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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