JSNA Healthy Lives

Our behaviours, personal circumstances and illnesses hugely affect our life expectancy and health. Influences on our health are particularly important before birth and during early childhood. These influences and risk factors continue to accumulate and their effects build as we move into adulthood. Preventing exposure to these risk factors, and reducing inequalities in how these risk factors are distributed among our population, can have a positive impact on our health. 

Local public health teams work to both prevent and reduce people’s exposures to risk factors across all stages of life. We commission services which help people reduce their risk factors, for example, smoking. We also work alongside other organisations to provide people with the support they need to make healthy decisions and prevent exposure to negative risk factors in the first place.  

This information focuses on:

• the risk factors, causes and protective factors which influence our health,
• the health inequalities which are evident
• and the potential impact COVID has had.   

Data in this summary is correct as at September 2022. The data in this report can be explored further by smaller geographies in the JSNA Healthy Lives data report.

The Global Burden of Disease (2019) provides a tool to help understand what is causing and driving the most death and disability globally and the differences across countries. This study suggests that on the Isle of Wight the most notable all age causes of disease burden were cardiovascular diseases, musculoskeletal conditions, and neoplasms. The top three risk factors driving this are tobacco, high blood sugars, and high body mass index (BMI).  

The major causes of disability for adults aged 70 years and over on the Isle of Wight are neoplasms, cardiovascular diseases, and neurological disorders. Tobacco, high blood sugars and high blood pressure are the three top risk factors for this older population group. 

Alcohol

Excess alcohol consumption can contribute to a broad range of illnesses, including liver disease, heart disease, stroke, high blood pressure, and mental health conditions. It is the sixth largest risk factor for ill health on the Isle of Wight. It is also be associated with a range of social and economic issues including loss of employment and crime.

The Isle of Wight was statistically significantly worse than the England rate in every time period since 2006/07-2008/09. An average of approximately 20 children admitted per year in the most recent period.

Alcohol-related mortality has remained stable since 2016. The rate on the Isle of Wight was similar to England in 2020 (47.2 per 100,000 compared with 37.8).

National data shows that people living in the most deprived areas are more than twice as likely to die from alcohol-specific conditions as those from the least deprived areas. During lockdowns there was also a change in consumption behaviours, with increased retail purchasing of alcohol and drinking at home. Locally, this has been reflected by a steady increase in referrals for alcohol treatment.

Drug Misuse

Drug misuse is a significant cause of disability. It is the fourth ranked cause of death in 15 to 49 year olds on the Isle of Wight. The health effects of drug misuse vary depending on the type of substances, and the pattern and context of their use.

Hospital admissions for those aged 15 to 24 due to substance misuse have remained stable since 2008/09. Rates in 2018/19-2020/21 are higher than they were in 2008/09-2010/11 both nationally and locally. 

There were 7.7 deaths per 100,000 residents from drug misuse on the Isle of Wight in 2018 to 2020. This is similar than the England average of 5.0. Deaths from drug misuse occur more often in men, with 18 of the 27 deaths from drugs misuse.

Smoking and Vaping

Smoking is the leading cause of preventable ill health and early death in England. It was responsible for almost 75,000 deaths and more than 500,000 hospital admissions in 2019/20. On the Isle of Wight between 2017 and 2019, it was responsible for 612 deaths in people aged 35 years and older. It is linked to many cancers, cardiovascular disease and respiratory diseases. It is also the largest preventable cause of foetal and infant illness and death.

The rates of hospital admissions on the Isle of Wight have increased and are getting worse. But they remain statistically significantly lower than England in 2019/20. Mortality attributable to smoking was lower on the Isle of Wight than England. It is showing a gradual downward trend as the prevalence of smoking declines.

On the Isle of Wight, an estimated 11.8% of adults smoke compared to 12.1% in England. In addition, men are more likely to smoke than women. Those in routine or manual occupations, are more likely to smoke than those in managerial or professional occupations. Those living in the most deprived areas are more likely to smoke than those in the least deprived.

