Health Survey for England 2018 [NS]

Background

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. Obesity is associated with an increased risk of a number of common causes of disease and death including diabetes, cardiovascular disease and some cancers. For individuals classified as obese, the risk of poor health increases sharply with increasing body mass index (BMI).

Successive governments have introduced a number of initiatives to tackle obesity in England.

The prevalence of overweight and obesity is indicated by body mass index (BMI) as a measure of general obesity, and/or waist circumference as a measure of abdominal obesity.

Waist circumference is measured, and categorised into desirable, high and very high, by sex-specific thresholds:

BMI, defined as weight in kilograms divided by the square of the height in metres (kg/m2) was calculated in order to group people into the following categories:

Overweight and obesity in adults

Prevalence of overweight and obesity in adults

In 2018, 63% of adults were classified as overweight or obese; 67% of men and 60% of women.

Obesity was more common in women than men; 26% of men and 29% of women were classified as obese. Being overweight but not obese was more common among men than women.

Adult obesity and waist circumference, by deprivation level

Deprivation level is based on Index of Multiple Deprivation (IMD) quintiles. For further information see section 8.7 of the HSE Methods report.

Obesity varied by area deprivation, with those in the most deprived areas having the highest mean BMI and highest prevalence of obesity. 35% of men and 37% of women living in the most deprived areas were obese compared with 20% of men and 21% of women in the least deprived areas.

Waist circumference was also associated with area deprivation, with the highest likelihood of very high waist circumference in the most deprived areas; 38% of men and 59% of women, compared with 29% of men and 40% of women in the least deprived areas.

2% of men and 4% of women were morbidly obese ('morbidly obese' are also included in the 'obese' figures).

Weight-related health risk in adults

More than half of adults (56%) were at increased, high or very high risk of chronic disease due to their waist circumference and BMI. 

Women were more likely than men to be in the high or very high risk categories (46% and 35% respectively). The proportion generally increased with age.

See the topic report on ‘Overweight and obesity in adults and children’ for information on how participants were assigned to a health risk category.

Overweight and obesity in children (aged 2 to 15)

Estimates of child overweight and obesity are based on data from the 2017 and 2018 surveys combined (unless otherwise stated).

Prevalence of overweight and obesity in children

28% of children aged 2 to 15 were overweight or obese; 31% of boys and 27% of girls.

17% of boys and 15% of girls were classed as obese.

The prevalence of child overweight and obesity increased with age. 4% of boys and 9% of girls aged 2 to 4 were obese compared with 22% of boys and 21% of girls aged 13 to 15.

Prevalence of overweight and obesity in children by parental weight

Children’s BMI status was associated with that of their parents, for both boys and girls.

26% of children of obese mothers were themselves obese, compared with 16% of children whose mothers were overweight but not obese, and 7% of children whose mothers were neither overweight nor obese.

22% of children of obese fathers were themselves obese, compared with 14% of children whose fathers were overweight but not obese, and 9% of children whose fathers were neither overweight nor obese.

Background

The protective health benefits of a diet rich in fruit and vegetables have been long recognised for both adults and children.

The 5 A DAY guidelines (see NHS Choices: 5 a day guide) were developed based on the recommendation from the World Health Organization that consuming 400g fruit and vegetables a day can reduce risks of chronic diseases, e.g. heart disease, stroke, and some cancers.

These guidelines state that everyone should eat at least five portions of a variety of fruit and vegetables every day. Advice on child portion size varies with age, body size and levels of physical activity. HSE questions are based on an 80g portion size for all age groups.

Questions about fruit and vegetable consumption were first included in the HSE in 2001.

Findings are taken from both the 'Adult's health related behaviours' and the 'Children’s health' topic reports.

Consumption of 5 or more portions a day among adults

In 2018, 28% of adults were eating the recommended five portions of fruit and vegetables a day, with fewer men than women having done so.

Since 2008, the figures for men have remained stable at around 24-26%. For women, the proportion declined to 30% in 2018.

Consumption of 5 or more portions a day among children

In 2018, 18% of children aged between 5 and 15 ate the recommended five or more portions of fruit and vegetables a day.

Since 2007, the prevalence of eating five or more portions has varied between 16% and 23% with no clear trend.

Background

The World Health Organization Report on the Global Tobacco Epidemic 2017 stated that tobacco use remains the leading cause of preventable illness and premature death in England and worldwide.

World Health Organization, Switzerland, 2017

Tobacco use contributed to around 20% of deaths in men and 12% of deaths in women aged over 35 in England in 2017.

