Adults

Overview

The JSNA identifies obesity, mental health, smoking, substance misuse, maternity risks, and service access as significant adult health priorities. These needs frequently overlap with long-term conditions and are shaped by deprivation, housing, employment, transport, social isolation, and the local environment.

Recent evidence shows increasing adult obesity and rising mental health demand. Older assessments remain relevant where they document enduring access inequalities. The scale of population need frequently exceeds available preventive or treatment capacity. This creates pressure across primary, community, acute, and specialist services.

Adult obesity has increased steadily and more rapidly than nationally. Approximately 800,000 Kent adults live with excess weight. Weight-management services can support only a small proportion of this population. Deprived and urban communities experience environmental barriers involving food access, transport, safety, and physical activity opportunities. Black and Asian communities develop cardiometabolic disease at lower Body Mass Index thresholds. Referral pathways are also under pressure from increased demand and interest in weight-loss medication.

Alongside access to appropriate weight management support, addressing obesity requires coordinated action across the whole system to improve access to healthier food and opportunities for physical activity, particularly for communities experiencing the greatest inequalities.

Mental health evidence describes rising depression, anxiety, severe mental illness, crisis demand, and unequal service use. Deprivation, housing pressures, unemployment, crime, poor transport, and isolation influence mental health outcomes. Thanet, Swale, Dover, and Medway experience higher recorded prevalence and worse outcomes. Emergency and crisis use is higher among deprived communities and Black or Black British groups. Long waits, unclear pathways, and weak coordination limit early support. Mental and physical health needs frequently coexist.

Maternity evidence demonstrates interactions between smoking, obesity, long-term conditions, and service use. Approximately half of pregnant women were overweight or obese at booking. Nearly two-fifths had at least one long-term condition. Mental health and respiratory conditions were most common. Service use and costs were higher for women with these risk factors. Geographical and ethnic variation affects maternal obesity. Inconsistent measurement and late booking limit reliable early identification.

Prevention pathways show inequalities in uptake and outcomes. Attendance for NHS Health Checks is higher among women than men and that gap widens with age. Furthermore, completion is lower within socioeconomically disadvantaged groups and several minority ethnic groups.

Smoking remains an important risk factor within adult pathways, including maternity, mental health, substance misuse, and long-term condition prevention. Reports which focus on service provision show that younger adults have higher smoking prevalence but lower engagement and quitting success. Economic inactivity predicts lower success among people accessing services. Smokers from more deprived communities set quit dates more often but succeed less often. Hospital smoking cessation activity has demonstrated a stated positive financial return. These findings support targeted access, tailored intervention, and sustained support.

Rising alcohol-specific mortality represents a significant public health challenge, reflecting the wide-ranging impact of alcohol on liver disease, cancer, cardiovascular conditions, and health inequalities. Although cardiovascular disease remains a leading cause of death overall, alcohol-related liver disease has become an increasingly important contributor to premature mortality, with the burden falling disproportionately on dependent drinkers and people living in more deprived communities.

Key issues and themes

  • Adult obesity is increasing, while treatment capacity reaches only a small share of need. Adult Obesity Needs Assessment prioritises environmental action, integrated pathways, and whole-system prevention.
  • Mental health demand and inequalities are increasing across depression, anxiety, severe mental illness, crisis presentations, and suicide. Mental Health Needs Assessment identifies fragmented pathways and inconsistent early support.
  • The number of neurodiverse people in Kent known to the health and care system is lower than expected. The HNA from 2023 reports that the number of accepted referrals for autism and ADHD each year fare exceeds the number of completed assessment. Life expectancy for males in Kent with a learning disability is 67 years and 66 years for females. This is 13 and 17 years respectively lower than the general population. Neurodiverse Adults Health Needs Assessment supports co-produced system redesign.
  • Mental health, respiratory conditions, obesity, and smoking increase maternity risks, service use, and costs. Maternity Needs Assessment identifies smoking reduction as an important health improvement opportunity.
  • Maternal weight varies geographically and by ethnicity. Measurement, referral, and support practices remain inconsistent. Maternal Weight Health Needs Assessment links excess maternal weight with an increased likelihood of medicalised birth, including caesarean section, and identifies evidence that excess maternal weight can adversely affect infant and child health, with implications for future health needs.
  • Perinatal mental illness affects mothers, infants, families, and later child development. Many cases remain unidentified. Perinatal Mental Health Needs Assessment identifies uneven provision and coordination gaps.
  • Health Check uptake varies by sex, age, ethnicity, deprivation, and housebound status. Health Checks Equity Audit also documents incomplete ethnicity and smoking information.
  • Alcohol-related deaths and alcohol-related liver disease increased substantially during and following the COVID-19 pandemic, with the greatest rise observed among heavy and dependent drinkers.  Alcohol Needs Assessment highlights prevention, early identification, and effective treatment pathways as key priorities for reducing alcohol-related harm.
  • People who misuse drugs experience significant socioeconomic and health inequalities, facing elevated risks of premature illness and death. The Drug Needs Assessment reports that recent trends show increasing drug use among adults under 30, particularly those aged 25–29. Among young adults aged 16–24, around 8.7% reported using a Class A drug in the past year.
  • Opioid‑dependent individuals face particularly high health risks. Almost all opioid‑dependent users are estimated to smoke, and evidence suggests they are more likely to die from smoking‑related illness than from drug use itself. These trends highlight persistent inequalities and the need for targeted prevention, harm reduction, and support across age groups.

Supporting reports

  • Adult Obesity Needs Assessment (2025) – Report
  • Mental Health Needs Assessment (2025) – Report
  • NHS Health Checks Invitation Method Evaluation (2024) – Report
  • Neurodiverse Adults Health Needs Assessment (2023) – Report
  • Drug Needs Assessment (2022) – Report
  • Alcohol Needs Assessment (2021) – Report
  • Maternal Weight Health Needs Assessment (2019) – Report
  • Health Checks Equity Audit (2017) – Report
  • Maternity Needs Assessment (2017) – Report
  • Perinatal Mental Health Needs Assessment (2016) – Report
  • National Health Service Stop Smoking Services Equity Assessment (2016) – Report
  • Smoking Cessation in Hospitals Return on Investment (2015) – Report