Vaping is much less harmful than smoking and an effective tool for adults who are quitting. However, it is not risk free. National Institute for Health and Care Excellence (NICE) recommends that vaping should be discouraged in children who have never smoked.

Physical Activity

• Being physically active:
• reduces mortality risk,
• helps prevent and address overweight and obesity,
• improves mental health,
• and reduces the risk of developing a wide range of illnesses, including:
  • including heart disease, 
  • stroke, 
  • type 2 diabetes, 
  • obesity, 
  • some cancers, 
  • mental health problems 
  • and musculoskeletal conditions. 

The proportion of children and young people on the Isle of Wight meeting the recommended 60 minutes of exercise per day is 44.8% in 2020/21. This is similar to the England percentage. National data shows that older children and minority ethnic groups are less likely to achieve the recommended amount of exercise. 

On the Isle of Wight 70.2% of adults undertake at least 150 moderate intensity equivalent minutes of physical activity per week. Being classified as physically inactive means undertaking less than 30 minutes of moderate intensity activity across the week. This equates to 9.5% of Island adults. Both of these statistics have remained at similar levels over the last five years. Nationally, data for adults shows that physical activity levels are lower in:

• females,
• older people (aged 75+),
• those from a lower socio-economic class,
• people with a disability,
• and minority ethnic groups.

Healthy Diet

A healthy diet reduces the risk of obesity, heart disease, some cancers, and bone and joint disorders. Limited data is available on the quality of people’s diets on the Isle of Wight. In a recent survey of school students on the Isle of Wight, 60% ate fruit every day and 61% ate vegetables every day. The proportion of adults meeting the recommended ‘5-a-day’ on a usual day has remained roughly static at 64.0%. This is higher than the England average of 55.4% in 2019/20. Additionally, national data shows that males and those from a lower socio-economic group are also less likely to have a healthy diet. 

The impact of the pandemic on diet in the UK is complex. With hospitality closed during long periods of restrictions, more people were cooking from home. However the quality of food varied across different groups. Thirty two percent reported eating more healthy main meals but 33% reported eating more unhealthy snacks. There was also an increase in families eating together and food waste decreased. Children from disadvantaged backgrounds were most likely to eat more highly processed food and least likely to be eating fruit and vegetables

Overweight and obesity

Poor diet and physical inactivity are leading risk factors for overweight and obesity. These in turn are risk factors for:

• heart disease,
• stroke,
• type 2 diabetes,
• liver disease,
• some cancers,
• dementia,
• and mental health conditions.

The proportion of children on the Isle of Wight who are overweight or obese increases from 25.6% in reception to 31.6% by year 6. Almost two thirds of Isle of Wight adults are either overweight or obese.

For both adults and children, overweight and obesity are more common in men than in women, and in lower socio-economic groups. Socio-economic inequalities in overweight and obesity are widening. In adults, the prevalence of overweight and obesity generally increases in older age groups. Nationally, rates of childhood obesity and overweight increased sharply over the pandemic.

Hypertension

Hypertension, or high blood pressure, is an important risk factor for a number of conditions including heart disease, stroke, kidney disease, and vascular dementia. Risk factors for hypertension include a diet high in fats and salt, smoking, alcohol, and physical inactivity. The prevalence of hypertension on the Isle of Wight has been consistently in the highest 20% of the country. In 2020/21, it was at 18.0%, which is significantly higher than the national average of 13.9%. This may be partly explained by the Isle of Wight having an older population for England.

Atrial fibrillation

Atrial fibrillation (AF) is the most common cause of an irregular heart rhythm and can lead to blood clots forming in the heart. Although mostly asymptomatic, people with AF are five times more likely to suffer a stroke. An AF-related stroke is more likely to result in death or severe disability. The prevalence of AF is higher on the Isle of Wight than England (2.93% compared with 2.1%). Again this may be related to the older population. Early identification and prescribing of blood thinning medicine reduces the risk of stroke by up to two-thirds. 

Sexual and Reproductive Health

Good sexual health encompasses a positive, respectful approach to sexuality and sexual relationships. This ensures sexual experiences that are safe, free of coercion, discrimination, and violence. In England, the definition of sexual health also includes:

• the provision of advice and services for contraception,
• termination of pregnancies,
• sexually transmitted infections (STIs),
• and Human Immunodeficiency Virus (HIV).

