Living Well 2016 to 2020

This section explores the healthy behaviours and lifestyle choices of the population in Hampshire.

The Global Burden of Disease study (2013) found that known risk factors accounted for almost 40% of Disability-Adjusted Life Years (DALY). A DALY is a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability. Poor diet (11%) and tobacco smoke (11%) are the biggest contributors to DALYs, followed by high BMI and high blood pressure.

This chart presents risk factors attributable to DALYs for specific diseases. Risk factors explain 84% of cardiovascular disease DALYs, 47% of neoplasm (Cancer) DALYs, 50% of injury DALYs and 62% of chronic respiratory DALYs.

Disability-adjusted life-years (DALYs) attributed to risk factors in 2013 in England for both males and females combined

The influence of different risk factors varies according to the level of deprivation in an area. Smoking, high BMI and high blood pressure are the leading risks in areas of relative deprivation. In areas of relative affluence high BMI accounts for more risk than smoking.

Smoking is a major cause of preventable ill health and early death. There are around 8 million smokers in England and smoking causes almost 80,000 deaths per year. In Hampshire in 2015, 1806 deaths were due to smoking. Smoking rates across England have fallen since the 1980s, from a third of the population in 1985 to less than a fifth today. There is clear evidence that through reducing smoking prevalence we can improve the overall health and healthy life expectancy of many people.

Smoking is the largest preventable cause of foetal and infant illness and death, and is implicated in placental problems, low birth weight, prematurity, reduced lung function in infancy, and stillbirth.

Treating smoking related diseases is estimated to cost the NHS £2 billion each year. In Hampshire, the cost of smoking to the NHS alone is estimated at £39m a year. In terms of the burden on local healthcare services, in Hampshire smoking results in an extra 186,216 GP consultations, 56,329 practice nurse consultations, 33,259 outpatient visits, 6,106 hospital admissions and 106,052 prescriptions per year.

The National Institute for Health and Care Excellence (NICE)

An estimated 13.6% of Hampshire adults smoke compared to 15.5% in England. The table below shows the prevalence of smoking in adults aged 18 and above for Hampshire and its districts compared to England. Whilst this is lower than the national rate, there is variation in prevalence between areas within Hampshire. Rushmoor, Basingstoke and Deane, Havant and Gosport have higher smoking prevalence rates than Hampshire and England, with Havant the only district where the prevalence is significantly different to England.

A higher proportion of people in lower socio-economic groups smoke. Over one quarter of people in Hampshire in routine or manual occupations smoke. This is comparable to the national prevalence of smoking. Again there is considerable variation across the County. Estimates suggest that almost half (45%) of adult routine and manual workers in Havant are smokers. Smoking is also highly prevalent amongst people with serious mental illness at approximately 40% and makes a significant contribution to their poor physical health and premature mortality.

The rate of smoking at time of delivery (SATOD) in Hampshire is 9.0% (2015/16), which is lower than the national average of 10.6%. Trend analysis suggests there has been an improvement over time with the rate reducing year on year, but this means that just over 1200 babies in 2015/16 were affected. An analysis of individual hospital’s data suggests that higher rates of SATOD correlate with Hampshire areas with the highest rates of smoking.

The Foresight report on obesity identified over 100 determinants working as a complex web to influence either directly or indirectly the energy balance of an individual.

Obesity has become one of the major public health challenges for the 21st century affecting both adults and children. It is estimated that obesity is responsible for more than 6% of deaths each year (30,000 nationally). Obesity is a risk factor for certain cancers, hypertension, type 2 diabetes, musculoskeletal conditions and liver disease. Public Health England states that on average, obesity deprives an individual of an extra nine years of life, preventing many people from reaching retirement age. It is estimated that the NHS in England spent £6.1 billion on overweight and obesity-related ill-health in 2014/15.

Health matters: obesity and the food environment

Overweight children

The Health Survey for England shows that nationally, the prevalence of excess weight in adults (overweight including obesity) rose substantially between 1993 and 2002, since when it has remained relatively stable for both men and women. Trend analysis shows that obesity prevalence continues to rise, but the rate of increase appears to have slowed among men, and shown a small decrease in women. The gap between men and women who are obese has narrowed over time. Obesity increases with age, with the highest prevalence found in the 55-64 years age group for men (35%) and 65-74 years age group for women (34.9%).

