NI Health Survey points to difficult conversations

22 Jan 2020 Ryan Miller    Last updated: 22 Jan 2020

Dr Michael McBride - crafting his message with care
Dr Michael McBride - crafting his message with care

If we save our health service, one key strut will be more personal responsibility for individuals. The latest annual Health Survey shows why encouraging healthier lifestyles can be tricky.


The latest annual NI Health Survey was not timed to coincide with Stormont’s return but did so nonetheless.

As is normal with such studies, it has good news and bad news for the changing trends in health. However, it also inadvertently points to an underestimated problem.

Health and Social Care (HSC) is collapsing and this crisis provided major impetus for the re-establishment of the Assembly.

The Executive was brought down and kept down by political wrangles but, by a crude analysis, the political cost to the relevant parties for remaining intractable eventually became higher than the apparent benefits in playing to their bases.

Saving HSC is the number one priority for our 90 MLAs. This is not a simple task. Demographic changes throughout our population have altered the demands placed on the system. Proportionally more people are older. Proportionally more are living with long-term conditions.

Thankfully, we know what the required overhaul looks like. From Transforming Your Care, through the Donaldson and Bengoa reports, and on to Delivering Together (the draft ten-year plan published in 2016, just before the last Stormont balloon popped) the general principles for change have been identified, reaffirmed, and broadly accepted.

One sticking point for politicians and health officials alike, however, has been selling the details of this vision to the public. Normally this fear relates to the need to centralise acute services, enabling greater efficiency and better outcomes. In other words, and speaking generally, fewer services in regional hospitals. Many people will have to travel further to access specialised care.

Less emphasis has been placed on the need to tell the public they have to do better at looking after themselves.


First, some good news.

  • Almost a fifth of respondents are current cigarette smokers (18%). Although there was no significant change from 2017-18, smoking prevalence has fallen from 24% in 2010-11, while the median number of cigarettes smoked per week fell from 90 in 2010-11 to 70 in 2018-19.
  • Smoking prevalence in the most deprived areas (29%) was more than twice that in the least deprived areas (12%), while 7% of respondents said they currently use electronic cigarettes, showing no statistically significant change from 2017-18.
  • For the first time, over half of respondents (51%) reported that they had never smoked.
  • The percentage of respondents saying they eat recommended five-a-day of fruit and veg rose to a high of 46% in 2018-19. Those in the most deprived areas were less likely to meet these guidelines (39%) than those in the least deprived areas (48%).

Over the past decade, we have become people who smoke less and eat more greens. That’s great, and indicates real efforts to lead healthier lives.

However, some other news is less encouraging.

  • A quarter of adults (25%) were classed as obese with a further 37% classed as overweight, figures that are similar to 2010-11.

The poor mental health of Northern Ireland’s population is notorious, and this is borne out by the survey:

  • Around a fifth of respondents (18%) showed signs of a possible mental health problem (by scoring highly on standardised questions). Respondents in the most deprived areas (24%) continue to be more likely to do so than those in the least deprived areas (12%).

Loneliness is not a new problem but it is one that, in recent years, has received greater focus.

  • Over a fifth of respondents (22%) showed signs of loneliness (meaning they scored highly on the UCLA loneliness scale). Those in urban areas (24%) were more likely to do so than those in rural areas (19%).
  • Over a third of those living in the most deprived areas (34%) showed signs of loneliness, compared with 14% of those in the least deprived areas.

However, almost three-quarters of respondents (72%) described their health as being good or very good and the majority (87%) feel they lead a fairly or very healthy life. That sound great – but it might be a problem.

Encouragement, not blame

Blaming people for their own poor health would not go well for politicians, clinicians or senior civil servants.

Firstly, while the risk of many conditions, ranging from heart disease to poor mental health, is exacerbated by a lack of exercise, bad diet, and other lifestyle factors, this is no straightforward scenario of cause and effect.

Secondly, people who are, for example, living with chronic depression are unlikely to respond well to being told it’s their fault and that they should get on an exercise bike or climb the Mournes. Encouragement might go better than chastisement.

Thirdly, such a message would be received especially poorly when everyone knows our local health system is coming apart at the seams. For officials to point the finger at the public and tell them to get chronic conditions under control would, in all likelihood, cause more scandal.

Nevertheless, a conversation needs to be had around prevention and healthier lifestyles. Prevention is a key part of coming health reform. It is a key part of being and staying healthy. Exercise and eating well have undeniable health benefits, both deep and wide. Ideas like social prescribing are believed to have huge potential.

But in a place where 87% of people aged 16 and over think they lead a healthy life, work needs to be done to get such a message to land.

Scope wrote previously about how transformational better population lifestyles could be for the health service, the public purse, and all of us as people. It is worth nothing again that:

The Academy of Medical Royal Colleges estimates that increased physical activity – which it defines as 30 minutes of moderate exercise five days a week – could save the health service up to £18 billion per annum. [Meaning across the UK]

To achieve this doctors would need to get into the habit of prescribing exercise as a treatment. This requires a significant cultural change – not just for doctors but for the rest of us as well. And it implies much more needs to be invested in public health campaigns, in sporting and other organisations that support healthy exercise.

Chief Medical Officer

And, of course, the state is trying to get this message across.

Chief Medical Officer Michael McBride re-announced the Department of Health’s commitment to tackling the prevalence of overweightness and obesity in Northern Ireland late last year.

“This is a long-term challenge which will require long-term action and commitment from service and delivery providers, health professionals, employers, government departments and most importantly, from people themselves.

“I don’t want to tell people what they should or should not be eating. I don’t want to continually lecture about the importance of physical activity. I want people to have choices in the way they live their lives, but I think it is absolutely vital that we inspire people to choose healthier food and be more active, for the sake of their own health and wellbeing.”

These words are carefully chosen. Dr McBride is clearly at pains to be encouraging rather than hectoring. This is very important. The bottom line, however, is that this sentiment needs to be heard and it needs to make a difference.

It is easy to write positive messages that are gentle and general but if too many people who could do with listening genuinely do not think such suggestions apply to them, the initiative itself is undermined.

Lifestyle campaigns – eat more greens, drink less booze, do more exercise, don’t smoke at all – are nothing new.

Northern Ireland needs to find a public message that works. Doing so won’t be easy, because it will require many people to see their lives are not as healthy as they think they are.

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