Health and wellbeing
Life expectancy
Why is this important?
Life expectancy and healthy life expectancy are extremely important summary measures of overall health. The Marmot Review, Fair Society, Healthy Lives, demonstrates clear and significant links between avoidable differences in health outcomes and deprivation, where people experiencing multiple deprivation not only living shorter lives, but spend a greater portion of their shorter lives with a disability or in poor health. As a Marmot city, Coventry has adopted and embedded the principles of Marmot, tackling the social conditions that can lead to health inequalities, and working to improve the areas in which people are born, grow, live, work and age.
What is the local picture? How does it compare?
Overall health in the city is below average, life expectancy has remained below the regional and national averages. Life Expectancy has decreased in the most recent data, this in part could be due to the inclusion of COVID 19 data. Life expectancy is a statistic giving a high-level picture of the health of Coventry residents and should be used with care in understanding likely life spans for people; excess deaths due to the COVID-19 pandemic will have a negative impact on life expectancy statistics but this may not have a permanent impact. Whilst this data includes 2020 and the pandemic will have undoubtedly affected mortality statistics, life expectancy increases had already stalled before 2020.
Life expectancy for females in Coventry is 82.0 years and for males is 78.0 from 2018 to 2020. This is below the national average of 83.1 for women and 79.4 for men.
Healthy life expectancy, which is the number of years a person can expect to live in good health, is at 64.0 years for females and 61.1 for males. Healthy life expectancy for Coventry males is lower than the national (63.1) and regional (61.9) averages whereas for Coventry females it is slightly higher (62.6) and (63.9). The trends show little change in recent years for women, but it has fallen a little for men.
The gap between healthy life expectancy and life expectancy is referred to as the ‘window of need’. It is the average number of years that a person can expect to live with poor health, during which they will be likely to need support from the health and care system.
In Coventry, females can expect to live almost a quarter of their lives in poor health (18 years) whilst males can expect to live 16.9 years in poor health. However, this difference has narrowed slightly in recent years with the window of need for women reducing marginally.
There are significant health inequalities across Coventry’s neighbourhoods that affect certain communities disproportionately. Males living in less deprived areas of the city can, on average live up to 10.7 years longer than those living in the most deprived areas of Coventry; and for females the gap is 7.8 years. This is not too dissimilar to regional averages of 7.9 years for women and 9.7 for men. The extent of inequality for Coventry men is the second worst of all West Midlands districts. People in more deprived parts of the city not only live shorter lives, but also spend a greater proportion of their shorter lives in poor health compared to those living in less deprived parts of the city.
Premature mortality (deaths amongst residents aged under 75 years) is higher than the national average for both males and females. The premature mortality rate by causes considered preventable is higher than both national and regional averages. Premature mortality is defined as deaths from causes considered avoidable, treatable, or preventable given timely and effective healthcare or public health interventions. Coventry’s premature mortality rates by all causes and causes considered preventable for both males and females rank slightly better than average compared to Coventry’s near neighbours.
GP patient register data gives estimates of the prevalence of a number of key health conditions amongst Coventry’s population. Many of the estimates are for all ages and we should be mindful that prevalence of certain diseases is heavily influence by age and age structure of populations. This means simply comparing these headline prevalence rates with national averages is not insightful. Also, recorded prevalence is influenced by diagnosis rates. In 2021/22 7.1% of Coventry patients aged 17+ were recorded as having Diabetes. This amounts to 24,627 people and has been on increasing trend for many years, as it has nationally, in Coventry from 5.7% (16,514) in 2010/11. 4.3% of Coventry patients aged 18+ were recorded as having CKD (Chronic Kidney Disease), this amounts to 14,648 people. 2.1% of Coventry patients of all ages have Coronary Heart Disease and 12.0% have Hypertension (high blood pressure). 1.5% of Coventry patients of all ages have COPD (Chronic Obstructive Pulmonary Disease).
What else is happening in the city? What else can be done?
Preventable deaths can be avoided by addressing the social conditions that lead to poor health, such as people’s prospects and opportunities; housing and environment; as well as behavioural and lifestyle changes. These are explored throughout this JSNA.
Health protection
Why is this important?
Health Protection is a term used to cover a set of activities within public health. It is defined as protecting individual, groups, and populations from single cases of infectious disease, incidents and outbreaks, and non-infectious environmental hazards such as chemicals and radiation. Monitoring health protection coverage helps to identify possible drops in immunity before levels of disease rise.
What is the local picture? How does it compare?
