Recent changes in health behaviours of young women and the

new public health system

David BuckThe King’s Fund

Us Girls! Get in the Know! What girls, think, feel and do! University of Warwick, 15th January 2013

Changes in health behaviours: What’s been happening?

For adults, some encouraging news on trends in behaviours in recent years

Source: Gregory et al (2012) Health policy under the coalition government: A mid-term assessment. The King’s Fund. Available from, http://www.kingsfund.org.uk/publications/health-policy-under-coalition-government

Even more encouraging for young women?

Source: King’s Fund analysis, derived from Health Survey for England adult trend tables, fromhttp://www.ic.nhs.uk/catalogue/PUB09302/HSE2011-Adult-trend-tbls.xlsNote: Each series has its own caveats and qualifications, see source for details. Data presented here has been chosen for reasonable comparability over time.

But we all know that most health behaviours are not experienced in isolation...

..this matters a lot. Having many poor behaviours has an increasing impact on health..

Source: EPIC-Norfolk cancer studies

So, what’s been happening?

Government policy has focussed on behaviours in isolation...

March 2011 October 2011 March 2012

...is this enough? We looked at the Health Survey for England to find out..

What has been happening over time?– As a population, do more or fewer of us smoke and drink above limits and

exercise below guidelines and eat unhealthily?– And if so, are we all doing so equally, or are certain groups more likely to be

doing so than others?

What might this mean for policy?– How government decides to focus its policies– How government designs payments to the NHS, and other elements of the

health and public health system

What might this mean for practice?– Does is mean we would be more effective if we focussed on people with

“clusters” of behaviour, rather than those with single behaviours?– What about local health and wellbeing strategies?

We found real improvements over time

Consistent with movements “down ladder”– Shedding 3 and 4 behaviours, maintaining 1 and 2– Overall about a 20% drop in 3+ behaviours for men and women– But, 70% of the population still have at least 2 behaviours

Within this there are 16 specific risk combinations, poor diet and exercise dominant

Prevalence of combinations of multiple lifestyle risk factors in 2003 by sex

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Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor

Significant changes over time in some of these combinations

Change in prevalence of combinations of multiple lifestyle risk factors between 2003 and 2008 by sex

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Combinations of lifestyle risk factors

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Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor; * = significant change

..but improvements come from some sectors of the population and not others

Change in prevalence of multiple lifestyle risk factors between 2003 and 2008 for men in professionals and

unskilled manual households

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2003 - All pop 2008 - All pop 2003 -Professionals

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People with no formal qualifications 3x as likely to have 3 or 4 behaviours in 2003 compared to those with the most

..by 2008, this had risen to 5x as likely.

What about girls?

Young women more likely to have very unhealthy and very healthy behaviour in 2003

Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor; * = significant change

Significant improvement by 2008, not more likely to be very unhealthy but also not very healthy

Note: S=Smoking; D=Drinking; F= Fruit&Vegetable; P=Physical activity; Capital letters= presence of risk factor; * = significant change

Overall, a real and significant improvement for young women

Number of risk factors

2003 2008 Statistically significant?

4 10.5% 5.7% Y

3 31.2% 23.8% Y

2 39.6% 43.3% N

1 14.9% 22.2% Y

0 3.8% 4.9% N

Pattern of lifestyle risk factors 2003-08 for women 16-24

... but 95% of young women will have at least one risk factor and almost 3 in 4 will have 2 or more

So what for policy and practice?

Findings have implications for policy...

Keep doing what seems to be working– For most of population, things look like “they are working”– Don’t forget what you already know e.g. Healthy Foundations

“Improving the health of the poorest fastest” – Relook at relationship between PH and inequalities policy– A multi-behaviours approach, with a socio-economic focus?– Public health ambitions – how targeted are they?

Levers– What does this mean for “Making Every Contact Count”?– How should levers and incentives be designed to take into

account lifestyle clustering?

Local authorities have new behaviour change responsibilities

New local authority role– Responsibility for health improvement including tobacco control, alcohol,

obesity and physical activity– Can call on a wide diversity of “channels” for behaviours change, from NHS

staff to council, to health trainers and health champions

..not forgetting the NHS– Making Every Contact Counts policy– Public health outcomes inc behaviour change in QOF– Enhanced potential for influence of NICE– New inequalities duties on the NHS

But...– often easy to see behaviours in isolation from one another– and from people’s individual & economic & social environment

..this sets the context for their new role

Be aware

– 70% of adults seen by services will not be adhering to government guidelines on 2+ unhealthy behaviours

– ...but many will have had a recent record of success in other areas of behaviour change, can be built on

– Health trainer evidence suggests “the visible” often drives first contact, but the real issues & desire to change are often in other areas

– Every relationship, not every contact that counts

..and for your practice?

Many of the young women you work with will have combinations or clusters of unhealthy behaviours, even though generally things seem to be improving over time

Q: Do you feel you have a better understanding of healthy and unhealthy behaviours, and the concept of clustering?

Q: Can you see the opportunity and the reason to engage with the health and local authority sectors?

Q: Do you know what your next step could be?