NHS Digital, Statistics on Smoking, 2019

In 2017, the government published Towards a smoke-free generation: a tobacco control plan. This set out a five-year plan to reduce the harms of smoking, and aims by the end of 2022 to reduce the proportion of adults smoking to 12% or less, and to reduce the prevalence of 15 year olds who regularly smoke from 8% to 3% or less.

Department of Health, 2017. Towards a Smokefree Generation - A Tobacco Control Plan for England

In 2013, all adults were for the first time in HSE asked questions on their use of electronic cigarettes. There is a consensus that e-cigarettes are safer than tobacco cigarettes, since e-cigarettes contain no tobacco and thus no tar, with some estimating them to be around 95% safer, although the longer term effects of e-cigarettes have not been established.

Public Health England. E-cigarettes: an evidence update, 2015

Findings in this section are taken from both the 'Adult's health related behaviours' and the 'Children’s health' topic reports.

Smoking among adults

Prevalence of smoking among adults

Current smoking among adults has steadily declined from 27% in 1993 to 17% in 2018.

The proportion of adults that have never regularly smoked cigarettes increased from 46% to 58% over the same period.

Use of e-cigarettes (vaping) among adults

6% of all adults were current users of e-cigarettes; 8% of men and 5% of women.

18% of current cigarette smokers were current e-cigarette users, and 36% had never used e-cigarettes. Nearly all (95%) of adults that have never regularly smoked cigarettes have also never used e-cigarettes.

Smoking among children (aged 8 to 15)

Whether children have ever smoked a cigarette

The proportion of children aged 8 to 15 who had ever smoked has decreased, from 19% in 1997 to 4% in 2018.

In 2018, 9% of children aged 13 to 15 had ever tried smoking, compared to 1% of those aged 11 to 12 and 0.1% of those aged 8 to 10.

Use of e-cigarettes (vaping) among children

Estimates of e-cigarette use in children are based on data from 2017 and 2018 combined.

7% of 8 to 15 year olds had used an e-cigarette.

This increased with age, from less than 1% of 8 to 10 year olds to 2% of 11 to 12 year olds and 15% of 13 to 15 year olds.

Background

Alcohol has been identified as a causal factor in many medical conditions, including cancers, cirrhosis of the liver, high blood pressure and depression. Additionally, alcohol increases the risk of accidents, violence and injuries. There is interest and concern about the impact of alcohol consumption among policy makers, health professionals and the general public.

In 2017/18 there were 337,870 estimated admissions where the main reason for admission to hospital was attributable to alcohol, with men more likely than women to be admitted for these reasons.

NHS Digital. Statistics on alcohol, England 2019

The Chief Medical Officer’s guidelines about drinking are that:

• men and women should not regularly drink more than 14 units a week. This level is considered to be ‘low risk’.
• Increased risk is drinking: over 14 units and up to 50 units a week for men, over 14 units and up to 35 units a week for women.
• Higher risk drinkers are: men who drink more than 50 units a week, and women who drink more than 35 units a week.

UK Chief Medical Officers’ Low Risk Drinking Guidelines, 2016

The Chief Medical Officer’s guidance on consumption of alcohol by children and young people is that alcohol consumption during any stage of childhood can have a detrimental effect on development, and young people may have a greater vulnerability than adults to the harmful effects of alcohol use. An alcohol-free childhood is the healthiest and best option, and children under 15 should not drink alcohol at all.

Department of Health. Guidance on the consumption of alcohol by children and young people. A report by the Chief Medical Officer, 2009

Findings in this part are taken from both the 'Adult's health related behaviours', and the 'Children’s health' topic reports.

Alcohol consumption among adults

Data in this section is based on typical weekly alcohol consumption across the year.

Adults who drink at increasing or higher risk levels

A higher proportion of men than women drank at increasing or higher risk levels (that is over 14 units in a usual week); 30% of men and 14% of women. 5% of men drank over 50 units and 3% of women drank over 35 units (higher risk levels) in a usual week.

Drinking at increasing or higher risk was most common among those aged 55 to 64.

Adults who drink at increasing or higher risk levels by deprivation level

Deprivation level is based on Index of Multiple Deprivation (IMD) quintiles. For further information see section 8.7 of the HSE Methods report.

Adults in the least deprived areas were more likely to drink at increasing or higher risk levels (27%) than those in the most deprived areas (18%).