The unprecedented COVID-19 pandemic fundamentally changed all our lives and had impacts on a global scale. Not only did it have direct health impacts, but it also had many indirect and varied impacts on several aspects of life. From 23 February 2020 to 30 April 2023, there were out of a total of 123,095 cases amongst Coventry residents, where an individual tested positive and officially reported the result, and 20,795,205 across England overall. Using Census 2021 population data to calculate the rate of Coventry cases per 100,000 population it is 35,856.39 compared to 36,781.97 nationally. These official cases do not represent all cases of course, not all people who had COVID-19 in this period will have taken and a test or reported its result and some people were asymptomatic so were unaware they had the virus. Therefore, these figures do not count total prevalence and make it difficult to conclude from differing case rates, it may be a result of different testing and reporting rates.
The Office for National Statistics (ONS) conducted a COVID-19 infection survey with the purpose of measuring total prevalence and its change over time; the highest national prevalence was the estimate for the week ending 2nd April 2022 with 7.6% of all people having COVID-19 at that time; in Coventry the peak was at 8.1% in the week ending 19th March 2022, equating to 27,800 Coventry residents with COVID-19 at that time. It may have been higher in the early weeks and months, but we are unable to make any conclusions as this survey did not start until May 2020, however ‘national lockdowns’, the first of which began on 26th March 2020, will have suppressed transmission and therefore prevalence of the disease.
By the time of the peak in cases in Spring 2022, when no restrictions were in place, the vaccination programme was well established and the number of patients seriously ill in mechanical ventilation beds at University Hospitals Coventry and Warwickshire (UHCW) and deaths due to COVID-19 were at relatively low levels, indicating the successful protection provided by vaccinations. The number of cases has fallen to much lower levels since then, but not to zero, the last ONS infection survey measure for the week ending 13th March 2023 estimated prevalence at 2.7%.
COVID-19 caused severe illness and deaths and put a pressure on the health system. A total of 9,246 COVID-19 patients have been admitted to UHCW up to end of April 2023. This hit its highest point at the peak of the winter wave in January 2021, when 286 beds at UHCW were occupied by COVID-19 patients, and 43 COVID-19 patients were occupying mechanical ventilation beds. Up to the end of March 2023 a total of 1,025 Coventry residents died where COVID-19 was named as a cause on the death certificate, this is out of a total 9,909 deaths in that time. Therefore, COVID deaths have made up 1 in every 10 (10.3%) deaths between 2020 and March 2023. In 2020 and 2021 COVID deaths made up 1 in every 8 (12.8%) of all deaths, 796 out of 6,225. Data from the Care Quality Commission suggests at least 200 care home residents in Coventry died due to COVID-19.
Deaths rates for COVID-19 are higher in older people. To compare overall death rates, we calculate age standardised COVID-19 mortality rates. Coventry’s 2020 rate was 130.25 per 100,000 population compared to 126.57 for England overall, and in 2021 Coventry’s rate was 129.40 compared to 116.69 for England. Therefore, after adjusting for Coventry’s younger population, death rates due to COVID-19 were higher in Coventry than the national average. We know death rates are higher amongst people living in more deprived areas, this may explain Coventry’s higher rate. Coventry’s COVID-19 age-standardised mortality rate per 100,000 population is not especially high compared to other areas in the West Midlands metropolitan area, ranking 5th highest out of 7 – rates in Walsall, Birmingham, Wolverhampton and Sandwell were notably higher, between 176 and 205 in 2021.
Many people experience ongoing symptoms of COVID-19 for a prolonged period, and many of these will need to access health services. People whose symptoms, covering a wide range, continue for more than 12 weeks are said to have post-COVID-19 syndrome or ‘long COVID’. The Office for National Statistics (ONS) estimates the prevalence of self-reported long COVID at 2.92% of all people living in private households in March 2023, this would equate to 9,700 Coventry residents suffering with long Covid at that time.
Coventry delivered hundreds of thousands of COVID-19 vaccines that protected many from severe illness or death and protected the health service. However, many remain unvaccinated. At the end of April 2023, 253,947 Coventry residents had received their 1st dose of the COVID-19 vaccine, an uptake of 69.3% of residents aged 12+, lower than England at 77.9%. 236,022 have received their 2nd dose, an uptake of 64.4% lower than England at 74.4%, and 176,528 had received dose 3 or a booster. These uptake rates may be underreported due to the population data used by the NHS, but still Coventry’s uptake is lower than England’s. There is a strong link with deprivation, with increasingly lower rates of vaccine coverage in areas of higher deprivation, and ethnic minority groups have lower rates in Coventry. There is a double impact, the harm from COVID-19 itself has been unequally distributed across the population. Also, the wider impacts from the pandemic and lockdown did fall more heavily on the communities most directly affected by the disease – with the burden falling disproportionately on communities in areas of greater deprivation who have less ability to mitigate against the impact of the pandemic.