The prevalence of overweight and obesity among adults, is measured using the Active People Survey (APS). The rates for Hampshire have been modelled from the survey by Public Health England using a three year average (2013-15)

The analysis shows that two thirds of the Hampshire adult population are overweight or obese - higher (worse) than the England rate (64.8%). Trend data from 2012-14 suggest the proportion of adults with excess weight in Hampshire has remained the same (2013-15).

With regards excess weight, Gosport, East Hampshire, Havant, Eastleigh and Fareham all had rates higher than Hampshire and England. Winchester (60.5%) and Hart (61.7%) have the lowest rates with both being significantly lower than Hampshire and England.

Prevalence of excess weight among adults 2013-15 in Hampshire and its districts

Prevalence of obesity among adults 2013-15 in Hampshire and its districts

In terms of obesity, almost a quarter of adults (24%) in Hampshire are obese compared to an England rate of (24.4%). Gosport (30.1%) and Havant (27.2%) had the highest rates of any district, significantly higher than Hampshire and England. Winchester (18.6%) and Hart (20.7%), Test Valley (21.4%) and East Hampshire (21.4) have had the significantly lower rate than Hampshire and England.

The risk of obesity varies across the population. Women living in more deprived areas are more likely to be obese. A much less consistent pattern is seen in men with smaller differences between deprivation quintiles. Obesity prevalence varies with levels of educational attainment, with those with the lowest level of education having the highest rates of obesity. Obesity prevalence differs by ethnic group and between sexes within ethnic groups. In some ethnic groups (Black African and Pakistani) the prevalence of obesity is higher in women compared to men. Prevalence of obesity is higher among women of Black Caribbean, Black African and Pakistani ethnicities compared to the other ethnic groups.

A series of factsheets with key information and data about obesity and its determinants

A healthy diet is important for obtaining the right nutrients and for maintaining a healthy weight. A healthy diet reduces the risk of obesity, heart disease, bone and joint disorders and some cancers. The new Eatwell Guide launched by Public Health England (PHE) in 2016, recommends that a healthy diet should include more fruit, vegetables and starchy carbohydrates, whilst limiting food and drinks that are high in sugar and saturated fat. This guidance reflects updated dietary recommendations from the Scientific Advisory Committee on Nutrition (SACN) report on Carbohydrates and Health published in 2015.

The Eatwell Guide includes:

• eating at least five portions of a variety of fruit and vegetables every day
• basing meals on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally wholegrain
• having some dairy or dairy alternatives (such as soya drinks) choosing lower fat and lower sugar options
• eating some beans, pulses, fish, eggs, meat and other proteins (including two portions of fish every week, one of which should be oily)
• choosing unsaturated oils and spreads and consuming them in small amounts
• drinking six to eight cups or glasses of fluid a day

Dietary component	Recommendation
Fibre	Consume 30 grams of fibre a day, the same as eating 5 portions of fruit and vegetables, 2 whole-wheat cereal biscuits, 2 thick slices of wholemeal bread and 1 large baked potato with the skin on
Salt	Adults should have less than 6 grams of salt
Saturated fat	Advises no more than 20 grams of saturated fat for women or 30 grams for men a day
Sugar	Limit the consumption of sugar, for example from sugary drinks and confectionery. Everyone over the age of 11 should consume less than 30 grams or 7 cubes of sugar a day
Drinks	Adults should aim to have 6 to 8 glasses of fluids per day ideally from water, lower fat milks, and unsweetened tea or coffee

Whilst local data on healthy eating behaviours is limited, current food patterns in the UK, drawn from the National Diet and Nutrition Survey (NDNS) (NatCen, 2015), suggest that:

• People only consume around 19 grams of fibre per day, less than two thirds of the recommended amount
• Adults have twice as much sugar as is recommended and children have over three times the recommended amount
• Consumption of oily fish was well below the recommended one portion a week for all age groups
• Whilst women aged 19 and above eat the recommended maximum amount of red and processed meat, men aged 19 and above exceeded the recommended amount

Data from the Public Health Outcomes Framework (PHOF) indicate that 58% of adults in Hampshire eat the recommended minimum of five portions of a variety of fruit and vegetables a day, compared to 52.3% of the England population. Hampshire’s most deprived districts, Rushmoor, Gosport and Havant, have low rates of fruit and vegetable consumption when compared to other Hampshire districts, although these rates are not significantly different to the England rate. Rates for Winchester, Eastleigh, New Forest, Hart, East Hampshire and Test Valley are significantly higher (better) than the England average.