Alcohol consumption among children (aged 8 to 15)

Whether children have ever had an alcoholic drink

The proportion of children aged 8 to 15 reporting ever having had a proper alcoholic drink - a whole drink, not just a sip - fell from 45% in 2003 to 14% in 2018.

The proportion increased with age. Only small proportions of younger children had tried drinking: 3% aged 8 to 10 and 6% aged 11 to 12, compared with 31% aged 13 to 15.

Whether children have ever had an alcoholic drink, by parental weekly alcohol consumption

A higher proportion of children had ever had a proper alcoholic drink if their mother or father drank alcohol at an increased or higher risk level (over 14 units a week) compared to those where their parents did not drink alcohol.

Children whose mother consumed alcohol at an increased or higher risk were over three times as likely to have consumed alcohol themselves than if their mother had not drunk any alcohol in the last 12 months (25% and 7% respectively). 

Similarly, children whose father consumed alcohol at an increased or higher risk level were four times as likely (20%) to have tried alcohol than if he had not drunk any alcohol in the last 12 months (5%).

Background

The current UK guidelines for physical activity recommend that adults aged 19 years and over should undertake a minimum of 150 minutes (2 ½ hours) of moderate intensity activity per week in bouts of 10 minutes or more. One way to approach this is to achieve 30 minutes of moderate intensity activity on at least five days a week. Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week, or combinations of moderate and vigorous intensity activity. 

HSE defines activity levels based on reported moderate or vigorous physical activity (MVPA). Respondents reporting below 30 minutes MVPA per week have been defined as “inactive”

The full summary activity level classification table, along with further background information and analysis, can be found in the physical activity section of the ‘Adult's health related behaviours’ topic report.

Adult physical activity

In 2018, 27% of adults reported less than 30 minutes of moderate or vigorous physical activity (MVPA) per week and were classified as ‘Inactive’. Overall, inactivity levels were similar for both men and women, with 26% and 27% respectively.

Inactivity levels tended to increase with age, especially for men. 18% of men aged 16 to 24 were classified as inactive, compared to 45% of men aged 75+.

Background

This part examines self-reported longstanding conditions among adults and children in England, using data from the 2017 and 2018 surveys.

These are conditions which affect the body or mind, lasting 12 months or more, some of which can be managed but not cured, and which are therefore likely to affect people for the rest of their lives.

Participants were asked this question: ‘Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more?’. Those who reported that they had such a condition, were further asked ‘What is the matter with you?’, and their answers for up to six conditions were recorded verbatim. These were coded into 42 conditions which were further grouped into the 14 chapter categories of the ICD-10, the 10th iteration of the International Classification of Diseases, covering infectious and non-communicable diseases of the body and mind.

ICD10: 10th revision of the International Statistical Classification of Diseases and Related Health Problems

For a full list of the condition categories used, see the ‘Longstanding conditions’ topic report.

Longstanding conditions in adults

Prevalence of one or more longstanding conditions in adults

43% of adults had at least one longstanding condition; 40% of males and 45% of females.

The proportion increased with age from 25% of 16 to 24 year olds, to 74% of those aged 85 and over.

Prevalence of longstanding conditions in adults by type

The most common types were conditions of the musculoskeletal system (17%), conditions of the heart and circulatory system (11%), mental, behavioural and neurodevelopmental conditions (9%), diabetes and other endocrine and metabolic conditions (8%), and conditions of the respiratory system (8%).

Only the most common conditions are shown below. Participants could state more than one condition.

Prevalence for most types of conditions increases with age, the main exception being mental, behavioural and neurodevelopmental conditions which decreased with age.

Longstanding conditions in children (aged 0 to 15)

Prevalence of one or more longstanding conditions in children

16% of children had one or more longstanding condition; 18% of boys and 13% of girls.

The proportion increased with age, from 7% of infants (aged 0 to 1) to 20% aged 10 to 15.

Prevalence of longstanding conditions in children by type

The most common types were respiratory conditions (5%), and mental, behavioural and neurodevelopmental conditions (4%).

Only the most common conditions are shown below. Participants could state more than one condition.

Prevalence of mental, behavioural and neurodevelopmental conditions increased from less than 1% of infants to 7% of those aged 10 to 15, and respiratory conditions increased from 1% to 6% across the same age groups.

Background

Self-reported health status was measured using the standardised instrument EQ-5D. The descriptive system used consists of five dimensions: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. For each dimension, participants are asked to rate their health state ‘today’ according to the following scale:

1. having no problems;
2. having slight problems;
3. having moderate problems;
4. having severe problems; or
5. having extreme problems (pain or discomfort, anxiety or depression), or being unable to perform activities such as walking about (mobility), wash or dress themselves (self-care), and do usual activities.

