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Summary of key findings
Key findings
Health status
Boys (24%) were more likely than girls (20%) to report
a longstanding illness, but the sex difference was no longer apparent
among young adults (25% of males and 26% of females).
Longstanding
illnesses were more common among informants in the lower income quintiles.
Informants assessed their general health using a five category
scale which ranged from very good, through good, fair and bad, to very
bad. Prevalence of good and very good health was higher among children
(93% of boys and girls) than young adults, and young men were more likely
than young women to report very good or good health (87% of young men
and 84% of young women). The chart shows a tendency for children and
young adults to report better health as household income
increased.
More children (79% of boys and 80% of girls) had last
visited the dentist for a regular check-up than young adults (49% of
young men and 55% of young women).
Dental service use was related to socio-demographic variables. The chart
shows that for both males and females regular visits to a dentist for a check-up were more likely in areas
with low levels of deprivation, as measured by the Index of Multiple Deprivation (IMD).
Smoking
The General Household Surveys have charted the marked decline in the
prevalence of cigarette smoking in the population over many years. However,
that downward trend ceased in the late 1980s, and since about 1990 estimates
of cigarette smoking prevalence in the adult population have fluctuated
(between 26% and 30%) without a clear trend. A decrease in self-reported prevalance
among young adults (16-24) was seen between HSE 1997 (representing combined estimates for 1995-1997) and HSE 2002 (combined estimates for 2001 and 2002). Prevalence for males was down from 37% to 33%, and for females from 36% to 35%.
The chart below shows the pattern
of self-supported smoking prevalence since 1993. The chart shows that smoking prevalence
among young adults increased in the early and middle 1990s, but this increase appears to have been temporary, being followed by the decrease between 1997 and 2002 noted above.
No clear trend was seen among children over this period.
The next chart shows smoking prevalence in both sexes at
each year of age. (The prevalence measure used here is the proportion
with 15 ng/ml or more of cotinine in saliva samples, a level regarded
as indicative of smoking. The samples at each age are small, therefore
the data are presented as moving averages of three consecutive age years.)
It will be seen that cotinine levels remained low until about age 11 or
12, after which they increased rapidly, the increase slowing down and
levelling off in the late teens and early twenties.
It will also be seen that levels were similar in both sexes. In the mid
teens prevalences were slightly higher for females, but this did not persist.
The apparent dip at age 21 in the figures for males is likely to be due
to sampling fluctuation in the estimates derived from the relatively small
samples for each age year.
A negative association between smoking and various measures
of socio-economic status has been well documented in previous research.
The chart shows a marked tendency for children's and
young adults' cigarette smoking prevalence to increase as equivalised
household income decreases.
Anthropometric measurements, overweight, and
obesity
HSE 2002 reports on height, weight, body mass index
(BMI), and the prevalence of overweight/obesity in children aged 2-15
and in young adults (aged 16-24). BMI, the key overweight and obesity
measure in this report, is weight (kg) divided by the square of height
(m2).
There is no generally agreed BMI criterion for classifying
overweight and obesity in children, but two widely favoured indicators
are based respectively on percentiles of UK reference curves (85th percentile
for overweight, 95th percentile for obesity) and on reference points
derived from an international (six country) survey.
For young adults, the customary adult classification
was used, with BMI grouped into:
20 kg/m2 or less = underweight, over 20-25
kg/m2 = desirable weight, over 25-30 kg/m2 = overweight,
over 30 kg/m2 = obese.
Height increased steadily to age 15 for girls and to
age 18 for boys. No marked sex differences existed in height until the
age of 13; from age 14 boys took the lead, so that from age 14 males
were taller than females by 12.2 cm on average. Males were markedly
heavier than females from the age of 15 onwards, by 9.7 kg on average.
For both males and females BMI decreased from about age 2 to about age
6 and then increased steadily through late childhood into young adulthood.
BMI differences between the sexes were generally small, but females
had notably greater BMI than males from ages 12 to 16, when females
had a higher BMI by 1.0 kg/m2 on average.
