Living well 2016 to 2019

This chapter will present the key factors that affect the adult population's health and how we live. It also examines the main causes of morbidity and mortality

Who's the population?

There are just over 1.07 million adults aged 18 and over in Hampshire, accounting for 79% of the total population. Hampshire has an older population compared to England with a higher proportion of the population aged 45 years and fewer young working aged people (aged 20-39).

The proportion of residents with a limiting long term illness or disability is comparable to England. However, the size of the Hampshire population means that the absolute numbers of people experiencing ill health or disability are large. There are approximately 87,900 people in Hampshire (6.7%) with a long term health problem or disability which greatly limits their day to day activities; a further 119,400 people (9.1%) are limited a little on a daily basis. Four percent of the population (n= 54,000) report their health to be bad or very bad.

Local robust data on the number of people with unhealthy lifestyles is not available, however, applying national extrapolated survey data to our population suggest that in Hampshire there are;

• 145,570 people who smoke
• 705,300 people who are overweight
• 283,000 people who drink above the recommended safe levels for alcohol each week

What's the issue?

Certain lifestyle behaviours are known risk factors for chronic disease and premature mortality. Smoking remains a major cause of preventable ill health and early death. Whilst smoking rates have declined nationally, rates remain stubbornly high in certain population sub-groups, including people employed in routine and manual occupations and people with mental health problems.

Obesity is recognised as one of the major public health challenges of the 21^st century. It is estimated that two-thirds of the Hampshire population have excess weight with almost a quarter of the adult population being clinically obese.

Hampshire compares well to national and regional averages on indicators of alcohol-related health and social harm, yet an estimated 26.5% of Hampshire residents drink above the safe recommended levels for alcohol each week. Similarly whilst fewer Hampshire adults are physically inactive than the England average, this still equates to a quarter of the adult population.

One in four adults experience mental ill health at any one time and people with mental ill health are twice as likely as the general population to have serious physical illnesses. The cohort of people with serious mental health problems tends to have a reduced life expectancy compared with the general population.

The proportion of people in Hampshire diagnosed with long-term conditions such as diabetes, dementia and Chronic Obstructive Pulmonary Disease (COPD) is increasing. Musculoskeletal diseases are an important cause of ill-health and disability in Hampshire.

Hampshire has a significantly lower mortality rate than England. The main causes of death are cancer, cardiovascular disease and respiratory disease. Deaths under the age of 75 years are considered premature. Whilst the rate of premature mortality for Hampshire is below that for England, there is variation between geographical areas. Gosport has significantly higher all age and premature mortality rates compared to the England rate.

What does this mean for Hampshire?

Whilst people are living longer in Hampshire we have a considerable burden of ill health and mortality that can be partly attributed to poor lifestyles. Academic research indicates that dietary risks, tobacco smoke and high body mass index (BMI) are the most important contributory factors. Whilst the proportion of the population engaging in these lifestyle behaviours is lower in Hampshire than in England, this masks variation between geographies and sub populations. If we fail to tackle these inequalities, there is a risk that overall health inequalities will increase. One notable exception is obesity, which may in part be driven by the older demographic profile.

The burden of ill-health within the population is likely to increase as our population ages. Detection and optimum management of long-term conditions remains a priority for Hampshire. A significant minority of the Hampshire population have a long-term illness or disability that limits their day to day activities. Ensuring people with disabilities are able to have the best quality of life they can is important.

Premature mortality remains a key issue for some parts of the County and is highest in Gosport. Across the County almost half of deaths were due to cancer and over one fifth were due to circulatory disease. Premature mortality reflects the risk factor profile and mortality burden of the Hampshire population. Rates are higher in areas of deprivation and in men.

What's the trend/projection?

Predicting trends can be challenging for many lifestyle risk factors. Our analysis shows that obesity prevalence continues to rise, but the rate of increase appears to have slowed among men, and shows a small decrease in women. The prevalence gap between men and women who are obese has narrowed over time. Smoking rates continue to fall in both men and women.

The proportion of the population with one or more long-term conditions is likely to increase. This is due to a combination of factors, such as population ageing, improved ascertainment and changes to the prevalence of underlying risk factors.