A key challenge is capturing information about people who are more likely to have an unhealthy diet – people who live in low income households, people who are homeless, older people, veterans, adults with chronic diseases, those with learning disabilities and those who also have poor mental health. A BMJ article highlights the fact that people in lower socioeconomic groups tend to have diets that provide cheap energy from foods such as meat products, full fat milk, saturated fats, sugars, preserves, potatoes and cereals, whilst being low in vegetables, fruit and wholewheat bread, and this pattern still remains. This type of diet is lower in essential nutrients such as calcium, iron, magnesium, folate and vitamin C than that of the typical diets of people in higher socioeconomic groups. This is one of the factors that contributes to the greater incidence of obesity, heart disease, type two diabetes, stroke, some cancers and premature and low birth weight babies in people in lower socio-economic groups, compared to those from higher socio-economic groups.

Physical inactivity is the fourth leading risk factor for global mortality accounting for 6% of deaths globally. There is a clear causal relationship between the amount of physical activity people do and all-cause mortality. Regular physical activity (for adults this means 30 minutes of at least moderate intensity physical activity on at least 5 days a week) helps to prevent and manage over 20 chronic conditions, including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions. The strength of the relationship between physical activity and health outcomes continues throughout people’s lives, highlighting the potential health gains that could be achieved if more people become more active at any stage of the life course.

While increasing the activity levels of all adults who are not meeting the recommendations is important, targeting those adults who are significantly inactive (i.e. engaging in less than 30 minutes of activity per week) will produce the greatest reduction in chronic disease and overall population impact.

Global Recommendations on Physical Activity for Health

Sporting Future - A New Strategy for an Active Nation

In 2015 it was estimated that 24.7% of adults in Hampshire are physically inactive which is lower (better) than the national figure of 28.7%. Across Hampshire’s districts, Fareham, Gosport, Havant, the New Forest and Rushmoor have the highest proportions of people achieving less than 30 minutes activity per week.

Considering the evidence around inactivity and those most at risk of developing long-term conditions, the gender gap in sport and exercise, the positive effect being active has on long term conditions especially mental health; a number of groups are considered at highest risk from physical inactivity.

These include: early years, children and young people especially girls, inactive adults with particular attention on inactive women, inactive families where the aim is to increase activity levels of the whole family, inactive adults with mental health conditions, inactive adults with learning disabilities, and older people who are at risk of falls.

Alcohol and substance misuse has a significant impact on an individual, a community and a population. Substance misuse and dependency are associated with a range of harms including poor physical and mental health, unemployment, homelessness, family breakdown, criminal activity and worse health and wellbeing of family members and carers.

Alcohol is a leading risk factor for ill-health, early mortality and disability and the fifth leading risk factor for ill-health across all age groups. Excessive alcohol consumption is a prevalent, costly and avoidable source of health and social harm. Much of the health burden from alcohol arises from its contribution to a wide range of common chronic conditions not wholly attributable to alcohol, but impacted by alcohol consumption. Drinking above recommended levels of alcohol increases the risk of coronary heart disease, liver disease and cancer.

Hampshire compares well to national and regional averages for indicators of alcohol-related health and social harm but there are notable exceptions and evidence of increasing health harm. An estimated 26.5% (just over 1 in 4) of Hampshire residents drink above the safe recommended levels for alcohol each week. This represents about 283,000 people across the county. 15.8% of adults reported binge drinking on their heaviest drinking day (women more than 6 units, men more than 8 units).

Alcohol issues affect people across the whole socio-economic spectrum and in all age groups. Levels of increasing and higher risk drinking are evident across the county. Estimated data for Hart, East Hampshire and Winchester show higher increasing and higher risk drinking behaviours in these areas, whilst deaths where alcohol is an attributable cause have higher rates in Rushmoor, Gosport and Havant.

Trend data in Hampshire for alcohol related hospital admissions shows that a historic year on year increase may be levelling off. In 2015/16 there were approximately 6,500 hospital admissions in Hampshire, either as direct result of alcohol or where alcohol was a significant contributing factor. Alcohol-related admissions can be due to regular alcohol use that is above the lower-risk levels and are most likely to involve increasing risk drinkers, higher-risk drinkers, dependent drinkers and binge drinkers.

