Health Hazards
Whilst many of the main contributors to loss of Disability Adjusted Life Years (DALYs) are conditions that develop over time, subject to a range of risk factors, other diseases – typically viruses and bacteria – are passed from person to person, such as through the air or direct, including sexual, contact. Transmission may also be from other species. Environmental hazards, such as air pollution, asbestos and ultra-violet in sunlight, are also considered here. ‘Health protection’ seeks to reduce the incidence and severity of diseases, either by preventing transmission or preparing the body’s defences by immunization.
Somerset is still feeling the effects of the Covid-19 pandemic, which was covered in the Annual Public Health Report for 2020 (First Wave) and for 2021 (Impact on Young People), and in the annual JSNA report for 2021 (Impact on Somerset’s communities including a qualitative report on Bridgwater).
Health protection cannot be isolated from other elements of public health, and multi-disciplinary teams, covering health promotion, health services improvement, health surveillance and intelligence, as well as health protection, should be engaged to tackle inequalities. Vaccine programmes, especially flu vaccination, can help reduce ‘winter pressures’ in the NHS.
Communicable Diseases
Preventing the spread of communicable diseases is a key public health intervention.
Key indicator: Mortality Rate from a Range of Specified Communicable Diseases, Including Influenza (persons)
Air Pollution
Poor air quality is a significant public health issue. There is strong evidence that air pollution causes the development of coronary heart disease, stroke, respiratory disease, and lung cancer, exacerbates asthma and has a contributory role in mortality The annual burden of air pollution in the UK has been estimated to be equivalent to approximately 28,000 to 36,000 deaths at typical ages and an associated loss of population life of 328,000 to 416,000 life years lost (Air Pollution Evidence Review from Public Health England, 2019).
Although air pollution can be harmful to everyone, it particularly affects people living in polluted areas, those who are exposed to higher levels of air pollution in their day to day lives, and those who are more susceptible to health problems caused by air pollution, widening health inequalities.
Key indicator: Fraction of Mortality Attributable to Particulate Air Pollution (new method)
Ultraviolet Light (UV)
The main source of UV light, which can damage DNA, is the sun. This means that those who spend (or have spent) long times in strong sun (such as in the Mediterranean) are at greater risk of skin cancer. Even in Somerset, prolonged exposure for people who work outdoors, such as in construction or agriculture, can increase risk. Sun lamps and beds are a further source of UV, and can cause harm for regular users. Cancerdata reported that for 2020 the age standardized rate of skin cancer incidence in Somerset (23.9/100,000) was higher than England, but not significantly so. This may reflect outdoor work, as described, and some elderly people who took overseas holidays in younger life.
Asbestos
The period 2018-20 showed an age-standardized rate of 66.2 deaths (from asbestos)/million in South West England for males, and 14.1 for females. These are both slightly higher than the comparable England figures of 65.1 and 13.9 respectively. Asbestos has been the most serious work-related environmental hazard, particularly associated with those in the construction sector, and which can lead to mesothelioma and lung cancer. Asbestos has been banned in the UK since 1999, but was widely used in insulation until then. Rates of death, nationally, have risen over the last four decades but are now showing signs of levelling off, reflecting its absence from the workplace. There are no county level statistics.
Vaccination
Vaccination is a highly focused and effective Public Health intervention. Health professionals can use Making Every Contact Count (MECC) to ensure vaccine advice is delivered across the health system. Catch up programmes for all vaccines can target groups at risk of not being fully immunized.
Vaccination - MMR
Measles, mumps and rubella have historically been major infectious diseases, particularly in children. They are highly infectious, common conditions that can have serious complications, including meningitis, swelling of the brain (encephalitis) and deafness. They can also lead to complications in pregnancy that affect the unborn baby and can lead to miscarriage. Vaccination coverage is the best indicator of the level of protection a population will have against vaccine-preventable communicable diseases. Coverage is closely correlated with levels of disease. Monitoring coverage identifies possible drops in immunity before levels of disease rise.
The first MMR vaccine is given to children as part of the routine vaccination schedule, usually within a month of their first birthday. They then have a booster dose before starting school, which is usually between three and five years of age. Previous evidence shows that highlighting vaccination programmes encourages improvements in uptake levels.
Key indicator: Population Vaccination Coverage MMR for Two Doses (5 year olds)
Vaccination - flu
Influenza (flu) is a highly infectious viral illness spread by droplet infection. The flu vaccination is offered to people who are at greater risk of developing serious complications if they catch flu. Immunization is one of the most effective healthcare interventions available and flu vaccines can prevent illness and hospital admissions among these groups of people. Increasing the uptake of flu vaccine among these high risk groups should also contribute to easing winter pressures on primary care services and hospital admissions. Coverage is closely related to levels of disease.
Key indicator: Population Vaccination Coverage Flu (aged 65 and over)
Next: Community Safety