, depression and anxiety accounted for 5.7% and 3.1% of total morbidity in the region respectively. The diagnosis rate of dementia is within the 66.7% national target set out in the prime minister’s 2013 challenge for dementia. Whilst cancer screening among other health services have been disrupted during the pandemic, cancer screening coverage for breast, cervical and bowel cancers in 2021 was nevertheless significantly higher than the national average.

Risk factors associated with ill health

Smoking, poor diet, physical inactivity and harmful alcohol use are leading risk factors driving the region’s preventable ill health and premature mortality. Tobacco dependency in pregnancy in Yorkshire and the Humber has been steadily decreasing although remains significantly higher than England. Smoking prevalence overall is not significantly different from England, however, there remains wide variation within the region linked to socio-economic status and mental health.

Levels of excess weight across the region remain higher than the England average with levels of physical activity and poor diet doing little to reverse this trend.

Wider determinants of health

Good quality and secure employment and income is the key link between health and wealth, and the focus of government’s levelling up agenda. Employment, as well as good quality and fair work that reduces in-work poverty, are major drivers of overall health and wellbeing. But employment in Yorkshire and the Humber, continues to be one of the lowest out of all regions, most recently second lowest ahead of the North East. Almost a third of the population did not reach the minimum income standard, significantly higher than the national average.

The quality of the built and natural environment such as air quality, quality of and access to green spaces and housing quality also affect health. Almost 90% of residents have access to private outdoor space however almost 17% of households experience fuel poverty.

Health protection

Health protection issues include the prevention and control of all types of infectious diseases, and chemical and environmental threats to the health of the population. The profile briefly presents information on air pollution, sexually transmitted infections, tuberculosis (TB), vaccinations and AMR (antimicrobial resistance). This report only covers a small section of health protection indicators, responsibility of which is now under UKHSA’s (UK Health Security Agency) remit. COVID-19 is also part of infectious diseases but given its wider impact it is covered separately in the report. Modelled estimates by Defra suggest that 4.8% of mortality in 2019 was attributed to air pollution in the region. The regional trend for TB incidence rate, between 2011 and 2019, has been rapidly decreasing in line with the trend for England. Diagnostic detection rates for Chlamydia per 100,000 population (aged 15-24) were 1,498, this is below the recommended detection rate of at least 2,300 but is significantly higher than the England rate 1,408 in 2020. Whilst coverage for childhood vaccinations were also interrupted during the pandemic, flu vaccination coverage was considerably higher than previous years. The regional trend between 2015 and 2020 shows that the rate of antibiotic prescribing in primary care has fallen every year, with the largest drop between 2019 and 2020 likely to be due to the pandemic and disruptions in access to health services.


Information about the interactive charts

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

Headline - overall data for the key indicator used in Yorkshire and The Humber, 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 Yorkshire and The Humber, by protected characteristics such as age, sex and ethnicity or categories of socioeconomic deprivation where possible. Some inequalities information presented at national level in the Health Profile for England 2021 is not available at regional and sub-regional level.

Sub-regional comparison - headline information on the indicator variation is presented at the Upper Tier Local Authority (UTLA) level. UTLAs affiliated with the government region are shown unless stated otherwise. UTLA codes and boundaries are subject to change pending the data released.

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

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

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

Further information is available from data methods and definitions (3)


Introduction to Yorkshire and the Humber

Yorkshire and the Humber is a geographically diverse region, with the north and east of the region being more rural and the south, west and centre of the region being largely urban. There is extensive coastline down the east side of the region and a 1.4 mile bridge over the Humber estuary links Hull to North Lincolnshire. North Yorkshire makes up half of the region geographically and large parts of this area are rural including the national parks of the North Yorkshire Moors and the Yorkshire Dales.

Yorkshire and the Humber covers over 15,000 square kilometres and has a population of 5.5 million which accounts for 10% of the population of England (2020 ONS mid-year estimates) (4). There are four sub regions in Yorkshire and the Humber and 15 Local Authorities (LAs). This includes; West Yorkshire (Bradford, Calderdale, Kirklees, Leeds and Wakefield), South Yorkshire (Barnsley, Doncaster, Rotherham and Sheffield), North Yorkshire (North Yorkshire and York) and Humber (East Riding, Hull, North East Lincolnshire and North Lincolnshire). Bradford has a high proportion of children and young people compared to other areas and the University cities of Hull, Leeds, Sheffield and York have a notably higher proportions of young adults. East Riding and North Yorkshire on the other hand have a higher proportion of older people.

The populations from ethnic minority groups (excluding white minorities) is estimated at 10.4%, Yorkshire and the Humber being the 3rd most diverse region after London and the West Midlands (5). Ethnic minority groups make up a sizeable population of the region which includes people from black African, black Caribbean, Bangladeshi and Pakistani ethnic backgrounds. However, there is a wide variety in the density of ethnic minorities within the region, with Bradford having a much higher proportion of ethnic minority residents compared to areas such as Barnsley and East Riding. People with these ethnic backgrounds are at a greater risk of worse health outcomes than the white British ethnic group. These outcomes may include a higher risk of death from COVID-19 or women from black ethnic groups often suffer worse maternal outcomes (6). ONS experimental statistics estimates suggest that lesbian, gay and bisexual population was 2.4% in 2019 1

Yorkshire and the Humber is the third highest deprived region out of the nine regions in England. As with other regions in the North of England, life expectancy and healthy life expectancy is lower than the national average. However, this masks wide differences in the region with areas such as Hull and Bradford having high deprivation scores whereas North Yorkshire and York are some of the least deprived areas in England.


COVID-19

Introduction

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.


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, while in regions in the south of England case rates increased later in December 2020 and January 2021.


COVID-19 cases

At the end of December 2021:

  • just over 1,167,600 confirmed cases of COVID-19 had been reported in the Yorkshire and Humber region (8)

  • the region’s highest 7-day average number of new cases was reported on the 31 December 2021, at 18,219 (Fig. 1a)

  • the three highest cumulative rates per 100,000 population were in Barnsley, Rotherham and Doncaster, and the lowest in North Yorkshire, York and North Lincolnshire.

Evidence of the disparities in COVID-19 cases and COVID-19 deaths has emerged throughout the pandemic. As in the rest of the country, in Yorkshire and the Humber the cumulative age standardised case rates per 100,000 population (up to December 2021) in the region have significantly differed by age, sex and ethnicity (Fig 1b):

  • case rates per 100,000 population were significantly higher in females (21,301) than males (19,257)

  • rates were significantly higher in age groups 25-49 and 0-24 (25,879 and 22,681 respectively)

  • lowest case rates are in mixed/multiple ethnic groups (16,639), whereas significantly higher case rates are in the Asian/Asian British and Black/Black British ethnic groups, respective rates of 20,709 and 20,823 per 100,000 population

  • unlike deaths involving COVID-19, deprivation does not appear to be linked to the case rates. In fact the four least deprived deciles, as well as deciles 4 and 5, had the highest rates per 100,000 population. The most deprived decile had the lowest rate at 19,371

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

Figure 1 - COVID-19 cases

Figure 1a - Trends

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

Figure 1b - Inequalities

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

Figure 1c - Local Authority

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

Deaths involving COVID-19

At the end of December 2021:

  • there were around 13,300 deaths registered with COVID-19 mentioned on the death certificate in the Yorkshire and Humber region (9)

  • the region’s highest 7-day average deaths occurred on 18 April 2020, with 106 deaths in total (Fig. 2a).