The pandemic had many impacts, not all directly on residents’ physical health. The restrictions due to the pandemic and the lockdowns, may have had an impact on different aspects of health, not least mental health. The ONS conduct an annual survey where they ask people about their personal wellbeing, it indicates increased levels of anxiety amongst Coventry’s population during the pandemic. The % who gave a score indicating high levels of anxiety increased from 20.6% in 2019/20 to 26.9% in 2020/21.
Responses to questions in the Coventry Household Survey 2022 also indicates a detrimental impact on mental wellbeing. A series of seven questions about respondents’ wellbeing were asked using the Short Warwick and Edinburgh Mental Wellbeing Scale (‘SWEMWBS’). Respondents can score from 1 (very low wellbeing) to 35 (very high wellbeing); the average score has reduced from 26.4 in 2018 to 22.94 in 2021 and 21.75 in 2022. Further to this, we can broadly categorise respondents’ level of mental wellbeing according to their score; in 2021 28% gave a score that suggests ‘possible’ or ‘probable’ depression, up from 10% in 2018, and only 18% gave a high mental wellbeing score, down from 43% in 2018. These are not clinical diagnosis of course, just an indication to the extent of the impact on wellbeing of the pandemic.
The proportion of Coventry adults diagnosed with depression according to GP registers, has been on an increasing trend. Mental ill health is of growing concern, in 2013/14 it was 6.5% which increased to 11.9% in 2021/22, amounting to 40,743 residents. This is not relatively high; the West Midlands rate is 13.3% and it is 12.7% for England overall. The 2021 Coventry & Warwickshire Adult Mental Health and Wellbeing Needs Assessment set out a few key findings:
- there are high levels of poor wellbeing and mental ill health;
- there is difficulty in accessing or understanding available services or support;
- there will growing demand in the future, either due to better diagnosis and recognition of mental health issues and / or a general increase in poor mental health.
Childhood vaccination take up rates in Coventry are relatively low and have decreased. The Health Index for England developed by the Office for National Statistics (ONS) brings together 56 statistics that measures broad range of aspects of health, and we can compare Coventry’s level and progress overall and for each measure against England’s. It is a good tool for understanding which health aspects Coventry has the biggest challenges with– rates of childhood vaccination are highlighted as the city’s worst performing aspect. With 100 denoting the England level in 2015, Coventry’s Health Index Score for child immunisations declined in 2020 to a low level (79.4) compared to 2019 (94.8).
Many of the uptake rates continued to deteriorate into 2021/22. Uptake rates in Coventry are below the 95% threshold for several different childhood vaccinations. The rates are lower than the national and regional averages and often lower than average compared to similar areas. Three examples are: DTaP/IPV/Hib for one-year-olds at 90.3%, a vaccination offered to babies to protect them against five serious childhood diseases; the rotavirus vaccine at 88.5%, which protects against gastroenteritis; and MMR for 2-year-olds has an uptake rate of 88.5%. However, some rank slightly better including HPV vaccine dose 1 for 12- to 13-year-olds and Meningococcal ACWY Conjugate for 14 to 15-year-olds vaccines.
The coverage of screening for cancers such as breast cancer, cervical cancer, and bowel cancer across at- risk populations are below the national average, moreover Coventry performs worse than similar areas with screening rates relatively low compared to the city’s’ CIPFA statistical neighbour’ areas.
Coventry has high rates for some communicable diseases; the COVID-19 pandemic may have also led to delayed diagnosis and initiation of treatment. The incidence of Tuberculosis (TB) in Coventry, at 15.8 new cases per 100,000 population in 2019-21, remains notably higher than national and regional averages, but is decreasing. However, nationally it is estimated that the COVID-19 pandemic will have led to delayed diagnosis and initiation of treatment which may contribute to increased morbidity, mortality, and disease transmission. There are some local populations with higher rates of TB, for example, some of the city’s newly arrived communities from countries with high rates of TB, as well as vulnerable groups facing severe and multiple disadvantages including rough sleepers, people who misuse drugs and sex workers. HIV remains an important public health concern in Coventry, there are a larger number of HIV diagnoses in males. In 2020, the diagnosed HIV prevalence rate in Coventry was 3.10 per 1,000 population age 15-59 years, which is higher than the 2.31 in England. Coventry has the 4th highest rate in the 16 similar local authorities. In Coventry between 2018 and 2020, 46.5% all HIV diagnoses were made at a late stage of infection compared to 42.4% in England.
