Across the life course there are factors which influence health and wellbeing of people and the need for services. Some of these are personal modifiable risk factors such as smoking, alcohol, obesity, exercise and healthy diet. In Norfolk it is estimated that smoking, alcohol and obesity contribute about 23,000 hospital admissions per year. Although smoking prevalence is declining, smoking is still the biggest driver of avoidable poor health.[1] The area with the highest smoking prevalence is Breckland.[2] Addressing factors that people can do something about will help reduce the prevalence of long term conditions and reduce demand on services helping free up valuable resources. However, in Norfolk there are over 81,000 people who have a common mental health disorder and that is expected to increase by 1,400 between now and 2025. The ultimate expression of poor mental health is suicide and this occurs across all age bands, not just young people.[3] In Norfolk suicide is similar to England, the number of emergency hospital stays for self-harm is better than England.[4]

  1. www.norfolkinsight.org.uk/health-and-social-care/report/view/8adfe19449304d2884fa0d2161bca496/E10000020
  2. fingertips.phe.org.uk/profile/tobacco-control/data#page/3/gid/1938132885/pat/102/par/E10000020/ati/101/are/E07000149/iid/92443/age/168/sex/4
  3. fingertips.phe.org.uk/search/self%20harm#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/41001/age/285/sex/4
  4. fingertips.phe.org.uk/search/self%20harm#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/21001/age/1/sex/4
Last updated: Apr-19

Mental health

Norfolk has a slightly worse than England average for reported low happiness score, however a slightly lower proportion of people with a high anxiety score.[5] There are over 81,000 people who have a common mental health disorder which is expected to increase by 1,400 by 2025. In Norfolk suicide is similar to England,[6] the number of emergency hospital stays for self-harm is better than England.[7]

Last updated: Apr-19
Mental health resources
Mental health needs assessment
2013 | Norfolk County Council


Mental health references
  1. www.norfolkinsight.org.uk/health-and-social-care/report/view/8adfe19449304d2884fa0d2161bca496/E10000020
  2. fingertips.phe.org.uk/search/self%20harm#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/41001/age/285/sex/4
  3. fingertips.phe.org.uk/search/self%20harm#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/21001/age/1/sex/4

General health


Under 75 mortality rates generally for Norfolk residents is better than for England across the measured causes. Although life expectancy is 7.0 years lower for men and 4.5 years lower for women in the most deprived areas of Norfolk then the least.[8] It is estimated that modifiable risk factors such as smoking, consuming too much alcohol, obesity, poor diet and lack of exercise contribute in excess of 23,000 hospital admissions each year. The area with the highest smoking prevalence is Breckland.[9] Alcohol related harm as well as self-harm hospital stays are worse than the average for England.[10] However smoking, cardiovascular disease and cancer related deaths are better than the average for England.Estimated levels of excess weight in adults[11] are similar to England average as is the recorded level of diabetes.[12] Screening for cancer within Norfolk is generally better than England recent trend for screening is getting worse.[13-15] The percentage of the population who have been offered and receive an NHS health check is better than the England average.[16,17]

Last updated: Apr-19
General health resources
Health audit – Cervical cytology screening and cervical cancer
Mar-14 | Norfolk County Council


General health references
  1. fingertips.phe.org.uk/search/life%20expectancy#page/3/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/92901/age/1/sex/2
  2. fingertips.phe.org.uk/profile/tobacco-control/data#page/3/gid/1938132885/pat/102/par/E10000020/ati/101/are/E07000149/iid/92443/age/168/sex/4
  3. fingertips.phe.org.uk/search/alcohol#page/3/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/91414/age/1/sex/4
  4. fingertips.phe.org.uk/search/excess%20weight%20in%20adults#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/93088/age/168/sex/4
  5. fingertips.phe.org.uk/search/diabetes#page/3/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/93347/age/187/sex/4
  6. fingertips.phe.org.uk/search/cancer%20screening#page/3/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/22001/age/225/sex/2
  7. fingertips.phe.org.uk/search/cancer%20screening#page/3/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/22002/age/167/sex/2
  8. fingertips.phe.org.uk/search/cancer%20screening#page/3/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/91720/age/280/sex/4
  9. fingertips.phe.org.uk/search/health%20check#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/91111/age/219/sex/4
  10. fingertips.phe.org.uk/search/health%20check#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/91112/age/219/sex/4