To ensure all women, trans-gender men and non-binary people with female reproductive organs have choice over if and when they decide to get pregnant, good access to long-acting reversible contraception (LARC) is important. Levels of prescribed LARC within the Isle of Wight fell within the pandemic because of difficulties in organising face-to-face appointments. Further to this, a noticeable decline was observed from 2018 to 2019.

Early identification and treatment of STIs is important. Untreated infections can lead to serious complications including infertility, ectopic pregnancy, cancer, and premature death. Up until the pandemic, the STI diagnosis rate had been increasing nationally, at which point it dropped. This is likely a result of both reduced sexual activity and less access to diagnostic services.

Chlamydia is the most commonly diagnosed bacterial STI in England. Rates are far higher in young adults than any other age group. Local authorities are targeted to reach a detection rate of 2,300 diagnoses per 100,000 15 to 24 year olds. This is to ensure infections are being adequately identified and treated. In 2022 there were changes to the National Chlamydia Screening Programme (NCSP). This focussed on reducing reproductive harm of untreated infection in young women and other people with wombs and ovaries. The detection rate target is still in place. However this change means young women without symptoms will be proactively offered a chlamydia test.

The new HIV diagnosis rate on the Isle of Wight was 3.5 per 100,000 in 2021. This was similar to the England rate of 4.8 per 100,000. Early HIV diagnosis and treatment will typically lead to a near-normal lifespan. In contrast, late diagnosis is an important predictor of morbidity and mortality. On the Isle of Wight, the proportion of people who are diagnosed late with HIV in 2019-2021 was 25.0%. This is lower than the England average of 43.4%. Due to small counts, the trend fluctuates yearly and should be interpreted with this in mind. 

Teenage pregnancy

Most teenage pregnancies are unplanned and around half end in an abortion. While for some young women having a child can be a very positive experience, for many, bringing up a child results in poor outcomes for both mother and child. These outcomes include:

• higher infant mortality rates,
• poorer child health,
• a higher risk of poor maternal mental health,
• lower maternal education,
• and a higher risk of poverty.

Teenage pregnancy rates on the Isle of Wight have continued to decrease and currently are 14.3 per 1,000 children under 18 years old. This is similar to the England rate and equates to 29 teenage pregnancies in 2020.

The total abortion rate on the Isle of Wight in 2020 was 15.5 per 1,000; this rate has increased over time. The abortion rate on the Isle of Wight for over 25s was 13.5 per 1,000 which is statistically lower than England at 17.6 but has been increasing since 2014.

The first 1,001 days, that is from conception to the age of two, is a period of uniquely rapid growth, when babies’ brains, their sense of self, and their understanding of the world are shaped by their experiences and environments. Sensitive, responsive caregiving including early attachment and bonding during the earliest years of life lay the foundation for later health and wellbeing, the benefits of which last a lifetime.

Breastfeeding

Breastfeeding has numerous health benefits for both mother and baby. Breastfed babies have stronger immune systems, lower rates of illness and a lower risk of infant death. Also, later in life, they have a lower risk of many diseases including diabetes, obesity and heart disease. Breastfeeding can also help promote mother-baby bonding and lowers a mother’s risk of breast and ovarian cancer. In 2018/19, 69.7% of the Isle of Wight’s babies had breastmilk as their first feed, similar to the national percentage of 67.4%.

Smoking, alcohol and obesity in pregnancy

Smoking, obesity and alcohol use in pregnancy can have health impacts on both mother and child. Smoking is detrimental to the health of the developing child and increases the risk of premature delivery, miscarriage, stillbirth and sudden infant death. It also increases a woman’s risk of complications during pregnancy.

In 2018/19, 18.9% of pregnant women were smoking in early pregnancy, during the time at which they booked an appointment with a midwife. This is higher than the England percentage of 12.8%. The proportion of women smoking at time of delivery on the Isle of Wight has had no significant change over the last five years, at 13.5%.