About one in 20 boys (5.5%) and about one in 15 girls
(7.2%) aged 2-15 were obese in 2002, according to the International
classification. Overall, over one in five boys (21.8%) and over one
in four girls (27.5%) were either overweight or obese. In comparison
with the International classification, obesity estimates derived by
the National BMI percentiles classification were much higher (16.0%
for boys and 15.9% for girls). The difference between the two estimates
is small for girls when the combined overweight including obesity category
is considered (30.7% vs 27.5%), but remains more marked for boys (30.3% vs 21.8%).
About one in ten young men (9.2%) and women (11.5%)
were obese, while about one in three young men (32.2%) and young women
(32.8%) were overweight or obese.
Overweight or obesity was more common in the more deprived
areas for both children and young adults. Among boys, obesity prevalence
was 4.5% in the least deprived quintile and 6.4% in the most deprived.
Corresponding figures for the other groups were: girls 4.5% and 8.8%,
young men 8.9% and 12.5%, and young women 7.6% and 14.1%. Having two
obese parents increased the risk of being obese by a factor of 12 for
boys aged 2-15 and a factor of 10 for girls.
Although there was no increase in the mean height
of children and young adults between 1995 and 2002, weight and BMI
increased year by year for all age and sex groups. As a result, there
was a steady upward trend in the prevalence of overweight and obesity
during these years. Although the figures produced by the two definitions
(International and National) differed considerably, the actual trend
was not affected by the definition used. Using the International classification,
between 1995 and 2002 obesity doubled among boys (2.9% to 5.7%) and
increased among girls from 4.9% to 7.8%. Among young men it increased
from 5.7% to 9.3% and among young women from 7.7% to 11.6%. The National
BMI percentiles classification trends are in agreement with the trends
produced using the International BMI cut-off points in that marked
increases have occurred in the prevalence of obesity, while the prevalence
of overweight has increased only moderately.
The upward trend in obesity prevalence over the last seven years was
more marked in manual social classes than in non-manual social classes.
Alcohol consumption
45% of boys and 40% of girls aged 8-15 reported ever
experiencing a 'proper' alcoholic drink (not just a taste). 22% of
boys and girls aged 13-15 reported drinking alcohol in the past week.
At age 8, 14% of boys and 8% of girls had ever had a drink. From age
12, the proportion increased steeply, so that by age 15 87% of boys
and 86% of girls had even had a drink. As the chart shows, boys were
more likely than girls to report ever drinking alcohol up to age 11,
after which the gap between the sexes disappeared. The chart also
shows that the proportion of children of all ages from 8 to 15 who
reported ever drinking alcohol has increased since 1997.
Young men aged 16-24 were much more likely than young
women to drink on three or more days a week (34% and 20% respectively).
42% of young men drank more than 21 units of alcohol a week, and 32%
of young women drank more than 14 units a week. The chart below shows
that up to age 18 young men and young women were equally likely to
exceed their respective limits, but between ages 19 and 24 young men
were much more likely to exceed 21 units than young women were to
exceed 14 units.
The chart also shows that, among both sexes, the
proportion exceeding the recommended weekly limits has increased since
HSE 1997: among young men, the increase was from 33% in HSE 1997 to
42% in 2002, and for young women it was from 22% to 32%. This increase
was found for every age year in both sexes.
Three in four (73%) young men and two in three (65%)
young women consumed alcohol in the week before the interview. Those
who had a drink in the last week were asked how much they had consumed
on their heaviest drinking day. Among those who drank in the last
week, 81% of young men drank 4 or more units on their heaviest drinking
day, and 77% of young women drank 3 or more units. These results
show that a large proportion of young men and women drinkers are
likely to exceed at least once a week the recommended number of
daily units (4 for men, 3 for women) that current government advice
says should not regularly be exceeded.
Since 1998 (the year these questions were first included in HSE),
there has been a large increase in the proportion of young women
drinking 6 or more units on their heaviest drinking day, from 38%
in 1998 to 52% in 2002. The proportion of young men drinking 8 or
more units has not changed significantly over this period (58% in
1998 and 61% in 2002).
Non-fatal accidents
As a survey of people living in private households,
HSE does not cover fatal accidents (these are covered in other statistics),
and will tend to under-represent accidents which have led to long
term hospitalisation.