There is some indication that sexual health is an issue in Coventry, with higher rates of Sexually Transmitted Infections (STIs) than national and statistical neighbours. For Coventry the indicator new sexual transmitted infections (STI) diagnoses per 100,000 decreased in 2020 and 2021 but was still at a higher rate than the West Midland and England averages. The highest rates of STI diagnoses most commonly occur within areas of Coventry where the city’s two Universities are located in the city centre and Gibbet Hill area. Higher-than-average rates are recorded in areas of greater deprivation in the city’s north eastern ‘corridor’, the south east and the Canley / Tile Hill areas.
Teenage conception rates are still higher than the national average but have fallen significantly. In Coventry in 2021, there were 18.6 conceptions per 1,000 people under the age of 18. This is higher than England’s 13.1 and the West Midlands’ 15.2. However, this is an improvement from 25.8 in 2019 and a significant improvement since a peak of 68.1 in Coventry vs 43.2 for the West Midlands and 39.7 for England in 2008.
Ensuring communities understand and trust public health messages, and that they are accessible and culturally appropriate is vital. Coventry has a very diverse and active voluntary and community sector with many small and well-connected groups, it is also blessed with many community leaders and “go to” people in local neighbourhoods. During the pandemic the Community Resilience Team created Community Messengers who consisted of existing faith, voluntary and community networks in the city. The number of messengers has now grown to 320. The messengers perform two main functions:
- they help to disseminate into their community the “stay safe” messages.
- they collect and feedback community intelligence which is then used to influence a number of things such as improving our communication materials, focusing our interventions and deploying our local
teams of COVID-19 advisors.
Young people were included through a partnership with The Positive Youth Foundation, a charity that supports young people in the Coventry area (and who chair the Coventry Youth Partnership), and a series of focus groups held with young people and the council’s communications team helped the development of specific messaging for young people, including several videos.
Community members now have a platform and a chance to participate directly in shaping how the council and communities engage with each other. This helps to facilitate a community-led response to communications and messaging surrounding several topics.
There is increasing recognition of the key role that places and communities play in our health. C groups are best placed to address health challenges, because they are trusted and have the networks understanding and legitimacy to do so. Health and care providers need to shift to an ‘enabling’ leadership style, supporting communities to maintain their health and well being by pooling engagement resources and helping to build capacity by sharing skills and facilities with the communities we serve. The One Coventry Plan is designed to work with our communities to ensure that they are able to address their health needs and to reduce inequalities.
Since 2021, Coventry was successfully awarded funding to deliver the Healthy Communities Together (HCT) programme. This programme is funded by the National Lottery and aims to support local areas to develop effective and sustainable partnerships between the voluntary and community sector, the NHS and local authorities to improve health and wellbeing, reduce health inequalities and empower communities.
A community-informed and culturally competent approach to healthcare is essential to increasing screening and vaccination rates. Asylum seekers and refugees typically have worse health than the wider migrant and UK-born population. During migration they are vulnerable to environmental threats – e.g., trafficking, and sexual exploitation – and may have experienced gender-based violence – e.g., torture, sexual violence, FGM, and conflict - that lead to health problems. They, and other newly arrived communities, can also spend long periods of their journey with limited access to healthcare which presents challenges in the form of poorly-managed long-term conditions – e.g., diabetes, and hypertension – and untreated communicable diseases such as TB, HIV and STIs. Newly arrived communities are at increased risk of poor mental health too potentially suffering with anxiety, PTSD, and depression. Therefore, newly arrived communities need healthcare on arrival and information and guidance about the NHS, what services are available, and about their health care rights. The impact of language and cultural barriers cannot be understated so services should be culturally appropriate, and trauma-informed.
Building on existing health and wellbeing infrastructures having a collaborative partnership approach, bringing together residents’ experience and partners’ skills and assets, should be taken to strengthen health and wellbeing in communities. An example of this is Vaccinating Coventry – a partnership group with membership from a range of council teams with a focus on improving vaccine uptake inequality across the city. While vaccine uptake across Coventry and Warwickshire has been good, early in the vaccination programme data started to reveal areas of Coventry with much lower uptake, particularly among minority ethnic groups and those living in more deprived areas. The work of the group is linked tightly with wider COVID-19 prevention inequality work, focused upon access to testing, understanding of and adherence to national guidelines.