Mothers who are overweight or obese have higher risk of complications or death during pregnancy, as do their babies. Obesity in early pregnancy data from 2018/19 suggest that almost one in four mothers (24.0%) on the Isle of Wight are obese, this is comparable to England (22.1%).

Foetal alcohol syndrome (FAS) is the most common single cause of learning disabilities, resulting in mental and physical problems in the baby from damage to the brain, spinal cord, and other parts of the body. Using figures on the European prevalence of alcohol use during pregnancy (25.2%), from a recent Lancet study, it is estimated that approximately 4 children are born with FAS on the Isle of Wight per year.

Fertility rate

The general fertility rate on the Isle of Wight has decreased over the last five years, and is currently 51.3 per 1,000 women aged 15 to 44 in 2020. This has also been consistently and significantly below the England rate for the last three time periods. In 2020 there were 1,009 live births on the Isle of Wight, compared to 1,329 in 2012.

Low birth weight and pre-term delivery

Low birth weight (defined as under 2.5kg) and very low birth weight (under 1.5kg) are associated with deprivation and often result from smoking in pregnancy, unhealthy maternal diet, babies being born prematurely and multiple births. On the Isle of Wight, the proportion of babies with low birth weight has remained fairly constant and, at 2.1%, is statistically similar to the England percentage (2.9%).

Protective factors that promote the health and well-being of children and families are vital such as:

• good early years development,
• good educational outcomes
• and having an economically stable and supportive home and family.

They are hugely influential to the development of children and young people and the life opportunities and health that they will have later in life.

Early Years Development

Achievement in Early Years is a good predictor of achievement later in childhood. On the Isle of Wight, the proportion of boys and girls achieving a good level of development by the end of reception is statistically similar to the England percentage (71.5% compared to 71.8%).

School attendance and educational attainment

There are clear links between school engagement, educational attainment, and both current and future health outcomes for children and young people. Good educational attainment and skills are key to breaking the intergenerational cycle of inequalities in income and employment opportunities which impact on health. 

Authorised and unauthorised absences from school can negatively impact student achievement. This impact is larger for children from low-income households. The Isle of Wight has similar rates of authorised absences and consistently higher rates of unauthorised absences than the England percentage. The percentage of suspensions on the Isle of Wight have been consistently higher than the England percentage, in 2020 it was 5.1%. Permanent exclusion rates on the Isle of Wight are similar to that of England (all schools 0.1% in 2020). 

Average Attainment 8 score was 47.0 in 2020/2021, this was statistically significantly worse than the England score of 50. The way GCSE grades were awarded changed during the Covid-19 pandemic, therefore 2019/2020 and 2020/2021 data should not be directly compared to attainment data from previous years.

Not in education, employment or training (NEET)

Young people are legally required to remain in education, employment or training until the end of the academic year in which they turn 18. A lack of further education and training can lead to poor basic skills, and limited academic and vocational qualifications. Those who are NEET have poorer health outcomes, and people who are unemployed for more than 12 months find it increasingly difficult to find permanent employment. The percentage of children who are NEET on the Isle of Wight is similar to the England percentage at 5.4%. 

Child poverty

Childhood poverty leads to poorer mental health, lower educational attainment, and poor health outcomes and premature mortality for adulthood. The Isle of Wight has a higher proportion of children are living in low-income households than the England average (22.1% compared with 18.5% in 2020/2021),

Children involved in the criminal justice system

A wide range of factors influence whether a child is involved with the criminal justice system; including their family, their local community and neighbourhood, and their engagement in school. Children in contact with the criminal justice system have high levels of mental health needs, and a higher risk of suicide than other young people. The rate of children and young people receiving a first reprimand, warning or conviction on the Isle of Wight has decreased between 2010 and 2021. Recent data shows that the Island rate is statistically significantly higher than the England rate at 238.5 per 100,000.

Vulnerable children

The Department of Education defines Children in Need (CiN) as a legally defined group of children (under the Children Act 1989) assessed as needing help and protection as a result of risks to their development or health. This group includes children subject to Child in Need Plans, Child Protection plans, Looked After Children, young carers, and disabled children. Children in Need also includes young people aged 18 or over who continue to receive care, accommodation or support from children’s services, and unborn children.

