Behaviour and Lifestyle

Glasses of alcoholic drinks


Behaviours, such as smoking, excessive use of alcohol, the use of illicit drugs, low levels of exercise and physical activity, engaging in unsafe sex, and a poor diet all impact on physical health and mental wellbeing.  It is known that each of these lifestyle risk factors is unequally distributed in the population and that there are differences in these behaviours associated with income, educational achievement and social class.

There is compelling evidence that lifestyle risk factors tend to cluster than present in isolation.  It is estimated that in England 70% of the adult population have two or more lifestyle risk factors (King’s Fund, 2012).  Whilst there has been an overall decline in the proportion of the population with three or four unhealthy risk factors from 33% of the population in 2003, to 25% in 2008, these reductions have not been equally distributed across the population. The percentage of people with three or more lifestyle risk factors is continues to increase for people from lower socio-economic and educational groups. For instance  people with no educational qualifications were  more than five times as likely as those with higher education to have four lifestyle risk factors in 2008, compared with only three times as likely in 2003.

This variation in the distribution of lifestyle risk factors contributes to the gaps in length and quality of life between deprived and affluent groups locally and nationally. The major causes of illness and premature deaths (deaths before age 75 years) in Hartlepool are circulatory diseases, cancer, respiratory disease and digestive diseases (including liver disease).  Lifestyle risk factors such as smoking, excessive alcohol use, poor diet and physical inactivity are known to contribute to these major causes of premature deaths.

Alcohol misuse

  • Levels of alcohol-related harm in Hartlepool are among the highest in England.  There are a higher number of alcohol-related hospital admissions and higher alcohol-specific mortality compared to England.
  • Alcohol misuse impacts upon physical and mental health, as well as having a detrimental effect on social cohesion, crime, violence and community safety.
  • Alcohol-related harm is a major problem in Hartlepool impacting on individuals, families and communities.

Illicit drug use

  • There is insufficient information in Hartlepool to accurately estimate levels of drug misuse.
  • The proportion of successful treatment outcomes for opiate users in Hartlepool is not as high as in England, but for non-opiate users they are similar to England.


  • More than one-in-four (28.2%) adults in Hartlepool are estimated to smoke regularly. The smoking prevalence rises to almost one-in-two adults in some deprived wards and disadvantaged population groups.
  • In Hartlepool, 21.7% of women smoke throughout their pregnancy posing a significant health risk both to mother and unborn child.  This rate is 70% higher than England (12.7%) and higher than the North East.
  • About one-in-five of all deaths in Hartlepool is estimated to be as a result of smoking.  Smoking-related deaths in Hartlepool are about 40% higher than in England.


Diet and nutrition

  • Eighty-one percent of adults in Hartlepool do not eat the recommended five daily portions of fruit and vegetables compared with 71% in England.  In England, 82% of school-aged children do not eat five portions of fruit and vegetables each day.
  • Breastfeeding rates in Hartlepool are among the lowest in England and the gap is widening.
  • There is low uptake of healthy start vitamin supplements in babies and infants.


Physical inactivity

  • More than one-third of the adult population of Hartlepool is inactive.  Significantly fewer adults take part in the recommended weekly levels of physical activity in Hartlepool compared with England.
  • There is variation in the quantity of PE provided at schools within Hartlepool.  In Hartlepool, walking and cycling to school is more common than in England; about six in ten primary school children and about half of secondary school pupils travel actively.
  • The groups with the lowest levels of physical activity are women (particularly those aged 14-24 years); black and minority ethnic (BME) groups; those with a limiting illness/disability; and lower socioeconomic groups.


  • The obesity rate for Hartlepool adults continues to be significantly higher than England and increasing. There are inequalities in relation to the prevalence of obesity according to income, social deprivation, age, ethnicity and disability.
  • Childhood obesity almost doubles from 11.0% in reception year to almost 21.2% in year 6 pupils.
  • The increasing prevalence rates of obesity increases demand on health services and costs to the NHS and wider economy.

Sexual health

  • Hartlepool rates of sexually transmitted infection and HIV tend to be similar to or lower than England.
  • Local teenage pregnancy rates are higher than England, but the gap has been narrowing.
  • Termination of pregnancy in under-18s is similar to England and Hartlepool has a lower uptake for Long Acting Reversible Contraception (LARC) compared to the regional and national averages.
  • There is low uptake of screening and preventative services, particularly for chlamydia and HIV.

The recommendations below relate to the Marmot review: Fair Society, Healthy Lives, the former National Support Team recommendations for tackling Health Inequalities and latest national policy and professional guidance.

Short-term (1-2 years)

  • Commission and deliver integrated public health services and programmes that address multiple lifestyle risk factors rather than taking an approach that focuses solely on single issues. Ensure that these interventions are accessible and acceptable to those at highest risk.
  • Ensure equitable access to sexual health services (prevention, early identification, awareness and treatment services) at address the high teenage pregnancy rates and sexually transmitted infections. 
  • Give all children the best start in life by tackling smoking in pregnancy, obesity in pregnancy, low breast feeding rates and low uptake of healthy start vitamins.

Medium-term (3-5 years)

  • Maximise the opportunities of creating a health promoting environment through enforcement, planning, regeneration and licence application processes.  This could include considering the restriction of planning permission for hot-food takeaways, alcohol premises (representations and cumulative impact areas), tackling availability, supply and demand for illicit drugs and tobacco.
  • Strengthen the role of primary care, social care and VCS organisations in delivering lifestyle and behaviour modification programmes.
  • Strengthen the use of community assets in addressing lifestyle risk factors.

Long-term (over 5 years)

  • Ensure that all town planning, regeneration and transport programmes incorporate active transport routes and that future planning complements strategies to reduce alcohol related crime and violence in the town centre.
  • Improve maternal and child health by addressing the social causes of poor health including; teenage pregnancy, educational attainment, unemployment, food poverty and maternal mental health.


Summary authors

Carole Johnson
Head of Health Improvement
Hartlepool Borough Council

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service


King’s Fund (2012). Clustering of unhealthy behaviours over time: Implications for policy and practice.