People making healthy lifestyle choices

The impact of the Covid-19 pandemic on lifestyle behaviours will be captured in the next National Survey for Wales. This topic will be updated accordingly.

It is poverty that leads to unhealthy choices and the poor health of those living in the most deprived areas as they have a limited range of options available to them due to low incomes and the stress associated with poor conditions. The poor diet of people in poverty is largely the result of poverty, not poor choices. People in persistent poverty are at particular risk of having poor physical and mental health and children in persistent poverty are at an increased risk of mental health problems, obesity and long standing illness. For example, the poorest 10% of English households would need to spend close to three-quarters of their disposable income on food to meet the guidelines in the NHS’s Eatwell guide compared with only 6% of income for the wealthiest households. [1]

Health inequities are avoidable inequalities in health between groups of people. In its public health strategy ‘Our Healthy Future’ Welsh Government notes that “where such differences could be avoided, it is unfair and immoral that we tolerate them”. Promoting healthy lifestyles helps to reduce health inequalities, and cover four of the ten priorities identified in ‘Our Healthy Future’ (reducing smoking, increasing physical activity, reducing unhealthy eating, stopping the growing harm of alcohol and drugs).

Compared to other unitary authorities in Wales, the citizens of Conwy County Borough are statistically more likely to make healthy lifestyle choices than the Wales average, but significant improvement is still needed. Healthy lifestyle indicators for Denbighshire are generally closer to Welsh averages.

Around 49.9% of adults in Conwy County Borough and 52.2% in Denbighshire are overweight or obese – the level is Wales 59.9%. See the ‘tackling obesity‘ topic for further information
25% of the adults in Conwy County Borough and 14.2% in Denbighshire are smokers compared to 17.4% across Wales. (Please note: we have to be mindful that The National Survey for Wales is a self-reported survey, which is sent out to a relatively small sample across Wales, and can cause result in variations in levels of self-reporting.)
7% of the adult population in Conwy County Borough and 51.5% of those in Denbighshire report being active for at least 150 minutes the previous week. Across Wales 53.2% report being active. These figures are higher than for previous years due to changes in the way the question is asked.
8% of adults in Conwy County Borough and 17.5% in Denbighshire report eating the recommended 5 a day fruit or vegetable portions the previous day. The Welsh average is 24.3%. Again, these figures differ significantly than for previous years due to changes in the way the question is asked.
3%cof adults in Conwy County Borough and 14.3% in Denbighshire reported drinking above the recommended guidelines of 14 units in the previous week. 2% in Conwy County Borough and 1% in Denbighshire reported that their drinking was harmful during the previous week (Welsh figures = 16% and 2%)[2]. Again, these figures differ significantly than for previous years due to changes in the way the question is asked.

PLEASE NOTE: We are still working on finding more recent data and projections on the following issues.

Smoking

Smoking continues to be the greatest single cause of avoidable mortality in Wales. In people aged 35 and over, smoking causes nearly one in five of all deaths and around one third of the inequality in mortality between the most and least deprived areas. Smoking in pregnancy has significant negative impacts for both Mum and her baby (see ‘Giving every child the best start‘ for further information).

Smokers that are referred to specialist NHS smoking cessation services to support their attempt to quit are four times more likely to succeed than if they go it alone. 5% of adult smokers should be treated by specialist NHS smoking cessation services at any given time.

In Denbighshire, the percentage of adults (aged 16 years and over) who said they smoked during between the years 2018 and 2020 is 14.2%. This is lower than the Wales average of 17.4% and the North Wales average of 17.6%. Conwy, however has seen steady increases in the percentage of adults smoking with 25% reporting they smoke between 2018 and 2020. This has steadily increased since 2016/17. Nationally a single brand of all stop smoking services has been established called “Help Me Quit”. The service enables smokers to access support in the community, pharmacy or over the phone. Help Me Quit also have a specialist service for pregnant women and patients in hospital.

