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 alcohol and obesity contribute about 17,000 hospital admissions per year. This equates to 19 admissions per thousand people, in England this rate is on average 17 admissions per thousand people.[1,2]
Although smoking prevalence is declining in most districts of Norfolk and England as a whole, smoking is still the biggest driver of avoidable poor health. In 2019 in Norfolk, the district with the highest prevalence of adult smokers was Great Yarmouth at 23.4% and the lowest was Breckland at 12.7%. This compares poorly with England at 13.9% in the same time period. 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 resources.
There were 135 hospital admissions for mental health issues in Norfolk in the year 2018/19, this was approximately 80 per 100,000 people, this has remained relatively stable over the past 5 years. Over the same time period England had a rate of 88. Suicide occurs across all age bands, not just young people, in 2019 there were 89 deaths due to suicide, 71% male, in Norfolk. This accounted for 0.88% of all deaths, compared to 1.1% in England over the same time period. In both England and Norfolk, the prevalence of suicide has remained relatively static over the past 5 years.
According to the Annual Population Survey in 2019/20 Norfolk had a greater percentage of people with high anxiety (24%) and roughly the same percentage of people with high happiness (74%) as England in the same time period. The estimated prevalence of common mental disorders in people over 16 years old in 2017 was approximately 16% compared with 17% in England over the same time period. Estimates predict this to be approximately 98,100 people aged 18 to 64 on Norfolk in 2020 rising to 101,450 in 2040.
There were 135 hospital admissions for mental health issues in Norfolk in the year 2018/19, this is approximately 80 per 100,000 people, this has remained relatively stable over the past 5 years. Over the same time period England had a rate of 88. Suicide occurs across all age bands, in the year 2019 there were 89 deaths due to suicide in Norfolk with 71% being male. This accounted for 0.88% of all deaths, compared to 1.1% in England over the same time period. In both England and Norfolk, the prevalence of suicide as a cause of death has remained relatively static over the past 5 years.
In Norfolk it is estimated that alcohol and obesity contribute about 17,000 hospital admissions per year. This equates to 19 admissions per thousand people, in England this rate is on average 17 admissions per thousand people.[15,16] The smoking prevalence in Norfolk is higher than England and the East of England and the Norfolk district with the highest rate is Great Yarmouth.
The percentage of adults classified as overweight or obese has remained stable over the past three years at approximately 60%, very similar to England. The rate of sight loss due to diabetes is similar to that of England.
The level of screening for breast cancer in Norfolk is higher than England but has been decreasing over the past decade. In addition, the percentage of the population who have been invited for an NHS health check has been steadily increasing over the last ten years and Norfolk has been consistently higher than England.
Norfolk’s population is set to increase during the next decade, with more significant increases in adult and older age groups than among children. 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 45% of the adult population has been seen by a dentist in the previous 24 months, however there is a proportion of the population who are not accessing services for regular checks and prevention.
In Norfolk 47% of the adult population has been seen by a dentist in the previous 24 months, compared to 45% in England. For children in Norfolk 25% of the population was seen compared to 30% in England over the same time period. There has been a steady drop in the number of people seeing dentists from June 2016 until the data was last recorded, December 2020.[27,28]
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. There is estimated to be 67,000 people in Norfolk and Waveney with diabetes, this is 7.6% of the population, similar to England at 7.1%.
The mortality rate for the under 75’s from cancers considered preventable has been decreasing in Norfolk and been consistently lower than England. The under 75 mortality rate from preventable cardiovascular diseases has been dropping over the past decade and has been consistently lower than the English average.
Exercise, activity & diet
The percentage of adults classed as either overweight or obese in Norfolk has remained relatively static over the past five years at approximately 60%, similar to the English average. Being overweight or obese can contribute to health issues such as heart disease, high blood pressure, strokes and diabetes. In 2019/20 just over 60% of adults in Norfolk did 150 minutes or more exercise a week compared to 63% on average across England.
Norfolk has a high rate of residents whom meet the recommended “5-a-day” on a “usual day” measure, 59%, where as the rate for England is just over 54%. Rates of deaths from preventable cardiovascular diseases and cancer are better than the English average.
Norfolk has a low rate for all new STI diagnoses for people aged 25 or over (excluding Chlamydia) at 2.0%. Where as the level for England is at 2.4%. For Chlamydia detection in Norfolk the rate is estimated to be about 2% in the age group 15-24 slightly less than the percentage in England. The rate of new HIV diagnosis in the population aged 15 or more is 5.9 per 100,000 in Norfolk and 9.0 in England.
Norfolk ranked 81st overall in the English Indices of Deprivation 2019. Education, Skills and Training is one of the IMD domains and Norfolk has a ranking of 31 for this domain (1 = most relatively deprived and 151 is the least). There is a range of rankings across the county with Great Yarmouth as the second most deprived district in England, with South Norfolk the best in Norfolk in terms of education. Ofsted inspected Norfolk Community Learning Services and gave a judgement of “Good” in January 2020.
