Behaviour and Lifestyle

Glasses of alcoholic drinks

Introduction

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 Redcar & Cleveland 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 Redcar & Cleveland are higher than England.  There are a higher number of alcohol-related hospital admissions and higher alcohol-specific mortality compared to the England average.
  • 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 Redcar & Cleveland impacting on individuals, families and communities.

Illicit drug use

  • Redcar & Cleveland is estimated to have increasing levels of drug misuse. 
  • The rate of successful exit from drug treatment services is below the national average.
  • The number of people accessing structured treatment for opiate and/or crack use is in decline.

Smoking

  • Nearly one-quarter of adults in Redcar & Cleveland smoke. The smoking prevalence rises to almost one in two adults in some deprived wards and disadvantaged population groups.
  • In Redcar & Cleveland, 25% of women smoke throughout their pregnancy posing a significant health risk both to mother and unborn child.  This is nearly double the national average.
  • The number of premature deaths (under the age of 75 years) in Redcar & Cleveland that are attributable to smoking is higher than the national average.

Sexual health

  • Some sexually transmitted infection (STI) rates are high and/or increasing, particularly gonorrhoea and syphilis. 
  • Teenage pregnancy rates in Redcar & Cleveland are higher than England.  There is inconsistency in the provision of dedicated young people’s sexual services, particularly those linked to educational establishments and in electoral wards with the highest teenage pregnancy rates.
  • There is low uptake for Long Lasting Reversible Contraception (LARC) compared to regional and national averages. 

Diet and nutrition

  • About four out of five adults in Redcar & Cleveland do not eat the recommended five daily portions of fruit and vegetables.
  • Breastfeeding rates in Redcar & Cleveland are among the lowest in England and the gap is widening.
  • There is low uptake of healthy start vitamin supplements in babies and infants.
  • Poor oral health is a robust indicator of poor nutrition and the prevalence of dental decay for children in Redcar & Cleveland children is one-and-a-half time the national average.  There are significant dental health inequalities between wards, with those in the most deprived wards having the worst oral health.

Obesity

  • Adult obesity rates in Redcar & Cleveland are significantly higher than the national average and increasing. There are inequalities in relation to the prevalence of obesity according to income, social deprivation, age, ethnicity and disability.
  • Childhood obesity doubles from 10% in reception year to almost 20% in year 6 pupils.
  • Maternal obesity in South Tees is higher than the regional and national averages with an increase in the number of pregnant women with a body mass index (BMI) greater than 40.  
  • The increasing prevalence rates of obesity increases demand on health services and costs to the NHS and wider economy. 

Physical inactivity

  • Approximately half of the adult population of Redcar & Cleveland is inactive, with only one-in-five taking part in the recommended weekly levels of physical activity.
  • The proportion of Redcar & Cleveland school pupils doing three hours of PE per week is above the national average, but one-quarter of school children do not get three hours of PE.  Active travel to school is above the national average.

Recommendations

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) and 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 rates of breast feeding and 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 voluntary and community sector (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.
  • 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 author

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


Reference

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