While the public health system responds to emerging diseases, such as the coronavirus Covid-19, there have been reports of widening health inequalities, increased levels of obesity, and a slowing down of improvements in infant mortality and life expectancy. Seven years on from the shift of responsibility for public health services from the NHS to local government, we’ve examined our indicators to see how the quality of public health services has changed in recent years.
A study by the Local Government Association presents a positive picture of “continuing improvements in health” despite councils nationally having their funding cut by 49% between 2010/11 and 2017/18. Estimates suggest that a boost of £1bn is needed in 2020/21 to restore funding to levels seen in 2015/16.
Here at QualityWatch, we looked at trends in public health services across five key areas:
- Obesity
- Smoking
- Substance misuse (drugs and alcohol)
- Sexual and reproductive health
- Immunisations
It is important to remember that whilst this national-level data presents a broad overview of the health of the population, it may mask differential changes that are occurring at a local level. Nevertheless, monitoring risk factors and preventative services is vital in order to measure the impact of system reforms, funding cuts, and wider societal factors. A summary of our public health indicators is shown below. Clink on the links for more detailed content and analysis.
Obesity
- Health Survey for England data shows that the proportion of adults who are overweight and obese has increased substantially over the last two decades. In 2018, 36% of the adult population was overweight and 28% was obese.
- Data from the National Childhood Measurement Programme shows that the proportion of children in Reception (aged 4-5 years) who are obese has remained relatively unchanged since 2006/07. However, obesity in children in Year 6 (aged 10-11 years) has increased by 2.7 percentage points over the same time period.
- One in five children in Year 6 (aged 10-11 years) were obese in 2018/19.
- In 2018/19, in both children aged 4-5 and 10-11, the obesity prevalence was over twice as high in the most deprived areas than the least deprived areas. Between 2006/07 and 2018/19, the gap in obesity prevalence between children from the most and least deprived areas increased for children aged 4-5 (from 4.5 to 6.5 percentage points) and aged 10-11 (from 8.5 to 13.9 percentage points).
NHS Stop Smoking Services
- The percentage of people using NHS Stop Smoking Services who self-reported that they were successful in quitting at four weeks has remained relatively steady over time, fluctuating at around 50%.
- The number of people using NHS Stop Smoking Services who set a quit date has fallen for seven consecutive years, decreasing by 14% in the last year alone. The reduction may partly be due to the increased use of e-cigarettes.
- In 2018, 18% of people aged 18 and over in the most deprived areas were current smokers compared with only 10% of people in the least deprived areas.
Smoking in pregnancy
- In 2006/07, 16% of women were smokers at the time of delivery and this decreased to 11% in 2018/19. However, the reduction in smoking rates among pregnant women has slowed in recent years, with a percentage increase of 0.1% in 2017/18 and a percentage decrease of 0.2% in 2018/19.
- Provisional data for the first half of 2019/20 shows that the percentage of pregnant women who smoke will continue to decrease. However, if the 6% target is to be met by 2022, the rate of decline will need to increase considerably.
Alcohol-related harm and drinking behaviour
- Out of the four UK countries, Scotland has had the highest alcohol-related death rate since the dataset began in 2001, while England has had the lowest.
- The rate of hospital admissions which were primarily due to alcohol consumption in England increased from 630 admissions per 100,000 people in 2017/18 to 660 admissions per 100,000 people in 2018/19.
- According to the Health Survey for England, since 2006 heavy drinking has fallen for people aged 16 to 54 years old but has increased for people aged 55 and over. The 25-34 age group report drinking the most heavily, and the 75 and over group report drinking the least.
- Between 2006 and 2018, the percentage of 13-15 year olds who reported that they have ever had a proper alcoholic drink decreased from 67% to 31%. Over the same time period, the percentage of 11-12 year olds who have drunk alcohol decreased from 26% to 6%, and for those aged 8-10 it fell from 9% to 3%.
International comparisons of preventable risk factors
- Daily smoking has decreased in most OECD countries since 2000. In Great Britain, the proportion of the population aged 15+ who are daily smokers decreased from 27% in 2000 to 17% in 2017.
- Obesity has been rising in most OECD countries over the past two decades. In England, the proportion of the total population who are obese increased from 21% in 2000 to 29% in 2017. Japan consistently has very low levels of obesity. In 2016, 40% of the total population of the United States were obese.
- In the UK, alcohol consumption decreased from 10.4 litres per capita in 2000 to 9.7 litres per capita in 2017, which is just above the average of the comparator countries. Sweden had the lowest alcohol consumption in 2017 and France had the highest.
Adult substance misuse services
- Since 2005/06, adult waiting times for a substance misuse treatment intervention have improved substantially. In 2018/19, nearly all individuals (98%) waited three weeks or less from first being identified as having a treatment need to being offered an appointment to start an intervention.
- Overall, around half of people complete substance misuse treatment free of dependence. In 2018/19, opiate users had the lowest rate of successful completions (25%) and alcohol only users had the highest rate (60%).
Sexual health services
- Between 2008 and 2018, rates of new STI diagnoses increased for chlamydia, gonorrhoea, genital herpes and syphilis, but decreased for genital warts.
- The proportion of the population aged 15 to 24 screened for chlamydia decreased from 27% in 2012 to 20% in 2018.
- In the UK, the proportion of HIV cases diagnosed at a late stage of infection decreased from 55% in 2008 to 40% in 2015, but has since increased again to 43% in 2018.
Teenage pregnancy
- Between 1990 and 2017, the under-18 conception rate decreased by 62%, from 48 per 1,000 women to 18 per 1,000 women.
- In 2017, 52% of under-18 conceptions resulted in an abortion, which is the highest percentage in over 25 years.
Vaccination coverage for children and mothers
- Coverage for all of the childhood vaccinations plateaued between 2011/12 and 2013/14, and has since declined. In 2018/19, for the first time since 2008/09, none of the routine vaccinations met the World Health Organisation’s target of 95% coverage.
- Provisional data shows that in 2018, there were 968 laboratory-confirmed measles cases in England. This is a steep rise in cases compared to the 283 confirmed measles cases in 2017, but is lower than previous outbreaks in 2008 (1,280 cases) and 2012 (1,920 cases).
- Uptake of the HPV vaccine has declined slightly over the last couple of years, with 89% coverage for the first dose and 84% for two doses in 2018/19.
- Pertussis vaccination coverage for pregnant women in England is not especially high, reaching 69% in September 2019. However, this is a considerable increase since its introduction in October 2012, when the uptake was 44%.
Adult flu vaccination coverage
- In England, the World Health Organisation target to reach or exceed 75% uptake of the flu vaccine for people aged 65 and over was last met in the winter of 2005-06.
- So far in winter 2019-20 (between 1 September 2019 and 31 December 2019), uptake has reached 71%.
- Between 2007 and 2017, the UK had some of the highest levels of flu vaccination coverage among those aged 65 and over compared to other OECD countries.