Contents Foreword 2 Preface 3 Part One: The Survey 1. Introduction 7 2. Survey Design 9 3. Data Validation 13 4. Profile of Respondents 17 Part Two: General Findings 5. General Health 27 6. Obesity 35 7. Diet 43 8. Smoking 65 9. Drinking 75 10. Physical Activity 89 11. Sunbathing 99 Part Three: Lifestyles 12. Lifestyle Trends 109 13. General Health 111 14. Obesity 119 15. Diet 127 16. Smoking 133 17. Alcohol 137 18. Physical Activity 141 19. Key Findings 143 Part Four: International Comparisons 20. Introduction 149 21. Obesity Comparisons 153 22. Diet Comparisons 159 23. Smoking Comparisons 163 24. Alcohol Comparisons 167 25. Sunbathing Comparisons 173 26. Key Findings 177 Part Five: Summary 27. Conclusions 181 28. Summing Up 187 Part Six: Appendices Appendix 1: Notes on Methods 193 Appendix 2: The Questionnaire 196 Appendix 3: References 202 Appendix 4: Acknowledgements 203 Gibraltar Health & Lifestyle Survey 2015 | 1 Foreword Preface Gibraltar’s second Health and Lifestyle Survey makes fascinating reading, It is hard to believe that seven years have passed since the first ever Health and especially for those of us with a particular interest in the health and wellbeing of Lifestyle Survey of Gibraltar’s adult population was conducted in 2008 and that our community. The information it contains gives an insight into how we live, but it has been possible to do it all over again. Yet, this report is proof of that and also challenges the very way in which we carry out our day-to-day activities. But it presents the findings of the second Health and Lifestyle Survey of Gibraltar’s adult should also encourage us to improve, as a community and also as individuals, who population, conducted during February 2015. daily make individual choices about what we do. The Gibraltar Health & Lifestyle Survey of 2008 was a landmark event and The most worrying, and quite surprising result of the Survey, is the fact that smoking repeating it is no less one. However, as pointed out in the first Report, population prevalence has increased in Gibraltar, whereas in all other countries compared surveys are expensive exercises and it is reassuring that the Government has it has either stayed static or decreased. This is especially surprising as no one is invested again in this important initiative to understand better the health of our today in any doubt at all as to the harmful effects of smoking. Fortunately, recent people. Indeed, the Minister’s announcement of a second survey in the Budget laws on smoking in enclosed spaces, and most recently in cars, do mean that those who don’t wish to smoke Speech of 2014 came just a year after the first survey was published. are much less exposed to the dangers of passive smoking, but the primary smoker is still a problem, and more importantly, still has a serious problem. This is one of the challenges that we need to overcome, and we must look This Report builds upon the previous one. From the outset, the goal of the Survey was not just to capture another at ways of discouraging smoking, especially among youngsters where the habit often starts. snapshot of the health of the local population, but to make comparisons wherever possible with the previous one and identify any trends over time. For this reason, the study methodology was kept as close to the first Survey as Other challenges, again nothing new, include diet and exercise. possible – the questionnaires were designed to be almost the same, the survey procedure was identical and the statistical interpretations were tuned with this purpose in mind. Ultimately we all make our individual choices, and the stresses of everyday life are not always conducive to our making the right ones. But this Survey provides us with the information, and challenges us all to do our best to The first Survey was ambitious in its scope and size, but this second one included more questions and more choices. improve our health and that of our families. For we are people and not statistics, and we must do all we can to live All in all, over 24,000 separate pieces of data were captured and analysed. However, unlike the first Survey, better, live longer, and be happier. which took over five years to process and report, this one has achieved the same in 18 months. With very best wishes It is also intended that this Report should shadow that of the first survey as closely as possible to enable comparisons to be made. Hence, the Report is similarly organised into five parts: Part One explains how the Survey was done and validated; Part Two discovers the key findings across different lifestyle topics; Part Three explores the relationships between the topics for insights on whole lifestyles; Part Four compares Gibraltar’s position Dr John Cortes internationally; and finally Part Five brings together the substance of the