In terms of future need, population projections suggest that across Hampshire over the next 5 years there will be approximately 2,000 more people with a moderate or severe physical disability.

Premature mortality is decreasing. This trend has plateaued in the last few reported time periods. The Hampshire mortality rate from causes considered preventable has continuously decreased over time.

Recommendations

These relate to priorities identified in the chapter.

Reducing the proportion of people with lifestyle risk factors:

1. All agencies should focus on promoting positive health behaviours to support improved health. This can be through implementing Making Every Contact Count across the public and voluntary sectors, integrating a focus on healthy lifestyles into commissioned contracts and taking local action with priority communities
2. Develop a deeper understanding of peoples attitudes, behaviours and self-efficacy in relation to lifestyle risk factors to ensure that services are co-produced to meet the needs of the population. Brief interventions and lifestyle services should be promoted and tailored to the needs of those most at risk in order to ensure success
3. Target interventions to maximise health outcomes. This includes populations which are already at a higher risk of poor health outcomes, such as people living in areas of deprivation and people with mental ill health
4. Reducing smoking in pregnancy will bring a long term benefit to both mother and child and should be a focus for all agencies working with pregnant women

Reducing the impact of the burden of disease:

1. The prevalence of long-term conditions is likely to rise given the ageing population. There is still variation in clinical indicators across primary care. Reducing unwarranted variation should be a focus for primary care commissioners and providers
2. We do not have a complete local understanding of the prevalence of multiple long-term conditions in the population and this impacts on health.  There is a need to quantify this in local geographies to assist health and social care commissioning and provision
3. Maximise the life opportunities of people with disabilities through a strength based approach to care and further develop work to address preventable causes of disability
4. Musculoskeletal conditions are a key issue for the Hampshire population. Whilst the diagnoses are varied, obesity and inactivity are avoidable risk factors that need to be addressed. Ensuring holistic responses to diagnoses is also key
5. Disproportionate premature mortality in people with poor mental health should be addressed through Parity of Esteem work. Reducing unhealthy lifestyles in this population group will have an important impact

Reducing premature and preventable mortality:

1. There should be a relentless focus on reducing the gap in premature mortality between those living in the least and most deprived areas. There is scope to impact on the main causes of premature mortality. The focus should be on identifying those most at risk in the short to medium term and planning interventions to reduce risk factors and optimising long-term condition management

Related Needs Assessments

Oral Health Needs Assessment

This needs assessment presents the oral health needs of Hampshire’s residents to inform the commissioning of oral health services. The report identifies evidence based interventions and provides evidence of unmet need so that we can best target resources to improve oral health.

Oral Health Needs Assessment

Findings from Hampshire's Oral Health Needs Assessment presentation

Hampshire Domestic Abuse Needs Assessment

This needs assessment aims to quantify current need, describe current services, and thereby inform the commissioning of domestic abuse services in Hampshire. The report provides insights into the challenges services will have to address, and also includes feedback received from stakeholders who work in, or refer to, Hampshire victim and perpetrator services, as well as from service users themselves. It has been developed following the recommendations of National Institute for Health and Care Excellence (NICE) Public Health Guideline 50 'Domestic Violence and Abuse: Multi-Agency Working'.

Hampshire Domestic Abuse Needs Assessment

Children affected by Domestic Abuse (Supplement to Domestic Abuse Needs Assessment)

Health Needs Assessment of Adults with Learning Disabilities in Hampshire

Adults with learning disabilities are one of the most vulnerable groups in society and inequalities in care can lead to increased premature deaths and improving the lives of adults with learning disabilities has become a national priority. This health needs assessment brings together a range of intelligence on the health of people with a learning disability and the particular risk factors that they experience. Recommendations are provided to continue improvements and direct focus to the areas of health and care that are needed most for people with learning disabilities. A useful presentation is also included.

Hampshire Learning Disabilities Needs Assessment 2017

Hampshire Health Needs Assessment for Adults with Learning Disabilities - Presentation

Alcohol Needs Assessment

The Alcohol Needs Assessment brings together the latest available data and information in respect of alcohol and the impact of alcohol on a range of cross-cutting issues including health, social and crime implications:

Hampshire Alcohol Needs Assessment