Substance abuse

Alcohol is widely available, is 60% cheaper than it was 40 years ago and is thoroughly integrated into all aspects of society and our culture. When it is drunk sensibly it can be enjoyed by many. However, alcohol misuse has a marked effect on the physical and mental wellbeing of the individual, their family and wider society. Alcohol misuse is linked to crime and disorder, antisocial behaviour, assault, domestic violence and is a major cause of illness and death (see the ‘Cohesive Community well-being goal‘ summary for further information). [3]

Referrals to health services for substance abuse (all types) in the area totalled over 1,800 in 2014 to 2015 (1,000 for Conwy County Borough residents and 800 for Denbighshire). Per 100,000 population, this gave a referral rate of 864 for Conwy County Borough and 857 for Denbighshire, compared to a Welsh average of 822 (Conwy and Denbighshire combined = 861). Conwy County Borough was ranked 9^th highest in Wales, Denbighshire was 11^th, however we recognise that this does not reflect the many people who do not present themselves to the health service. W

Drug abuse is sometimes very visible in public places and is of concern to the public, and has an impact on reported acquisitive crime. However, the number of drug crimes committed and the people involved is quite small (26% of the public in the North Wales Police Force area reported high levels of perceived drug use despite an annual rate of only 2.06 crimes per thousand population[4]). Of greater concern for health and wider community well-being are psychoactive substances and new novel drugs, which are not necessarily illegal). Addiction to prescription drugs is also an issue.

The biggest concerns about substance misuse are connected to alcohol. Both Conwy County Borough and Denbighshire have high rates for alcohol specific hospital admissions, with, respectively, age standardised rates of 389 and 383 admissions per 100,000 population in 2014/15 [5] and is significantly above the Welsh average of 333 admissions. This ranked them as the third and fourth highest in Wales. 38% of adults resident in Conwy County Borough and 42% in Denbighshire reported drinking above the recommended guidelines at least once each week, and 20% and 22% respectively reported binge drinking at least once in the last week [6].

Alcohol misuse costs Wales approximately £25 billion per year in healthcare, crime and lost productivity.

There were 84 alcohol specific deaths annually in North Wales over a three-year period from 2015-2017. During 2017/18 there were an estimated 11,682 alcohol related hospital admissions across North Wales (7,647 males & 4,035 females).[7]

Internationally, alcohol is estimated to result in approximately 3.3 million deaths each year, which arise from over 200 diseases and injury related conditions that are wholly or partly caused by alcohol.[8] Some studies also suggest that the likelihood of obesity can be higher in binge drinkers and heavy drinkers than in other people, but that this may be due as much to adverse behaviours including poor diet, unhealthy weight control, body dissatisfaction and sedentary lifestyles as to the calorific intake from alcohol.

Until recently, research on the burden of alcohol has focused predominantly on the harms experienced by drinkers themselves. However, there is growing recognition of the harms that an individual’s alcohol consumption can place on those around them including family members, friends, co-workers and strangers.[9]

These harms include alcohol-related violence and aggression (including domestic and nightlife violence); neglect, abuse or exploitation (including children); criminal behaviour (property damage and theft to support drinking habits); unintentional injury (e.g. road traffic crashes); and even foetal alcohol spectrum disorder.
People can also experience harm to their mental health and well-being, through anxiety about behaviours of drinkers’, including fear of assault and sleep disturbance. Care burdens and worries about family/household finances arising from alcohol addiction.
Six in ten (59.7%) adults in Wales have experienced harms due to someone else’s drinking in the last 12 months. Nationally, this is estimated to be equivalent to 1,460,151 people aged 18 years and older.
The Crime Survey for England and Wales estimated that in 2013/14 just over half (53%) of all violence was perpetrated by someone who was under the influence of alcohol
In Wales the number of individuals admitted for alcohol specific conditions is 2.4 times higher than admissions for illicit drug use
As already stated, in 2017-18 there were over 11,682 hospital admissions relating to drugs and alcohol in North Wales[10]
There were 4,404 public order offences across North Wales in 2017/18, the majority of which involved alcohol.
In one North wales county a review reported that in 2018 a spouse or partner of the victim was the offender in 41.7% of alcohol related violence.