Report. The Appendix carries a few notes on methodology and the Questionnaire itself. Minister for Health, the Environment, Energy and Climate Change This Report has been deliberately written for a wide audience, from scientists to casual readers. However, efforts have continuously been taken to ensure that scientific rigour is not sacrificed in the pursuit of an easy readable style. It is hoped that this Report will not only be informative and educational in itself, but also enable informed decision making and purposive action to improve the health and lifestyle for all of Gibraltar’s people. Dr Vijay Kumar Director of Public Health Gibraltar Health Authority 2 | Gibraltar Health & Lifestyle Survey 2015 Gibraltar Health & Lifestyle Survey 2015 | 3 Part ONE The Survey 4 | Gibraltar Health & Lifestyle Survey 2015 Gibraltar Health & Lifestyle Survey 2015 | 5 01Introduction 1.1 Background 1.1.1 During March 2015, the Gibraltar Health Authority carried out its second Health and Lifestyle Survey of the local population. The first ever Health and Lifestyle Survey was conducted in 2008. Such surveys are sometimes conducted every year or two in large countries such as the UK, but for Gibraltar, a survey every five years is adequate. 1.1.2 The survey was designed, managed and analysed by the Public Health Department of the GHA, supported by fieldwork undertaken by Copywrite and data input provided by Micro Business Systems, both being locally-based commercial firms. 1.2 Report Contents 1.2.1 This Report presents the findings from the 2015 Survey and provides an insight into the health and lifestyle habits of the people of Gibraltar. The findings have been analysed and put into context, so that comparisons could be made in relation to the 2008 survey and other findings. Each chapter highlights the key points for easy reading. 1.2.2 Just as in the 2008 survey report, the findings here are also compared with countries close to Gibraltar, in terms of proximity and culture. International comparisons enhance the value of the Report, as Gibraltar can be viewed in context, in relation to its neighbours and peers. 1.2.3 It should be emphasised that this is a survey-based research project which closely follows 2008 procedures on a small sample of the population. This sample is used to estimate and predict the behaviour of the population as a whole. This means that there is room for error or ambiguity and therefore just as in 2008 these findings are only presented as a guide. 1.2.4 The volume of data generated by such surveys is vast and therefore quite deliberately, summaries have been added to each chapter and together with an end of Report summary to facilitate understanding and assimilation. 1.2.5 Finally, there are appendices with notes on the methodology applied, the Questionnaire employed and the References used. 6 | Gibraltar Health & Lifestyle Survey 2015 Gibraltar Health & Lifestyle Survey 2015 | 7 02 Survey Design 2.1 Overview 2.1.1 The Gibraltar Health and Lifestyle Survey 2015 is the second survey of its kind conducted in Gibraltar, following on from the Health and Lifestyle Survey of 2008. The survey, like its predecessor, was aimed at understanding the perceived levels of health in the Gibraltar people and gathering data on lifestyle parameters. However, it had an additional purpose, to discover any time trends in the subjects studied. 2.1.2 The survey randomly selected 777 adult residents in Gibraltar via the Gibraltar Electoral Register, about 3% of the population. Trained surveyors were recruited to administer 20 minute face to face questionnaire to each respondent at their doorstep, but without any identity details being recorded. 2.1.3 The proportion of people who responded to the survey was more than 50% of the sample that was selected. Overall, females were over-represented in the sample (18% more than men), while the youngest age groups were under-represented. 2.2 Target Population 2.2.1 The target population is the term given to the population being studied, which in this case, is the adult population (persons of age 16 and over) of Gibraltar. The exact count of the population is unknown between censuses and therefore estimates were calculated. 2.2.2 The most recent actual count of the resident population is from the 2012 Census. As the survey was carried out in March 2015, it was desirable that figures were used as denominators should be more recent if possible. At the time of analysis, the Gibraltar Government Statistics Office had not published estimates for 2014 and therefore, figures from their publication “Abstract of Statistics 2013” were used to construct estimates. The numbers for each of the age and sex based sub-groups of the population were estimated by applying the proportional distributions of the 2012 Census to the estimated population for 2013.