Tobacco, drugs & alcohol
The percentage of the adult population who smoke has continued to fall in Norfolk and England over the past decade, with the prevalence in Norfolk being approximately 20% very similar to England. Smoking prevalence is influenced by several demographic factors. Norfolk has a Tobacco Control Strategy revised in March 2016 and the NHS offers support and guidance on quitting smoking.
Admission episodes for alcohol-related conditions (narrow definition) is very similar in Norfolk to England in general with an incident rate of approximately 7 per 1000 people. The age group with the highest rate of admissions is the over 65’s with approximately 10 per 1,000 people. The rate is similar to England and in both areas has been increasing over the last decade.
Cannabis is the most reportedly used drug in the last year by adults in England and Wales followed by cocaine and nitrous oxide. The proportion of 16 to 24 year olds using any drug in the past year has slightly increased recently and in 2019/20 was approximately 21%.
Norfolk Learning Disability Partnership Board Joint Commissioning 2018-2022’s vision is “That all people with a learning disability have the ambition, choice and opportunity to be equal members of the Norfolk Community.” They aim to do this through a strategy focused on better health outcomes, housing, employment and having a full and wholesome life. People with Learning disabilities have poorer mental health, education and employment, they also have a lower life expectancy and a higher risk of early death compared to the general population, for example men with learning disabilities die on average 14 years younger than men in the general population and women 17 years younger. The prevalence of learning disabilities in Norfolk is higher than England and the East of England.
In the 2011 census people whose day-to-day activities are limited by their health or disability was just over 1 in 5. In Norfolk 33% of the population aged 16-64 are disabled according to UK law or a have a work-limiting disability compared to 29% in England, this is estimated to be 130,000 people in Norfolk.
Criminal justice system
Norfolk has three prisons; HMP Bure, HMP Norwich and HMP Wayland. As of 31st March 2021, these had populations of 585, 687 and 877 respectively. 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. In 2018 Norfolk prisoners had a reoffending rate of 30% for adults and 42% for juveniles. Both rates are higher than the average in England & Wales.
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 abuse and also includes honour-based violence, forced marriage and female genital mutilation.
In Norfolk there were approximately 20 police recorded domestic abuse related incidents and crimes per 1,000 people in the year 2019/20. This is similar to the East of England and lower than England & Wales over the same time period. Although domestic abuse is generally under reported, in Norfolk it accounted for 17% of all crime, slightly higher than the East of England and England & Wales. Domestic abuse can be the cause of depression and other mental health issues in women, contributing to self-harm and attempted suicide. The total cost of domestic was estimated to be £66 billion in 2017/18, this included the cost to the victims and the costs to public services. But even this number is thought to an under-estimate.
Crime & sexual exploitation
Hospital admissions for victims of violent crime (including sexual violence) is significantly lower for Norfolk than that of England although the rate of violent crime and sexual offences rates per 1,000 population is higher than that of England and the East of England.
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.[63,64]
In 2017 the Homelessness Reduction Act was introduced that placed a duty on local authorities to intervene at an earlier stage to prevent homelessness in their areas by helping those threatened with homelessness or eviction. It also requires housing authorities to provide homelessness services to all those affected, not just those in priority need.
Statutory Homelessness per 1,000 household has remained relatively static over the last decade with Norfolk having a lower rate than England over that time period. In Norfolk the Great Yarmouth district has by far the highest amount of household owed a homelessness duty per 1,000 people and South Norfolk the lowest. Not all types of homelessness are measured in official statistics. Informal homelessness, such as sofa surfing, is not recorded but was found to be quite prevalent amongst young people. A 2016 survey of UK 16–25 year olds found that 35% had “stayed with friends or family on their floor or sofa because they had nowhere else to go”.
According to the 2011 census there were estimated to be 100,000 adult carers in Norfolk, an estimated rate of 11% of the adult population. In England over the same time period this was 10%. According to the 2011 census more than half of carers are female, with the majority of carers being over 50. Just under 40% were aged 50-64 and just under 30% were 65 and over. As of August 2020, there were estimated to be 18,000 individuals eligible for the carers allowance in Norfolk, 3.4% of the population similar to England at the same point in time at 2.9%.
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 have cost £1.9 billion per year in 2011 if it had to be paid for by public services. 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” 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.
During the year 2019/20, 4,174 safeguarding concerns were raised to the Norfolk Safeguarding Adults Board, resulting in 1,877 safeguarding enquiries. The most common type of abuse was “Physical”, and the second was common was “Neglect and acts of omission”. Men between the ages of 18 to 64 were more likely to be subject to a safeguarding enquiry than women in the same age band. In Norfolk in 2019/20 the rate of completed Safeguarding enquiries per 10,000 adults was estimated to be 23 for all adults but the rate was highest is the 85+ age group with an estimated rate of 160 completed enquires for every 10,000 adults in that age group.
Norfolk is a beacon site for National Domestic Abuse charity SafeLives 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.