Quick start guide: Health Survey for England (HSE)

The HSE is a cross-sectional survey that monitors trends in health conditions and health behaviours of adults and children in England. The survey has run every year since 1991, except for 2020 due to the Covid-19 pandemic. The HSE is carried out by NHS digital and is run conjointly by the Joint Health Surveys Unit of NatCen Social Research and the Research Department of Epidemiology and Public Health at UCL. The data are collected from adults aged 16 and over, and children aged 0 to 15 through face-to-face in-home interviews and self-completion questionnaires. The interview is followed by a nurse visit – if the eligible participants consent – to take some measurements and ask further questions. Approximately, 8,000 adults and 2,000 children participate in the survey every year.

The HSE collects data on different health indicators regularly. The core topics of the survey are on general health and psycho-social measures (e.g. questions about feeling depressed, having mental health illness, and types of counselling or therapy for a mental health or emotional problem). The survey also covers demographic and socioeconomic indicators every year. In addition, the HSE includes questions on other health topics that vary from year to year. These additional topics are included in the survey to monitor trends on certain health issues over time.

See the Health Survey for England content page on the NHS Digital website if you are interested in the topics that were included each year of the survey from 1993 to 2019.

Obesity is more common in England than you think!

• Did you know that among adults aged 16 and over, over a quarter were obese and over one third were overweight in 2019?
  The 2019 HSE found that 28% of adults were obese and 36% were overweight (but not obese).
• Did you know that there were no substantial differences between levels of obesity of men and women in 2019?
  The 2019 HSE found that 29% of women in England were obese compared to 27% of men.
• Did you know that among children aged 2 to 15, boys were more obese or overweight than girls in 2019?
  The 2019 HSE found that 20% of boys were obese compared to 13% of girls. The percentages of overweight (but not obese) boys and girls were 12% and 15% respectively.
• Did you know that children with an obese parent were more likely to be obese themselves?
  The 2019 HSE found that 27% of children with an obese mother were obese, and 23% of children with obese fathers were obese.

Core questions and rotating modules

The HSE aims to provide annual information on public health and estimates of people with certain health conditions, and the potential risk factors that trigger these conditions. To fulfil those aims, the HSE survey provides annual updates on a range of core topics including smoking status, alcohol consumption, general health status, and long-standing illness. Also, the survey provides frequent data on anthropometric measurements (height and weight), physical examination (blood pressure) and lab test (blood analysis and saliva samples). In addition, the HSE has a module of questions on certain topics that change from year to year. For instance, the 2019 HSE collected additional data on various topics such as providing unpaid social care, dental health, eating disorders, use of GP and counselling services, and awareness of mental health resources.

Survey routing/split sample

The HSE collects data using individual and household questionnaires. Each questionnaire consists of different modules and topics that are not necessarily applicable to all the survey respondents. When this is the case, survey routing is used to skip these questions and those not asked are coded as missing with a “does not apply” label. You will see these missing values for such variables in the dataset you download. However, the HSE survey is designed to be representative of target population and to give accurate results.

The full questionnaire of the HSE survey used is available on the documentation section of the UK Data Service datasets for each survey year. FAQs are available.

Unit of analysis

The HSE survey represents adults aged 16 and over living in private households in England. As of 1995, the HSE has collected data of children aged 2 to 15. Data of infants aged below 2 have been included in the survey since 2001.

Sample design

The sample of the HSE is designed to be representative of the target population (adults aged 16 and over, and children aged 0 to 15) living in a private household in England. Individuals living in institutions such as students, hostels and care homes are excluded from the survey sample. The HSE uses the Postcode Address File (PAF) as the sampling frame. The households whose address are not in the PAF are excluded from the survey. The HSE adopts a multi-stage stratified probability sampling design.

If you are interested in detailed information about the HSE sample design used in each year of the survey, use the survey documentation section on the data catalogue. You can also access the full reports for each year of the survey from the Health Survey for England publications page on the NHS Digital website.

Are there survey weights?

Weights should always be applied when analysing the HSE data. The HSE datasets consist of several weighting variables. Before 2003, selection weights were the only weighting methods used for the HSE core sample to correct for sample design. In 2003, non-response weights were added to the HSE data to adjust for possible non-response bias.

The HSE implements separate non-response weights for individual and household level analyses. These are:

• Interview weight (wt_int): these weights are computed separately for adults and children in the core sample. It adjusts for non-response among individuals within participating households. This weight is used for individual level analysis.
• Household weight (wt_hhld): this weight is for the general population sample. It adjusts for non-contact and refusal of households to participate in the survey. This weight is used for household level analysis.

There are also additional weights that take into consideration the non-response of survey participants in different stages of the survey. These weights change from year to year depending on the new topics that are added to the survey. For instance, the 2019-HSE survey consists of:

• Nurse weight (wt_nurse): which adjusts for non-response to the nurse visit section of the survey. This weight should be used in all analysis of nurse visit-related questions.
• Blood weight (wt_blood): which adjusts for non-response to the blood sample section in the survey. This weight should be used in all analysis of blood samples-related questions.
• Cotinine weight (wt_cotinine): which adjusts for non-response to the saliva sample section in the survey. This weight should be used in all analysis of saliva samples-related questions.

The decision of which weighting variables to use is based on the variables used in the analysis. For instance, use individual weights when you analyse data from the interview stage only. If you analyse combined data from different stages of the survey, use the weights of the latest stage of the survey. For instance, if you analysis data from the saliva samples and the interview stages, use the cotinine weight.

For more information on the HSE weights and how they were created, an example is on the Health Survey for England, 2019 under documentation available via the UK Data Service. Information about the HSE weights is also provided in the Health Survey for England 2019 Methods report (PDF).

Accessing the HSE data from the UK Data Service

The HSE datasets are available from the UK Data Service website. Some HSE data have additional conditions (for instance, the 2019-HSE file has a location agreement meaning that the data must not be accessed at a location outside the UK).

For more information about data access levels and conditions, visit our Access levels and conditions page. You can also read information about the terms and conditions of data access from the Types of data access page.

You can learn more about the HSE survey from:

• The Health Survey for England on the UK Data Service data catalogue. Each dataset comes with documentation including the questionnaire and user guide.
• The HSE reports from the Health Survey for England publication series page on the NHS Digital website.
• The NatCen Social Research website.
• The UCL HSE website.
• Our online data exploration tool Nesstar. You can explore online the survey questions and responses and do some basic analysis.