England sees a drop in unhealthy lifestyle behaviours but a widening gap between different groups

Fewer people are engaging in multiple unhealthy lifestyle behaviours, according to a new report from The King’s Fund, which looked at data from the Health Survey for England from 2003 to 2008. This is the first study of its kind in the English population. They examined the clustering of four key behaviours: smoking, excessive drinking, poor diet and lack of exercise. Here’s what they found:

  • The proportion of the population engaging in 3 or 4 of these behaviours fell by 8% over this period (from 33% to 25%), suggesting that public health initiatives have been important in improving the health of the population overall


  • The proportion of manual workers and people with no educational qualifications engaging in all four behaviours has unchanged
  • The gap between higher and lower socioeconomic groups has widened. Those with no qualifications are five times more likely to engage in all four behaviours than better educated groups, compared to three times as likely in 2003

The report suggests:

  • 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
  • Public health policy should focus more on tackling multiple behaviours and targeting those in lower socio-economic and educational groups
  • More research and better use of the data already available is key. 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

David Buck, lead author of the report, said there is a need for a shift in focus in public health initiatives, from targetting single behaviours to reducing multiple unhealthy behaviours, and also for an understanding of behaviour patterns within localities. He is optimistic about the potential for the success of local initiatives:

“We also believe there is great potential in the existing health trainer and community champions networks to make a real impact on reducing the evident inequalities in the clustering of behaviours our report has unearthed.”

You can learn more from David Buck through his blog and slidecast, as well as accessing the full report, from the links below.


Buck D, Frosini F. Clustering of unhealthy behaviours over time. Implications for policy and practice. The King’s Fund. August 2012

Listen to lead author David Buck talking about the key findings here

Improving the health of the poorest, fastest: why clusters of lifestyle behaviours matter. David Buck’s blog.

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Sarah Chapman

My name is Sarah Chapman. I have worked on systematic reviews and other types of research in many areas of health for the past 17 years, for the Cochrane Collaboration and for several UK higher education institutions including the University of Oxford and the Royal College of Nursing Institute. I also have a background in nursing and in the study of the History of Medicine.

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