As of March 2022, there were 938 Children in Need, 266 were on a Child Protection Plan, and 152 Looked After Children (full time) identified by the Isle of Wight Council's Children’s Services.  

Unemployment

Work is typically good for an individual’s physical and mental health and wellbeing. Access to local employment and good working conditions can influence the health of a community. In England, the proportion of adults claiming Universal Credit has declined after a sharp increase during the COVID-19 pandemic, to 3.9% in May 2022. The rate on the Isle of Wight was slightly lower at 3.6%.

Poorer quality employment can impact on health and wellbeing. One example of this is zero-hour contracts. While these types of contracts can provide flexibility for employees to choose when they work, they have also been associated with poorer mental health. South East England has the second highest prevalence of people on zero-hour contracts in the UK, with 3.2% of people in employment on a zero-hour contract in 2021. Similar to national trends, this has been increasing in recent years. Applying this percentage to the Isle of Wight population, this suggests approximately 4,500 people are currently working on a zero-hour contract on the Isle of Wight. Nationally, the proportion of people on zero-hour contracts is higher in females and 16 to 24-year-olds.

Low pay and poverty

A ’living wage’ can be defined as a job which pays enough to meet the local cost of living – this is different from the National Living Wage set by the government. The proportion jobs where the pay is lower than 'living wage' has decreased between 2014 and 2021 nationally from 22.6% to 17.2%. On the Isle of Wight, the proportion of people is much higher, but has also decreased from 2014 to 2021 from 25.6% to 22.2%. However, this decline was not linear, with a peak in 2020 at 31.3%.

Cost of living

The increasing cost of living crisis has been covered widely in the media. Data has shown that in 2022 there have been sharp increases in the costs of everyday essentials and fuel.

Households are calculated to be living in fuel poverty when the energy efficiency rating of their home is in bands D, E, F or G, and when their income after housing costs is below the poverty line. It is therefore driven by three factors: energy costs, energy efficiency of the home, and income. Cold homes have been linked to an increased risk of developing a wide range of health conditions including asthma, arthritis and pneumonia, as well as unintentional injury. There are higher numbers of households with lower energy ratings (D to G) on the Isle of Wight, and the majority of homes with low energy ratings are owner-occupied and likely to be older buildings.

Gambling

Gambling can be a fun recreational activity when self managed well and within personal financial limitations. Excessive gambling can impact on the health and wellbeing of individuals, families, communities and society. Problem gambling can have negative impacts on the day-to-day lives of gamblers and those close to them, in terms of resources (e.g. money and debt), physical and mental health, and relationships. Applying national survey figures to the Isle of Wight population suggests that there are just under 4,000 problem gamblers across the Isle of Wight

Serious Violence

Serious violence impacts physical and emotional health, and can cause serious impacts on the health, social, and economic outcomes of individuals, communities and societies. An individual's involvement in serious violence increases risks of health harming behaviours, such as higher risk of future violence, and reduced prospects in employment, education and wellbeing.

There is no one single reason to explain why some people or populations are vulnerable to violence. Instead, there are a range of factors which increase the risk of being involved in violence. These are grouped into four categories: Society, Community, Relationship and Individual.

Using the Hampshire Constabulary definition of serious violence, there were 511 serious violence crimes across the Isle of Wight between October 2016 and November 2021. Analysis of the hotspots suggests that the Isle of Wight had a significantly higher serious violent crime rate than the Hampshire average, with the Island only ranking below the districts of Gosport and Rushmoor. 

People affected by domestic abuse

In 2021, the government published the Domestic Abuse Act. The act created a statutory definition of domestic abuse. Defining domestic abuse as both persons involved being “each aged over 16 and are personally connected to each other, and the behaviour is abusive”. Behaviour is recognised as abusive if it is an incident or pattern of any of the following:

• physical,
• sexual,
• economic,
• psychological,
• emotional or any other abuse
• or violent,
• threatening, controlling or coercive behaviour.