The Integrated Care System has an opportunity to improve population health and wellbeing in its broadest sense, with a wide range of partners working together to improve health outcomes and tackle health inequalities, starting with the root causes by addressing the wider determinants of health. The development and implementation of the Integrated Care Strategy sees the importance of working together at all levels and as locally as possible. Much of the activity to integrate care and improve population health will be driven by organisations working together in places, and through multi-disciplinary teams working together in neighbourhoods, adopting new targeted and proactive approaches to service delivery, informed by a shared understanding of the needs of our population. The ICS brings together a wide range of partners – local government, NHS, voluntary and community sector, housing, Healthwatch, universities and others, to lead the system’s activity on population health and wellbeing and drive the strategic direction and plans for integration across Coventry and Warwickshire.
Demand and access
Why is this important?
The demand for health and care services is expected to increase as the city’s population grows and ages. To manage this growth there is a need to shift the emphasis to proactive and preventative care. This means ensuring people have better general health regardless of where they live, requiring fewer visits to hospital and shorter stays if they need inpatient care; and remodelling urgent and emergency and planned care so that it can cater to the expected increase in demand.
What is the local picture? How does it compare?
Coventry has good access to health services, with most residents being able to reach a pharmacy within a few minutes. Over 95% of Coventry residents could reach a GP or pharmacy within 10 minutes by public transport in 2020 (data on recently reduced bus services is not available yet.) 51 of 97 pharmacies in Coventry are currently listed as being open on a Saturday. This is particularly important as many community pharmacies are often located in deprived areas with high population density and inflexible work patterns. This means that they are an important first point of contact for patients seeking ad-hoc health advice alongside picking up regular prescribed medicines or purchasing over the counter medicines. Nonetheless, physical proximity is not the only metric for physical access. Pavements and pathways in the wider areas around healthcare facilities can be inconsistent with regards to accessibility for people with low mobility, mobility scooters, and prams. There are also challenges for the severely deprived or even homeless to access healthcare due to no provisions to accommodate their pet or an unwelcoming atmosphere in the waiting area.
We can understand satisfaction with GPs in Coventry by examining responses to the national GP patient survey by Coventry patients annually between 2019 and 2023. It shows reducing satisfaction levels amongst Coventry GP patients in the last two recent years, most notably between 2021 and 2022. The pandemic didn’t appear to have an impact on overall satisfaction levels with responses to three key questions not changing significantly between 2019, 2020 and 2021 but satisfaction has deteriorated since. When asked ‘Overall, how would you describe your experience of your GP practice?’, 71% of Coventry respondents in 2023 said good or very good, the same as England overall – but down from 81% in 2019 and 83% in 2021.
When asked ‘Generally, how easy is it to get through to someone at your GP practice on the phone?’, 59% of Coventry respondents in 2023 said easy or very easy, better than 50% for England overall – but down from 70% in 2019 and 73% in 2021.
When asked ‘How satisfied are you with the general practice appointment times that are available to you?’, 58% of Coventry respondents said satisfied or very satisfied, better than 53% for England overall – but down from 65% in 2019 and 69% in 2021. While satisfaction is reducing, as it is across England overall, this data does indicate that access to GPs, in terms of getting through to the surgery by phone and getting the appointments patients want, is better than the national average in Coventry.
In the winter of 2022/23, the NHS was facing significant challenges, with waiting lists and waiting times in A&E and for Ambulances high. There are indications that it is worse than average in Coventry. We can examine snapshots of three statistics, published by the BBC, to get a flavour of how the local hospital trust, University Hospitals Coventry & Warwickshire (UHCW), is doing and if the pressures were better or worse. For UHCW Trust in the week beginning 16th January 2023 29% of Ambulances were waiting 30 minutes or more to hand over their patients to A&E, compared to 20% for England overall and to 12% in the equivalent week in 2020. For UHCW Trust for the month of December 2022, 42% of patients were waiting longer than the target time of four hours in A&E, compared to 40% for England overall and to 23% in December 2019. For UHCW Trust for the month of December 2022, 49% of patients were waiting longer than the target time of 18 weeks for routine treatments, compared to 42% for England overall and to 18% in December 2019.
The impact of the pandemic means that performance reports show there are less people satisfied with social care. This is most likely because of the restricted way we have had to operate during periods of the pandemic. Understanding more about customer experience and how this can improve is increasingly important.
The delivery of Adult Social Care in Coventry focuses on approaches that promote well-being and independence to prevent, reduce or delay the need for long-term support and to enable people to achieve their outcomes. In performance terms, this means that we would expect to see a relatively smaller number of people in receipt of ongoing social care, and where ongoing social care is required that this is mainly provided in people’s own homes. We would also expect that the short-term services we have in place to enable people to be independent are successful in reducing demand for ongoing Adult Social Care.
