Health Survey for England, 2021 part 2

Self-assessed general health is an important indicator of the general health of the population. It is a valid measure for predicting future health outcomes and can be used to project use of health services and provide information useful for policy development. In older people, self-assessed poor overall health has been associated with increased mortality risk (Mossey and Shapiro, 1982) and functional decline (Idler and Kasi, 1995).

Participants were asked ‘How is your health in general?’ and offered five response options, ranging from very good to very bad. The responses to this question are described as self-reported general health.

In 2021, 77% of adults reported good or very good general health. 17% said their health was fair and 6% reported bad or very bad health.

A higher proportion of men (78%) than women (76%) reported good or very good general health. A higher proportion of women (7%) than men (5%) reported bad or very bad general health.

For more information: Table 1

Findings from the 2021 survey are not directly comparable with previous HSE survey years.

Between 1993 and 2019, the proportion reporting very good or good general health varied between 74% and 78% among men and between 73% and 76% among women with no clear pattern.

The prevalence of very bad or bad general health among adults remained steady at 5% between 1993 and 1995. From 1996 to 2019, this proportion varied between 6% and 8%.

Acute sickness is defined as any illness or injury (including any longstanding condition) that has caused the participant to cut down in the last two weeks on things they usually do.

14% of adults reported that they were affected by acute sickness in the last two weeks. The prevalence of acute sickness was higher among women (16%) than men (11%).

Findings from HSE 2021 are not comparable with those from previous surveys.

Over the period 1993 to 2019, the prevalence of acute sickness was consistently higher in women than in men. Acute sickness varied between 12% and 16% of men and between 14% and 19% of women.

For more information: Table 1

Longstanding conditions affect the body or mind for 12 months or more. Most longstanding conditions increase in prevalence with age (Moody, 2019), and vary in their effects on individuals, from minimal impact to disability. Most longstanding conditions are managed in the community, but some require inpatient stays, or domiciliary or residential care. Some of the longstanding conditions treated by GPs are monitored through the Quality Outcomes Framework (QOF) for prevalence and achievement of treatment targets.

The question on longstanding illness is included in the main interview. Prior to 2012, the question referred to ‘an illness, disability or infirmity…that has troubled you over a period of time or that is likely to affect you over a period of time’. In 2012, the questions on longstanding illness were changed to be consistent with the Office for National Statistics (ONS) harmonised disability questions designed for use in social surveys (HSE 2012). 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?’

Participants who reported that they had a physical or mental health condition or illness lasting or expected to last 12 months or more 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, covering infectious and non-communicable diseases of the body and mind.

In 2021, 40% of adults aged 16 and over had at least one longstanding illness or condition. Participants could record up to six conditions and so the overall prevalence of having any longstanding condition is lower than the combined prevalence of individual conditions.

For more information: Table 1

The most common conditions were:

• conditions of the musculoskeletal system (13%)
• mental, behavioural and neurodevelopmental conditions (9%)
• conditions of the heart and circulatory system (9%)
• conditions of the respiratory system (8%)
• diabetes and other endocrine and metabolic conditions (7%).

Other types of longstanding conditions had prevalence levels below 5%.

Women were more likely than men to have one or more longstanding conditions (43% of women had a longstanding condition, compared with 37% of men).

Women were more likely than men to have:

• musculoskeletal conditions (15% compared to 11%)
• mental, behavioural and neurodevelopmental conditions (11% compared to 8%)
• diabetes and other endocrine and metabolic conditions (8% compared to 6%)
• nervous system conditions (5% compared to 3%).

Heart and circulatory conditions were more commonly reported by men (9% of men, 8% of women).

For more information: Table 2

The current question wording for longstanding illness was introduced in 2012. Since then, there has been a gradual increase in the prevalence of longstanding illness among men, from 35% in 2012 to 41% in 2017, and it remained at a similar level (40%) in 2018 and 2019. Among women, prevalence was stable between 2012 and 2015 and has increased since, from 41% in 2015 to 45% in 2017, remaining at that level in 2018 and 2019.

Findings from HSE 2021 are not comparable with those from previous surveys.

For more information: Table 1