My Life, My Health
Guy Goodwin, Chief Executive, National Centre for Social Research
Last month, NHS Digital released “England’s changing health since the 1990s” which provides health data over 25 years on subjects from high blood pressure to alcohol consumption. I would encourage you to use the new data tool that we developed to support this project. On the social statistics side, we have been generally bad at producing long time series (by “time series” I mean data collected at regular intervals over a number of years) and yet they give some great insights into how our lives are changing.
I have become much more aware over the last year of how our health (and mine as I get older) is an issue for the country and, of course, the National Health Service (NHS). The last Health Survey for England results (2015) provided some welcome encouragement for those promoting good health, for example with reduced percentages smoking.
However the survey, which we conduct at NatCen for NHS Digital, also showed:
- Approaching two thirds of us are obese or overweight;
- Under a quarter of children aged 5 to 15 met the physical activity guidelines of being moderately active for at least 60 minutes every day;
- Among non-smoking children, aged 4 to 15, over a third of boys and girls still had detectable levels of cotinine (indicating exposure to other people’s smoke) despite some reductions since the smoking ban in public places a decade ago;
- 31 per cent of men and 16 per cent of women drank over 14 units of alcohol in a usual week (above the recommended guidelines).
These data continue to raise issues for policy makers and I reflect on these in this latest “Let’s Talk about Society” article.
In particular, if we need people to be in good health for longer - both for their benefit and to avoid the increasing costs and pressures on services associated with an ageing society - can we continue as individuals to see our health as ultimately a matter of personal choice, with us occasionally being “nudged” towards different behaviours? Or will policy makers need to increasingly intervene more intrusively in our health choices and think radically about the societal factors that can influence those choices and support healthy behaviour?
The National Health Service (NHS)
It didn’t take long in the New Year for health to be back in the spotlight with the Chief Executive of the British Red Cross saying the NHS faced a “humanitarian crisis”.
The British Social Attitudes survey shows that more than 9 in 10 of us believe the NHS has a funding problem. As consumers, we demonstrate relatively low levels of dissatisfaction with the service (23% of us were dissatisfied with the NHS in 2015, compared with 50% in 1997: few of us were dissatisfied with GPs and Dentists, about a third of us with social care). Of those that were dissatisfied, the vast majority selected a reason which related to resources.
Reasons for dissatisfaction with the NHS:
Reasons for satisfaction with the NHS:
But here is the rub. Although we may believe the NHS has a funding problem, only a minority of us in 2015 said we would be happy to pay more through our income tax if the service needs more money. Nor would we limit the NHS as a service to just those on lower incomes to reduce costs.
So why is this? The answer probably lies in the data that show significant numbers of us still believe that money is being wasted in the NHS and many feel the NHS should stop providing treatments that are poor value for money. This discussion leads us into the uncomfortable territory around personal responsibility and the extent to which the state should be obliged to pay for avoidable costs, such as calls on A&E for those getting drunk at weekends.
The NatCen Panel findings in May showed that approaching 4 in 10 of us would accept charging for some NHS services and the majority of us would increase taxes on alcohol, tobacco and sugary foods. But how far might our determination to stop certain so-called lifestyle choices go?
The scale of the nation’s problem with obesity is an example of these tensions and the subject is at the top of the political agenda. In the March 2017 Budget, the Government announced a new sugar tax on soft drinks would be introduced from April 2018 in one initiative to reduce obesity.
In 2016, I was told at my 50 year old NHS check-up that I had joined the two thirds of men who are now categorised as overweight or obese. The letter I got from my GP was a wake-up call, especially since I had deliberately timed my check-up to coincide with losing a few pounds. Whereas in my 20s I would have simply cut back on my food for a few weeks, it has taken me almost a year to reduce my weight sufficiently. I am not alone. The figures on overweight and obese children are particularly dismal reading for policy makers with 28% of 2 to 15 year olds already one or the other. Children from lower income households are more likely to be obese than those that aren’t.