Diabetes is characterised by high blood glucose levels (hyperglycaemia). Untreated, hyperglycaemia is associated with damage and possible failure of many organs, especially the eyes, kidneys, nerves, heart, and blood vessels. HSE measures diabetes in two ways; The prevalence of self-reported doctor-diagnosed diabetes, and additionally, glycated haemoglobin  (HbA1c) levels are measured in blood samples collected at the nurse visit. Raised levels HbA1c 48mmol/mol or above are diagnostic of diabetes.

High cholesterol is considered one of the risk factors for cardiovascular diseases, including narrowing of the arteries (atherosclerosis), heart attack, and stroke. Cholesterol levels were measured via blood samples taken at the nurse visit. Raised total cholesterol is defined as total cholesterol equal to or greater than 5mmol/L.

Hypertension (high blood pressure) is an important public health challenge worldwide because of its high prevalence and the associated increase in risk of other diseases. It is defined as a systolic blood pressure (SBP) at or above 140mmHg, or diastolic blood pressure (DBP) at or above 90mmHg, or on medication prescribed for high blood pressure.

Adult self reported health status

Adults with no health problems

Health problems were those as self-reported through the EQ-5D questionnaire.

41% of adults reported no health problems across any of the five dimensions. More men than women reported no health problems (44% of men and 39% of women).

The proportion decreased with age from 56% of men and 48% of women aged 16 to 24, to 22% of men and 19% of women aged 75 and over.

Prevalence of health problems in adults by type

Problems were most commonly reported for pain or discomfort (44% of men, 48% of women), and anxiety or depression (30% of men, 35% of women). Problems were more prevalent in women than in men across all domains except for self-care.

Diabetes in adults

Prevalence of doctor diagnosed diabetes in adults

The proportion of adults with doctor-diagnosed diabetes increased between 1994 and 2018, with some year-on-year fluctuation; from 3% to 8% among men, and from 2% to 6% among women.

Prevalence of total diabetes in adults

Total diabetes comprises those with doctor diagnosed diabetes and those with an HbA1c level of 48mmol/mol or above who did not report having doctor-diagnosed diabetes.  

In 2018, total diabetes prevalence was 8%. This comprised 6% with doctor-diagnosed diabetes and a further 2% with undiagnosed diabetes. More men (9%) than women (7%) had total diabetes.

There has been no significant variation in prevalence since 2011.

Raised cholesterol and hypertension in adults

Prevalence of raised total cholesterol in adults

In 2018, the prevalence of raised total cholesterol was 47%.

From 1998 to 2018 there has been a decline in the proportion of adults with raised total cholesterol from 66% to 44% among men, and from 67% to 49% among women.

Prevalence of hypertension in adults

In 2018, the prevalence of hypertension was 30% in men, and 26% in women.

Compared to 2003, untreated hypertension has fallen for both men (20% to 13%) and women (16% to 10%).

Background

Asthma is a common long-term respiratory disease that can affect people of any age. Symptoms, which are often worse at night or in the early morning, include wheezing, cough, chest tightness, and shortness of breath.

Asthma can be mild: some people seldom have any asthma symptoms except when they have a cold or during their ‘hay fever’ season, when they are exposed to a particular pollen to which they are allergic. However, asthma can be fatal. In the three years 2015-17, there were 3,625 deaths in England from asthma.

NHS Digital. Compendium – Mortality from respiratory disease, 2019

Self-reported diagnosed asthma is used for this report. Participants (or their parents/guardians) were asked if they had ever been told by a doctor or nurse that they had asthma.

Participants with diagnosed asthma were also asked if they had any symptoms of asthma in the last 12 months, or whether their symptoms were controlled by medication. Current asthma was ascribed to participants who reported any symptoms of asthma in the last 12 months, or who were taking medication to control symptoms in the last 12 months.

Participants were classified as having controlled asthma if they reported being diagnosed with asthma and their asthma symptoms had been controlled by medication in the last 12 months.  Participants with diagnosed asthma who reported symptoms of asthma in the last 12 months were defined as having uncontrolled asthma.

Asthma in adults

Prevalence of diagnosed asthma in adults

In 2018, 17% of men and 18% of women had ever had asthma diagnosed. A higher proportion of younger people reported diagnosed asthma (21% of adults aged 25 to 34) than those in older age groups (13% of adults aged 75 and over).

