Covid-19: England’s health declined in 2020, but not across all areas

The health of the population in England declined in 2020 during the early stages of the pandemic, although there was a mixed picture across different areas of health, official data from the Office for National Statistics (ONS) show.1

The Health Index for England declined from 100.5 in 2019 to 100.1 in 2020, driven in large part by falls on indicators relating to personal wellbeing and mortality. But the data also shows improvements in some areas that are likely to have been affected by pandemic preventive measures.

Emma Rourke, interim deputy national statistician (health, population, and methods) at the ONS, explained, “We can see that there was an improvement in the Healthy Places domain in part because of factors such as better air quality, fewer road accidents, and less crime impact. This was likely driven by the need for people to stay at home at this time. However, the score for the Healthy People category declined considerably, which reflects the impact the pandemic had on mental health and wellbeing.”

The index provides a single value for health in England, drawing on three overarching domains—Healthy People, Healthy Lives, and Healthy Places—and a number of subdomains. All scores are ranked relative to a baseline of 100 from 2015, with higher numbers meaning better health.

Between 2019 and 2020, the Healthy People domain declined substantially (by 4.2 points from 99.6 to 95.4), the Healthy Lives domain declined by 0.6 points from (102 to 101.4), but the Healthy Places domain improved considerably (by 3.7 points from 99.7 to 103.4).

The decline in the Healthy People domain was predominantly in the personal wellbeing and mortality subdomains. In 2020 mortality worsened by 4.8 points (from 102.9 to 98.2), while personal wellbeing had the greatest subdomain decline between 2019 and 2020 of 12.0 points (from 99.4 to 87.4). Life satisfaction was the biggest driver of decline for the personal wellbeing subdomain, falling by 13.8 (from 100.7 to 86.9), the largest decline of any indicator across the whole health index.

Worsening mental health (falling by 0.9 points from 98.4 to 97.5) also contributed to the declining Healthy People score. This included a 2.5 point decline (from 95.6 to 93.1) in children’s social, emotional, and mental health.

The improvement in Healthy Places was largely because of the crime subdomain having the greatest subdomain improvement compared to its 2019 score (up 6.6 points from 95.9 to 102.5). In addition, air pollution in the living conditions subdomain had the greatest year-on-year improvement of any indicator (up 15.7 points from 98.9 to 114.6).

But not every aspect of Healthy Places improved, with economic and working conditions declining by 2.9 points (from 103.4 to 100.5), mostly because of worsening unemployment during this period.

Commenting on the data, Gwen Nightingale, assistant director at the Health Foundation, said, “Good health is one of the nation’s primary assets, and the index provides leaders with authoritative information to inform local plans to improve health. The index also provides a common language to talk about health, and this is why we would like to see central government departments using the health index to describe progress and understand the local picture.”