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

  • significantly higher in males than females, with the rate of 377 in males compared with females at 224 per 100,000 population

  • significantly higher in over 65 age groups onwards. The 75-84 age group is 3.5 times higher than the 65-74 age group, and the 85+ age group over 11 times higher than the 65-74 age group

  • in line with the national findings, death rates gradually increased with deprivation - the death rate in the most deprived decile is nearly three times higher than in the least deprived decile (a rate of 493 compared to 173 per 100,000)

  • death rates were significantly higher in Asian and Asian British and black and black British ethnic groups and significantly lower in the white ethnic group. Mortality in the mixed/multiple and other ethnic groups were not significantly different to the regional average

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

  • age standardised cumulative death rates were highest in Hull and Barnsley, and lowest in North Yorkshire and North Lincolnshire.


Inequalities in Covid deaths rates in England

HPfE reported that inequalities in death rates from COVID-19 largely reflected inequalities in COVID-19 case rates (1). Deaths are also influenced by differences in survival following COVID-19 infection. During the first wave of the pandemic in England, people aged over 80 years were 70 times more likely to die from COVID-19 once infected, compared with those aged under 40 years (10). Survival was higher in females than males and, after controlling for age, deprivation and pre-existing health conditions, survival among many ethnic minority groups remained lower than the white group. The Bangladeshi ethnic group had the lowest survival and had almost twice the odds of dying once diagnosed than the white ethnic group. The Pakistani, Chinese, and black other ethnic groups had 1.35 to 1.45 times the odds of dying once diagnosed and the Indian group 1.16 (11). The possible reasons for these differences and further interpretation of ethnic inequalities in COVID-19 mortality rates are discussed in Health Profile for England 2021.


Figure 2 – COVID-19 deaths

Figure 2a - Trends

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

Figure 2b - Inequalities

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

Figure 2c - Local Authority

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

Excess mortality during the COVID-19 pandemic


HPfE 2021 outlined evidence on inequalities in excess deaths and the association between deprivation and excess mortality in England (1). The 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.


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 black and Asian groups and deprived areas. Between 27 March 2020 and 31 December 2021, the cumulative all-cause deaths were (Fig 3b):

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

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

  • higher than expected in all ages, with the exception of males under 25, with the highest excess in females aged 25-49

  • tending towards higher excess mortality in the more deprived quintiles. For males, the excess mortality ratio was the highest in the most deprived quintile and the lowest in the second least deprived. For females the highest was in the second most deprived quintile and the lowest in the second least deprived

  • excess mortality is highest in the Asian ethnic group with males with 1.5 times higher than would be expected and females 1.4 times higher

  • highest excess mortality were found in Barnsley, Rotherham, Doncaster and Bradford local authorities, with a higher than expected ratio above 1.17.

Figure 3 – Excess deaths

Figure 3a - Trends

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

Figure 3b - Inequalities & UTLA

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

COVID-19 vaccinations

By the end of Dec 2021, 86.9% of the Yorkshire and Humber population aged 18 and over had received two vaccination doses. However, there has been variation in uptake by (Fig 4b):

  • country of birth with nearly 12% point difference for those born in the UK compared to those non-UK born (87.9% v 76.2%)

  • English language proficiency (people who report that their main language is not English and that they cannot speak English well or at all) with nearly 18% point disparity: 87.8% for those whose main language is English compared to 70.2% for those whose it is not

  • sex: 85.1% of males had received 2 doses compared to 88.6% of females

  • disability: those who report having some level of disability where day to day activities are limited to as greater or lesser extent, have higher vaccination coverage than those with no disability

  • deprivation: there is a clear gradient with those in the most deprived quintile having the lowest levels of two doses at 76.4% up to those in the least deprived quintile having the highest coverage at 93.1%

  • occupation: highest vaccination rates are in the managerial and professional occupations (92.7%) with those who have never worked or long term unemployed with lowest at 67.1%

  • ethnicity: vaccination rates were lowest in Pakistani, black African, black Caribbean and mixed ethnic groups

  • housing tenure: uptake is highest in people who own their own house 90.6%. This compares to those who private - 78% or social rent - 77.4%

  • religion: Jewish and Christian groups have the highest rates at 92.4% and 90.4% respectively, compared to Muslims at 67.5%

  • area characteristics: rural populations appear to have higher proportion with 2 doses at 91.9% against urban populations at 85.8%

  • local authority: East Riding, North Yorkshire, Rotherham, Barnsley and North Lincolnshire had the highest coverage of people receiving their second COVID-19 vaccinations, whereas Bradford, Hull, Leeds, Sheffield, and Kirklees had the lowest coverage (Fig. 4c).

Figure 4 – COVID-19 Vaccinations

Figure 4a - Trends

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

Figure 4b - Inequalities

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

Figure 4c - Local Authority

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

Life expectancy and mortality

Introduction

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

Life expectancy

Life expectancy is an important measure of the health of a population or particular group. Since 2010, improvements in life expectancy have stalled, and in some areas or groups declined. Yorkshire and the Humber ranks 3rd lowest for life expectancy in both in males and females compared to other regions. In 2020, the difference to the South West, the region with the highest life expectancy, was 2.5 years in males and 2.1 years in females (12). Further analysis for the region shows (Fig. 5):

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

  • in 2020 life expectancy fell to 77.6 in males and to 81.7 years in females the region - to its lowest level since early 2000s. Provisional data for 2021 however show an increase in life expectancy to pre-pandemic levels for both males and females (14)

  • the latest fall in life expectancy between 2019 and 2020 has seen inequalities by deprivation widened in males - the life expectancy gap by deprivation 2 rose from 10.6 to 11.2 years (15). In females this gap increased from 8.5 to 9.5 (Fig. 5b)

  • compared with the regional average (Fig. 5c), life expectancy in 2020 was significantly lower in females in Hull (79.5), Rotherham (79.8), Doncaster (80.2), Barnsley (80.2), Wakefield (80.5), Bradford (80.6) and significantly higher in North Yorkshire (84.1), York (83.4), East Riding (83.1) and North Lincolnshire (82.7)

  • in males life expectancy was significantly lower in Hull (74.4), Bradford (76.2), Barnsley (76.3), Wakefield (76.4), Doncaster (76.5), Rotherham (76.7), and significantly higher in North Yorkshire (80.1), York (79.4), East Riding (79.2) and North Lincolnshire (78.6).

Figure 5 – Life expectancy

Figure 5a - Trends

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

Figure 5b - Inequalities

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

Figure 5c - Local Authority

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

Child health

Introduction

Every child having a good start in life is the foundation for the future health and wellbeing of England’s population. The proportion of children in absolute low income families at 20.9% is the second highest in the country after North East (16). For children in relative low income families at 25.1%, the region ranks third highest after North East and West Midlands (17).

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

Low birthweight


Whilst around 220,000 (20.9%) children live in absolute low income families, some gains have been made in child health including admissions for unintentional injuries and child development where the gap between England and the region has either narrowed or the regional average has been improving similar to the England trends.

The most recent data suggests that the proportion of babies born with low birthweight as well as infant mortality rate, have not changed significantly since the start of the pandemic. However, the region’s infant mortality rate in 2018-20 was significantly higher than the England average. Directly comparable data on child obesity or child development are not available for the pandemic period, but the latest evidence suggest an increase in child obesity similar to the rest of the country. Child obesity has been increasing and is significantly higher than the England average for both Reception and Year 6 children. Physical activity levels in children seem to have increased contrary to the most recent national trend but the change is not statistically significant.


Low birthweight (less than 2500 grams) is measured as a proportion of all live births only (excludes still births).