Alcohol harm is concentrated in the relatively deprived areas of Gosport, Havant and Rushmoor. At a district level Rushmoor’s rate of admissions for alcohol related conditions was significantly worse than Hampshire and comparable to England. Although lower than England, trend data shows an increasing rate of alcohol related hospital admissions in the districts of Eastleigh, Test Valley and Winchester.

The health harms arising from both the use and misuse of substances are wide-ranging and represent a major public health burden. They vary depending on the type of substances and the pattern and context of their use. Drug misuse is a significant cause of premature mortality in the UK. Analysis of the Global Burden of Disease Survey 2013 shows that drug use disorders are now the third ranked cause of death in the 15–49 age group in England.

Estimating the prevalence of drug use and problematic drug use is difficult due to the illegality of possession and supply of illicit drugs and the social stigma attached to drug addiction. Much of the evidence is only available at a national level, therefore may be of limited value when applied locally.

There are multiple factors which may lead to increased risk of substance use. Broadly these are an individual’s personality, social environment, biology and stage of development (age). If an individual has multiple risk factors, their likelihood of drug misuse is increased. Those individuals with more complex needs are more likely to develop dependencies and addiction. Therefore, identification of the risk factors and of those individuals with vulnerabilities that make them more susceptible to substance misuse is key to effectively planning substance misuse services.

The latest results of the Home Office Crime Survey for England and Wales 2015/16 suggest that among people aged 16-59, use of most drugs has continued to decrease and is around the lowest since measurements began in 1996. Whilst 35.0% of adults aged 16 to 59 have taken drugs at some point during their lifetime, around round 1 in 12 (8.4%) adults aged 16 to 59 had taken a drug in the last year. This level of drug use was similar to the 2014/15 survey (8.6%), but is statistically significantly lower than a decade ago (10.5% in the 2005/06 survey). Three percent of all adults aged 16 to 59 were classed as frequent drug users.

Around 1 in 5 (18.0%) young adults aged 16 to 24 had taken a drug in the last year. This proportion is more than double that of the wider age group. This level of drug use was similar to the 2014/15 survey (19.5%), but statistically significantly lower than a decade ago (25.2% in the 2005/06 survey).

Those with dual diagnosis (co-existing mental health and substance use problems) have some of the poorest health, wellbeing and social outcomes, and are often unable to access appropriate care and support.

Emerging themes in the JSNA Demography section highlighted an ageing substance misuse population. This presents challenges for services; older people show complex patterns and combinations of substance misuse. In Hampshire 5% (n = 132) of the clients in treatment were aged 60 years or more. The proportion of older clients is increasing.

Good sexual health is an important aspect of wellbeing and the consequences of poor sexual health can be serious. Sexual health in Hampshire is relatively good with teenage conception, HIV and acute sexually transmitted infections (STI) rates below national and regional averages. Achieving good sexual health requires a positive and respectful approach to sexuality and sexual relationships, in which people are able to enjoy their sexuality, free of coercion, discrimination and violence. Those most at risk of poor sexual health include young people, men who have sex with men and people from certain BME communities.

Left untreated, STIs can lead to a range of complications including infertility, ectopic pregnancy, disability, cancer and premature death. Unintended pregnancies can have a significant impact on both the physical and mental health of women and their children, as well as on their educational outcomes and lifelong social and economic well-being.

Poor sexual health is not evenly distributed within the population. There is a clear association with deprivation and social exclusion and a greater impact on young people, men who have sex with men and certain minority ethnic groups. There is also evidence of clear links between poor sexual health, poor mental health and the use of alcohol and drugs.

Chlamydia is the most commonly diagnosed sexually transmitted infection in the UK and in Hampshire with infection rates being highest in young adults. Other less common infections include syphilis and gonorrhoea.

In 2015, Hampshire’s rate of new STI diagnoses per 100,000 population was significantly lower than the England rate at 423 per 100,000 population compared to 768 per 100,000 population nationally. There is variation across Hampshire with Basingstoke having the highest rate of new STI diagnoses of any district in Hampshire at 708 per 100,000 while Gosport had the lowest at 210 per 100,000. This may reflect underlying differences in the age structure of the population or the way in which services are accessed across the districts. This indicator only includes those patients accessing sexual health services and may not be representative of the general population. This needs further investigation to understand this variation.

