The emergence of the coronavirus (Covid-19) pandemic has created a public health emergency across the world. In the UK, national lockdowns and social distancing measures have been implemented to limit the spread of the virus. Concerns have been raised about the impact of such measures on the wider determinants of health, and the potential for the pandemic to exacerbate existing health inequalities. This comes following historic cuts to public health funding and a slowing down of improvements in life expectancy.
In this indicator update, we looked at longer-term trends in public health services across key areas including preventable risk factors (such as obesity and smoking), substance misuse (drugs and alcohol), and sexual and reproductive health. We also explored trends in vaccination coverage, excluding Covid-19 vaccinations. The rollout of Covid-19 vaccines began in December 2020, and the UK COVID-19 vaccines delivery plan was published in January 2021, outlining an aim to offer a first dose of the vaccine to everyone in the most vulnerable groups by 15 February.
A summary of our public health indicators is shown below. Click on the links for more detailed content and analysis.
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 2019/20, for the second consecutive year, none of the routine vaccinations met the World Health Organisation’s target of 95% coverage.
- In the 2019/20 school year, coverage of two doses of the HPV vaccine fell to 65%, following school immunisation programmes being paused when schools closed in March 2020 during the national lockdown. This compares to coverage of 84% for two doses in the 2018/19 school year.
- Pertussis vaccination coverage for pregnant women in England is not especially high, reaching 67% in September 2020. However, this is a considerable increase since its introduction in October 2012, when the uptake was 44%.
Adult flu vaccination coverage
- So far in winter 2020-21 (between 1 September and 31 November 2020), uptake of the flu vaccine for people aged 65 and over has reached 77%. This is the first time the World Health Organisation target of 75% uptake has been met since winter 2005-06.
- Between 2007 and 2019, England had some of the highest levels of flu vaccination coverage among those aged 65 and over compared to other OECD countries.
Smoking
- The percentage of people using NHS Stop Smoking Services who self-reported that they were successful in quitting at four weeks remained relatively steady between 2007/08 and 2019/20 at around 50%. In Q1 2020/21 (April to June 2020), following the onset of the Covid-19 pandemic, it increased to 58%.
- The number of people using NHS Stop Smoking Services who set a quit date has fallen for eight consecutive years, from 816,444 in 2011/12 to 221,678 in 2019/20.
- In 2019, 17% of people aged 18 and over in the most deprived areas were current smokers compared with only 9% of people in the least deprived areas.
Smoking in pregnancy
- In 2006/07, 15.8% of women were smokers at the time of delivery and this decreased to 10.4% in 2019/20. Provisional data for the first half of 2020/21 suggests that the percentage of pregnant women who smoke will continue to decrease to 9.8%.
NHS Health Check programme
- Between 2013/14 and 2019/20, the number of NHS Health Checks offered each quarter has fluctuated at around 700,000, with an average of 333,000 eligible people receiving an NHS Health Check each quarter. In Q1 2020/21 (April to June 2020), the number offered plummeted to 30,190 and only 8,961 people received an NHS Health Check.
Effectiveness of sexual health services
- Between February and April 2020, the number of consultations at sexual health services almost halved. Alongside this, the percentage of consultations carried out via the internet almost doubled from 23% to 45%.
- Between 2012 and 2019, rates of new STI diagnoses increased for chlamydia, gonorrhoea and syphilis, but remained constant for genital herpes and decreased for genital warts.
- 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 42% in 2019.
Teenage pregnancy
- Between 1993 and 2018, the under-18 conception rate decreased by 60%, from 42 per 1,000 women to 17 per 1,000 women.
- In 2018, 53% of under-18 conceptions resulted in an abortion, which is the highest percentage in over 25 years.
Breastfeeding
- In England, the percentage of babies that had a first feed status recorded with a first feed of maternal or donor breast milk decreased slightly from 74% in 2017/18 to 72% in 2019/20. In the first half of 2020/21 it remained constant at 72%.
- Between 2009/10 and 2018/19, the percentage of infants totally or partially breastfed at six to eight weeks fluctuated at around 45%.
Obesity
- The proportion of adults who are obese has increased from 15% in 1993 to 28% in 2019.
- Between 2006/07 and 2019/20, the gap in obesity prevalence for children aged 4-5 between the most and least deprived areas increased from 4.5 to 6.5 percentage points.
- The gap in obesity prevalence between the most and least deprived areas for children aged 10-11 increased from 8.5 percentage points in 2006/07 to 13.3 percentage points in 2019/20.
Alcohol-related harm and drinking behaviour
- The rate of hospital admissions that 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, between 2006 and 2019 heavy drinking fell for people aged 16 to 54 years old but increased for people aged 65 and over.
- Between 2006 and 2019, there has been a large decrease in the percentage of 8 to 15 year olds who reported that they have had an alcoholic drink. The largest decrease was in 13 to 15 year olds, where the percentage who had drunk alcohol fell from 67% to 35%.
Adult substance misuse services
- Since 2005/06, adult waiting times for a substance misuse treatment intervention have improved substantially. In 2019/20, nearly all individuals (98.5%) waited three weeks or less from 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 2019/20, opiate users had the lowest rate of successful completions (24%) and alcohol only users had the highest rate (59%).
International comparisons of preventable risk factors
- In Great Britain, the proportion of the population aged 15+ who are daily smokers decreased from 27% in 2000 to 17% in 2018. Sweden had the lowest rate of tobacco smoking in 2018 and France had the highest.
- In England, the proportion of the total population who are obese increased from 21% in 2000 to 28% in 2018. Japan has consistently had the lowest levels of obesity, while the United States has the highest.
- In the UK, alcohol consumption decreased from 10.4 litres per capita in 2000 to 9.8 litres per capita in 2018, which is above the average of the comparator countries. Greece had the lowest alcohol consumption in 2018 and Austria had the highest.