In Yorkshire and the Humber region (Fig. 9a):

  • prior to the pandemic the proportion of babies born at full term with a low birthweight decreased overall between 2006 and 2012 and has remained relatively stable since then

  • the proportion of low birth weights continues to remain higher than the England average, currently at 3.0% in 2020 compared to 2.9% for England

  • local authority comparisons show wide variation with Bradford and Leeds significantly higher than the regional average (4.2% and 3.5% respectively) whilst East Riding, North Yorkshire and York are significantly below the regional average (Fig. 9b).

Figure 9 – Low birthweight

Figure 9a - Trends

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

Figure 9b - Local Authority

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

Infant mortality

Infant mortality covers all deaths within the first year of life. The majority of these are neonatal deaths which occur during the first month and the main cause is related to prematurity and preterm birth, followed closely by congenital anomalies (19).

The infant mortality rate in the Yorkshire and Humber region:

  • fell from 5.9 per 1,000 live births in 2001-03 to 4.2 in 2012-14 and it remained similar to this level up to 2018 to 2020. (Figure 10a)

  • local authority comparisons show that out of the 15 local authorities, two (Bradford and Kirklees) have significantly higher rates of infant mortality compared to the regional average rates of infant mortality while one (North Yorkshire) LA is significantly lower (Fig. 10b).

Figure 10 – Infant mortality

Figure 10a - Trends

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

Figure 10b - Local Authority

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

Child development

Starting primary school is a significant milestone in a child’s educational journey. Language and communication skills are fundamental to young people’s potential development and achievements later in life (20). Being able to express themselves, interact with peers and make themselves understood helps to build a child’s confidence and boost their self-esteem. Inadequate communication skills can lead to poorer adult outcomes in literacy, mental health and employment (21,22). A good level of development is defined as children achieving at least the expected level in the early learning goals in the prime areas of learning (personal, social and emotional development; physical development; and communication and language) and the early learning goals in the specific areas of mathematics and literacy.

In the academic year 2018/19:

  • the level of development was slightly below England for both males and females, but has improved since 2012/13 (Fig. 11a)

  • fewer boys than girls achieved the expected level of development. 63.4% of girls and 77.0% of boys achieved at least the expected level of development at the end of Reception (Fig. 11a)

  • local authority comparisons show that in 2018/19 significantly better than regional average rates were found in four local authorities, namely, Doncaster, East Riding, North Yorkshire, and York (Fig. 11b)

COVID-19 impact on child development

Due to the pandemic, data on child development at the end of Reception year was not reported for the academic year September 2019 to July 2020. In March 2020, Early Years settings were closed to most children, with only children from key workers and vulnerable families continuing to attend (around 7% of children aged 2 to 4) (23). Outside formal Early Years settings, young children may also have experienced a lack of social activities and interactions that would normally have helped to prepare them for the start of school, such as with grandparents and via play dates.

Although the full impact of the pandemic on early years development will not be known for some time, a study carried out by the Education Endowment Foundation (EEF) found that out of the schools in England surveyed, 76% reported that children who started school in the Autumn 2020 term needed more support than children in previous cohorts (24). 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%).

There is emerging evidence that the pandemic will also lead to increased inequalities faced by children over their lifetimes. The Child of the North: Building a fairer future after COVID-19 report, produced by the Northern Health Science Alliance and N8 Research Partnership in 2021 states that children in the North of England’s loss of learning experience over the course of the pandemic will cost an estimated £24.6 billion in lost wages over lifetime earnings (25).

Figure 11 – Child development

Figure 11a - Trends

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

Figure 11b - Local Authority

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

Childhood obesity

Prevention and treatment of childhood obesity presents a significant public health challenge. Obesity in childhood can result in the early onset of cardio-metabolic, respiratory and musculoskeletal conditions, as well as adverse psycho-social outcomes and an increased risk of living with obesity and associated mortality and morbidity later in life (26).


Inequalities in child obesity

England level data from 2020/21 reported by NHS Digital suggest that between 2006/07 and 2020/21 the gap between obesity prevalence for children attending schools in the most and least deprived areas increased from 4.5 to 10.7 percentage points, with the steepest increase shown between the latest two academic years (27). NHS Digital reports that 2020/21 NCMP data show a gap of 11.3 percentage points for girls and 10.1 percentage points for boys between the least and most deprived areas of England. The latest deprivation gap in Year 6 overall is 16.6.%, but narrower in girls than boys: 14.7 percentage points for girls and 18.4 percentage points for boys. Obesity prevalence by ethnicity was highest for black children at 22.5% in both reception and Year 6 at 35.7%. It was lowest for Chinese children in Reception (8.3%) and white (23.6%) and Chinese children in Year 6 (24.3%) (28).


Trends

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

Trend data up until 2019/20 academic year for Yorkshire and the Humber shows (Fig. 12a):

  • whilst trends obesity in girls at Reception age had been relatively stable until 2014/15, obesity levels have increased since then, from 8.4% to 10.3% in 2019/20

  • obesity levels in boys at Reception age are higher than girls and again after being relatively stable for a number of years to 2014/15 had gradually increased from 9.2% to 10.6% in 2019/20

  • in Year 6 - trends have been steadily increasing for boys since 2014/15, up from 20.7% to 24.2% in 2019/20. The proportion of obesity in girls is lower than boys at 19.5% in 2019/20, showing a 1% increase from 2018/19 after remaining fairly static in previous years.

Covid impact on child obesity and physical activity

The latest findings during the 2020/21 academic year, reported by NHS Digital, suggest that obesity has increased across all regions in both Reception age children and children in Year 6 (29). A link between weight gain and out of school time in the school holidays has previously been demonstrated (30). Closure of schools, sporting and leisure facilities, park facilities and recreational areas, together with an increase in screen time over the pandemic period have led to an overall reduction in physical activity in children and young people (31), and confirmed by the latest Sport England survey estimates for the country (32). However, in Yorkshire and the Humber, physical activity levels in children saw a small but not statistically significant increase in 2020/21: from 43.2% from the previous year to 46.4% (33). In some other regions - namely the East of England, South East, South West and West Midlands - physical activity in children also dropped bringing the average to a small decrease in England overall from 44.9% to 44.6%. The UK Chief Medical Officers’ (CMOs’) definition and recommendation is that that children and young people (5-18 years) are physically active for an average of at least 60 minutes per day across the week (34). Data also suggests that the proportion of respondents snacking “more often” during the pandemic has increased most in younger age groups, possibly contributing to increased weight gain and obesity in children and young people (18).


Inequalities in physical activity in England

Recent survey results from Sport England suggest that in England, there has been a reduction in physical activity in boys, and an increase in girls during the pandemic in England (32). Whereas the differences by deprivation have widened.


Fewer children were measured as part of the National Child Measurement Programme (NCMP) in 2020/21 than in 2019/20, making direct comparisons between the two years unreliable. However, in the academic year 2020 to 2021, data reported by NHS Digital (29) suggests that:

  • 15.3% of children aged 4 to 5 (Reception year) in the region were obese, which represents a significant increase although the years are not directly comparable

  • in year 6 with 26.5% of children in Yorkshire and the Humber aged 10 to 11 years (Year 6) were obese.

Data from the 2020/21 NCMP is not published at local authority level due to the inconsistent reporting, with the exception of a small number of LAs where data was collected for 75% or more children (31). From Yorkshire and the Humber, prevalence of obesity in 2020/21 was reported only for North Lincolnshire, Leeds and Wakefield. Long term implications to childhood obesity due to the pandemic are still uncertain whilst we wait for NCMP results from the next few years.

