Healthy behaviours: future trends

Research undertaken by the Department of Health suggests that less than two-fifths of the population put a high value on their health and are motivated to adopt a healthy lifestyle.

The segmentation also shows a link between poor motivation and coming from a more deprived area.

Source: Department of Health (2010). Toolkit. Healthy Foundations Life-stage Segmentation Model Toolkit. Version 1: April-June 2010

Source: Department of Health (2010). Toolkit. Healthy Foundations Life-stage Segmentation Model Toolkit. Version 1: April-June 2010

A significant proportion of adults drink beyond safe limits, but prevalence of drinking in young people is falling.

Alcohol has been identified as a causal factor in more than 60 medical conditions including mouth, throat, stomach, liver and breast cancers; hypertensive disease (high blood pressure); cirrhosis; and depression¹. In 2010, there were 6,669 alcohol-related deaths in England².

Alcohol-related illness is placing an increasing burden on the NHS. In the past 10 years there has been a sharp rise in the number of hospital admissions related to alcohol³.

Hospital admissions attributable to alcohol in England 2002/3 to 2009/10

Source: Appleby J, (2012). Article. British Medical Journal

Admissions for alcohol harm differ significantly by area and gender. In 2010/11, hospital admission rates for alcohol-related reasons per head of population were 80 per cent higher in north-west than in south-central strategic health authority regions³.

Alcohol consumption has nearly doubled since the 1950s, with increasing amounts of alcohol consumed in the home. The increase in consumption is now levelling off⁴.

Government recommendations are that adult men should not regularly drink more than 3-4 units of alcohol a day and adult women should not regularly drink more than 2-3 units a day. More than 10 million adults in England exceed the recommended levels. The proportion of women who drink more than 14 units per week has increased from 12 per cent in 1992 to 18 per cent in 2009. There has been no significant change in the proportion of men who drink more than 21 units per week (about 27 per cent)³.

Alcohol misuse affects all socio-economic groups and trends show significant increase in the middle-aged, middle-class cohort. The overall proportion of adults exceeding the recommended level on at least one day in the past week was greater in managerial professional group (38 per cent) than in routine and manual group (28 per cent)³.

The percentage of young people aged 11-15 years drinking alcohol is falling. In 2010, 13 per cent said they had drunk alcohol in the past week, down from 26 per cent in 2001.

Proportion of pupils (11-15) who drank alcohol in the last week, by sex (1988-2011)

Source: NHS Information Centre (2010). Report. Smoking, drinking and drug use among young people in England in 2010

1. NHS Information Centre (2010). Report. Smoking, drinking and drug use among young people in England in 2010

2. Office for National Statistics (2012). Report. Drug use, alcohol and smoking

3. NHS Information Centre (2011). Report. Statistics on Alcohol

4. British Medical Association (2008). Report. Alcohol Misuse: Tackling the UK Epidemic

Having two or more unhealthy behaviours – smoking, drinking above sensible levels, and not sticking to guidelines on exercise and diet – increase the risk of mortality.

Having four of these behaviours reduces life expectancy by 14 years compared to having none¹.

'Between 2003 and 2008, there was a 20 per cent reduction in the number in the population with three or four unhealthy behaviours, and a corresponding increase in those with one, two or none¹.'

More disadvantaged groups are also more likely to have a cluster of unhealthy behaviours – smoking, drinking, low consumption of fruit and vegetables, low levels of physical activity. While the proportion of the population that engages in three or four unhealthy behaviours has declined from around 33 per cent in 2003 to 25 per cent in 2008, these reductions have been seen mainly among those in higher socio-economic and educational groups. People with no qualifications were more than five times as likely as those with higher education to engage in all four poor behaviours in 2008, compared with only three times as likely in 2003¹.  

Research on why people adopt, maintain and give up unhealthy behaviours is sparse. The overall improvement in unhealthy behaviours is good news for public health as a whole. But the lack of progress for the poor will lead to widening health inequalities if the trend continues.

1. Buck D, Frosini F (2012) Clustering of unhealthy behaviours over time The King's Fund

Hospital admissions for drug-related conditions is rising, but the rate of drug misuse in young people is falling.

Drug-taking can cause significant social problems and carries significant risks.

In 2010/11, there were 6,640 admissions to hospital with a primary diagnosis of a drug-related mental health and behavioural disorder. More than twice as many males were admitted than females in this year. These figures show a 14.3 per cent increase on the previous year (2009/10), when there were 5,809 hospital admissions¹.

Hospital admissions of drug-related mental health and behavioural disorders in England (2000/01)

Source: NHS Information Centre (2011). Report. Smoking, drinking and drug use among young people in England in 2011

In 2010, the total number of deaths related to drug misuse was 1,784 in England and Wales. Of those, 77 per cent were male. The most common underlying cause of death was from accidental poisoning¹.