Oral health

Norfolk’s population is set to increase during the next decade, with more significant increases in adult and older age groups than among children.[18] There are already higher proportions of older people in Norfolk. Older people are more likely to have complex dental care needs due to treatment patterns earlier in their lives. There is a well established link between deprivation and poor oral health. Vulnerable people are more likely to seek dental treatment when they have a problem. Health promotion targeted and drop-in style services are particularly needed in areas of deprivation. Almost 56% of the adult population has been seen by a dentist in the previous 24 months,[19] however there is a proportion of the population who are not accessing services for regular checks and prevention.

Last updated: Apr-19
Oral health resources
Oral health references
  1. www.norfolkinsight.org.uk/population/
  2. digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/nhs-dental-statistics-for-england-2016-17

Long term conditions

Long term health conditions include Diabetes, Atrial Fibrillation, Asthma, COPD, Stroke and TIA. For some long term conditions addressing factors that people can do something about will help reduce the prevalence and demand on services. This will help free up resources to enable services to find and manage those who have not yet been diagnosed. For example, it is estimated that there are currently almost 16,500 people in Norfolk with undiagnosed Diabetes. Estimated prevalence of undiagnosed and diagnosed diabetes for Norfolk is 9.3%, higher than the 8.5% for England (2015).[20] Cardiovascular disease and Cancer have been deceasing generally in Norfolk over the past decade and has continued to be at a level better than the England average.

Last updated: Aug-18
Long term conditions resources
Health audit – Cervical cytology screening and cervical cancer
Mar-14 | Norfolk County Council


Long term conditions references
  1. fingertips.phe.org.uk/search/diabetes#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/92952/age/164/sex/4

Exercise, activity & diet


Levels of excess weight are worse than those on average for England with approximately two out of three adults in Norfolk are overweight or obese which contributes to health issues such as heart disease, high blood pressure, strokes and diabetes. Just over 66% of adults (19+) are physically active, doing at least 150 “equivalent” minutes of at least moderate intensity physical activity per week similar to the England average. Norfolk has a high rate of residents whom meet the recommended “5-a-day” on a “usual day” measure at just over 61% where the rate for England is just over 57%. Rates of early deaths from cardiovascular and respiratory diseases are better than the average for England although Cancer are slightly higher.[21]

Last updated: Aug-18
Exercise, activity & diet resources
Exercise, activity & diet references
  1. www.norfolkinsight.org.uk/health-and-social-care/report/view/8adfe19449304d2884fa0d2161bca496/E10000020

Sexual health

Norfolk has a low rate for all new STI diagnoses aged <25 (excluding Chlamydia) of 5.5 % where the England level of 4.7%[22] and for Chlamydia detection rate / 100,000 aged 15-24 of just over 1,500 slightly less than the England rate of 1,882 / 100,000.[23] HIV new diagnosis is lower than England although the HIV late diagnosis level is similar.[24]

Last updated: Aug-18
Sexual health resources
Sexual health references
  1. fingertips.phe.org.uk/profile/sexualhealth/data#page/4/gid/8000035/pat/6/par/E12000006/ati/102/are/E10000020/iid/91308/age/182/sex/4
  2. fingertips.phe.org.uk/profile/sexualhealth/data#page/4/gid/8000035/pat/6/par/E12000006/ati/102/are/E10000020/iid/90776/age/156/sex/4
  3. fingertips.phe.org.uk/profile/sexualhealth/data#page/4/gid/8000035/pat/6/par/E12000006/ati/102/are/E10000020/iid/91818/age/188/sex/4

Adult education

Norfolk, ranked 88th overall the English Indices of Deprivation 2015.[25] Education, Skills and Training is one of the domains within the IMD and Norfolk has a ranking of 31 for this domain (1 = most relatively deprived), there is a range of rankings across the county with Great Yarmouth as the district most relatively deprived in this area. Ofsted inspected Norfolk Community Learning Services and gave a judgement of “Good”,[26] impressed by the new vision, strategic objectives and operating model for the service. Approximately 8,000 learners had taken part in courses offered by Adult Learning during the previous full contract year.