The HIV diagnosed prevalence rate per 1000 population aged 15-59 is relatively low at 1.03 per 1,000 in Hampshire in 2015 compared to 2.26 for England and 1.77 for the South East region. However, the number of people diagnosed and living with HIV has continued to increase. There is significant variation between districts with Rushmoor having the highest prevalence of HIV in Hampshire at 2.01 per 1000 persons aged 15-59 while Fareham had the lowest prevalence at 0.59 per 1000.

It is estimated that there are a further 13% of people with HIV who are unaware of their infection and who are yet to be diagnosed. Significant advances in treatment for HIV mean that an increasing proportion of people on treatment are likely to live into old age.

Late diagnosis of HIV (i.e. diagnosis after the point at which HIV starts to have a significant impact on the body) is associated with greater HIV transmission, a poor prognosis and higher health and social care costs. There has been a reduction in the rate of late diagnosis in Hampshire from 53.7% in 2009-11 to 46.9% in 2013-15 but this is still higher than the England rate of 40% in 2013-2015.

Violence damages physical and emotional health and can have long-lasting negative impacts across a wide range of health, social and economic outcomes. It increases individuals’ risks of a broad range of health damaging behaviours, including further violence, and reduces their life prospects in terms of education, employment and social and emotional wellbeing.

There is no single reason to explain why some people or populations are vulnerable to violence. Instead, a wide range of factors relating to individuals, their relationships and the communities and societies in which they live can interact to increase or reduce vulnerability to violence.

The acute consequences of violence include physical and emotional injury, disruption to education, employment and housing, and restrictions to social behaviours.

There is a paucity of local data on the prevalence of violence. The figure below outlines some of the key issues in relation to violence. The accuracy of each of the measures is impacted by recording, hospital attendance or police offences information.

The latest Hampshire and Isle of Wight Constabulary Force Strategic Assessment 2017 reported a 15% increase in serious sexual offences. This trend is also evident at a national level and can be attributed partly to the more accurate recording of offences and an improved public confidence to report offences. However, there has been a 30% decrease in ‘victim based – no formal action’ outcomes. The main driver for this is victim disengagement. Victim disengagement is particularly prevalent for domestic abuse offences and poses the greatest risk to positive outcomes. Over the last three years serious sexual offences have been increasing at a greater rate than violence offences.

Domestic abuse accounts for 13% of all recorded crime in Hampshire; there has been a 15% increase when compared to the previous year's intelligence. Spouse/partner relationships are the most prominent association in domestic abuse offences. The known victim profile for domestic violence is largely female, aged 21-30 years. Hampshire police intelligence suggests there has been an increase in the number of male victims.

A domestic abuse assessment of needs was undertaken to ascertain the prevalence of domestic abuse and the need for support in Hampshire. The challenges of providing a comprehensive picture of the true extent of domestic violence in a geographical area are recognised nationally. In Hampshire an estimated 44,675 females and 25,673 males experience domestic abuse a year.

National trends and academic research suggest that areas with the highest levels of income deprivation and unemployment have the highest level of domestic abuse per population. The distribution of domestic crimes and incidents across Hampshire and the analysis of hotspots supports this finding, and suggests Gosport, Havant and Rushmoor are areas of higher risk for increased domestic abuse.

The five leading causes of life lost in England are ischaemic heart disease, lung cancer, cerebrovascular disease, chronic obstructive pulmonary disease and Alzheimer's disease.

Lower back and neck pain, ischaemic heart disease and stroke make up the highest percentage of DALYs in the South East Region for males and females, all ages. It should be noted that in addition, sensory organ diseases or disabilities consisting of hearing loss and vision loss, and depressive disorders are leading causes of disability, although they do not have substantial years of life lost (YLL) associated with them.

Local data on the burden of ill health is not readily available, however, GP practice registers for specific conditions can be used as a proxy for ill health in a community. The Quality and Outcomes Framework (QOF) data provide information about the number of people who are registered with a GP and are on a disease register. The latest disease prevalence data available cover 2015/16. It is not possible to disaggregate how many people have more than one condition from this data source.

The highest prevalence rates are for Hypertension (14.5%), Depression (9%), Asthma (6.1%) and diabetes (6%).

