Six years on from the shift of responsibility for public health services from the NHS to local authorities, and three years on from the publication of our QualityWatch report, Focus on: Public health and prevention, we re-examined our indicators to see how the quality of public health services has changed in recent years.
A new 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. Elsewhere, there have been reports of widening health inequalities, increased levels of obesity, and a slowing down of improvements in infant mortality and life expectancy.
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 preventive services is vital in order to measure the impact of system reforms, funding cuts, and wider societal factors. Below is a summary of our public health indicators, with links to 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 2017, 36% of the adult population was overweight and 29% was obese.
- Data from the National Childhood Measurement Programme shows that the proportion of children in Reception (aged 4-5 years) who are overweight and obese has remained relatively unchanged since 2006/07. However, obesity in children in Year 6 (aged 10-11 years) has increased by 2.6 percentage points over the same time period.
- One in five children in Year 6 (aged 10-11 years) were obese in 2017/18.
- In 2017/18, in both Reception and Year 6 children the obesity prevalence was over twice as high in the most deprived areas than the least deprived areas.
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 setting a quit date has fallen for six consecutive years, decreasing by 11% in the last year alone. The reduction may partly be due to the increased use of e-cigarettes.
- In 2016, 27% of people aged 18 and over in the most deprived areas were current smokers, compared with 8% 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 2016/17. But the reduction in smoking rates among pregnant women has slowed in recent years, with a percentage decrease of only 0.3% in 2016/17 and a percentage increase of 0.1% in 2017/18.
- Provisional data for the first half of 2018/19 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.
- In 2017, the alcohol-related death rate in males (16.8 deaths per 100,000 males) was more than twice the rate in females (8.0 deaths per 100,000 females).
- The rate of hospital admissions which were primarily due to alcohol consumption has remained broadly stable over time, at around 640 admissions per 100,000 people each year.
- According to the Opinions and Lifestyle Survey, since 2005 heavy drinking has fallen for people aged 16-24 and 25-44 but has increased for people aged 45-64, and 65 and over. Nevertheless, the 16-24 age group continue to report drinking the most heavily and the 65 and over group report drinking the least.
Adult substance misuse services
- Since 2005-06, adult waiting times for a substance misuse treatment intervention have improved substantially. In 2017-18, 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 2017-18, opiate users had the lowest rate of successful completions (26%) and alcohol only users had the highest rate (61%).
Sexual health services
- Between 2008 and 2017, 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 19% in 2017.
- 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 2017.
Teenage pregnancy
- Between 1990 and 2016, the under-18 conception rate decreased by 60%, from 48 per 1,000 women in 1990 to 19 per 1,000 women in 2016.
- In 2016, 51% of under-18 conceptions resulted in 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. Currently, only the DTaP/IPV/Hib vaccination measured at a child’s second birthday is meeting the World Health Organisation’s target of 95% coverage.
- Uptake of the HPV vaccination has declined slightly over the last couple of years, with 89% coverage for the first dose and 84% for two doses in 2017/18.
- Pertussis vaccination coverage for pregnant women in England is not especially high, reaching 71% in March 2018. However, this is a considerable increase since its introduction in October 2012, when the uptake was 44%.
About this data
Please note that these indicators use different time frames due to differences in data availability.