Health in Adult Life
Health in adult life is partly derived from 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.
The behaviours affecting health include smoking, exercise and social isolation. These are, of course, partly a matter of choice but a choice that can be constrained by physical, economic and social environment in which people live. These behaviours contribute considerably to the risk of long term conditions such as cancer and circulatory disease, and preventative action in adulthood – a healthier diet, not smoking, reducing alcohol intake, being physically active for at least 150 minutes per week, maintaining a healthy weight and reducing exposure to air pollution through active travel – can help reduce the burden of disease for 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 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.
Prevention across the life course, including working with schools to ensure that statutory RHSE (Relationship, Health and Sex Education) is implemented is fully implemented to a high quality, with links to services and advice available. Sexual and reproductive health advice can also be embedded into Making Every Contact Count (MECC) programmes, and access to contraception – including Long-Acting Reversible Contraception (LARC) – can be prioritized in primary care and maternity services.
Key indicator: STI testing rate (excluding chlamydia aged under 25) per 100,000
Mental Health
In Somerset, the prevalence of common mental disorders is increasing, which is mirrored by an increase in anti-depressant prescriptions and demand for mental health services. Whilst wellbeing indicators are generally better in Somerset than
nationally (life satisfaction, happiness, feeling things are worthwhile, loneliness), there has been a statistically significant decrease in happiness in Somerset between 2020-2021 (ONS). National data sets indicate that there has been a deterioration in
all personal wellbeing measures since April 2017. Depression prevalence (2020/21) is higher in Somerset than nationally and regionally – Somerset is in the highest quintile nationally, with data currently showing an increasing trend. Similarly, the
number of antidepressant prescriptions is also showing an increasing trend.
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