Figure 12 – Child obesity

Figure 12a - Trends

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

Figure 12b - Local Authority

Hospital admissions for injuries in children

Admissions caused by unintentional and deliberate injuries in children aged 0-14 have been decreasing in the last ten years with the latest year 2020/21 showing a further dip with disruptions to health services during the pandemic likely to be one of the reasons for the decrease. In Yorkshire and the Humber:

  • the rate has been consistently higher than the England average since 2010/11, however in 2020/21 the rate fell to 74.2 per 10,000 children aged 0-14 which is lower than the England average (75.7) for the first time (Fig. 13a)

  • local authority comparison shows significantly higher than regional average rates in Calderdale (107.9), Bradford (91.6), North Yorkshire (91), North East Lincolnshire (86.1) and Rotherham (83.6) (Fig. 13b).

Smoking at the time of delivery

Smoking is the most important modifiable risk factor in pregnancy associated with premature births, miscarriage, stillbirth, neonatal complications, low birth weight and sudden infant death syndrome (35). Smoking in early pregnancy in deprived areas of England was more than five times the least deprived in 2018/19 (36).

In Yorkshire and the Humber:

  • smoking at the time of delivery has been steadily decreasing in the last ten years, from 16.9% in 2010/11 to 13.1% in 2020/21 - similar to the England trend. However, the proportion of mothers smoking at the time of delivery, in the region, remains significantly higher than the England average at 9.6% (Fig. 14a)

  • local authority comparisons show that the proportions range from 9.8% in North Yorkshire and Sheffield to 20.8% in Hull, with four local authorities significantly worse than regional average (Kirklees, North Yorkshire, Sheffield and York - note due to data quality issues no data is available for Calderdale and Leeds) (Fig. 14b).

Other indicators of child health

Previous Health Profile for England reports, prior to the pandemic, demonstrated inequalities in many other aspects of children’s health (37), including regional variations:

  • three of Yorkshire and the Humber region’s local authorities were within the England’s highest 10 areas for obesity in early pregnancy in 2018 to 2019: Hull, North East Lincolnshire and Barnsley (38)

  • as in the rest of England, the rate of under 18s conceptions has been declining in Yorkshire and the Humber over the past 20 years (39). The rate however remains significantly above the national average at 19.3 per 1,000 births compared to England rate of 15.7 in 2019

  • admissions for self-harm for ages 10-24 years have been at a similar level to England over the last 10 years and significantly better for the last 4 years (40). The rate for Yorkshire and the Humber fell in 2020/21 to 358.4 per 100,000 from 424.1 in 2019/20, significantly better than England overall with an admission rate of 421.9 in 2020/21

In 2020, England level data for hospital admissions of children and young people (under 25 unless otherwise stated) for asthma, diabetes, epilepsy, gastroenteritis (0 to 4 years), lower respiratory tract infections (0 to 4 years) and following accidents were generally below average for 2018 and 2019. Admissions in this age group for self-harm and assault were reduced in the quarter from April to June 2020, but returned to similar to average for 2018 and 2019 levels in the latter half of 2020, except for the 5 to 14 age group which were above average (41).

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 (42). 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% (43). This survey data is not available at regional level.

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


Inequalities in child health

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


Mental health in children and young people

The pandemic has had a profound effect on the life of young people, through isolation and interruptions to education. Some of these effects will be longer-term and data are not available to measure them yet. One national survey comparing aspects of mental health found that in 2020, one in six (16.0%) children aged 5 to 16 years were identified as having a probable mental disorder, increasing from one in nine (10.8%) in 2017. When compared with those unlikely to have a mental disorder, children and young people with a probable mental disorder were more likely to say that lockdown had made their life worse with 54.1% of 11 to 16 year olds, and 59.0% of 17 to 22 year olds stating this, compared with 39.2% and 37.3% respectively (44).

It is estimated that in the region in 2021, nearly 23,000 school pupils have social, emotional and mental health needs, this represents just under 3% of children at school. This has increased from around 1.8% in 2015. There is variation within the region: 3 of the region’s local authorities are significantly higher than England (North Lincolnshire, Bradford and Barnsely) whereas 6 are significantly lower.

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

Figure 13 – Injuries resulting in hospitalisation

Figure 13a - Trends

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

Figure 13b - Local Authority

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

Figure 14 – Smoking in pregnancy

Figure 14a - Trends

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

Figure 14b - Local Authority

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

Health in adults

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

Figure 15 – Healthy life expectancy

Figure 15a - Trends

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

Leading causes of morbidity

The Global Burden of Disease (GBD) study uses years lived with disability (YLDs) to attribute the burden of morbidity. YLDs is a measure of morbidity that combines the prevalence of each disease with a rating of the severity of its symptoms (excluding death itself), to give an overall measure of the loss of quality of life. Figure 16a identifies the most common causes of morbidity in 2019 according to GBD, as measured by age-standardised YLDs per 100,000 population. It also shows the change in YLDs since 1990. Change over time needs to be interpreted with caution as this may reflect changes in methodology and categorisation. Overall, the top 3 leading causes of morbidity in the region in 2019 were lower back pain, depressive disorders and headache disorders. GP patient survey shows that long-term musculoskeletal problems - which includes low back pain - overall are reported by 21.4% of respondents aged 16 and over in 2021, making this the region with the third highest proportion and significantly higher than the England average (45).

GBD estimates show that years lived with disability caused by diabetes has significantly increased since 1990. There were some differences by sex (Fig. 16a):

  • for males, the top three causes were lower back pain at 941.7 years lived in disability per 100,000 population, depressive disorders at 613.3 years and diabetes mellitus at 611.5 years. The percentage of total years lived in disability that is attributable to diabetes has more than doubled in the last 30 years

  • for females, the top 3 causes were lower back pain at 1,282.5 years lived in disability per 100,000 population, headaches disorders at 934 years and gynaecological diseases at 841.7 years. Depression and neck pain were the fourth and fifth highest cause for years lived in disability.

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

Figure 16 – Leading causes of morbidity

Figure 16a

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

Figure 16b - Local Authority

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

Mental health and wellbeing

According to the Global Burden of Disease, in 2019, mental health conditions such as depression and anxiety, accounted for 5.7% and 3.1% of total morbidity in the Yorkshire and Humber respectively (46).These estimates relate to 2019, and for all ages.

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

In the region (Fig. 17a):

  • 1 in 4 of the population reported feeling high levels of anxiety in 2020/21, up from over 1 in 5 in 2018/19

  • Similarly, the proportion of the population experiencing low happiness has worsened since 2017/18, from 9.1% to 10.3 in 2020/21

  • 6.6% of the population reported feeling low satisfaction and 4.9% reported low scores for life feeling worthwhile in 2020/21

  • At local authority level, there is some variation. East riding of Yorkshire and North Yorkshire have significantly lower reported high anxiety scores than the regional average. East Riding of Yorkshire also has significantly higher self-reported happiness than the regional average (Fig. 17b).

These Office for National Statistics wellbeing measures have been monitored throughout the pandemic, and at the time of writing Yorkshire and the Humber specifically had a statistically significant increase in low self worth (7.8%) reported in Sept 2021 and compared to 2019 (47). The UCL COVID-19 Social Study showed that in England and in the region anxiety levels were high during the first lockdown, a trend that went down once restrictions were lifted.

Self harm

Emergency admissions for self-harm per 100,000 population in Yorkshire and the Humber are significantly lower than England and the fourth lowest region (48). Figure 18a shows the rate of emergency hospital admissions per 100,000 in 2010/11 to 2020/21 for intentional self harm in the region.

In Yorkshire and the Humber:

  • trends in emergency hospital admission for self-harm have seen a decrease since 2018

  • the rate in 2020/21 is 172.7 per 100,000, this is lower than the England average of 181.2 per 100,000

  • local authority comparison by sex shows the highest rates tend to be in females, and rates for girls and women are highest in Barnsley and Hull (Fig. 18b)

  • for males, emergency admissions for self-harm are highest in Barnsley and Wakefield.