In comparison to other local authorities, Coventry continues to have low rates of new requests for Adult Social Care but has seen an increase in requests for support. In 2022 there were 11,316 new requests for support (an increase of 14% on 2021's figure of 9,902). 6.5% of requests resulted in a long-term service (an increase on last year's 5%) however there was a reduction in those that received low level support in 2022 (18%) compared to 34% in 2021.
Coventry has a higher rate of safeguarding concerns per 100,000 population in 2021/22 (1962) compared to 2020/21 for England (1121) and West Midlands (1038). Coventry has a comparable number of enquiries started in 2021/22 (301) with England (343) and West Midlands (217) rates per population. The high number of concerns stated compared to England and West Midlands has meant that Coventry’s conversion rate (15%) is lower than England (34%) but comparable to the median West Midlands conversion rate (15%).
Responses to the Census 2021 indicate that 27,400 Coventry residents provide some level of unpaid care, this amounts to 1 in every 12 (8.5%) residents aged five and over. This is made up of 4.0% providing up to 19 hours or care per week, 1.9% providing 20-49 hours per work and 2.6% providing 50 or more hours per week. Over the 10 years since the previous census in 2011 the number providing unpaid care has fallen a little (after accounting for changing age structure of the population) – particularly due to the proportion providing less than 20 hours of care falling from 6.1% to 4.0%, the proportion providing more than 20 hours increased, from 4.0% to 4.5%.
What is happening in the city? What else can be done?
Improvements can be made to fairer, more inclusive access to services for people. Physical proximity is not the only metric for physical access to pharmacies and services. Pavements and pathways in the wider areas around healthcare facilities can be inconsistent with regards to accessibility for people with low mobility, mobility scooters, and prams.
Improving people’s awareness of support groups and available activities can be a more efficient and effective way to help them meet their health needs. However, these groups need support to build their capacity and to ensure their sustainability. The city has a range of peer support groups, where people use their own experiences to help each other. Coventry’s Adult Social Care and Communities Directory gathers information and advice in one central place so that information can be accessed easily and quickly.
Digital inclusion the move of services from face-to-face and telephone based to online services has caused significant concern to many residents, particularly those who are not used to using digital services or do not have regular access to the internet. COVID-19 significantly increased trends for online and remote primary healthcare, specifically the NHS 111 service and remote GP appointments. This increased access for some sections of society; however, it did not preclude a significant reduction in overall access to primary healthcare during and after the pandemic. There is significant scope to improve digital access to healthcare, and awareness of digital access options for healthcare. Nonetheless, physical health cannot be supported with online services only. Therefore, a balanced approach to providing access to primary healthcare using digital access where beneficial, plus physical access vis both GPs and pharmacies is preferred.
Access to services, particularly booking an appointment with a GP practice is of importance and concern to residents. Engagement undertaken by Coventry and Warwickshire Integrated Care Partnership (ICP) found that access to services particularly booking an appointment with GP practice, receptionists becoming a barrier to accessing services, difficulties in face-to-face appointments and ordering prescriptions and dentistry was problematic. Public perception of services also plays a large part, with several respondents expressing concern that services will not be able to cope with them if they were to
attempt access, meaning they were choosing to not even try to make contact to get support.
Additional support services for 16/17-year-olds transitioning into adult services is also a concern due to the lengthy waiting times to support this age group. Once referred to mental health services they receive their initial assessment, however they then usually have a long wait to commence therapy.
Although Kooth and other online facilities are available and very supportive, this still isolates them from the direct contact and intervention they require.
Lifestyles
Why is this important?
Individual behaviours, such as eating enough fruits and vegetables, smoking, alcohol consumption, and physical activity can affect health. These lifestyle behaviours are strongly influenced by the environment in which people live. For example, people living in a ‘food desert’, with limited access to affordable and healthy food, are more likely to eat unhealthily; an unsafe environment is likely to discourage people from walking or cycling; and social and cultural influences, including friendship groups, advertising and media, play an important role in determining people’s lifestyles.
These lifestyle risk factors – poor diet, physical inactivity, excessive alcohol consumption and smoking – are all linked to ill health and premature death. Having a combination of the risk factors contributes to greater ill health. People facing poorer social circumstances are more at risk of having multiple risk factors, exacerbating avoidable differences in health.
What is the local picture? How does it compare?
Seven in ten Coventry residents (71%) consider that their general health is either very good (29%) or good (42%) and the proportion rating their health as bad has decreased. Compared to the 2021 Household survey, the proportion who rated their health as good (either very good or good) has decreased marginally from 73% to 71% in 2022.