Two types of accident are distinguished in the survey: 'major accidents'
include all those involving contacts with medical services; 'minor
accidents' include all other accidents that caused pain or discomfort
for over 24 hours. The recall period for major accidents was six
months, and for minor accidents was two weeks before the interview.
However, the figures have been multiplied up so that they can be
presented as annual accident rates per 100 persons.
The charts show major and minor accident rates by age (separately
for each sex) in 1995-1997 and in HSE 2001-2002. To reduce random
variation the charts are based on moving averages of three consecutive
age years.
Annual major accident rates in 2001-2002 per 100 persons were estimated
to be 24 for boys, 19 for girls, 36 for young men and 18 for young
women. Accident rates were higher in males than in females at almost
all ages, the gap tending to widen by age. Major accident rates
decreased between 1995-1997 and 2001-2002 in most age groups in
both sexes.
Annual minor accident rates in 2001-2002 per 100 persons were 210
for boys, 159 for girls, 357 for young men and 177 for young women.
Minor accident rates were broadly similar in both sexes until the
early teens, with both sexes showing a steady increase up to this
point. However, while the increase continued for males, rates for
females started to decline, so that by the mid-teens, rates were
much higher for males than females. Differences in minor accident
rates between 1995-1997 and 2001-2002 were small and not significant.
Physical activity
Information on physical activity among children
(aged 2-15) was collected using a reduced version of the children's
questionnaire used in the Health Survey in 1998. Questions asked
about participation in four categories of activity: Sports and
Exercise; Active Play; Walking and Housework/Gardening. Information
was collected about children's activities in the 7 days before
the interview. Activities carried out as part of the school curriculum
were excluded.
93% of boys and 91% of girls participated in
some physical activity on 5 or more days in the last week. The
chart shows the average number of hours spent doing physical activities
in the last week. Boys spent a mean of 14.2 hours in the last
week doing physical activities with no clear trend by age. Among
girls the mean number of hours spent participating in physical
activities was 12.2 hours, declining steadily with age, from a
mean of 13.0 hours among those aged 2 to 9.6 hours among those
aged 15.
The proportion of children who were active for 60 or more minutes
on 7 days in the last week was calculated. Assuming that all reported
activities were of at least moderate intensity, this proportion
refers to those children who met the recommended levels of physical
activity. Overall, a higher proportion of boys than girls achieved
the recommended levels - 70% of boys compared with 61% of girls.
Among boys, the proportion active for at least 60 minutes on 7
days did not vary markedly with age. In contrast, levels of physical
activity among girls declined from about age 11.
Information on physical activity among young adults
was collected using the short version of the questionnaire introduced
in 1999. Questions concerned participation in activity at home
(Housework, Gardening, DIY) and Walking for at least 30 minutes
and in Sport and Exercise activities for at least 15 minutes.
Overall, 51% of males carried out physical activities
for at least 30 continuous minutes on 5 days or more a week on
average. Among females, the proportion was far lower than that
of males, at 28% overall.
Respiratory health
Questions on wheezing and doctor-diagnosed asthma,
addressed to informants of all ages, were concerned with both
lifetime prevalence and the prevalence of these conditions in
the last twelve months. For those aged 2-24, comparisons have
been made between 2001-2002 and earlier Health Surveys in 1995,
1996 and 1997.
Around a third of informants aged 0-24 reported
that they had ever wheezed. Among children the proportion who
had ever wheezed was higher in boys than in girls (36% vs 29%).
It was also higher among young men than young women, but the difference
was less marked (38% vs 36%).
About a fifth of informants reported having wheezed
in the last twelve months. Prevalence was higher at both ends
of the surveyed age range than in the intervening years. It was
higher among boys than girls, but higher among young women than
young men.
Between 1995-1997 and 2001-2002, the proportion
who had ever wheezed increased in both sexes and in all age groups,
while the prevalence of wheezing in the last twelve months remained
stable. It is possible that this reflects better control of wheezing
symptoms in recent years, so that those with the disease experienced
relatively fewer recent symptoms even though the tendency has
been for prevalence of the disease to increase over time.
About a fifth of children and a quarter of young
adults reported that they had had a medical diagnosis of asthma.