Parental substance misuse, including alcohol, can cause considerable harm. Children are at risk from emotional and physical neglect as they grow up, including basic necessities like the provision of a decent diet. Many children end up providing both practical and emotional care for their parents (and possibly siblings), often from a very young age. This includes protecting their parents from harm, and looking after the home. They also risk developing emotional and social problems later in life, including a higher than average likelihood of developing mental health and substance misuse issues themselves (see ‘Giving every child the best start in life‘ for further information).[11]

Calling Time for Change: Alcohol Harm Reduction Strategy 2020-24 states that, across North Wales:

An estimated 865 children are receiving care due to parental substance or alcohol misuse
An estimated 120 children over the age of 10 years old are receiving care with a reported problem of substance and alcohol misuse (7.4% of all those receiving care).
3 pupils per 1,000 were permanently excluded from school due to drug and alcohol use in 2016/17
68% of school aged children in North Wales had drunk alcohol for the first time under the age of 15 years old
25 pregnant women were referred to the health board’s substance misuse midwife (2018/19)

Alcohol and drug use can be contributory factors in susceptibility to injury or death from fire in the home. Many substances affect people’s ability to judge and react to danger – cooking after drinking alcohol can be a specific risk, for example. Alcohol interferes with normal response, impairs judgement, decreases perception and, in sufficient quantity, can lead to unconsciousness. Medication or illegal drugs can have similar effects, and a combination of drugs and alcohol can make people particularly vulnerable.

Substance abuse is sometimes a self-medication response to mental health issues and often goes hand in hand with depression and anxiety disorders. A lack of co-ordination between health, social care and other welfare providers (e.g. social housing) can cause compound problems for suffers, their family, friends and the community they live in, and for the service providers.

[1] Health Equity in England: The Marmot Review 10 years on (2020)

[2] The National Survey for Wales 2019/20

[3] Calling time to Change: Alcohol Harm reduction strategy 2020-2024

[4] British Crime Survey; Crime in England and Wales statistics year end 06/16, ONS

[5] Patient episode database for Wales, Welsh Government

[6] Welsh Health Survey, 2013-14

[8] Jones L, Bellis MA. 2014. Updating England-specific alcohol-attributable fractions. Liverpool: Public Health Institute, Liverpool John Moores University. http://www.cph.org.uk/publication/updating-england-specific-alcohol-attributable-fractions/ and World Health Organization. 2014. Global status report on alcohol and health 2014. Geneva: World Health

[9] Alcohol’s harms to others, Public Health Institute (PHI), Faculty of Education, Health and Community, Liverpool John Moores University, September 2016

[10] Calling time to change: Alcohol Harm Reduction strategy, 2020-2024, The North Wales Area Planning board

[11] Alcohol’s harms to others, Public Health Institute (PHI), Faculty of Education, Health and Community, Liverpool John Moores University, September 2016 and Silent voices: supporting children and young people affected by parental alcohol misuse, Children’s Commissioner for England, September 2012.

The Welsh Health Survey is now run as the National Survey for Wales, and data collection is different. This makes it difficult to make comparisons with the past. However, broadly:

Obesity levels have risen since 2003/4 (see ‘Tackling obesity‘ for further information)
The proportion of adult smokers has fluctuated between 2016 and 2020 with increases seen in Conwy
Those who report being physically active for 150 minutes in the previous week has fluctuated since 2016
The proportion of adults reporting eating the recommended 5 a day fruit or vegetable portions the previous day has fluctuated since 2016
Levels of drinking above the recommended guidelines has continued to fall each year since 2016.

Prevention of health harming behaviour and promotion of healthy behaviour is a priority. However, support for those with unhealthy lifestyles, in particularly obesity and alcohol misuse, also needs to be provided.