Suicide

Whilst rates of self-harm are generally higher for females compared to males, suicide follows the opposite trend; in 2018-20 the regional rate per 100,000 was 19.2 in males and over three times lower in females with the rate of 6.1 (49,50).

Figure 18 shows:

  • rates of suicide have been increasing (Fig. 18a)

  • Yorkshire and the Humber have the highest suicide rate per 100,000 (12.5) of any region in 2018-20 and is significantly higher than the England rate (10.4) (Fig. 18a)

  • at local authority level, Calderdale and Wakefield are in the top three local authorities within the region with the highest rates of suicide, for both males and females (Fig. 18b).

Figure 17 – Mental health and wellbeing

Any missing values are due to small sample sizes by local authority

Figure 17a - Trends
<b>Source:</b> <a href = 'https://fingertips.phe.org.uk/public-health-outcomes-framework#page/0/gid/1000042/pat/15/par/E92000001/ati/6/are/E12000004/yrr/1/cid/4/tbm/1' target = '_blank'> OHID Public Health Outcomes Framework </a> <b>Date accessed:</b> 31/03/2022 <a href = 'https://fingertips.phe.org.uk/static-reports/health-profile-for-england/Data/Yorkshire_and_The_Humber_017a_mental_health_and_wellbeing.csv' target = '_blank'><b>Download data</b></a>

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

Figure 17b - Local Authority

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

Figure 18 – Suicide and Self-harm

Figure 18a - Trends
Figure 18b - Local Authority

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

Dementia and Alzheimer’s disease

Dementia and Alzheimer’s disease is known to be a leading cause of death within the region (Fig. 8), although not a leading cause of years lived with a lower quality of life due to disease (YLD), dementia remains a significant cause of ill health in the Yorkshire and Humber region.

In 2021, the estimated dementia diagnosis rate was 63.2% in the population ages 65 and over, a proportion that represents nearly 42,000 registered patients with a diagnosis (51). The rate is within the 66.7% national target set out in the prime minister’s challenge in 2013 for dementia - although slightly below, the difference is not statistically significant (52). The diagnosis rates are compared to the prevalence estimated by the Cognitive Function and Ageing Study II.

The diagnosis rate in the region has decreased from 71.6% in 2019 with the biggest drop in 2021, which is likely to be due to the pandemic and disruption in health services. Six local authorities in the region are significantly below the 66.7% target: Wakefield, North Yorkshire, Calderdale, East Riding of Yorkshire, York, North Lincolnshire.

Referrals to memory clinics from primary care practitioners reduced in April 2020. Referral numbers remained flat until June 2021 and by November 2021 there was evidence that referrals were returning to pre-pandemic levels (18).

Cancer

Cancers are a significant cause of ill health and mortality in region. Between 30% to 50% of cancers are preventable by implementing existing evidence-based prevention strategies, avoiding risk factors, and through supporting people to live healthier lives, including: stopping smoking, losing weight, eating healthily, taking more exercise and reducing and sun exposure (53). Strategies to improve early diagnosis and detection along with appropriate treatment are key factors for higher survival rates from cancer. April 2020 at the start of the pandemic saw the lowest level of cancer diagnosis at 1,634 new cancer cases diagnosed compared to 2,759 at the same month in the previous year, April 2019, when comparing the monthly trends in new cancer diagnoses for all sites combined (Fig. 19a). Cancer screening coverage for breast, cervical and bowel cancers in 2021 were however significantly better than the national average. The four most commonly diagnosed cancer sites are a lung, breast, colorectal and prostate cancers (54).

Figure 19 – Cancer incidence

Figure 19a - Trends

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

Health service contact during the pandemic

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

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

  • the percentage change in emergency hospital admissions from all causes dropped by 28.8% in the first quarter of 2020/21 compared to 2018 and 2019 baseline and have remained below the baseline in the first quarter of 2021//22 at 6.7% (18)

  • outpatient attendances in the first quarter of 2020/2021 reduced by 39.8% and were still below the baseline by 5.5% a year later - in the first quarter of 2021/22 (18).

Risk factors associated with ill health

Introduction

Risk factors play an important role in determining whether a person becomes ill, at what age, and the associated effect on quality of life. The Global Burden of Disease (GBD) study divides risk factors into 3 main groups: behavioural, metabolic, and environmental and occupational (46). These are underpinned by the broader social and economic risk and protective factors that shape people’s lives such as education, income, work and social capital. These wider determinants are discussed in the next section of this report. At the time of writing GBD 2019 results for regions and local authorities were available but an update is due during 2022.This section focuses on behavioural and metabolic risk factors in adults. It examines the contribution that these risk factors make to morbidity and mortality, using GBD data. Trends and inequalities in some of the risk factors making the largest contribution are examined.


HPfE 2021 reported inequalities in risk factor prevalence contributing to inequalities in ill health and mortality (1). For example, inequality in smoking prevalence by deprivation is a large determinant of the inequalities in mortality and life expectancy. In 2019, smoking prevalence remained much higher than average in some groups, for example, people in manual occupations (23.2%), people with a long-term mental health condition (25.8%), deprived areas (16.9%), and the mixed ethnic group (19.5%). The prevalence of ‘increasing or higher risk’ drinking was greatest in the highest household income group at 34.8%. The prevalence of obesity in adults was higher in the more deprived areas, and there were wide inequalities in the proportion of adults meeting recommended level of physical activity and fruit and vegetable consumption. Health Survey for England evidence suggest that prevalence of multiple risk factors is higher in men, the white ethnic groups, lowest income households, most deprived areas, and people with long term health conditions (55).


Leading risk factors

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

  • The risk factors making the biggest contribution to morbidity in Yorkshire and the Humber are high body mass index, tobacco, high fasting plasma glucose, alcohol use, drug use and occupational risks. Although calculated independently, these risk factors are connected, and individuals often have more than one risk factor.

  • The risk factors making the biggest contribution to mortality in Yorkshire and the Humber are tobacco, high systolic blood pressure, dietary risks, high fasting plasma glucose, high body mass index (or obesity), and high LDL cholesterol.

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


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


Smoking

The latest prevalence for Yorkshire and the Humber is estimated at 12.9% in 2020 (56). This is the third highest region but it is not statistically significantly different from the England average of 12.1%.

In the last decades smoking prevalence has continued to decrease. Fig. 21a show trends between 2015 and 2019 as the latest year 2020 is not directly comparable due to methodological change in 2020.

There is also wide variation in smoking by:

Recent methodological changes mean that current prevalence from the Annual Population Survey (APS) cannot be reliably compared to previous years, but according to previous surveys in the last two decades smoking rates have been decreasing. Other data sources suggest that this trend continues. There is also evidence of an increase in the rates of people attempting to quit smoking during the pandemic (18). Although the rates have fluctuated, quit rates remained consistently higher than in 2019. Analysis of Opinion and Lifestyle Survey suggests that across all regions the latest smoking prevalence is lower compared with 2019, London being the only exception, although the differences between the 2019 baseline and the four week period ending 10 October 2021 are not statistically significant.

Alcohol

Increasing and high risk drinking is defined as drinking more than 14 units per week. HPfE reported that in 2019 the prevalence of ‘increasing or higher risk drinking’, was highest in North East (28.7%) followed by the North West (26.9%) and the East Midlands the lowest (18.7%) (1).