Under one in ten (7%) consider it to be bad, which leaves just over a fifth (22%) of residents who consider their general health to be fair. The proportion rating their health as bad has decreased from 8% in 2021 to 7% but is 6% more than the 1% recorded in 2018. As may be expected, younger residents, namely those aged under 35 (79%) or 35-44 (81%) are significantly more likely than the survey average to say they have good general health, whereas those aged 55-64 (64%) or 65+ (47%) are significantly less likely to feel they have good health.
Whilst smoking rates continue to fall, those living in a very deprived area (IMD Decile 1) are much more likely to smoke. Between one-in-nine and one-in-seven adult Coventry residents are current smokers, using two different data sources – but both sources show smoking prevalence to be falling.
The local Coventry Household Survey 2022 asked residents and 11% said they currently smoke cigarettes down from 12% in 2021 and 18% in 2018. The other data source, the national Annual Population Survey (APS) for 2021 estimates smoking prevalence in adults in Coventry at 13.7%, not significantly different to the overall rates for the West Midlands region at 13.8% and for England overall at 13.0%. This has been on a generally reducing trend from 18.8% in 2013; although there was a blip in 2020 when smoking prevalence appeared to increase to 17.1%, maybe related to the pandemic, before falling again in 2021.
In the 2022 Coventry Household Survey, 7% said they use e-cigarettes, on the increase from 2021 (4%) and 2018 usage (5%).
The estimated number of deaths in Coventry that are attributable to smoking has remained relatively high however, it may take some time for this to fall. The latest smoking attributable mortality rate per 100,000 for Coventry was 234.7 for 2017-19, contributing to an estimated 1,112 death over those three years. This is significantly worse than the England average of 202.2 and the West Midlands average of 203.8.
The consumption of alcohol overall in Coventry, at population level, appears not to be disproportionately high compared to other places, however hospital admissions for alcohol related conditions in Coventry is significantly worse compared to England. This may be related to the city’s demographics. The last time data was collected that allows some tentative comparison, in the Health Survey for England for 2015 to 2018, 29% (+/-6% points) of Coventry respondents said they don’t drink compared to 16% for England overall and 21% (+/-5 points) said they drank more than 14 units of alcohol a week compared to 23% for England overall. The Coventry Household Survey asks residents about drinking habits; while responses indicate a small increase in alcohol consumption at population level between 2018 to 2022, changes are not large. In 2022, 34% of
respondents said they don’t drink alcohol, compared to 42% in 2018. Of those that do drink alcohol, in 2022, 25% said they drink more than 2-3 units on 2 or more days per week compared to 26% in 2018. Due to sample sizes of the survey, small changes do not imply real change at population level.
Alcohol is causing disproportionate harm to health in Coventry. Hospital admissions for alcohol-related conditions in 2020/21 shows Coventry’s rate of 649 per 100,000 is significantly worse than the England average rate of 494 and the West Midland average rate of 564. Coventry’s rate is also higher than average compared to its statistical neighbour areas. Rates of deaths related to alcohol are also higher than average; in 2021 the ‘alcohol specific mortality’ rate was 19.4 per 100,000 compared to the West Midlands 15.8 at and England at 13.9. Alcohol-related hospital admission and deaths are much higher amongst men in Coventry, they make over two-thirds of the admissions and deaths. Moreover, the problem is relatively bigger amongst Coventry males with rates higher than the national average for males whereas admission and mortality rates amongst females are not significantly higher than their counterparts elsewhere, on average.
The importance of eating healthy food remains well recognised by the majority of residents and being able to cook from scratch every night is becoming more challenging for some, both due to time pressures and by not having everything needed in their kitchen to do so. Just over a fifth (22%) of residents surveyed said they eat at least 5 portions of fruit or vegetables a day. Nearly two-thirds (62%) of residents surveyed said they eat at least 3 portions.
In 2022 survey residents were provided with a series of statements relating to eating habits. The responses give a few insights: the importance of eating healthy food remains well recognised by the majority of residents (93%); being able to cook from scratch every night is becoming more challenging for some, both due to time pressures and by not having everything needed in their kitchen to do so (although a majority of 81% still state that they have what is needed) and the proportion who stated that price is the most important factor when buying food has significantly increased to 64% compared to 57% in 2021, a potential impact of the cost-of-living crisis. 29% said they eat takeaways at least once a week.
Levels of physical activity in Coventry are still relatively low compared to the West Midlands and England. Responses to the Active Lives Survey in 2020/21 gives an estimate that 59% of adults in Coventry take part in 150 minutes of moderate intensity activity per week, which is the level amount of physical activity recommended by the chief medical officer. This is significantly lower than the West Midlands (63%) and England (66%) averages, and lower than average amongst similar areas. Activity levels fell during the pandemic nationally and Coventry was no exception, this explains the drop in 2020/21; while activity rates in Coventry have remained lower than national averages, the data indicates slowly increasing rates in recent years until the pandemic year of 2020/21. National data indicates that activity levels were falling before the pandemic hit, among young people aged 16-34, the pandemic accelerated this. The drop in Coventry’s rate in 2021/22 may have been influenced by having a relatively young population.