What is perhaps most surprising about NHS Digital’s figures is the number of us who don’t recognise (or accept) that our own children are overweight in the first place: the vast majority of overweight children (excluding the obese) were described as being about the right weight by their mothers (91%) and fathers (80%). Only just over a quarter of the children aged 8 to 15 who were obese or overweight described themselves as too heavy.
The National Centre for Social Research (NatCen) did some work for Cancer Research UK last year on how primary school children engage with advertising of unhealthy food on television.. The findings were not encouraging with children saying they find advertising tempts them to eat unhealthily despite a good level of nutritional knowledge. After watching an advert for take-away pizza one child said “you feel like you're just going to lick the screen”.
Why does it all matter? Being obese or overweight can lead to many health complications, especially later in life, leading to calls on scarce NHS resources. For example, being overweight can cause many types of cancer (including breast and bowel cancer).
Against that backdrop, it perhaps should not surprise us if questions are raised in the coming years about the cost to the taxpayer of paying for treatments for what can be perceived, in some if not most cases, to be an inevitable consequence of our lifestyle choices. Understanding the extent to which societal level factors can and do influence, constrain and shape those choices is also crucial in designing the most appropriate policy interventions.
Another “big” health story in the media this year has been around our mental health - from January when the Prime Minister unveiled Government plans to better tackle the associated issues to what the parties said in their recent election manifestos.
Every seven years since the 1990s, a rigorous assessment of the nation’s mental health is carried out in England by NHS Digital through the Adult Psychiatric Morbidity Survey (APMS). The last survey was conducted here at NatCen in 2014. A similar survey for children is being conducted this summer by the ONS and NatCen in partnership.
The 2014 survey indicated:
- One adult in six had a common mental disorder (CMD) (one in five women and one in eight men). Female rates have risen since 2000;
- Reported rates of self-harming increased in men and women and across age groups since 2007;
- Young women have emerged as a high-risk group, with high rates of CMD, self-harm and positive screens for posttraumatic stress disorder (PTSD) and bipolar disorder. The gap between young women and men has increased and we will be doing secondary analysis of APMS data in the coming months to better understand this;
- Most mental disorders were more common in people living alone, in poor physical health and not employed;
- Only one in three people with CMD reported current use of mental health treatments, an improvement from 2007 but still implying the majority of people with CMD don’t use them. There were demographic inequalities in who received treatment (more likely if you are White British, female or in mid-life, less likely if you are young or Black).
The figures for young women, aged 16-24, have particularly drawn attention. The study, for example, found that 13% of young women had post-traumatic stress disorder (PTSD) - three times the rate recorded in 2007.
Sally McManus, an expert in mental health and lead researcher at NatCen, said that exposure to violence and abuse was the biggest predictor of mental illness. However, there was also evidence that poverty was a factor and there were possible links to social media use.
A consultation on the 2014 survey by NHS Digital showed that respondents would like to see more data in the future on eating disorders in particular, but also on gambling, e-cigarettes and social media. Over nine in ten wanted the APMS conducted more frequently, including over a half wanting it either every year or two years. Given the importance now being associated with mental health, the need to monitor trends more closely and the calls for mental and physical health to be treated on a more equal footing, there seems a strong case for the frequency of these data collections to be increased; the main constraint to doing so is cost.
Of course, these are just three of the biggest issues of many that have been reported on in relation to our health this year. I could instead have chosen to focus on dementia, social and end-of-life care, or cancer.
In the various areas of our health, the national picture hides considerable inequalities, including by geography, and suggests that much of our poor health can still be avoided. At birth, males and females in the most deprived areas of the country can live 19 and 20 years less in good health, respectively, than those in the least deprived areas. So it may be the right time for policy makers to be more radical, to look closely at the wider societal factors and for an increasing number of “invest to save” initiatives and evaluations of policy interventions to reduce the costs and pressures on the NHS. In relative terms to the cost of care, such interventions are likely to be money well spent.
But there is only so much Government and policy makers can do without our help. “Self-help” on health can go some way to helping us resolve the problems that the NHS is facing too. If we don’t look after ourselves better, then the implication may well be that we have to pay more, either through our income tax or by paying for what we need on demand.
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