In the first of a new series focusing on the impact of data use in the Research Excellence Framework (REF) 2014, Dr Jennifer Mindell, Reader in Public Health in the Department of Epidemiology & Public Health at UCL, discusses the role of the Health Survey for England in informing obesity policy.
Worldwide, obesity represents one of the most challenging health problems, with the UK having among the highest rates in Europe. The associations between obesity and health problems such as type 2 diabetes are set to add substantially to health service costs in the future.
Held by the UK Data Service, the Health Survey for England (HSE) is an annual, health survey of the general population in England. It combines self-reported data with objective measures of health (such as measured height, weight, and waist circumference). HSE is one of the few health surveys in Europe to obtain objectively measured anthropometric data, rather than relying on self-reporting which consistently under-reports obesity. It has been run by the Joint Health Surveys Unit of UCL and NatCen Social Research since 1994; the 25th survey is currently in the field. The UCL contribution to the HSE falls into three categories: providing the clinical expertise and some methodological advice for the survey; jointly writing and editing the annual HSE reports; and leading the work on secondary data analysis and policy evaluation. The fieldwork and operational side of the HSE are conducted by NatCen, with UCL providing clinical oversight.
Measuring the obesity problem
HSE data have enabled the extent and escalation of obesity within the population to be quantified, drawing the attention of Government and policy-makers to the issue. Importantly, HSE data enabled the quantification of the obesity problem within sub-groups of the population, highlighting the high rates in children and among adults from different socio-economic positions. The Foresight Report, funded by the Government Office for Science, used HSE 1994-2004 data to project population trends to 2050 and examine future impacts on life expectancy and economic costs of overweight and obesity.
Influencing Government policy
HSE measurement data are used by Government to produce evidence-based strategies to combat obesity. The Chief Medical Officer (CMO), the Government’s most senior medical advisor, publishes an annual report to identify priorities in health and recommend action to improve public health. The CMO’s 2011 report used a range of HSE data, including on obesity. The UCL team were responsible for the analyses which identified obesity as one of the main risk factors behind the differences in prevalence of multiple lifestyle risk factors by age and by socio-economic position.
Informing clinical guidance
The National Institute of Health and Care Excellence (NICE) clinical guidelines on the prevention, identification, assessment and management of overweight and obesity in adults and children, currently being reviewed and updated, used HSE data to justify the document’s creation, quantifying the issue of obesity, attaching economic costs to this, and assessing cost-effectiveness of clinical treatments. NICE 2012 guidance Obesity: working with local communities also used HSE obesity data to quantify the extent of the problem.
Monitoring and evaluating the success of obesity strategies
HSE data showed early indications that the focus on childhood obesity was paying off, with wider evaluation shifting further strategy work to adults. One area of particular importance has been the monitoring of equality considerations. For example, equality impact assessments for the two Government reports Healthy Weight, Healthy Lives and Healthy Lives, Healthy People used HSE BMI data related to age, sex and ethnicity to show that the strategies met their legal requirements and could be implemented.
Public Health England cites the HSE as a source of data as’ the most robust data source to monitor trends in adult obesity.’
Since the publication of the Impact Case Study for REF 2014, two new publications documenting the use of HSE examination data by policy makers are available:
Oyebode O, Mindell JS. Use of health examination data from the Health Survey for England in government policy. Arch Public Health. 2014;72:24. and Oyebode O, Mindell JS. Use of data from the Health Survey for England in obesity policy making and monitoring. Obesity Rev. 2013;14:463-76.