The Health Index 2020 – measuring the nation’s health

The ONS’ Health Index is a rich data set that gives us an overall picture of the nation’s health and how it has been declining or improving. We can also see in close-up how health varies from area to area and what local factors are in play. As we publish our findings up to 2020, Greg Ceely explains what our data show and how the Health Index is already proving a useful tool for local health leaders.

How does the Health Index work?

The Health Index uses a broad definition of health, including health outcomes, health-related behaviours and personal circumstances, and wider drivers of health. It provides a single value for health that can show how health changes over time.

The Health Index is organised around three broad areas:

  • Healthy People: covers health outcomes such as life expectancy, physical health conditions like dementia, cancer and kidney disease, disability, personal well-being and mental health.
  • Healthy Lives: covers health-related behaviours and personal circumstances including obesity, hypertension, drug misuse, smoking and cancer screening.
  • Healthy Places: covers the wider social, economic and environmental drivers of health such as crime, unemployment, child poverty, pollution, noise and road traffic.

Every level from the overall Health Index right through to the individual indicators is indexed around 100. A score of 100 means health is equal to England’s health in 2015. A score higher than 100 means health is better; a score lower than 100 means health is worse.

The findings 

Overall, health in England declined in 2020 (from 100.5 in 2019 to 100.1). By breaking down the aspects of health used to calculate this overall figure we can understand some of the reasons behind this decline. For example, the Healthy People score declined considerably compared to 2019. This was driven by higher mortality, and considerably worse mental health and personal well-being levels. However, the Healthy Places score improved in 2020. This was driven by improvements in living condition factors, such as a reduction in air pollution and traffic accidents.

2020 was of course the year when the pandemic began, and it’s important to consider these changes to health within this context. While there are some aspects which we hope will improve as we continue to emerge from the pandemic, there are also improvements which we would hope can be built on going forward. We see from the Index prior to 2020 that our health wasn’t really improving. Our ability to sustain some of the improvements we observed in levels of air pollution and road safety (among others) will be crucial to both recover from the shocks of 2020, and protect our future health too.

A local Health Index

The value of the Health Index is not only in the broad understanding it provides of our health as a country, but the local insight which can be gleaned from the local data. Our collaboration with Northumbria Healthcare NHS Foundation Trust shows the potential for the Heath Index to become a ‘small area’ health tool for planning health and healthcare provision. Working with the ONS, the team at Northumbria used the Health Index framework to explore the varied health challenges facing its residents to create their own beta version Local Health Index. Their analysis has created a deeper understanding of how health and the drivers of health differ between areas within the local authorities of Northumberland and North Tyneside, and provides a framework to effectively tackle inequalities in health.

Our work with Northumbria Healthcare NHS Foundation Trust is an example of ‘highly local’ data being used to shine a light on a population’s need and to plan for better, healthier communities.

You can read more about Northumbria Healthcare NHS Foundation Trust’s Local Health Index project here and explore the findings of the beta Local Health Index in an interactive explorer

Future work

We will continue our work with Northumbria and also explore the feasibility of leveraging Northumbria’s learnings to create local health indices for other local areas.

We’ll add 2021 results to the Health Index next Spring, and it will be fascinating to see how the scores changed as we move through the pandemic. How many of the negative impacts have bounced back after an initial drop? How many of the improvements we saw as a result of changing behaviour during 2020 have persisted?

We also have a few more methodology improvements in the pipeline. The Alan Turing Institute have conducted a critical review of our index construction process, leading to some recommendations we want to explore; and we want to see how different the Health Index looks if the different topics of health within the Index are weighted based on expert opinion of importance.

The ONS is also continuing development of a projection tool to illustrate how changing one aspect of health within the Health Index might have an impact on other parts of health in the future.

If you have any feedback on the Health Index, email

Greg Ceely is Health Analysis and Pandemic Insight

Greg Ceely is from the Health Analysis and Pandemic Insight team at the ONS