At reception, Coventry’s obesity rate is similar to the England average; but by year 6, the city’s obesity rate is higher than the England average. 1 in 5 reception year (aged 4-5) Coventry children were measured as overweight in 2021/22, doubling to 2 in 5 children in year 6 (aged 10-11). There is a clear link with deprivation at age 4-5 and age 10-11 with successively higher rates of obesity in areas of higher levels of multiple deprivation. The general trend over the last seven years is of increasing proportions of 10-11 years being overweight or obese. The chart shows that in 2021/22, 41.1% of Coventry children in year 6 were measured as overweight or obese. Amongst reception year children aged 4-5 the prevalence is 22.0%, so weight problems increase as children get older. The prevalence of obesity amongst Coventry children, the higher weight threshold (BMI in the highest 5% of the reference population from 1990), is 10.4% in reception year and 26.7% is year 6.
The proportion who are overweight or obese is higher amongst adults, an estimate of 68% of Coventry adults are overweight and this has been on an increasing trend in recent years, and 26% are obese.
The Health Index created by the Office for National Statistics allows us to compare Coventry in Lifestyles to England overall and to see how Coventry has made progress in the years before the pandemic compared to England. The index includes 3 domains Healthy People: Healthy Lives and Healthy Places. The Healthy Lives domain includes the behavioural risk subdomain which is built on seven lifestyle indicators: smoking; sexually transmitted infections; sedentary behaviour; physical activity; drug misuse and alcohol misuse. The index shows overall that Coventry’s health in this area is worse than the England average for 2015 – 2020. However, there are a couple of indicators, drug misuse and smoking, where Coventry is performing better than the England average in 2015.
What is happening in the city? What else can be done?
To address health inequalities and establish an environment that promotes and preserves good health, it is important to acknowledge that lifestyle factors are rooted in socioeconomic conditions. Therefore, a citywide integrated working approach is needed. This could include addressing limited access to affordable food by improving public transport connections to and from places where people can find reasonably priced and nourishing food; lowering risky behaviours by changing social norms and connecting people to peer support groups, such as encouraging them to use health check services, sexual health check services, stop smoking services and improving their access to drop-in sessions for psychological therapy and child clinics in the neighbourhood.
There is a raft of both national and locally based initiatives, strategies, policies, plans and partnerships taking effect at pace to encourage healthy lifestyles and providing opportunities for organisations to work closer together to better meet the needs of Coventry residents. This could also include creating integrated strategies that combine air quality improvements, active travel plans, investment in transportation infrastructure, and physical activity promotion.
One of the priorities for the Integrated Care Strategy is to prioritise prevention and improve future health outcomes through tackling health inequalities. Prevention will be embedded and resourced across all plans, policies, and strategies for the population, supporting a reduction in inequalities and improvement in health and wellbeing outcomes. This includes addressing the impact of the wider determinants of health across the life course, ensuring residents live in affordable and good quality homes, have access to good jobs, feel safe and connected to their communities, utilize green space, and are enabled to use active travel. The strategy aims to deliver a whole system, all-age, person-centred approach to mental health and wellbeing, that is driven by access to physical and mental health and social care in the same place at the same time, with no wrong door, and where prevention is at the heart of it.
Priorities around improving access to parks and green spaces, reducing loneliness and social isolation, hyper-local community interventions showcasing services to improve health and wellbeing have been identified to support and promote communities’ health and lifestyles. Areas of deprivation have had funding through Sport England's Priority Place project to support local activities and improve physical activity levels. The Council is working with school nurses and health visitors to support children and families around healthy eating, being active and wellbeing, including supporting healthy behaviours alongside the buggy workout programme for new mums. Coventry’s Family Health and Lifestyle service is participating in a study with Newcastle University to test a series of different interventions with parents following on from a child’s participation in the national child management programme. This study is due to end in 2023.
The Be Active Be Healthy Service promotes healthy nutrition and physical activity to families across Coventry. The Be Active Be Healthy (BABH) team deliver a range of healthy lifestyle and exercise programmes designed to reduce the risk of obesity among children by supporting families to reduce weight, increase physical activity and adopt healthier long-term behaviours. The team works closely with schools and early years settings to promote a healthy food environment and to maximise opportunity for physical activity.