In Yorkshire and the Humber:

  • the prevalence was 22.5%, for females the proportion was 14.8% and twice as high in males at 31.0% in 2019 (1)

  • Health Survey for England latest estimates for local authorities in 2015-18 show variance within the region with Kingston upon Hull reporting 11.4% and Rotherham 31.1% of adults drinking more than 14 units a week (55)

  • the number of deaths related to alcohol in the region was 2,180 in 2020, which represents a rate of 41.2 per 100,000 population and significantly higher than the England average, and highest in Kingston upon Hull (52.7 per 100,000) (59). Five of the local authorities in the region are significantly higher than England

  • Sheffield has the highest rate of alcohol-specific mortality with a rate of 22.9 per 100,000, significantly higher than England (13.0 per 100,000) (60)

  • the number of admission episodes for alcohol-related conditions (narrow) was almost 26,000 for 2020/21, this is a rate of 489 per 100,000 and is significantly higher than England. 10 of the regions local authorities have significantly higher rate than the national average with Kingston upon Hull having the highest rate in the region (61).

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


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

Drug use

Pre-pandemic survey-based estimates for recent drug use in England vary year-on-year (64). An estimated 9.4% of people aged 16 to 59 had taken any drug in the last year in 2019 to 2020. Rate of deaths due to drug-misuse continue to be highest among those born in the 1970s (65).

Regional differences are significant ranging from 3.5 per 100,000 in London up to 9.9 per 100,000 in the North East (2018-20) (66).

In Yorkshire and the Humber:

  • the rate of deaths due to drug misuse was 6.7 per 100,000, significantly higher compared to the England average (5.0 per 100,000) (67). This represents 1,030 deaths during 2018-20 due to drug misuse

  • local authority comparison shows a range of values from 2.0 per 100,000 in East Riding up to 10.4 per 100,000 in Wakefield (68). Nine out of 15 local authorities are significantly worse than the England average.

Physical activity

In 2020 to 2021, 65.2% of adults were physically active in Yorkshire and the Humber, a measure which means undertaking at least the recommended level of 150 minutes of moderate intensity physical activity or equivalent per week (69).

The regional:

  • rate of physical activity is similar to the England average

  • variation by local authority shows the highest proportion of adults being physically active in Leeds (71.1%), and lowest in Kingston upon Hull (55.2%) in 2020/21

England level findings from mid-May 2020 to mid-May 2021 by Sport England Active Lives survey confirms wide inequalities in physical activity in adults (70). Compared to general population at 60.9%, the proportion of physical activity was lower for: people who are routine/semi routine jobs and those who are long-term unemployed or have never worked (52%); living with a disability or long term health condition (45%); and Asian (48%) and black (52%) ethnic groups.

Obesity

Long-term trend shows an increase in adult obesity in England, although with some fluctuation year to year (71). HPfE showed that in 2019 obesity prevalence was highest in the North East (34.0%) and lowest in London (23.4%) (1).

In Yorkshire and the Humber in 2020 to 2021:

  • the percentage of adults classed as either overweight or obese was 66.5% in 2020/21, significantly higher than the England average of 63.5%. The region has remained higher than the England average since 2015/16 (Fig. 21a)

  • variation by local authority ranges from 61.4% in North Yorkshire up to 71.6% in Wakefield (Fig. 21b)

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

The longer term impact of the pandemic on adult obesity levels is not known but given the changes in other risk factors presented (diet, physical activity and alcohol) it is possible we will see an increase and widening of inequalities.

Diet

The proportion of the population meeting the recommended ‘5-a-day’ on a ‘usual day’ was 53.5%, significantly lower than the England average of 55.4% in 2019 to 2020. There is wide variation by LA from 44.4% in Hull up to 60.9% in East Riding. Eight local authorities out of 15 were significantly lower than the England average and two significantly higher.

HPfE 2021 reported wide inequalities at England level: the recommended 5-a-day is lower for people who were unemployed (45.2%), living with a disability (52.1%), working in routine and manual occupations (45.8%), Asian (47.2%), black (45.7%), or living in the most deprived areas (45.7%) (1).


COVID-19 impact on risk factors

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

High blood pressure

The diagnosed prevalence of high blood pressure (hypertension) in the Yorkshire and Humber region in 2020/21:

  • is estimated to be 14.5% of all the population registered with a GP. This has remained largely stable since 2015/16 when the prevalence was 14.2% (Fig. 21a)

  • trend has been consistently higher than the England average (13.9% 2020/21) (Fig. 21a)

  • shows some variation by local authority from 12.1% in York up to 18.0% in East Riding (Fig. 21b).

Whilst public health and healthcare would aim to reduce prevalence of hypertension through lifestyle changes and interventions, this variation in hypertension prevalence can also be related to better diagnosis rates by GPs and the age structure of the population.

These figures include adults with blood pressure higher than 140/90 mmHg, and also those with blood pressure below this limit who report taking medication to lower their blood pressure. It should be noted that these figures reflect the prevalence in GP registered population where condition has been identified and diagnosed, as opposed to estimated prevalence in the overall population.

Blood glucose

Increased blood glucose levels may lead to diabetes and can increase the risk of heart disease and stroke, kidney disease, vision and nerve problems. A blood glucose level that is above normal but not in the diabetic range is referred to as Non-diabetic hyperglycaemia (NDH). Whilst we have no prevalence estimates available for the region overall, the CCG (clinical commissioning group) level estimates from the National Diabetes Audit for 2020/21 suggests that prevalence in Yorkshire and the Humber ranges from 2.2% to 6.6% for patients aged 17 and over registered at the general practice - the equivalent figures for England, from lowest to highest are 1.7% to 9.6% respectively (72).

Figure 20 – Leading risk factors

Figure 20a - Morbidity

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

Figure 20b - Mortality

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

Figure 21 – Risk factors

Figure 21a - Trends
Figure 21b - Local Authority
<b>Source:</b> <a href = 'https://fingertips.phe.org.uk/covid19#page/1/gid/1938133364/pat/15/par/E92000001/ati/6/are/E12000003/yrr/1/cid/4/tbm/1/page-options/car-do-0' target = '_blank'> Wider Impacts of COVID-19 on Health: Wellbeing and behavioural risk factors </a>, <a href = 'https://fingertips.phe.org.uk/covid19#page/3/gid/1938133361/pat/15/ati/6/are/E12000004/iid/219/age/1/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1/page-options/car-do-0' target = '_blank'> Wider Impacts of COVID-19 on Health: Hypertension QOF </a> <b>Date accessed:</b> 31/03/2022 <a href = 'https://fingertips.phe.org.uk/static-reports/health-profile-for-england/Data/Yorkshire_and_The_Humber_021b_risk_factors.csv' target = '_blank'><b>Download data</b></a>

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

Wider determinants of health

Introduction

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

This section presents some key indicators for a range of wider determinants of health including the built and natural environment, education, employment and income, and communities and social capital.

Area deprivation in Yorkshire and the Humber:

The Index of Multiple Deprivation 2019 is a relative measure of deprivation measured across seven distinct domains: Income; health and disability; employment; education, skills and training; barriers to housing and services; crime; and living environment (73). Area deprivation is closely link to risk factors and health outcomes.

In Yorkshire and the Humber:

  • around 1 in 5 residents live in geographical areas that are classified as being in the most deprived decile of England. But there are big differences by local authority, e.g. in Kingston upon Hull over half of the population living in the two most deprived deciles, compared to less than a third of all Yorkshire and the Humber residents

  • the more deprived areas tend to have lower proportion of older age groups, for example, 13% of population in the most deprived areas are aged 65+ compared to 25% in the least deprived decile

  • Kingston upon Hull is in the 10 most deprived local authorities in the country when comparing overall deprivations scores (74). Six out of the 15 Yorkshire and the Humber local authorities are within the 25% local authorities with highest deprivation score overall

  • number of children in low income families is estimated at around 220,000 which represents 20.9% of children aged 16 and under. The proportion is higher than the England average of 15.6%. East riding of Yorkshire, North Yorkshire and York are significantly lower than England whilst all the others are significantly higher.