Domestic abuse-related crime within the Hampshire Constabulary area has seen an increase from 2016/17 to 2020/21, with an 8% increase in 2020/21 when compared to the previous year. This trend is also evident at a national level, with a 6% increase in 2020/21 compared to the previous year. This can be partly attributed to improved recording by the police alongside increased reporting by victims.

Vaccination

High vaccination coverage is essential to ensuring population protection against vaccine-preventable diseases. These diseases often lead to serious complications which can include lasting disability and death.

Local coverage is better than the England average for almost all vaccinations. Vaccinations that are not meeting the target coverage levels set for them, include:

• both doses of the MMR vaccine,
• meningitis vaccines,
• and the vaccine for Diphtheria, Tetanus and Pertussis (DTaP).

National data shows that vaccination coverage is lower in areas of deprivation. 

Generally, vaccination coverage has not been affected by the pandemic and, in the case of flu vaccination, there were large increases in coverage for 2 to 3 year olds, and people aged 65 years old and over. 

However, with schools being closed, HPV vaccination coverage reduced in girls. HPV vaccine coverage had already been declining before the pandemic, reducing from 99.1% in 2015/16 to 81.5% in 2020/21. 2019/20 was also the first year that boys were also offered the HPV vaccine.

Screening

Screening can detect people who are at high risk for a health problem but are not experiencing symptoms. Early detection can reduce the intensity of treatment required and improve chances of survival. Therefore, screening is a key public health action as part of wider preventative and healthcare activities. 

All adults aged 60 to 74 are invited for bowel cancer screening every two years. All adult screening programmes on the Isle of Wight have seen notable drops in coverage recently as a result of the pandemic, with the exception of bowel cancer screening which individuals carry out themselves at home. 

Prior to the pandemic, adult screening programmes on the Isle of Wight had a higher coverage than the England average. The only exception to this was cervical cancer screening within the 50 to 64 year old group, which has been consistently significantly lower than the England average. 

However, no screening programme had reached their national performance thresholds. Prior to the pandemic, breast cancer screening had met its acceptable target (70%) but missed its achievable target (80%). Aortic aneurysm screening had met its acceptable target (75%) but not its achievable target (85%). Cervical cancer screening had missed its acceptable target (80%) in both younger and older women.

NHS Health Checks

The NHS Health Check programme invites people aged between 40 and 74 for a check every five years. This assesses their risk of heart disease, stroke, kidney disease and diabetes. High uptake is important to ensure that individuals at a high risk can be identified and take appropriate actions to lower their risk of serious conditions which can result in disability or death. 

On the Isle of Wight, 28.6% of those eligible for an NHS Health Check had received one between 2017/18 to 2021/22, statistically similar to the England percentage of 28.4%. The uptake rate is the rolling five year cumulative percentage of the eligible population aged 40 to 74 who are offered and receive an NHS Health Check. Over this period there has shown a slight decrease to 49.6% in the five years to 2021/22 from a high point of 52.7% in the five years to 2019/2020.

• Download the Isle of Wight Healthy Lives - Full Report (PDF, 1.51MB)
  

Good sexual and reproductive health is a key Public Health priority. This joint Health Needs Assessment (HNA) reflects the partnership between the Public Health Teams in Hampshire and the Isle of Wight. It shows our commitment to work together to improve sexual and reproductive health across the whole system. This will ensure that all our residents have access to effective, efficient, and fair services.

• Download the Hampshire and Isle of Wight sexual and reproductive health needs assessment 2022 (PDF, 5.36MB)

The first 1,001 days, that is from pregnancy to age two, is a period of uniquely rapid growth, when babies’ brains, their sense of self, and their understanding of the world are shaped by their experiences and environments. A child’s physical, social, and cognitive development during the early years strongly influences their school-readiness and educational attainment, economic participation and health for the rest of their life. Ipsos MORI explain “Science tells us that a child’s experiences from conception through their first five years will go on to shape their next 50”. This report presents a summary of the key national and local data and evidence supporting the first 1,001 days. 

• Download the First 1,001 Days Summary Infographic (PDF, 604MB)