QOF (Quality and Outcomes Framework)recorded Disease Prevalence, 2015/16
(Source https://digital.nhs.uk/)

Disease	Number on register	Hampshire Prevalence (%)	England Prevalence (%)
Dementia	12,047	0.9	0.8
Depression	98,336	9.0	8.3
Epilepsy	8,416	0.8	0.8
Mental Health	10,288	0.8	0.9
Atrial Fibrillation	27,565	2.0	1.7
Coronary Heart Disease	43,667	3.2	3.2
Heart Failure	9,732	0.7	0.8
Hypertension	198,329	14.5	13.8
Stroke and Transient Ischaemic Attack	25,955	1.9	1.7
Asthma	83,812	6.1	5.9
Chronic Obstructive Pulmonary Disease	22,563	1.6	1.9
Cancer	39,361	2.9	2.4
Chronic Kidney Disease (18yrs+)	40,918	3.7	4.1
Diabetes Mellitus (17yrs+)	66,093	6.0	6.5
Rheumatoid Arthritis (16yrs+)	8,014	0.7	0.7

Physically disabled people still face social, environmental and attitudinal barriers, which can restrict their participation in society. Policies that increase independence and enablement are important in supporting good outcomes amongst this group of people. Independent living is about ensuring rights and entitlements are addressed so that people with physical disabilities can enjoy the same freedoms and lead the lives they wish.

The relationship between physical disability and other health determinants is well understood from national data, however, there is a paucity of local data. The information on visual and physical disabilities available locally mainly relates to older people.

In the Census (2011), 6.7% of the Hampshire population (almost 88,000 people) reported having a long term illness or disability that limited their day to day activities a lot. This is slightly lower than England at 8%. A further 9% of the population (119,500 people) reported their illness or disability limited their day to day activities a little, which is comparable to England.

In terms of future need, population modelling suggests that across Hampshire over the next 5 years there will be a 2.4% increase in the number of people aged 18-64 years with a moderate physical disability (an increase of 1,515 people) and a 3.3% increase in the number of people with a severe physical disability (an increase of 636 people)

Personal Independence Payment (PIP) helps with some of the extra costs incurred due to long-term disability, ill-health or terminal ill-health.  From 8th April 2013 the Department of Work and Pensions (DWP) started to replace Disability Living Allowance (DLA) for working age people with Personal Independence Payment (PIP). This is a gradual process and as a result there are a substantial number of residents still in receipt of DLA. The latest data reported show 40,029 people in Hampshire are in receipt of DLA (August 2016). These data give an indication of morbidity in the population but should be treated with caution as the switch from DLA to PIP continues to progress. The experimental badging was only recently removed from PIP statistics and this indicates that methodologies and definitions are still being developing for this data collection.

As at February 2017 there were 17,252 Hampshire residents receiving PIP; this equates to a crude rate of 15 people per 1,000 population aged 16 years and over. At a district level Gosport and Havant had the highest crude rate of people claiming PIP at 23 and 22 per 1000 population respectively. Just over half, 56%, of the PIP recipients were female.

The chart shows the disability category by clinical code for all PIP claims in payment. Almost two thirds of all recipients in Hampshire were claiming PIP as a result of a mental and behavioural condition ( 33%) or a musculoskeletal system condition ( 30%). It should be noted that these figures are based on a primary disabling condition as recorded on the PIP computer system. Claimants may often have multiple disabling conditions upon which the assessment is based but only the primary condition will be reflected in the these statistics.

Modelling the data to cover the whole Hampshire population equates to a total of 53,195 Hampshire residents with a disability or condition that qualifies them for financial help. This would equate to a crude rate of 46 people per 1,000 population aged 16 years and over who are in receipt of benefit due to a disability or condition.

The JSNA ageing well section reports how sight loss is one of the leading causes of disability for the older population, however, registered sight loss is significantly higher in Hampshire than in the rest of the country and affects people of all ages. Sight loss can have a profound effect on access to services.

An estimated 3.6% (48,620 people) of the total population of Hampshire are living with sight loss, compared to 3.1% across England. Projected estimates suggest that by 2030 this number will have increased by 44.7% equating to 70,350 people. Sight loss affects people of all ages, estimated numbers of working age in Hampshire is presented in the table.