The proportion was higher in males than females at all ages.
The prevalence of doctor-diagnosed asthma was significantly
higher in 2001-2002 than 1995-1997 for those aged over 6, typically
by about 5 percentage points in boys, and between 2 and 5 percentage
points in girls. Among those aged 2-6, in contrast, prevalence
decreased over time, more in boys than in girls.
Fruit and vegetable consumption
Questions on fruit and vegetable consumption (among those aged
5 and over) were introduced into HSE in 2001. Since no significant
differences in the results between 2001 and 2002 were observed,
this report combines data from both years. The questions focused
on consumption on the day before the interview, which was assumed
to be a 'typical' day. The World Health Organisation (WHO) recommends
the consumption of at least 400g (five 80g portions) of fruit
and vegetables a day. A 'portion' of 80g was defined in terms
of everyday measures, such as tablespoons, cereal bowls and
slices. The analysis focuses on mean consumption and on the
proportion of informants eating the recommended amount of five
or more portions per day.
Females tended to eat more portions of fruit
and vegetables, on average, than males (girls 2.6, boys 2.5;
young women 2.9, young men 2.6) and were more likely than males
to eat five or more portions per day (18% compared with 15%).
There was no significant difference between the sexes in the
proportion eating five or more portions a day, though boys were
more likely than girls not to have eaten any fruit and vegetables
(12% compared with 8%). Fruit made up nearly half of children's
total daily portions of fruit and vegetables (1.2 for girls,
1.1 for boys), but vegetable consumption increased with age,
so that young adults' consumption of fruit and vegetables was
spread more evenly between fruit (young women 1.1, young men
0.9) and vegetables (young women 1.0, young men 0.9).
There was a positive association between fruit
and vegetable consumption and various measures of socio-economic
status. The charts show that the proportion eating the recommended
number of portions was higher in managerial and professional
than lower supervisor and semi-routine and routine households
(a difference of around five percentage points).
Fruit and vegetable consumption also increased
with household income. Around one in ten children in the lowest
three income quintiles ate five or more portions a day compared
with around on in six in the highest income group. Similarly,
over a fifth of young women in the highest quintile (22%) ate
fiv e or more portions a day, compared with a sixth in the lowest
(16%). The gap between the highest and the lowest quintiles
was greater for young men, with nearly twice the proportion
eating five or more portions a day (22% compared with 12%).
Fruit and vegetable consumption was associated
with smoking and drinking behaviour for young adults but not
for children. The chart shows that young adults who were current
smokers ate less fruit and vegetables than non-smokers (including
ex-smokers).
Blood pressure
It is well established that raised blood pressure
is a risk factor for coronary heart disease and stroke in
adults. External evidence is now available to suggest a relationship
between blood pressure levels in childhood and adulthood.
Blood pressure was measured in informants aged 5 and over
using an automated device, the Dinamap 8100.
Mean systolic blood pressure (SBP) generally increased with
age. At any given age, it also increased with height in both
males and females. Males and females showed similar mean SBP
values up to age 13. After age 13 mean SBP was higher in males
than females. Mean diastolic blood pressure
(DBP) also increased with age, after age 15.
Comparisons over time for SBP (adjusted by height within age groups) have been made using the combined years 1995-97 and 2001-02. Among males there was a slight decrease on SBP from 1995-97 to 2001-02 after age 15, but no change among children aged 5-15. Among females, from age 13, height-adjusted SBP was significantly lower in 2001-02 than in 1995-97.
Maternal health
The health of mothers before and during
pregnancy affects the health of their unborn child. Maternal
health was a new topic to the Health Survey in 2002.
Women who are pregnant and those planning
pregnancies are advised to increase their intake of folate
to reduce the risk of birth defects. Just over half (55%)
of mothers planning their pregnancy took folate before
pregnancy. Among those who had planned their pregnancy,
the proportion of women supplementing their diets with
folate increased with age from 32% of those aged 16-24
to 59% of those aged 25-34 and 60% of those aged 35 and
over. Overall, almost four in five (79%) mothers increased
their folic acid intake during pregnancy, with lower uptake
in the youngest age group.
