Cross-cutting themes

This page highlights the main cross-cutting themes identified across the Kent JSNA reports. You can explore more detailed insights via the health intelligence, health inequalities and the wider determinants of health pages.

Wider determinants repeatedly shape health need and service access. Poverty, insecure housing, homelessness, food insecurity, employment, transport, education, discrimination, isolation, and digital exclusion feature across reports. These ‘building blocks of health’ affect childhood development, mental health, obesity, caring, domestic abuse, and long-term conditions. Coastal, urban, and deprived areas often have worse outcomes. Financial pressures also reduce the ability of households to meet essential needs. The evidence supports coordinated action beyond healthcare services.

Mental health is a core theme across every life stage and several service systems. Evidence from reports focused on childhood identify anxiety, low mood, trauma, self-harm, influence of social media, and increasing complexity. Reports related specifically to adults identify rising depression, anxiety, severe mental illness, crisis presentations, and suicide. Vulnerable groups experience mental health needs alongside homelessness, domestic abuse, substance misuse, caring responsibilities, discrimination, and unstable housing arrangements. Perinatal mental health connects maternal wellbeing with infant development and family stability.

Obesity and being overweight (excess weight) reflects interacting biological, behavioural, social, economic, and environmental influences. Childhood and adult obesity disproportionately affect deprived groups. Ethnic inequalities are also recorded. Excess weight interacts with diabetes, maternal health, mental health, physical activity, and the risk of future long-term conditions. Food insecurity, local food environments, transport, greenspace use, and service capacity influence prevention opportunities. Individual treatment pathways cannot address the reported population scale without wider system action.

Smoking remains a recurrent driver of avoidable illness and inequality. It contributes to cancer, respiratory disease, cardiovascular disease, pregnancy complications, and multimorbidity. Prevalence remains high among deprived communities, people with mental health conditions, community offenders, and people experiencing substance dependence. Younger smokers have lower cessation engagement and success. More deprived smokers have lower quitting success. Targeted and sustained interventions remain necessary alongside broad tobacco prevention such as smoke-free sites and reducing the availability of illicit tobacco.

Multimorbidity creates disproportionate demand across primary care, emergency care, outpatient services, hospitals, and social care. It appears earlier within deprived populations and increases with age. Mental and physical conditions commonly coexist. Substance misuse can add further complexity. Adults with multiple disadvantages experience particularly severe combined morbidity. System dynamic modelling via the JSNA Cohort model indicates smoking cessation, weight management, and wider prevention could reduce future disease burden. Population ageing will nevertheless continue increasing frailty and service pressure.

People often experience barriers to accessing services. As described in other sections,  neurodiverse adults describe difficulty navigating multiple services. Unpaid carers frequently consider support insufficient, difficult to navigate, inconsistent, and provided too late. Rough sleepers and offenders are less likely to use primary care. Domestic abuse refuges cannot always manage co-occurring mental health or substance needs.

The JSNA repeatedly identifies opportunities for prevention and early intervention. Schools can identify emotional, developmental, substance-related, and family needs. Maternity pathways can address smoking, obesity, mental health, and breastfeeding support. Health Checks can identify cardiovascular risks, although participation remains unequal. Routine physical activity advice can support older adults’ independence. Pharmacy accessibility entails more than access to medicines. Pharmacies provide a range of accessible healthcare services, including vaccinations, contraception, hypertension case-finding, smoking cessation support, and other services that contribute to prevention, early intervention, and improved population health outcomes.

Data recording gaps restrict understanding of need and inequalities across several populations. For example Armed Forces Veteran status is not recorded consistently across health and care systems. Likewise, systems do not routinely identify Gypsy, Roma and Traveller ethnicity. GP clinical systems also identify fewer unpaid carers than responses to the 2021 Census would indicate. Older analysis of NHS Health Check data shows that Ethnicity and smoking status are incompletely recorded.