Prevalence of current asthma in adults

More women than men had current asthma (11% and 9% respectively). This includes 8% of women and 5% of men who reported uncontrolled asthma, and 4% of women and 3% of men who reported controlled asthma.

Asthma among children (aged 0 to 15)

Prevalence of diagnosed asthma in children

More boys than girls had diagnosed asthma; 12% of boys compared to 7% of girls.

The proportions of children with diagnosed asthma fell 10 percentage points from 20% in 2001-02 to 10% in 2018.

Prevalence of current asthma in children

8% of boys and 4% of girls had current asthma.

It was more likely in older children; 10% of children aged 10 to 12 and 8% of children aged 13 to 15, compared with 5% of children aged 0 to 9 (a similar pattern was observed for diagnosed asthma).

Background

The social care report examines need for social care among adults aged 65 and over in England in 2018 and the extent to which these older adults receive the support they need.

Questions on social care have been asked in the survey since 2011. The need for and receipt of social care among older people is measured using a number of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

ADLs are activities relating to personal care and mobility about the home that are basic to daily living. IADLs are activities which, while not fundamental to functioning, are important aspects of living independently.

ADLs

• Having a bath or shower
• Using the toilet
• Getting up and down stairs
• Getting around indoors
• Dressing or undressing
• Getting in and out of bed
• Washing face and hands
• Eating, including cutting up food
• Taking medicine

IADLs

• Doing routine housework or laundry
• Shopping for food
• Getting out of the house
• Doing paperwork or paying bills

If participants indicated that they needed help for any ADL or IADL, they were then asked whether they had received any help in the last month. Unmet need has been identified where participants indicated that they needed help with a particular ADL or IADL but had not received any help with it in the last month. For further information please refer to the 'Social care for older adults' topic report.

Need for help

Older adults with need for help in last month

27% of older adults needed help with at least one ADL in the last month; 22% of men and 31% of women.

Similarly, 26% needed help with at least one IADL in the last month; 20% of men and 32% of women.

Need for help increased with age for both ADLs and IADLs.

Older adults with need for help in last month by deprivation level

Deprivation level is based on Index of Multiple Deprivation (IMD) quintiles. For further information see section 8.7 of the HSE Methods report.

More than half of women needed help with ADLs in the most deprived areas, compared with 26% in the least deprived areas. For men, more than a third needed help with ADLs in the most deprived areas, compared with 15% in the least deprived areas. The pattern was similar for IADLs.

Unmet need for help

Older adults with unmet need for help in last month

24% of adults had some unmet need for help with ADLs. Unmet need for help with IADLs was lower at 13%.

Unmet need for help was higher among women than men; 28% of women and 19% of men had some unmet need with at least one ADL, whilst 15% and 12% respectively had some unmet need with at least one IADL.

Unmet need for care increased with age for both ADLs and IADLs.

Older adults with unmet need for help in last month by deprivation level

Deprivation level is based on Index of Multiple Deprivation (IMD) quintiles. For further information see section 8.7 of the HSE Methods report.

Unmet need for ADLs in both men (32%) and women (48%) in the most deprived areas was at least double that of men (12%) and women (24%) in the least deprived areas. There was a similar pattern for IADLs.

Background

For all gambling activities, participation was defined as having ‘spent money’ on the activity over the past year. Adults aged 16 and over were shown a list of gambling activities and were asked to think about any gambling they had done over the past 12 months. The activities included in the list were intended to cover all types of gambling available. However, to allow for the possibility that an activity was missed or that participants may have misunderstood an activity description, an option was provided for participants to mention another form of gambling.

Prevalence of problem gambling among adults aged 16 and over was also assessed. ‘Problem gambling’ is typically defined as gambling to a degree that compromises, disrupts or damages family, personal or recreational pursuits. Findings on problem gambling are not included in this summary but details of the assessment methods and outcomes can be found in the ‘Adult's health related behaviours’ topic report and accompanying Excel data tables.

Gambling activity

Participation in gambling activities in the last 12 months

In 2018, 54% of adults had participated in some form of gambling activity (including National Lottery) during the previous 12 months. This proportion falls to 40% when gambling on the National Lottery is excluded.

For gambling excluding the National Lottery, participation was most likely among the 25 to 34 age group (49%), and then declining with age.

Participation in online gambling in the last 12 months

Online gambling excludes the national lottery.

15% of men had participated in any online gambling in the previous 12 months, compared with 4% of women. Participation peaks in the 25 to 34 age group, and then declines with age for both sexes.