The Department of Health
recommends that all pregnant women and women trying
to conceive limit their alcohol consumption to less
than 1-2 units of alcohol per week. 97% of mothers
reported consuming no more than 2 units per week during
pregnancy.
Decreasing cigarette smoking
or stopping all together is also recommended during
pregnancy. Overall, 18% of mothers smoked during pregnancy.
Smoking during pregnancy was more common among younger
mothers than older mothers (34% of those aged 16-24
vs 12% of those aged 35 and over) and the percentage
of mothers who smoked decreased as income increased.
Over one quarter of mothers (27%)
reported their labour was induced. A planned caesarean
section was reported by 9% of mothers, and 14% reported
an emergency caesarean section. The overall caesarean
rate, 23%, matches the national rate of 22% derived
from the 2000-2001 hospital episode statistics.
Mothers were asked about any childbirth-related
health problems that they had experienced. Around
a quarter (27%) of mothers reported haemorrhoids;
a problem that was more common among older mothers.
15% of mothers reported relationship problems with
a partner or spouse. Younger mothers were more likely
to report relationship problems (24% of mothers aged
16-24, 14% of mothers aged 25-34 and 11% of mothers
aged 35 and over).
Mothers who reported being the sole parent of their
infant had higher scores on the Edinburgh Post Natal
Depression Scale, indicating possible depression (41%
of lone-parent households compared with 21% of two
parent households).
In addition, over half (52%) of mothers from lone
parent households perceived a lack of social support,
twice as many as in two parent households (23%). Lack
of social support was also related to area deprivation.
As area deprivation (IMD) increased, so did reported lack
of social support. Over a third of mothers (39%) from
the most deprived areas reported a lack of support
compared with 17% of those in the least deprived areas.
Infant health
Information about infants under
1 was collected in both 2001 and 2002. The report
presents data from both years about birth weight,
use of services and immunisations. The report also
presents data about infants collected in 2002 during
the maternal interview (eg problems at birth, stay
in hospital and breastfeeding).
Low birth weight (less than 2.5
kg) is a leading cause of infant mortality as well
as being associated with health and behavioural
problems later in life. The mean reported birth
weight of infants was 3.32 kg. There was no significant
difference in birth weight between boys and girls;
though boys were more likely to have been born prematurely
(9% vs 4%). There were also no significant differences
by the age of the mother or socio-economic status,
owing to small sample sizes. Mean birth weight was
lower among those whose mothers had smoked in pregnancy
(3.13 kg) than those who had not (3.46 kg).
37% of mothers reported that their
baby had a health problem at, or shortly after,
birth. The most common problem was jaundice, reported
by 25% of mothers (18% of babies required hospital
treatment for jaundice, 8% did not). Other problems
mentioned were problems with breathing and infections.
Breastfeeding is widely promoted
as the best way of feeding an infant in the first
six months of life; offering benefits to both the
infant and the mother. 73% of mothers breastfed
their infant initially, and 47% are estimated to
have breastfed for at least a month. 15% are estimated
to have breastfed their baby beyond six months.
Older mothers (81% aged 35 and over) and those in
managerial and professional households (86%) were
the most likely to have breastfed their baby and
continued breastfeeding for longer.
Data were collected about use of health services
by infants. 98% of infants had been seen by a health
visitor. 61% of those under six months and 81% of
those aged six months and over had had a development
check (these are usually carried out between six
and eight weeks and seven and nine months).
Reports on the
2002 Health Survey
This booklet is a summary of findings from the 2002 Health Survey for England:
Sproston K and Primatesta P (eds) Health Survey for England 2002. Volume 1: The health of children and young people. The Stationery Office, London, 2003.
Sproston K and Primatesta P (eds) Health Survey for England 2002. Volume 2: Maternal and Infant Health. The Stationery Office, London, 2003.
Sproston K and Primatesta P (eds) Health Survey for England 2002. Volume 3: Methodology and Documentation. The Stationery Office, London, 2003.
Full results are available in the survey reports, and also in an anonymised data file lodged with the Data Archive at the University of Essex. Reports and data files from earlier surveys are similarly available.
For the adult general population, tables showing selected trends from 1993 to 2002 will be found on the Department of Health website (address below).
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