Employment

Employment, as well as good quality and fair work that reduces in-work poverty, and the focus of government’s levelling up agenda, are major drivers of overall health and wellbeing (75). Good employment improves health and wellbeing across people’s lives, boosting quality of life and protecting against social exclusion.

The employment rates in Yorkshire and the Humber (73.8%), continues to be worse than the England average (75.1%) in 16-64 year olds. There are also differences between males and females in the region (Fig. 22a):

  • employment rates have historically been lower for females compared to males, ranging from 63.4% in 2011/12 to 69.9% in 2020/21

  • employment increased for males, from 71.7% in 2011/12 to 78.2% in 2019/20. During the pandemic, the proportion of males classed as employed decreased to 77.8%.

There is inequality in employment rates at local authority level across region (Fig. 22b);

  • Leeds has the highest employment rate (78.2%) and is significantly higher than England (75.1%)

  • three of the regions local authorities are significantly lower than England: Sheffield (69.3%), Bradford (70.0%) and Kirklees (70.9%).

Interpretation of trends should be undertaken with caution due to the likelihood that the impact of the pandemic has not yet been fully reflected in the available data (18). All face to face interviews were suspended affecting interviews from March 2020 due to the pandemic, a change in survey methodology which increases the potential for a non-response bias. ‘Furlough’ scheme has not been previously defined or measured and may have led to apparent contradictions or unexpected trends.


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


Figure 22 – Employment

Figure 22a - Trends

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

Figure 22b - UTLA

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

Income

Many physical and mental health outcomes improve incrementally as income rises (76,77). Income is related to life expectancy, disability free life expectancy, and self-reported health (77). The relationship operates through a variety of mechanisms. Financial resources determine the extent to which a person can both invest in goods and services which improve health and purchase goods and services which are bad for health. Low income can also prevent active participation in social life and day to day activities, affecting feelings of self-worth and status. It can also influence health through feelings of shame, low self-worth and exclusion (78).

The average weekly median earning in Yorkshire and the Humber in 2021 was £454.6, and significantly lower than the England average of £496.0 (79). The estimated gender pay gap (by workplace location) was 15.5% in 2020, fourth lowest compared to other regions where the gap ranges from South East with the highest gap at 16.6% and North West the lowest at 13.5%.

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 (76). In 2016/17 to 2018/19, 33.8% of the population of region did not reach the MIS, significantly higher than the national average of 29.4% (Fig. 23a).

Child poverty and children in low income families

Around half of children (49.9%) in the region are estimated living in a household with income not meeting the minimum acceptable standards of living (Fig. 23a). Another measure from Loughborough University looks at child poverty rates after housing costs (Fig. 23b), this study looks at the number of children (0-15 years) that are in households with incomes net of housing costs that are below 60% of the median. Local authority comparison shows that the highest estimated percentages are in Bradford (38%), Kingston upon Hull (36%) and Sheffield (36%). The lowest percentages re in Harrogate (20%) and Hambleton (23%).

Another income measure looks at the proportion of children in both absolute and relative low income families (80,81). The proportion of children in both absolute low income families in 2019/20 was second highest in Yorkshire and the Humber compared to other regions, and for this measure and children in relative low income families the trend has increased since 2015/16. Moreover, the proportion of children living in low income families was significantly higher than England in most of the region’s local authorities. East Riding of Yorkshire, North Yorkshire and York are significantly lower than England for each of these measures. The number of children in children in absolute low income families is estimated at 220,000 which makes up 20.9% of children aged 16 and under in 2019/20 (80). The proportion living in relative low income families is 25.1%, which equates to an estimated 263,500 children in the region (81).

Figure 23 – Minimum income standard

Figure 23a - Trends

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

Figure 23b - Local Authority

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

The built and natural environment

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

Homelessness and temporary accommodation

Homelessness and the use of temporary accommodation remain at high levels in England (82). In Yorkshire and the Humber the rate of homelessness (defined as households owed a duty under the Homelessness Reduction Act) was not significantly different to compared to the England average (11.4 v 11.3 per 1,000) (83). There was wide variation between local authorities ranging from 2.7 in North Lincolnshire up to 22.3 in Hull. Six local authorities in the region were significantly worse than the England average in 2020/21 and seven were significantly better.

In Yorkshire and the Humber, 0.8 per 1,000 households are in temporary accommodation in 2020/21 (significantly better than the national average of 4.0, though this is skewed by London with a regional rate of 17.0). All LAs in Yorkshire and the Humber are significantly better than the England average.

Fuel poverty

16.8% of households in Yorkshire and the Humber experienced fuel poverty in 2019, a measure which defines a household as fuel poor if it has income (after accounting for fuel costs) below a certain level and a low energy efficient home (84). A study on cold-attributable winter deaths by temperature level demonstrates the majority of deaths (97% in the North East example) in an average winter occurred at temperatures above the alert threshold temperature of 2\(^\circ\)C (85). Children living in a cold home may also find it more difficult to study or do homework which affects educational and long-term work opportunities. The proportion of households experiencing fuel poverty is likely to increase as the cost of energy increases.

Active travel and access to green spaces

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.

In Yorkshire and the Humber:

  • the average distance to the nearest park or public garden is 1,086.2 metres, which is the fourth highest region, according to a survey from April 2021. 89.6% of people have access to private outdoor space (18)

  • in 2019/20, 14.2% of adults walked and 1.8% cycled to work at last least three days a week, proportions of those walking were the fourth highest region, and for cycling the fourth lowest compared to other regions (86,87). Both are significantly lower than England. London is the only region with significantly better rates than the England average

  • within the region, York and Leeds have a significantly higher proportion of people walking for travel at least three days a week at 22.3% and 18.2% respectively (88). York also ranks highest for cycling (6.8%) and is significantly higher than England (2.3%) (89).

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 (90). Education provides knowledge and capabilities that contribute to mental, physical, and social wellbeing. Educational qualifications are also a determinant of an individual’s labour market position, which in turn influences income, housing and other material resources associated with health.

In Yorkshire and the Humber in 2020:

  • the proportion of 16-17 year olds not in education, employment or training (NEET) or whose activity is not known is 6.3%, which represents 7,470 children aged 16-17, and at similar level to England (5.5%) (91)

  • the proportion varied by local authority, with significantly higher proportions in North Yorkshire (11.4), Leeds (7.9) and Sheffield (7.4) compared to England.

Health protection

Introduction

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

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

There are also a range of environmental threats such as air pollution, climate change and flooding. Climate change is a major risk to health both nationally and globally. It affects all aspects of our everyday life and our environment, including the places we live, the air we breathe, as well as our access to food and water (92). Climate change also increases the likelihood of extreme weather events such as flooding and heat waves (93).

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

Infectious diseases

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

Impact of the pandemic on infectious diseases

The 2021 HPfE reported that the level of testing for or detection of some infectious diseases such as TB and STIs decreased during the pandemic, which may reflect a real decrease in incidence due to social distancing measures, reduction in access to testing or a reluctance to be tested (1). The prevalence of several infectious diseases such as seasonal influenza and norovirus has been reduced in the last 2 years of the pandemic, possibly a beneficial side-effect of public health measures against COVID-19 (94). However, there are likely to have been negative impacts and risks of late diagnosis due to changes in health seeking behaviours during the pandemic period. Childhood vaccinations were interrupted during the pandemic and there has been a reduction in MMR (measles, mumps, rubella) vaccine coverage.