Drugs misuse among adults (16-59 years), in England and Wales, has increased from 30.5 per cent in 1996 to 36.3 per cent in 2010/11².

In 2010/11, 3 per cent of adults had used a Class A drug in the last year, compared with 3.1 per cent in 2009/10. This shows a long term increase from 2.7 per cent in 1996². 

Both drug dependence and misuse vary by ethnicity and income. Adults from the white ethnic group had higher levels of illicit drug use (9 per cent) than those from non-white backgrounds (5.8 per cent). Households in the lowest income groups also had the highest levels of drug misuse³.

The percentage of young people (16-24 years) who have taken illegal/illicit drugs or children (11-15 years) who have taken or been offered illegal/illicit drugs illegal drugs has fallen¹.

In 2010/11, 20 per cent of young people had used one or more illegal/illicit drug in the previous year a reduction from 30 per cent in 1996. In 2010/11, 12 per cent of children reported taking drugs in the past year, a fall from 20 per cent in 2001. The percentage of young people taking class A drugs is also falling, and was 6.6 per cent in 2010/11, down from 9.2 per cent in 1996. Mark Easton has written a blog on the fall in drug, alcohol and tobacco use amongst teenagers.

Trends in drug use among all pupils aged 11-15 (2001-2011)

Source: NHS Information Centre (2011). Report. Smoking, drinking and drug use among young people in England in 2011

1. NHS Information Centre (2011). Report. Smoking, drinking and drug use among young people in England in 2011

2. NHS Information Centre (2011). Statistical Bulletin. Statistics on drugs misuse

3. The Home Office (2012). Statistical Bulletin. Drug Misuse Declared: Findings from the 2010/11 British Crime Survey

Adult obesity rates are rising and driving an increased risk of chronic disease.

Health risks

Obesity presents a major threat to health. It is associated with an increased risk of diseases including diabetes, heart disease, osteoarthritis and cancer. 

Estimates suggest that being overweight (BMI 25 to less than 30) reduces life expectancy by about three years, and being obese (BMI 30 or more) can reduce life expectancy by 10 years¹.

Relative risk factors for obese people of developing disease by gender

The table below indicates the extent to which obesity increases the risks of developing a number of diseases relative to the non-obese population. The relative risks are based on a comprehensive review of international literature that was carried out by the National Audit Office, to provide the best estimates that could be applied to the English population².

Source: National Audit Office (2001). Report. Tackling obesity in England. Report by the comptroller and auditor general HC220 Session 2000- 2001: 15 Feb 2001

Obesity rates

The prevalence of adult obesity increased from 15 per cent in 1993 to 26 per cent in 2010. In 2010, 67.8 per cent of men and 57.8 per cent of women were overweight or obese¹.

Obesity rates vary across the country and are higher for women in lowest income quintiles. There is a distinct north-south divide¹.

Changes in the food system, including reductions in food preparation time, are thought to be one of the major drivers of the global obesity epidemic over the past 40 years³.

Overweight and obese adults aged 16+ years

Source: NHS Information Centre. Survey. Health Survey for England 1993-2010 data

Future trends in adult obesity

Wang et al estimate that by 2020, 37 per cent of men and 34 per cent of women (aged 16+) will be obese. By 2035 they predict this will rise to 46 per cent of men and 40 per cent of women.

Wang et al also estimate that during the next 20 years, obesity-attributable disease risks will add between 544,000 and 668,000 cases of diabetes, between 331,000 and 461,000 cases of coronary heart disease and strokes, and between 87,000 and 130,000 cases of cancer⁴.

After rising steadily since the early 1990s, rates of childhood obesity are stabilising.

In 2010, around three in ten children aged 2 to 15 were classed as either overweight or obese⁵.

The proportion of boys and girls aged 11 to 15 who were obese increased steadily from 17 per cent in 2001 to 25 per cent in 2004. Between 2005 and 2010, numbers have been fluctuating but, overall, the trend is stable⁶. 

In 2010, Stamatakis et al used childhood and adolescent obesity trends from 1995 to 2007 in England (from the Health Survey for England) to project growth in the prevalence of childhood obesity. Their report projects that by 2015, obesity prevalence will be 10.1 per cent for boys and 8.9 per cent for girls (aged 2-10) and 8 per cent in male and 9.7 per cent in female adolescents (aged 11-18)⁷.

Recent trends in the United States show that the proportion of teenagers with pre-diabetes or full-blown type 2 diabetes has more than doubled in recent years although the prevalence of childhood obesity is levelling off. This raises concerns for England⁵.