Last updated: Aug-18
Adult education resources
Adult education references
  1. www.gov.uk/government/statistics/english-indices-of-deprivation-2015
  2. reports.ofsted.gov.uk/provider/42/53545

Drugs & alcohol


Smoking prevalence continues to fall with the level of current smokers in Norfolk is similar to England.[27] Smoking prevalence is influenced by a number of demographic factors, Norfolk has a Tobacco Control Strategy revised in March 2016.[28] Admission episodes for alcohol-related conditions – narrow definition is worse for Norfolk than England.[29] The age group with the highest admission episodes is that of the 40-64 year old and although within this group males have a higher rate. For this age group Norfolk is worse than England.[30] Cannabis is the most commonly used drug by adults in the UK, fewer younger people are using heroin, and the population in treatment for heroin problems is getting older. Cocaine and ecstasy remain popular and ‘Legal highs’ pose dangers to users because new substances are rapidly appearing on the market. ‘Prescription only’ or ‘over the counter’ drugs are also substances included in addiction. Monitoring the prescription, abuse and withdrawal from certain prescription drugs has implications for primary healthcare, both in terms of practice and budgets.

Last updated: Apr-19
Drugs & alcohol resources
Substance misuse needs assessment
2013 | Norfolk Drug and Alcohol Partnership


Drugs & alcohol references
  1. fingertips.phe.org.uk/search/smoking#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/92443/age/168/sex/4
  2. www.norfolkinsight.org.uk/resource-norfolk-tobacco-control-strategy/
  3. fingertips.phe.org.uk/search/alcohol%20admissions#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/91414/age/1/sex/4
  4. fingertips.phe.org.uk/search/alcohol%20admissions#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/92320/age/287/sex/4

Learning disabilities

Norfolk Learning Disability Partnership Board Joint Commissioning 2010-2015 strategy focused on Better Health, Housing, Making choices (personalisation), Employment and Having a Life.[31] People with Learning disabilities have poorer health than the general population, much of which is avoidable, for example men with learning disabilities die on average 13 years younger than men in the general population and women 20 years younger.[32] Learning disability prevalence (all ages) in Norfolk is higher in Norfolk than England as a whole.[33]

Last updated: Apr-19
Learning disabilities resources
Learning disabilities references
  1. www.norfolk.gov.uk/care-support-and-health/disabilities/learning-disabilities/learning-disabilities-partnership-board
  2. www.learningdisabilitytoday.co.uk/people-with-learning-disabilities-have-significantly-lower-life-expectancy-than-the-general-population
  3. fingertips.phe.org.uk/search/life%20expectancy%20learning%20disability#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/200/age/1/sex/4

Physical disabilities

People whose day-to-day activities are limited by their health or disability is just over 1 in 5.[34] It is estimated prevalence of physical disability aged 16 to 64 is 11.8% a little less than 62,000 people, slightly higher than England at 11.1%.[35]

Last updated: Apr-19
Physical disabilities resources
Physical disabilities references
  1. www.norfolkinsight.org.uk/health-and-social-care/
  2. fingertips.phe.org.uk/search/moderate%20physical%20disability#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/90557/age/204/sex/4

Criminal justice system

Norfolk has three prisons; HMP Bure, HMP Norwich and HMP Wayland. Offenders are more likely to smoke, misuse drugs and/or alcohol, suffer mental health problems, report having a disability, self-harm, attempted suicide and die prematurely compared to the general population. The links between poor health and reoffending have been documented along with the links with drugs and alcohol, housing and employment. Norfolk’s level of reoffending as a percentage of those who reoffend is similar to the national level, however first time offenders rate is higher than the national figure.[36]

Last updated: Aug-18
Criminal justice system resources
Offender health profile for Norfolk
2014 | Norfolk County Council


Criminal justice system references
  1. fingertips.phe.org.uk/search/offender#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/92456/age/1/sex/4

Domestic abuse


Domestic abuse is an incident or pattern of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 years or over, who are or have been intimate partners or family members, regardless of gender or sexuality. This can encompass, but is not limited to, psychological, physical, sexual, financial or emotional and also includes honour-based violence, forced marriage and female genital mutilation. Domestic abuse is generally under reported but accounts for 14% of total crimes for year ending March 2018.[37] Domestic abuse can be the cause of depression and other mental health issues in women, contributing to self-harm and attempted suicide. The cost of treating physical and emotional health of victims of domestic abuse victims themselves is £47 billion.[38]