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

Air pollution

Air pollution can contribute to cardiovascular and respiratory conditions and shorten lives. It is estimated that long-term exposure to the air pollution mixture in the UK has an annual effect equivalent to 28,000 to 36,000 deaths (95). Modelled estimates by Defra estimated that 4.8% of mortality in 2019 was attributed to air pollution in Yorkshire and the Humber, the fourth lowest proportion out of all regions (96).

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

Data for the levels of PM2.5 from 2011 to 2020 shows:

  • by 2019, man made fine particular matter level of air pollution were 6.1 per cubic metre (\(\mu\)g/\(m^{3}\)) in the region compared to 6.9 for England (Fig. 24a)

  • the regional trend between 2011 and 2020 has been changing from highest in 2013 at 9.0 per \(\mu\)g/\(m^{3}\) to its lowest in 2020, following a steepest drop during the first year of the pandemic (Fig. 24a)

  • within region, the levels range from highest in Leeds with 7.2 per \(\mu\)g/\(m^{3}\) to lowest in North Yorkshire at 4.9 per \(\mu\)g/\(m^{3}\) (Fig. 24b).


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


Figure 24 – Air quality

Figure 24a - Trends

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

Figure 24b - UTLA

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

Sexually transmitted infections

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

In Yorkshire and the Humber (Fig. 25a):

  • the diagnostic rates per 100,000 for Chlamydia (aged 15-24), Gonorrhoea and Syphilis had been increasing in England 2012 and 2019. The diagnostic rate per 100,000 for Genital warts has been decreasing since 2012. 2020 saw a decline in the detection rates of all STIs

  • diagnostic detection rates for Chlamydia per 100,000 population aged 15-24 were 1,498, this is below the recommended detection rate of at least 2,300 but is significantly higher than the England rate 1,408.

There is wide regional variation in the diagnostic rates of STI across Yorkshire and the Humber region (2020) (Fig. 25b):

  • the local authority with the highest Chlamydia diagnostic (aged 25+) rate per 100,000 in the region was Leeds (531), the lowest was East Riding (97)

  • the local authority with the highest Gonorrhoea rate per 100,000 in the region was Leeds (118), the lowest was East Riding (16)

  • the local authority with the highest Genital warts rate per 100,000 in the region was Leeds (73.5), the lowest was East Riding (16.5)

  • the local authority with the highest Syphilis rate per 100,000 in the region was Kingston upon Hull (8.1), the lowest was Sheffield (0.3).


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


The impact of STIs remains greatest in young heterosexuals aged 15 to 24 years, black ethnic minorities and men who have sex with men (MSM). MSM account for 11% of Yorkshire and Humber residents diagnosed with a new STI excluding chlamydia diagnoses reported. STIs disproportionately affect young people. Yorkshire and Humber residents aged between 15 and 24 years accounted for 59% of all new STI diagnoses in 2018. The white ethnic group has the highest number of new STI diagnoses: over 26,700 (86%), but whilst only 1% of new STIs are in black Caribbeans, they have the highest rate: 1,947 per 100,000, which is 3 times the rate seen in the white ethnic group.The trend for increases in gonorrhoea diagnoses is also concerning due to the emergence of antibiotic resistant gonorrhoea (97).

Figure 25 – Sexually transmitted infections

Figure 25a - Trends

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

Figure 25b - Local Authority

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

Tuberculosis

The number of new cases of tuberculosis (TB) have fallen dramatically in England over the last century. More recently there has been a steady decline in the incidence rate (new cases per 100,000 population) up to 2018, but then a levelling off (Figure 26a).

  • by 2019, the incident rate per 100,000 of Tuberculosis (TB) was 6.5 in the region compared to 8.4 for England

  • the regional trend between 2011 and 2019 has been rapidly decreasing in line with the trend for England

  • there is variation within the Yorkshire and Humber region. Bradford has the highest TB incidence (three year average 2018-20) 13.2 per 100,000. Bradford and Kirklees (9.6 per 100,000) have significantly higher rates than England (8.0 per 100,000)

  • many of the regions local authorities have significantly lower rates of TB incidence than England, however numbers are very small and hence we see large confidence intervals.


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


Figure 26 – Tuberculosis

Figure 26a - Trends

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

Vaccines and vaccine preventable infections

The HPfE 2021 cites evidence of uptake rates in winter 2020 to 2021 in England that were higher than they had been in previous years due to increased efforts to reach as many people as possible and increased awareness due to the COVID-19 pandemic (1).

  • Influenza vaccine uptake in GP registered patients from 1 September 2020 to 28 February 2021 in England was 80.9% for patients aged 65 years and over compared with 72.4% in 2019 to 2020, and 53.0% for patients aged 6 months to under 65 years old in one or more clinical risk groups compared with 44.9% in 2019 to 2020 (98,99)

  • in Yorkshire and the Humber, people aged 65 and over receiving the flu vaccine went from 73.8% in 2019/20 to 83% in 2020/21. This is above the 75% ambition set. Those who are clinically at risk went from 45.0% uptake to 53.7% (100). This is below the 55% ambition.

As a consequence of this and the social distancing measures introduced for the COVID-19 pandemic influenza-like illness was much lower in 2020 to 2021 than in other seasons.

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. Measles is a highly infectious disease which can only be controlled by vaccination. People who have not received 2 doses of the MMR (measles, mumps, rubella) vaccine are at risk of developing measles. In 2019 to 2020 only 86.8% of children aged 5 had received the 2 doses, a slight decline from previous years (101).

Monthly monitoring of MMR vaccination coverage shows that the measures implemented to manage the pandemic have impacted vaccination uptake. MMR (first dose) monthly vaccine coverage estimates measured at 18 months of age from 2019 to 2021, show a decrease from April 2020.

Antimicrobial resistance

Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to antibiotics and other antimicrobial medicines. This makes infections harder and more costly to treat. It also increases the risk of the infectious disease spreading, and leading to more severe illness and death. In England, antibiotic-resistant bloodstream infections rose by an estimated 32% between 2015 and 2019 (102).

AMR occurs naturally over time, but can also be caused by the misuse and overuse of antimicrobials (103).

Antibiotic prescribing in primary care is often measured in STAR-PU, which are weighted units to allow comparisons adjusting for the age and sex of the population.

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

  • in 2020, the indirectly standardised antibiotic prescribing ratio was 0.81 in the region, slightly above the England average at 0.75

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

  • the local authority variation (Fig 27b) ranges from lowest in North Yorkshire (0.7) to highest in Wakefield (0.9).

Figure 27 – Antibiotic prescribing

Figure 27a - Trends

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

Figure 27b - Local Authority

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

Conclusions

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

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

Data on many aspects of health during the pandemic are not yet available but will be added to the Wider Impacts of COVID-19 on Health (WICH) monitoring tool (18) where possible and summarised in future Health Profile for England reports. Inequalities in health are monitored via various OHID public health profiles and tools (104). Continued monitoring of the indirect impacts of the pandemic by OHID on the nation’s health as well as health inequalities will remain a priority.

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Footnotes

  1. At the time of writing Census 2021 estimates were yet to be released, a release of which will include information about gender identity, added as voluntary question for the first time (7).↩︎

  2. Life expectancy gap by deprivation is measured by the slope index of inequality (SII) (15). This is a measure of the social gradient in an indicator and shows how much a health outcome varies with deprivation. It takes account of inequalities across the whole range of deprivation within England and summarises this into a single number. The measure assumes a linear relationship between the indicator and deprivation. The higher the value of the SII, the greater the inequality within an area.↩︎