Trends in child (2-15) obesity prevalence

Source: National Obesity Observatory (2012), using Health Survey for England 1993-2010 data

Drivers of childhood obesity

Obesity in children has a marked social gradient. Children in the highest income quintiles are the least likely to be obese, whereas the proportion of obese children is highest in the lowest income quintiles. In the lowest quintile, 20 per cent of boys and 17-18 per cent of girls are obese. The proportion of children who are overweight, including obese, increases as the income quintile decreases⁵.

Parental BMI is also a very significant indicator and driver of children’s BMI. 24 per cent of boys aged 2-15 living in overweight/obese households were classed as obese compared with only 11 per cent in normal/underweight households. Equivalent figures for girls classed as obese were 21 per cent and 10 per cent⁸.

There has been variable progress in improving population diet.

Population eating habits

While the number of children eating the recommended amounts of fruit and vegetables has increased in recent years, 80 per cent of children still do not eat the recommended '5-a-day'. Adults also showed an improving trend until 2006, when numbers began to fall and 70 per cent of adults still do not eat the recommended amount. There is a relationship between consumption of fruit and vegetables and income quintiles, with consumption increasing as income increases as the graph below shows.

Fruit and vegetable indicators by equivalised income

Source: Department for Environment, Food and Rural Affairs (2011). Food Statistics Pocketbook

There has been a relatively steady reduction in the consumption of salt in recent years, but the consumption of fat and saturated fats has hardly changed.

The population is currently eating too much fat, sugar and salt, and not enough fruit, vegetables and fibre, although those in high-income groups are consuming more fruit and vegetables than those in low-income groups. This pattern is unlikely to change without some significant incentive or regulatory change.

Quality of the current population diet

Source: Department for Environment, Food and Rural Affairs (2011). Food Statistics Pocketbook

More people are physically active than 10 years ago; however, the proportion is still very low in the population. The current levels of inactivity in the population present a major threat to public health.

Staying active and exercising regularly is key for a healthy life. People who exercise regularly are likely to have improved functional and cognitive health. Estimates suggest that in England physical inactivity causes 10 per cent of heart disease, 13 per cent of type 2 diabetes, 18 per cent of breast cancer and 17 per cent of all mortality⁹.

The Health Survey for England (2007) showed that many people are unaware of the recommended minimum levels and see themselves as relatively active. Lack of time and work commitments were cited as the main barriers to increasing physical activity¹⁰.

Current government recommendations for adults are for at least 30 minutes of at least moderate activity, either in one session or in multiple bouts of at least 10 minutes, on five or more days each week. In 2008 (most recent data), 61 per cent of men and 71 per cent  of women aged 16 and over did not meet the recommendations, compared with 68 per cent and 79 per cent respectively in 1997¹¹.

Percentage of adults (aged 16+) meeting previous physical activity recommendations

Source: NHS Information Centre (2010). Survey. Health Survey for England 2010: Trend Tables

Government recommendations for children and young people are for a minimum of 60 minutes of at least moderate activity each day. In 2007, 72 per cent of boys and 63 per cent of girls met the recommended level, compared with 70 per cent and 61 per cent respectively in 2002⁹.

1. NHS Information Centre (2010). Survey. Health Survey for England 2010: Trend Tables

2. National Audit Office (2001). Report. Tackling obesity in England. Report by the comptroller and auditor general HC220 Session 2000- 2001: 15 Feb 2001

3. Swinburn BA, Sacks G, Hall KD, McPerson K, Finegood DT, Moodie ML, Gortmaker SL (2011). Research paper. 'The global obesity pandemic: shaped by global drivers and local enviromments'. Lancet, vol 378, pp 804-14

4. Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M (2011). Research paper. 'Health and economic burden of the projected obesity trends in the USA and the UK'. Lancet, vol 378: pp 815-25

5. NHS Information Centre (2012). Survey. Health Survey for England - 2010. Child trend tables

6. National Obesity Observatory (2012). Slideset. Prevalence of obesity among children

7. Stamatakis E, Zaninotto P, Falaschetti E, Mindell J, Head J (2010). Research paper. Time trends in childhood and adolescent obesity in England from 1995-2007 and projections of prevalence to 2015. Journal of Epidemiology and Community Health, vol 64: pp 167-174

8. Reuters health (May 2012). Article. 'Pre-diabetes', diabetes rising among U.S. teens'

9. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, Lancet Physical Activity Series Working Group (2012). Research paper. ‘Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy’. Lancet, vol 380, no 9838, pp 219–29.

10. NHS Information Centre (2012). Statistical Bulletin. Statistics on obesity, physical activity and diet in England 2010

11. NHS Information Centre (2007). Survey. Health Survey for England 2007: Healthy lifestyles: knowledge, attitudes and behaviour

A high number of sexual partners and unprotected sex put individuals at risk of unplanned pregnancy and contracting sexually transmitted infections (STIs), including HIV. Many STIs have a long-term effect upon health.