Last updated: Apr-19
Domestic abuse resources
Domestic abuse references
  1. www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/datasets/domesticabuseinenglandandwalesdatatool
  2. www.gov.uk/government/publications/the-economic-and-social-costs-of-domestic-abuse

Crime & sexual exploitation

Hospital admissions for victims of violent crime (including sexual violence) is significantly lower than that of England[39] although the rate of violent crime and sexual offences rates per 1,000 population is slightly lower than that of England.[40]

Last updated: Apr-19
Crime & sexual exploitation resources
Crime & sexual exploitation references
  1. fingertips.phe.org.uk/search/violent%20admission#page/0/gid/1/pat/6/par/E12000006/ati/102/are/E10000020
  2. www.norfolkinsight.org.uk/crime-and-community-safety/

Homeless


Homelessness includes those households who are defined as statutorily homeless within the Housing Act 1996 and Homelessness Act 2002 (families with dependent children, pregnant women and adults who are assessed as vulnerable), however non-statutory homeless include single or couples without dependents who are sleeping rough, living in supported accommodation or are deemed as “hidden homeless” often sleeping on friends or family sofas.[41] It is estimated that there has been a 30% rise in rough sleeping nationally from 2014 to 2015, Norwich has the highest rate with South Norfolk the lowest. Statutory homelessness is currently highest in Great Yarmouth and north Norfolk, lowest in South Norfolk.[42] However non-statutory homeless which includes single or couples without dependents who are sleeping rough, living in supported accommodation or are deemed as “hidden homeless” often sleeping on friends or family sofas. It is estimated that there has been a rise of 73% in rough sleeping nationally from 2014 to 2017.[43]

Last updated: Apr-19
Homeless resources
Homeless references
  1. www.gov.uk/guidance/homelessness-code-of-guidance-for-local-authorities/overview-of-the-homelessness-legislation
  2. fingertips.phe.org.uk/search/homeless#page/4/gid/1/pat/6/par/E12000006/ati/102/are/E10000020/iid/11501/age/-1/sex/-1
  3. www.homeless.org.uk/facts/homelessness-in-numbers/rough-sleeping/rough-sleeping-explore-data

Carers


In Norfolk, there are estimated to be just under 100,000 unpaid adult carers who look after a family member or friend.[44] Caring affects people from all walks of life, at all ages, living in the smallest village or the larger towns and cities. Carers UK has estimated that the care provided in Norfolk by our local adult carers would cost £1.9 billion a year if it had to be paid for by public services.[45] More than half of carers are female, the majority of carers are over 50; just under 40% are aged 50-64 and just under 30% are 65 and over.There is an increased demand on the Carers of older people with Long-term conditions. The health and wellbeing of carers is also reported to be affected by the levels of caring, with Carers who care for someone for more than 50 hours a week twice as likely to be in poor health as non-carers. Carers UK report “Alone and caring”[46] reveal 8 out of 10 carers have felt lonely or isolated as a result of their caring responsibilities. 57% had lost touch with friends and family and 38% of carers in full time employment have felt isolated from other people at work.

Last updated: Apr-19
Carers resources
Carers references
  1. www.carersuk.org/
  2. www.sheffield.ac.uk/polopoly_fs/1.546409!/file/Valuing-Carers-2015.pdf
  3. www.carersuk.org/for-professionals/policy/policy-library/alone-caring

Safeguarding

Norfolk Safeguarding Adults Board annual report 2017-18 reported physical abuse as the most common type of abuse, more women than men were likely to be at risk.[47] Norfolk is a beacon site for National Domestic Abuse charity SafeLives[48] which will bring in at least £2m funding into the county. The Beacon Project, a 5 year programme of work complementing the Domestic Abuse Change Programme already in progress in Norfolk, comprises of 3 elements; One front door, the Connect Model (being piloted in Norwich) and Drive Perpetrator programme.

Last updated: Apr-19
Safeguarding resources
Safeguarding references
  1. www.norfolksafeguardingadultsboard.info/assets/Uploads/NSAB-ANNUAL-REPORT2017-2018FINAL.pdf
  2. www.safelives.org.uk