Is everybody happy?

Brighton and Hove’s director of public health Dr Tom Scanlon talks about happiness – and sex and drugs and alcohol. Frank le Duc finds out more

Brighton and Hove has the third highest rate of sexual infections of anywhere in England outside London. More than 20,000 people – and rising – go along to the sexual health clinic in Brighton each year. Tom Scanlon, the director of public health in Brighton and Hove, devotes a chapter of his newly published annual report to sex and happiness. Unlike many official documents, Dr Scanlon’s reports are written in plain English.

The chapter in question was penned by Stephen Nicholson, the council’s lead public health commissioner for sexual health. He said: “Most adults in England are sexually active and for many people a fulfilling sex life is fundamental to their happiness and wellbeing. The 2012 Health Counts survey suggests that this is also the case in Brighton and Hove. People with a sexual partner in the previous year are significantly happier than those without.

“Of course, not all sex is risk-free, and some people are unable or unwilling to make informed, responsible decisions about their sex lives. For the first time, the Health Counts survey of 2012 asked people if they had ever been diagnosed with a sexually transmitted infection. The survey confirmed the rates reported through the Health Protection Agency. Around twice as many respondents to the local Health Counts survey reported having been diagnosed with a sexually transmitted infection compared to respondents to the national Health Survey for England (2010).

“Despite ever rising levels of testing, there has been little impact on rates of infection”

“Brighton and Hove has long held the reputation of a young, fun-loving, liberal party town but this is not without risks. Around 17 per cent of survey respondents reported drinking alcohol above safe limits including three per cent drinking at very high risk levels. Among its many adverse effects on health, the survey results show that excessive alcohol consumption is associated with higher numbers of sexual partners and a higher risk of acquiring a sexually transmitted infection.

“It is a similar picture for illicit drug use. People who reported drug use in the last year were four times as likely as those who had not used drugs to have had four or more sexual partners in the past year. Furthermore, 31 per cent of those who had used drugs in the last year reported having ever being diagnosed with a sexually transmitted infection compared with 13 per cent of those who had not.

“The survey suggests then that there is an association between levels of drug and alcohol use and risky sexual behaviour which result in higher levels of sexually transmitted infections. But is this group happier? The short answer is ‘no’. There was no association between increasing numbers of sexual partners and increased happiness, greater life satisfaction or a feeling that life was more worthwhile. In fact, respondents who reported having one sexual partner in the last year recorded the highest levels of happiness.

“Other published evidence supports this finding. Drugs and alcohol can lower inhibitions and lead to poor sexual choices and increased risk-taking, which in turn can lead to feelings of remorse and regret – especially if a sexually transmitted infection is the outcome.

“One group stands out as at particularly high risk. Men aged less than 25 years who have sex with other men reported having more sexual partners and significantly higher rates of sexually transmitted infections. In fact, men who had sex with men in the previous year reported four times as many sexual partners as the general population. In addition, 40 per cent of men who had sex with men reported ever having been diagnosed with a sexually transmitted infection compared with 17 per cent of the general population.

“Services for at-risk groups are becoming more effective, certainly at engaging these groups and at testing for sexually transmitted infections. Three quarters of men who have sex with men have ever had a test for HIV compared with a third of the general population. And 60 per cent have ever tested for chlamydia compared to 38 per cent of the general population. Younger women are twice as likely to have ever had a test for chlamydia (75 per cent of women aged 18 to 24 years) than men of the same age (44 per cent).
“Unfortunately, despite ever rising levels of testing, there has been little impact on rates of infection. The data from the Brighton and Hove Health Counts survey make a strong case for tackling risky sexual behaviour together with drug and alcohol misuse.

“A more systematic approach to screening and offering brief interventions and onward referral for drug and alcohol misuse in sexual health services is required. In the same spirit, people who present at drugs and alcohol services should have their sexual health needs addressed and be offered testing for sexually transmitted infections.

“More ‘joined-up’ services are not a substitute for targeted health promotion work with high-risk groups, but they may offer a more effective mechanism for reducing in particular the number of repeat sexually transmitted infections. Furthermore, as well as reducing sexually transmitted infections
the evidence suggests that improved sexual health will lead
to improved wellbeing and in the end, greater happiness.”

Happy place
Happiness is at the heart of the latest annual report of Brighton and Hove’s director of public health Tom Scanlon. And Rottingdean looks like the place to be if you want a happy life. More than eight out of ten people living in the Rottingdean Coastal council ward who took part in a survey last year reported being happy.

In Brunswick and Adelaide the figure was nearer six out of ten and across Brighton and Hove it was just above seven out of ten, close to the national average. Dr Scanlon’s report, Happiness – the Eternal Pursuit, with its echo of the United States Declaration of Independence, looks at sex and drugs and alcohol.

It also analyses the effects of smoking and physical activity on our happiness and touches on inequality, social inclusion and depression. Why happiness? It’s a serious question. Those who are genuinely happy seem to enjoy better health. Or maybe it is those who are healthiest who are happiest.

Either way, Dr Scanlon’s deputy Peter Wilkinson gave a presentation about the report and its findings to the Brighton and Hove Strategic Partnership on Tuesday 25 June. Unusually in a meeting of the great and the good in Brighton and Hove, Dr Wilkinson was warmly applauded after he finished.

His conclusions were:
• Levels of wellbeing and happiness vary considerably across the city
• Drink, drugs, smoking and unsafe sex are all linked with lower levels of happiness
• Mental wellbeing is steady but certain previously unidentified groups were at greater risk
• Young children are drinking less but students are at risk as are some older people
• Well-off people are now as likely to drink too much as the poor
• Fewer people are dying after a drug overdose and drugs linked to clubbing have become more popular
• Obesity is increasingly linked to deprivation
• Gay men under 25 suffer the most sexual infections especially after drinking or taking drugs
• Policy-makers, the NHS and other public bodies could help improve people’s health by addressing their happiness and wellbeing

David Cameron has spoken about wanting a national wellbeing index. And former Brighton College head Anthony Seldon introduced happiness classes, based on positive psychology, shortly after joining his current school, Wellington College, seven years ago. The classes touch on how to manage relationships, ambitions and physical and mental health.

Dr Scanlon’s report on happiness and health has been published in a magazine format. The findings are presented in a clear, concise and accessible style. Dr Scanlon is emphatic that he is not “dumbing down”. Rather, he has relied on the evidence of a great deal of research and analysis presented in a way that ensures that his work reaches the widest possible audience. Who could be unhappy about that?