Fight to tackle unhealthy lifestyles has widened gap in health inequalities

BMJ 2012; 345 doi: (Published 23 August 2012) Cite this as: BMJ 2012;345:e5707
  1. Adrian O’Dowd
  1. 1London

Efforts to persuade people to follow a healthier lifestyle have worked only for wealthier parts of the population and widened the health inequalities divide.

This is the conclusion of a report from health think tank The King’s Fund, which found that poorer people have been left behind in the fight against unhealthy lifestyles.

The report1 claims to be the first study to examine how patterns of multiple lifestyle behaviours have changed over time in England.

Researchers used data from the Health Survey for England2 to analyse changes in four key lifestyle behaviours—smoking, excessive drinking, poor diet, and lack of exercise—between 2003 and 2008.

They focused on these four categories of unhealthy behaviour because they have been estimated to account for half of the disease burden in the developed world collectively.

Analysis of the data showed that the proportion of the population engaging in three or four of these behaviours fell by 8% over the period—from 33% to 25%—indicating that various public health initiatives in that time had helped to improve health among the population as a whole.

However, these initiatives failed to have the same impact among lower socioeconomic groups during this period. The proportion of unskilled manual workers who engaged in all four behaviours remained unchanged at around 9% over the period. But among professional men those engaging in all four behaviours fell from 6% in 2003 to 4% in 2008.

The authors said there had been notable successes in public health initiatives, but these initiatives had focused too much on tackling individual behaviours.

The period studied is described in the report as “a story of much effort, and some real successes, but also of far too little coordination.”

Individual lifestyle policies were developed in “siloes” and behaviour change policies were produced separately from inequalities policy.

In the future, public health policy should focus more on tackling multiple behaviours and targeting those in lower socioeconomic and educational groups, says the report.

There were opportunities for improving matters, said the authors, given that the public health system in England was currently being reformed, and from next April local authorities would have ring fenced money to spend as part of more than £2bn (€2.5bn; $3.1bn) being allocated to delivering health improvement programmes.

David Buck, senior fellow at The King’s Fund and the lead author of the report, said: “Our research highlights an unsung public health success—a reduction in multiple unhealthy lifestyle behaviours among the general population. However, the lack of progress among lower socio-economic and educational groups is worrying and has exacerbated health inequalities.”

One aspect of the Department of Health’s vision for public health, outlined in the Public Health Outcomes Framework3 published in January of this year, is “to improve and protect the nation’s health and wellbeing, and improve the health of the poorest fastest.”

Buck added: “If the government is serious about improving the health of the poorest fastest, it must focus on reducing multiple unhealthy risky behaviours among the poorest groups, rather than only relying on focusing on single behaviours.”

A Department of Health spokesman said: “We are working hard to tackle health inequalities—from next year, local authorities will receive a specific public health budget for the first time, targeted at the areas that need it most. Additionally, the health act has given the NHS its first ever duties concerning the need to reduce health inequalities.”


Cite this as: BMJ 2012;345:e5707


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