Estimated number of people in Hampshire blind and partially sighted

Cohort	Estimated number of people in Hampshire
Working Age	One in four blind and partially sighted people of working age are in employment. 8,962 people of working age are living with some degree of sight loss 1,215 people of working age are registered as blind or partially sighted

Data source: RNIB, 2016

People living with sight loss are likely to be more adversely affected by the challenges and costs of their condition in areas of deprivation or where transport and mobility is more of an issue, (see JSNA Demography section). 85% of Hampshire is defined as rural .

Estimated and predicted number of people in Hampshire with sight threatening eye conditions that are more likely to impact on working age people

Condition	Estimated current number of people In Hampshire (2016)	Predicted % increase in Hampshire (2030)
Glaucoma	13,420 people living with glaucoma	11% increase in glaucoma, compared to 14% nationally
Diabetic Retinopathy	91,610 people are estimated to be living with diabetes putting them at risk of diabetic retinopathy. Three quarters of diabetic patients attend their annual retinal screening appointment 27,070 people are living with diabetic retinopathy 2,490 living with severe diabetic retinopathy	17% increase in the estimated number of adults living with diabetes, compared to 18% nationally 9% increase in diabetic retinopathy, compared to 11% nationally 9% increase in severe diabetic retinopathy, compared to 11% nationally

Data source: RNIB, 2016

People with more severe learning disabilities (LD) have poorer health outcomes than the general population. Currently there are very few indicators for this population that can help us understand whether their health is improving. It is important that health information for people with learning disabilities is recorded so that future need can be better understood.

Information on the prevalence of LD comes from a range of sources, which are not consistently robust. Recorded prevalence is sourced from the general practice learning disabilities register. In 2015/16 there were 5,053 people on a practice learning disability register. This equates to a prevalence of 0.4% which is lower than the national prevalence of 0.5%.

Source based on Emerson,E and Hatton,C.  Estimating Future Need/Demand for Supports for Adults with Learning Disabilities in England. Institute for Health Research, Lancaster University: Lancaster, 2004.

People with all levels of learning disability in the UK die younger than the general population. The all cause mortality rates for people with moderate to severe LD are 3 times higher than in the general population. The median age at death for people living with learning disabilities in Hampshire is 57.5 years, compared to 55 years for England. There is some evidence that life expectancy for some people with LD, in particular those with Down’s syndrome and mild LD, are increasing.

A report by the IHAL (Improving Health and Lives) Observatory identified two potentially preventable causes of mortality that were associated with large numbers of deaths across all people with a learning disability. These are lung problems caused by solids or liquids going down the wrong way (aspiration pneumonia), accounting for 14% of deaths and epilepsy or convulsions, accounting for 13% of deaths in people with a learning disability.

One in four adults experience mental ill health at any one time and people with mental ill health are twice as likely to have serious physical illnesses. Mental ill health includes common conditions such as depression and serious mental illness such as schizophrenia.

Data about common mental health disorders, such as depression or anxiety, for Hampshire are taken from the self-reported GP survey. The survey found that 10.4% of people in Hampshire reported having anxiety or depression. Serious mental health such as schizophrenia data show that in Hampshire, 10,339 (2015/16 QOF data) people are registered as having a serious mental illness.

Reducing risk factors for the causes and triggers of poor mental health can reduce the potential for mental ill health to develop, become long term in nature, or become more severe. Risk factors which are known to affect mental wellbeing include socioeconomic deprivation; low educational attainment or disengagement with education, domestic abuse, higher risk drinking, poor access to green space, long term disability, insecure or unstable housing and unemployment (particularly long term).

People with a serious mental illness are disproportionately overweight, more likely to be smokers, and have higher rates of alcohol or substance misuse, which contribute to their risk of dying younger than we would expect.

Over 80 percent of people with serious mental illnesses are overweight or obese.

From national data we know 33% of people with a mental health problem smoke. A PHE and NHS England survey found that smoking rates among service users in mental health units is even higher at 70%.

It is hard to disentangle the complexity of the impact of homelessness and unemployment on mental health. For every 100 adults on the care programme approach (for people with serious mental health issues) only 27.6 are in stable accommodation, and 5.7 are in employment.

A dual diagnosis of alcohol and drug misuse alongside mental health problems is common. Up to 70% of people in drug services and 86% of alcohol services users experience mental health problems.