The use of tobacco remains the leading single cause of premature death in Wales and a major contributor to health inequalities. Although smoking prevalence has decreased in Wales, it is estimated that it is still accountable for over 5,000 deaths each year (around one in every six deaths in people aged 35 years old and over). Those in deprived areas are more than twice as likely to smoke, be less active and eat less fruit and vegetables.[1]

Physical inactivity, diet and obesity levels are also significant burden of disease risk factors. If the trend of inactivity and eating less fruit and vegetables continues, by 2025 two thirds of the adult population in Wales will be overweight or obese. However, those in the most deprived areas are less likely than those in the least deprived areas to drink above the recommended guidelines.[2] The cost of physical inactivity to Wales is estimated to be £650 million per year [3]. As well as helping to reduce levels of obesity, increasing levels of physical activity has beneficial consequences in terms of increasing peoples’ healthy lifespans. It is widely recognised that several of the key health issues faced by Wales (and other countries) are considered to be ‘preventable’ (Chief Medical Officer Annual Report 2013-14 & 2014-15). These include many of the chronic conditions that insufficient physical activity contributes to, such as cardiovascular disease, Type 2 diabetes, chronic kidney disease, some cancers, osteoporosis and arthritis. Because of the extent of, and harms caused by, obesity, we have a dedicated topic available here.

Use of the natural environment to help improve physical fitness and reduce obesity can support social resilience by providing opportunities for interaction and engagement (see ‘Living in isolation and access to service‘ for further information). This helps build social cohesion, along with improving mental well-being and increased physical activity, both of which are of particular benefit in more deprived areas, where social resilience is often at a lower level.

In comparing our support to tackle substance misuse with accepted models, we have found ourselves to be good at treatment and support, but there is a recognised need to improve early intervention, prevention and also recovery.

Recovery is about getting people self-sufficient and no longer dependent on the public services. Continuing support through recovery and beyond – perhaps from the volunteer sector – is essential to help avoid the revolving door syndrome of treatment-recovery-relapse, and in helping people become fully functioning members of the community.

Calling Time for Change: The Alcohol Harm Reduction Strategy for North Wales, 2020-24, is aligned with The Well-being of Future Generations Act (2015) Wales, and has been produced to reduce the harm associated with alcohol to the individual and the wider society. Its ambition is to have a culture in North Wales that promotes and enjoys a positive relationship with alcohol, where non-drinking or low level of alcohol consumption is valued and considered the norm.

[1] Calling time to change: Alcohol Harm Reduction strategy, 2020-2024, The North Wales Area Planning board

[2] Chief Medical officer Annual Report 2018/19

[3] Climbing higher: creating an active Wales, Welsh Government 2009

The need to support healthy lifestyles was raised as a concern for people locally, particularly in respect of tackling obesity crisis, through increased leisure opportunities, partnership working and by building on our active travel network (see ‘transport‘ for further information).

People are concerned about child poverty, and the extent to which the public sector is working to improve the quality of life for people and children in poverty. Child hunger is a particular concern for people and they want to understand the root causes for hunger. People also want to ensure we ask those living in deprived areas to find out what they feel would improve their lives.

Homelessness is seen as a factor in deprivation and so too housing quality. Poor housing has been highlighted by people as having a causal relationship with lower life expectancy.

People would like to see more investment in factors that support young people’s well-being:

Investment in activities for young people e.g. community projects, young people’s exercise classes, youth clubs (so young people have a place to go e.g. make them more attractive with better activities, more publicity so young people know about them)
Support to improve young people’s mental health, specifically following the Covid-19 pandemic
Young people more involved in council decision making
Leisure centre and facility improvements to attract young people e.g. better clubs, classes that are well publicised and targeted to young people.

People identified those with disabilities, including learning difficulties, and older people as people they feel should be supported, in particular to reduce feelings of isolation and loneliness. They thought that there could be ways of building generational links through younger volunteering to support older people.

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