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Report

Clustering of unhealthy behaviours over time: Implications for policy and practice

  • 22 August 2012

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People’s lifestyles – whether they smoke, how much they drink, what they eat, whether they take regular exercise – affect their health and mortality. It is well known that each of these lifestyle risk factors is unequally distributed in the population.

Less is known about how these behaviours co-occur or cluster in the population and about how these patterns of multiple lifestyle risk have been evolving over time. This paper considers this in the context of the English population and sets out the implications for public health policy and practice that flow from the findings.

It reviews the current evidence on multiple lifestyle risks and analyses data from the Health Survey for England on the distribution of these risks in the adult population and how this is changing over time.

Key points

  • The overall proportion of the English population that engages in three or four unhealthy behaviours has declined significantly, from around 33 per cent of the population 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 2003.

  • The health of the overall population will improve as a result of the decline in these behaviours, but the poorest and those with least education will benefit least, leading to widening inequalities and avoidable pressure on the NHS.

Policy implications

More effective ways must be found to help people in lower socio-economic groups and those with the least education to improve their health behaviours.

This requires a more holistic approach to policy and practice, addressing lifestyles that encompass multiple rather than individual unhealthy behaviours.

In addition, behaviour change should be linked more closely to inequalities policy and be focused more directly on improving the health of the poorest.

More research and better use of the data already available is key. In particular, it would be helpful to know whether it is easier or harder to change the behaviour of those with multiple risks, whether it is more effective to tackle the risks in sequence or in tandem, what the most cost-effective approaches are and what we can learn from other areas of care.

Summary presentation

David Buck introduces the key findings of our paper, Clustering of unhealthy behaviours over time: implications for policy and practice, examining the impact multiple lifestyles has on health and how four key risky behaviours – smoking, excessive drinking, poor diet and lack of exercise – cluster in the English population and how that is changing over time.