There were 36,164 deaths in Hampshire during the three year period 2012-14, equivalent to a mortality rate of 869.7 per 100,000 persons. Hampshire has a significantly lower mortality rate than England and the South East, and trend data shows the rate is decreasing. In the ten years since 2004 Hampshire has seen a 19% reduction in its mortality rate, comparable to 18% seen nationally. Males have a higher mortality rate than females. In 2012-14 the rate for males was 1015.7 compared to 758.4 per 100,000 for females.

During 2016 12,480 residents of Hampshire died. The bubble diagram presents the number of deaths by underlying cause. There were 3,505 deaths due to cancer - almost one third (28%) of the total deaths in 2016. The largest number of cancer deaths were lung cancer (n=637). One quarter of the deaths were due to diseases of the circulatory system; 40% (n= 1258) of these were ischaemic heart diseases which includes angina and myocardial infarction (heart attacks).

Just over one in ten deaths (12%) were due to diseases of the respiratory system; 38% (n=598) of these deaths were as a result of pneumonia and 35% (n=550) were from other chronic obstructive pulmonary diseases which includes chronic bronchitis and chronic asthma (obstructive). Mental and behavioural disorders were coded as the underlying cause of death in one in ten (10%) of all Hampshire resident deaths in 2016. The majority (98%, n=1242) were from dementia. Vascular dementia accounted for 446 of these deaths and unspecified dementia was coded in 796 deaths.

Deaths before the age of 75 years are considered premature. There were 3,354 premature deaths, accounting for 27% of all deaths in 2016. Almost half of premature deaths (45%, n= 1,513) were due to cancer and over one fifth (22%, n= 724) were circulatory diseases (NHS Digital - Primary Care Mortality Database).

Males have a higher premature mortality rate than females. In 2012-14 the Hampshire rate for males was 335.3 compared to 228.9 per 100,000 for females. Premature mortality is decreasing, however, this trend has plateaued in the last few reported time periods. The trend is not consistent across the county; people living in the most deprived parts of Hampshire are still more likely to die before they reach the age of 75. Gosport has significantly higher all age and premature mortality rates when compared to the national and regional rates.

Public Health England’s Longer Lives tool presents premature mortality data for the three year period 2013 to 2015. Here are Hampshire premature deaths by condition and the relative rank out of the 150 authorities nationally. The data show that premature mortality outcomes in Hampshire are ranked the best in England (depicted by the colour key) for all conditions reported except breast cancer where the county is ‘better than average’

Hampshire's rank within the 150 local authorities in England

A death that is considered amenable or preventable to health care is one which was from causes considered potentially avoidable through timely and effective healthcare or public health interventions. During the three year period 2013 to 2015 there were 6,171 deaths in Hampshire which were considered preventable. The Hampshire mortality rate from causes considered preventable has continuously decreased over time and is consistently lower than the national and regional rates.

Nationally more than one quarter of premature deaths in men and 18% of premature deaths in women were from cardiovascular disease (CVD). Although the death rate from CVD in Hampshire is significantly lower than the England average, there are significant differences in the mortality rates between districts. The geographical variation reflects the correlation between deprivation and premature mortality.

Under 75 Mortality rate from Cardiovascular disease considered preventable 2013-2015 Directly Standardised Rate per 100,000- Persons

Deaths from drug misuse substantially increased in England in 2013 and 2014, with a 42% total increase in these two years. Hampshire has a similar rate of deaths from drug misuse to England, 3.4 per 100,000 of the population compared to 3.8 respectively. Hampshire ranks 10 out of 16 when compared to its nearest statistical neighbours, local authorities found to be ‘most similar’ to Hampshire using modelled measures created by the Chartered Institute of Public Finance and Accounting (CIPFA) These are based on a selection of demographic and socioeconomic variables.

Premature mortality in people with a severe mental illness (SMI) is much higher than the general population. The premature mortality rate for people with SMI in Hampshire is over four times as high ( 1,410 per 100,000 population) as that of the general population ( 280 per 100,000).

Suicide rates in Hampshire 2012-2014 are similar to the England rate. The rate in Hampshire was 8.2 per 100,000 population (England 8.9). Looking at gender specific rates there is a marked difference, with the rate in males being much higher than in females (12.4 per 100,000 population (England 14.1) compared to 4.3 per 100,000 population (England 4.0) - Source: PHOF). In Hampshire the suicide rates for women are slightly higher than the England rates.