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Health Education Population Survey (HEPS) 1996-2003

3. Attitudes towards own health

In addition to the behavioural risk factors outlined in the previous chapter, how respondents view their own health provides a further relevant context for health education and promotion. The way people view their own health, and their ability to influence their own health, is likely to have an impact on how responsive they are to health education messages, and to the effort they would be willing to make to improve their health in the longer term. Moreover, self-assessed general health status has been shown to predict mortality independently of other factors and is used in Scotland as a measure of Healthy Life Expectancy along with Limiting Longstanding Illness (ISD, 2004).

3.1 Self-reported general health

Respondents were asked how they would rate their own health.

Table 3.1: Percentage who feel their health is very/fairly good, by age/social grade/DEPCAT

Each year, around three quarters of repsondents reported that their health was good (Table 3.1) and fewer than one in ten reported that their health was poor (8% in 2003). This was consistent with the findings of the Scottish Health Survey in 1995 and 1998 (Dorg & Erens, 1997; Shaw et al. 2000). There was no obvious pattern of change over time with no significant change from 1997 to 2003. Without information on previous years it is impossible to say whether the apparently lower figure for 1996 reflects any change in the longer term.

There was no difference by sex, but there were clear differences by social grade and deprivation, with self-reported general heatlh worse among the E group and those living in the most deprived areas. Not surprisingly, there was also an age gradient, with older respondents less likely to feel their health is good. The decline in self-reported health tended to start at the 45-54 age group and was consistently worse amongst those aged 65-74. This is also consistent with the findings of the Scottish Health Survey in 1995 and 1998.

The key gradients by sex and age are illustrated below in Figure 3.1, using the data collected in 2003.

Fig 3.1: Percentage who feel their health is very/fairly good, by age/social grade

Base: all respondents 2003 (1720)

3.2 Long-standing illness

For some respondents, self-perceived health is likely to be related to having a long-standing illness or disability. Around one in three respondents reported having some form of long-standing illness or disability. There was no consistent pattern of change over time (Table 3.2).

Table 3.2: Percentage who have a long-standing illness or disability, by age/social grade

Whilst there was no difference by sex, there was a clear age gradient. As for self-perceived health, the increase in long-standing illness tended to sharpen amongst the 45-54 age group and long-standing illness is consistently higher for the oldest respondents. Long-standing illness was also more likely amongst respondents in the E social grade, although there was no clear pattern of difference between any of the higher social grades. There was no clear pattern of difference by DEPCAT.

These key gradients by sex and age are illustrated below in Figure 3.2, using the data collected in 2003.

Figure 3.2 Percentage who have a long-standing illness or disability by age/social grade

Base: all respondents 2003(1720)

3.3 Ability to influence own health

In addition to consideration of self-perceived health measures. It is equally important to consider how much control people feel they have over their own health since the perceived ability to influence one's health is likely to have some impact on future changes in health behaviours, and ultimately on longterm health. In order for any specific health promotion activity to have an impact, it is fundamentally important that people believe that they will be able to influence their own health in order for them to be willing to take on board and act on the message. Indeed, encouraging people to believe that they can influence their health, and the health of their children, has been a central message of many health education campaigns in Scotland. In 1996, 76% believed that they could do something to make their own life healthier; by 2002 this had risen to 80% (Table 3.3). This difference is only of borderline significance and longer-term tracking would be useful to give further evidence of this apparent trend.

Table 3.3: Percentage who believe they can do something to make their own life healthier, by self-perceived health/age/social grade

As for the other measures there were patterns of difference by both age and social grade. The vast majority of those in the youngest age groups believe they can influence their own health. This starts to fall in the 45-54 age group and was significantly lower each year for those aged 65-74. This reflects quite closely the pattern seen for long-standing illness. Those in the highest social grade (AB) tended to be most likely to feel they coul:d influence their own health, while social grade E respondents and those living in the most deprived areas were least likely to feel they could influence their own health. The proportion of C1 respondents believing they can influence their own health has increased over time so that there is now no difference between AB and C1 respondents. There has, however, been no consistent change over time for those in the lower social grades, nor were there any consistent time trends by DEPCAT.

The key gradients by sex and age are illustrated below in Figure 3.3, using the data collected in 2003.

Fig 3.3 Percentage who believe they can do something to make their own life healthier, by age/social grade

Base: all respondents 2003 (1720)

Those who felt their health was poor were considerably less likely to feel they could do something to make their own life healthier than those who considered their health to be good or fair. As discussed in Section 3.1 there is a strong correlation between self-perceived health, and age, social grade and deprivation. It is interesting, therefore, that there is a much greater difference in self-perceived control over health by age than by social grade.

Main points

• The majority of people felt that their health was good, although around
• a third reported a long-standing illness or disability and this has not changed over time.
• Most people felt that they could influence their own health and the number appears to have increased slightly over the last eight years. The increase has been greatest for those in social grade C1.
• Those in the lowest social grades and, in particular, older people were least likely to think their health was good, most likely to report a longstanding illness and least likely to feel they have any influence over their own health. This suggests that those groups most in need of improvements to their health are also likely to be those who are least open to health education messages because they don't believe they can influence their own health.