The most recent data available (2008/9) show slight increases in the number of people having protected sex and relatively high rates of protected sex in those who have had more than one sexual partner. Condom use in those who were either currently in a sexual relationship or who had been in the past year were 46 per cent in men (increased from 40 per cent in 2000) and 51 per cent in women (increased from 48 per cent in 2000). Condom use in those who had had more than one sexual partner were higher (82 per cent in men and 75 per cent in women)¹.

The majority of women under 50 (75 per cent) use contraception. The most popular methods are the contraceptive pill (25 per cent) and the male condom (25 per cent)¹.

59 per cent of men and 52 per cent of women who were not in a long-term exclusive relationship reported making no changes to their behaviour as a result of what they had heard about HIV/AIDS and other STIs¹.

The recent increase in STIs in older people indicates that sexual risk-taking behaviour occurs among older people as well as in young people².

'The under-18 conception rate for 2010 is the lowest since 1969 at 35.5 conceptions per thousand women aged 15-17.'

A number of factors are thought to account for this fall including education programmes, a shift in aspirations of young women towards education, and the stigma associated with being a teenage mother³. However, the United Kingdom still has the highest teenage birth rate in Europe⁴.

1. Lader D (2009). Report. Contraception and Sexual Health, 2008/09

2. Bodley-Tickell AT, Olowokure B, Bhaduri S, White DJ, Ward D, Ross JD, Smith G, Duggal HV, Goold P (2008). Research paper. ‘Trends in sexually transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system’. Sexually Transmitted Infections, vol 84, pp 312–17

3. Office for National Statistics (2012). Statistical Bulletin. Conceptions in England and Wales 2010, a statistical briefing

4. United Nations Children’s Fund, Innocenti Research Centre (2001). Report. A League Table of Teenage Births in Rich Nations. Florence, Italy.

Smoking prevalence has decreased to one in five in England, but the socio-economic divide persists.

Smoking is the single greatest cause of preventable deaths in England. In 2010, around 18 per cent of all deaths in adults aged 35 and over were attributed to smoking. Smoking significantly increases risks of cancer, respiratory disease and circulatory disease. 36 per cent of deaths due to respiratory disease are linked to smoking. One in every two regular smokers is killed by tobacco and half of all smokers will die before the age of 70, losing on average 10 years of life¹.

The General Lifestyle survey shows that overall, smoking prevalence was decreasing in England but now seems to be levelling. The number of adults who reported smoking has decreased from 39 per cent in 1980 to 21 per cent in 2009².

Currently 22 per cent of men and 20 per cent of women are regular smokers. The smoking ban on public places was introduced in July 2007. While there has been debate on how effective the ban has been, recent research suggests that it has been successful in reducing cigarette consumption among male heavy smokers, females and younger people, and is contributing to the long-run downward trend in smoking rates³.

The socio-economic variation in smoking rates has become more marked. In 1992, there were 14 smokers from manual socio-economic groups for every 10 smokers from non-manual groups; in 2010, there were 22 for every 10 respectively. This is because the drop in rates is much greater in non-manual groups – from 23 per cent to 13 per cent as opposed to the drop from 33 per cent to 28 per cent in manual groups. Smoking is the primary reason for the gap in healthy life expectancy between rich and poor¹.

Cigarette smoking status among adults, by socio-economic classification of household reference person, 2009

Source: Office for National Statistics (2010). Survey. General Lifestyle Survey, 2010

The prevalence of regular smoking among 11 to 15 year olds has more than halved since its peak in the mid 1990s – 13 per cent in 1996. Girls are more likely to smoke regularly than boys (6 per cent and 4 per cent respectively in 2010). The prevalence of smoking also increases with age, from less than 0.5 per cent of 11 year olds to 12 per cent of 15 year olds¹.

Proportion of pupils (aged 11-15) who were regular cigarette smokers, by sex: 1982-2011

Source: NHS Information Centre (2010). Report. Smoking, drinking and drug use among young people in England in 2010

Current trends in unhealthy behaviours show an overall improvement. However, we can still see marked socioeconomic inequalities within most of these. Looking ahead, there is concern that those from lower socio economic groups will find it even harder to lead healthy lifestyles. If this happens, the gap between the richest and the poorest in society might widen further.

1. NHS Information Centre (2011). Statistical Bulletin. Statistics on smoking: England

2. Office for National Statistics (2010). Survey. General Lifestyle Survey, 2010

3. Jones A, LaPorte A, Rice N, Zucchelli E (2012). Report. A model of the impact of smoking bans on smoking with evidence from bans in England and Scotland. Health Econometrics and Data Group. Centre for Health Economics, University of York