Public health

We’re monitoring trends in the wider determinants of health.

Indicator update

Published: 31/03/2022

The coronavirus (Covid-19) pandemic has been a global public health emergency, requiring national lockdowns and social distancing measures to limit the spread of the virus. Last year concerns were raised about the wider impacts of the pandemic on people’s health and wellbeing. As we move into the third year of the Covid-19 pandemic, this QualityWatch indicator update explores the impact the pandemic has had through longer-term trends in key public health measures. 

The Covid-19 pandemic has brought some successes in public health: flu vaccine uptake for adults over the age of 65 has increased alongside the rollout of the Covid-19 vaccine, rates of daily smokers and teenage pregnancy are lower than in previous years. However, some areas of public health have deteriorated and health inequalities have exacerbated. The prevalence of obesity in Year 6 children rose to one in four in 2020/21, and for children in the most deprived areas, this rose to one in three. Alcohol-specific deaths have increased, particularly in the most deprived areas of the country. In 2020/21, childhood vaccination coverage remained below the WHO target for all routine vaccinations. 

Before the pandemic, there had been historic cuts to public health funding. In March 2019 the Quality in public health: a shared responsibility was published with the ambition to “protect, promote and improve” public health and reduce health inequalities by making it a shared responsibility across the NHS, government and local councils. In August 2020, Public Health England was replaced by two separate organisations, UK Health Security Agency and the Office for Health Improvement and Disparities. The government has a long way to go to meet the ambitions set out in their public health strategy. It is clear that there are some areas where the Covid-19 pandemic has deepened health inequalities and there must be sustained effort to improve health outcomes for the whole population. 

Below is a summary of these indicators, with links to charts and more detailed analysis.

Alcohol-related harm and drinking behaviour

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  • Alcohol-specific mortality rose to 13 per 100,000 people in 2020, a 19% increase from 11 per 100,000 people in 2019. 
  • In the most deprived decile of the population, alcohol-specific mortality increased to 19 per 100,000 people in 2020, a 25% increase from 15 per 100,000 people in 2019.
  • The rate of hospital admissions that were primarily due to alcohol consumption in England decreased from 1,810 per 100,000 people in 2019/20 to 1,500 per 100,000 people in 2020/21.

Adult substance misuse services 

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  • Since 2005/06, waiting times for substance misuse treatment in adults have improved substantially. In 2020/21, the proportion of people waiting three weeks or less from being identified as having a treatment need to being offered an appointment to start an intervention remained at 98.5%, the same as 2019/20. 
  • Overall, around half of people complete substance misuse treatment free of dependence. In 2020/21, opiate users had the lowest rate of successful completions (25%) and alcohol only users had the highest rate (62%).

Obesity

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  • One in four children (26%) in Year 6 were obese or severely obese in the 2020/21 school year, up from one in five in 2019/20 (21%). 
  • One in seven children (14%) in Reception were obese or severely obese in the 2020/21 school year, up from one in 10 in 2019 (10%).
  • For Reception aged children in the most deprived areas, prevalence of obesity increased from 13% to 20% between 2019/20 and 2020/21.
  • Between 2006/07 and 2020/21, the gap between the most and least deprived areas in obesity prevalence for children aged 4-5 increased from 4.5 to 10.7 percentage points.

Smoking

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  • The percentage of people who self-reported that they were successful in quitting using NHS stop smoking services increased from 51% in 2019/20 to 59% in 2020/21.
  • In 2020, the prevalence of smoking in adults was 15% for the most deprived decile of the population and 9% for the least deprive decile of the population. 

International comparisons in preventable risk factors 

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  • In Great Britain, the proportion of the population aged 15+ who are daily smokers decreased from 27% in 2000 to 16% in 2019. Canada had the lowest rate of tobacco smoking in 2019 and Greece had the highest.
  • In England, the proportion of the total population who are obese increased from 21% in 2000 to 28% in 2019. 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 9.7 litres per capita in 2019, which is above the average of the comparator countries. Greece had the lowest alcohol consumption in 2019 and Austria had the highest.

Effectiveness of sexual health services 

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  • Between 2011 and 2020, the proportion of people in the UK diagnosed with HIV at a late stage of infection decreased from 43% to 36%, with the absolute number falling from 2,143 to 742.
  • There was a 32% decrease in the number of new STI diagnoses between 2020 (317,901) and 2019 (467,079); in the same time period there has been a 25% reduction in the number of STI screenings. 
  • The biggest decline in rate of new diagnoses was for genital warts, a 47% decrease from 91 to 48 per 100,000 population. Syphilis had the smallest decline in new diagnoses of 14% from 14 to 12 per 100,000 population.
  • The proportion of the population aged 15 to 24 screened for chlamydia decreased from 27% in 2012 to 14% in 2020. The number of chlamydia diagnoses in this age group decreased from 2,058 per 100,000 in 2019 to 1,420 per 100,000 in 2020. 

Vaccination coverage for children and mothers

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  • Vaccine coverage for all of the childhood vaccinations has generally been declining since 2013/14. In 2020/21, for the third consecutive year, none of the routine vaccinations met the World Health Organisation’s target of 95% coverage.
  • Coverage for the Measles, Mumps and Rubella vaccine (by second birthday) fell by 0.3 percentage points to 90.3% in 2020/21.
  • Coverage for the Hib and meningitis C booster fell by 0.4 percentage points to 90.2% in 2020/21. 
  • In the 2020/21 school year, coverage of the second dose of the HPV vaccine in females aged 13 to 14 fell to 61%, compared to 65% in 2019/20. Before the Covid-19 pandemic in 2018/19, HPV vaccine coverage was 84% for this age cohort. 

Adult flu vaccination coverage 

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  • In 2020/21, uptake of the flu vaccine for people aged 65 reached 81%, exceeding the World Health Organisation target of 75% for the second consecutive year.
  • Between 2019 and 2020, flu vaccination coverage for those aged 65 and over increased in all OECD countries with published data. England has the highest vaccination coverage of countries who have reported data.

Teenage pregnancy 

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  • Between 1993 and 2019, the under-18 conception rate decreased by 63%, from 42 per 1,000 women to 16 per 1,000 women.
  • In 2019, 54% of under-18 conceptions resulted in an abortion, whilst this percentage has been increasing year-on-year the estimated number of abortions have decreased from 14,031 in 1993 to 8,082 in 2019. 

Smoking in pregnancy 

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  • The prevalence of smoking during pregnancy has been decreasing over time. In the first two quarters of 2021/22, the percentage of pregnant women known to smoke at the time of delivery decreased to 9.1%. The current target is to reduce the prevalence of smoking during pregnancy to 6% or less by the end of 2022.

Breastfeeding

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  • In 2020/21, the percentage of infants totally or partially breastfed at six to eight weeks has remained at 48% for the second year in a row. 

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