Health in Adult Life
Health in adult life is partly shaped by a healthy start in life. It is also affected by external factors and behaviours. Some external factors, such as housing and employment, are closely linked to inequality and environmental hazards. Their impact can be significant, with the costs to the NHS of poor housing estimated at £1.4bn/year for example, and homeless people typically dying 30 years younger than the general population.
Health is affected by behaviours like smoking, exercise, and social isolation. While these are partly personal choices, they can also be influenced by where and how people live. These behaviours can increase the risk of long-term conditions like cancer and heart disease. Taking steps in adulthood, such as eating a healthier diet, not smoking, drinking less alcohol, being active for at least 150 minutes a week, keeping a healthy weight, and reducing exposure to air pollution through active travel, can help reduce these health risks for both individuals and society.
Exercise
Somerset generally has higher levels of physically active adults than nationally. However, this leaves a significant proportion of physically inactive, whose health is at risk as a result. The lead role in promoting physical activity is taken by the Somerset Activity and Sports Partnership.
Smoking
Smoking tobacco is the biggest risk for cancer, as well as contributing to circulatory and respiratory disease. Rates have fallen steadily, but this remains a priority for action because of the impact it has on those who do smoke. The national charity leading on smoking reduction is Action on Tobacco and Health (ASH).
Key indicator: Smoking Prevalence in Adults in Routine and Manual Occupations (18-64) – current smokers (APS)
Alcohol
Alcohol can contribute to ill health in the short term as increasing the risk of accidents and violence – including domestic abuse, and in the longer term is a risk factor for cancer, liver disease, stroke and heart disease. It can also have social impacts through unemployment and divorce. Consumption rates at a population level in Somerset are broadly similar to the national average. Unlike many behaviour patterns, alcohol consumption does not show a simple economic gradient with more deprived people consuming more, and interventions to reduce it have to take account of this. More information can be found in the OHID Local Alcohol Profile.
Key Indicator: Alcohol Specific Mortality (persons, 1 yr range)
Substance Misuse
Drug-specific hospital admissions in Somerset in 2020-21 were estimated at 64.91 per 100,000 persons, significantly above the England rate of 50.22 per 100,000 for the same period. Latest prevalence estimates indicate there are 2,393 possible dependent opiate/crack users in Somerset, a rate of 7.3 per 1,000. Estimates of unmet need show that Somerset compares poorly for England rates of unmet need, with an estimated 56% of Somerset OCUs not accessing treatment. The proportion of individuals accessing treatment for drug misuse in Somerset who also have a mental health need has increased in recent years. Numbers of treatment episodes for drug use in Somerset have decreased since 2018, driven by falling numbers of treatment episodes for opiates clients. Cannabis is the named substance in 74.5% of all possession offences. More information is available in the Somerset Drugs and Alcohol Needs Assessment 2022.
Key indicator: Hospital Admissions due to Substance Misuse (15-24)
Key indicator: Successful completion of drug treatment (non opiate users)
Diet
A healthy diet, as exemplified by the ‘eatwell guide‘, has a range of components which should be consumed in a reasonable balance over the medium and long term (not necessarily every meal). Eating well, combined with exercise, can help reach and maintain a healthy weight, avoiding the risks associated with obesity. For most people in Somerset, the biggest change to improve the diet is to increase the proportion of fruit and vegetables. The Somerset population generally shows a better diet than the national average, but still only a minority consume the recommended ‘5-a-day’ portions of fruit and vegetables.
Key indicator: Percentage of adults aged 16 and over meeting the ‘5 a day’ fruit and vegetable consumption.
Sexual Health
Health issues related to sexual activity cover a wide range. It can include the transmission of disease such as HIV and syphilis, sexual violence, conception – which can be a matter of concern in girls under 18 years because of the impact on their lives at that age, and abortion.
It is important to teach Relationship, Health, and Sex Education (RHSE) in schools to a high standard, with easy access to services and advice. We should also include sexual and reproductive health advice in Making Every Contact Count (MECC) programmes. Making sure people can get contraception, like Long-Acting Reversible Contraception (LARC), in primary care and maternity services is also essential.
Key indicator: STI testing rate (excluding chlamydia aged under 25) per 100,000
Mental Health
In Somerset, more people are experiencing common mental health issues, which has led to an increase in antidepressant prescriptions and a higher demand for mental health services. Although wellbeing indicators like life satisfaction, happiness, feeling things are worthwhile, and loneliness are generally better in Somerset than the national average, there was a significant drop in happiness between 2020 and 2021 (Office of National Statistics). National data shows that all personal wellbeing measures have worsened since April 2017. The rate of depression in Somerset for 2020/21 is higher than the national and regional averages, placing Somerset in the highest group nationally, and this trend is increasing. Similarly, the number of antidepressant prescriptions is also rising.
Key indicator: Depression QOF Prevalence (18yrs+)
The effect of a death resulting from suicide on family and friends is devastating. Others who knew the person through work or education, or who were involved in providing support and care will feel the impact profoundly. Suicide can be the end point of a complex history of risk factors and distressing events; and action to prevent suicide has to address this.
Key indicator: Suicide rate (persons)
Social isolation and loneliness
In recent years the importance of social isolation as a factor in ill health has become more apparent. It has been suggested that loneliness is as harmful to health as smoking 15 cigarettes a day. Factors affecting loneliness include ill health – which can therefore be both cause and effect, old age and low income. For many, the Covid-19 lockdowns further exacerbated isolation. Modelled data for Somerset show how loneliness appears to be most prevalent in the more deprived urban areas than in the more sparsely populated countryside.
Next page: Ageing Well